Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

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Daniels, Michael N; Maynard, Sharon; Porter, Ivan; Kincaid, Hope; Jain, Deepika; Aslam, Nabeel

2017-01-01

Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several negative

Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

Directory of Open Access Journals (Sweden)

Michael N Daniels

Full Text Available Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents.This was a repeated cross-sectional survey of internal medicine residents before (Group 1 and 3 years after (Group 2 the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology.131 (80.9% of 162 residents completed the survey. 19 (14.8% residents indicated interest in a nephrology career, with 8 (6.3% indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2 and residents who were not (Group 1. The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed, practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed, and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed. More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04, whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02.The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several

[An evaluation of costs in nephrology by means of analytical accounting system].

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Hernández-Jaras, J; García Pérez, H; Pons, R; Calvo, C

2005-01-01

The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.

[Nephrology as seen by nephrologists. An introspective investigation into the history and future of the professional community].

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Susi, Alessandra

2010-01-01

The professional community of nephrologists is going through a phase of ''rethinking'' the discipline that sees the role of nephrologists in an uncertain position between inpatient and outpatient care. A comparison of opinions within the community is necessary to understand what could be the future position of nephrology in the Italian healthcare system. In June 2009 a questionnaire was distributed among the members of the Italian Nephrology Society (SIN) to collect (i) their professional biographies and (ii) their opinion on the state of the art of nephrology, (iii) the working context in which they operate, (iv) the likely sources of change, and (v) the prospects for the development of the field. In October 2009 the respondents were 506, a sufficiently representative sample of the national population of nephrologists. One of the main findings was a lack of consensus about the clinical practice for the treatment of CKD. In particular, there was no general agreement about the stage of CKD at which the patient should enter the exclusive care of the nephrologist. Opinions were less divergent on (i) departmentalization phenomena, (ii) the outsourcing of dialysis services, and (iii) the future prospects of the specialty. In order to pursue common goals for the development of the discipline, the internal relations of the professional community should be strengthened both in terms of sharing clinical experience and defining the roles of clinicians within the community. The involvement of young nephrologists in the definition of strategies for the positioning of nephrology in the Italian healthcare system might also be considered a priority.

The Social Media Revolution in Nephrology Education.

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Colbert, Gates B; Topf, Joel; Jhaveri, Kenar D; Oates, Tom; Rheault, Michelle N; Shah, Silvi; Hiremath, Swapnil; Sparks, Matthew A

2018-05-01

The past decade has been marked by the increasing use of social media platforms, often on mobile devices. In the nephrology community, this has resulted in the organic and continued growth of individuals interested in using these platforms for education and professional development. Here, we review several social media educational resources used in nephrology education and tools including Twitter, videos, blogs, and visual abstracts. We will also review how these tools are used together in the form of games (NephMadness), online journal clubs (NephJC), interactive learning (GlomCon), and digital mentorship (Nephrology Social Media Collective [NSMC] Internship) to build unique educational experiences that are available globally 24 hours per day. Throughout this discussion, we focus on specific examples of free open-access medical education (FOAMed) tools that provide education and professional growth at minimal or no cost to the user. In addition, we discuss inclusion of FOAMed resource development in the promotion and tenure process, along with potential pitfalls and future directions.

Nephrologic Impact of Hurricanes Katrina and Rita in Areas Not Directly Affected.

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Dossabhoy, Neville R; Qadri, Mashood; Beal, Lauren M

2015-01-01

Hurricanes Katrina and Rita resulted in enormous loss of life and disrupted the delivery of health care in areas affected by them. In causing mass movements of patients, natural disasters can overwhelm the resources of nephrology communities in areas not suffering direct damage. The following largely personal account evaluates the impact these hurricanes had upon the nephrology community, patients and health care providers alike, in areas not directly affected by the storms. Mass evacuation of hundreds of dialysis patients to surrounding areas overwhelmed the capacity of local hemodialysis centers. Non-availability of medical records in patients arriving without a supply of their routine medications led to confusion and sub-optimal treatment of conditions such as hypertension and congestive heart failure. Availability of cadaveric organs for transplantation was reduced in the surrounding areas, as the usual lines of communication and transportation were severed for several weeks. All of these issues led to prolong waiting times for patients on the transplant list. The hurricanes severely disrupted usual supply lines of medications to hospitals; certain rare conditions may be seen in higher numbers as a result of the shortages induced. We present the interesting surge in cases of acute kidney injury secondary to use of intravenous immune globulin.

Nephrology in Africa--not yet uhuru.

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Swanepoel, Charles R; Wearne, Nicola; Okpechi, Ikechi G

2013-10-01

Nephrology is a 'Cinderella speciality', a disregarded area of health care, in Africa. Other health issues have relegated the treatment of kidney diseases to a low priority status, and the cost of treating the more common and widespread communicable diseases, financial mismanagement and corruption in many countries has sounded the death knell for expensive therapies such as dialysis. The communicable diseases that have devastated the health systems around Africa are tuberculosis and HIV/AIDS. Until recently, very little information was available on the impact of HIV on acute and chronic dialysis admissions. Patients with acute kidney injury (AKI) in most of Africa are seldom treated because of great distances to travel, lack of expertise, poverty and poor sustainable funding for health matters. An acute peritoneal dialysis (PD) programme has now been initiated in Tanzania but the sustainability of this project will be tested in the future. The International Society of Nephrology (ISN) has developed a training programme for nephrologists from developing countries, which may now be bearing fruit. A report from the sub-Saharan Africa region shows that the numbers of patients on dialysis and those diagnosed with chronic kidney disease (CKD) has increased significantly. Other ISN-sponsored programmes such as Continuing Medical Education activities for physicians and community screening projects have had far-reaching positive effects. Government funding for a dialysis programme is well established in South Africa, but this funding is limited so that the numbers accepted for public dialysis are restricted. Consequently in the Western Cape province of South Africa, a 'category system' has been formulated to attempt to cope with this unacceptable and restrictive ruling.

[Nurses and nephrology in Italy].

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De Pietro, Carlo

2010-01-01

An acceleration in the professionalization of Italian nurses has taken place in recent years. This pattern, together with the increasing prevalence of kidney diseases and the decreasing number of active nephrologists, makes a new collaborative structure between nurses and nephrologists both possible and welcome. This article describes the recent changes and future prospects of the Italian nursing profession. Observations about nephrology are based on interviews conducted with key opinion leaders of nursing in nephrology and dialysis. Italian nurses have recently acquired a status of professional autonomy. Nursing training is now fully integrated in the university system and nurses have obtained more responsibilities and a higher status within healthcare organizations. Future developments may be related to the internal articulation of the profession, supported by master courses and specialist training. Another possible evolution refers to the ongoing restructuring of the healthcare system with an emphasis on nursing activities and skills rather than medical specialties, which will lead to new and stronger managerial roles for nurses. The increase in the prevalence of kidney diseases and the declining number of nephrologists will result in a change in the distribution and utilization of nephrology services. The professionalization of nurses allows a new work division with a task shift from doctors to nurses. Italian nephrologists should seek a preferential relationship with the nursing profession, also considering the nursing shortage in several regions. Possible means to accomplish this preferential relationship could be, in addition to task shifting, nurses' involvement in research, and support for postgraduate training.

Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey.

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Raffaele Antonelli Incalzi

Full Text Available Chronic kidney disease (CKD is highly prevalent in the elderly and negatively impacts survival and health status. Thus, nephrological competence is mandatory for a skilled geriatrician. The present study aimed to assess nephrological competence in a sample of geriatricians recruited through a web survey. To this aim, a 12-items questionnaire was produced by an expert panel of nephrologists and geriatricians and was available online for members of the Italian Society of Gerontology and Geriatrics (SIGG. Two-hundred-eighty-seven geriatricians volunteered to fill in the questionnaire. The majority of them indirectly estimated the glomerular filtration rate (GFR using mainly the Cockroft-Gault (C-G formula. Selected nephrological exams, such as urinary Na and serum D-vitamin measurements, did not qualify as routine exams although the majority of geriatricians supplemented their patients with fat-soluble secosteroids. Ten percent of geriatricians asked for nephrological consultation only for stage 5 CKD patients and 30,9% only for stage 4 or 5. Erythropoietin supplementation was common practice for the majority of geriatricians, while only one third of them systematically used a procedure intended to prevent the contrast induced nephropathy (CIN. Finally, an alleged 50% adherence to the international guidelines for the management of CKD patients emerged from the questionnaire. Overall, results from this survey strongly recommend promoting nephrological education among geriatricians. Didactic standards for in training geriatricians need to be updated and the cooperation between geriatrics and nephrological societies promoted.

Onco-nephrology: an appraisal of the cancer and chronic kidney disease links.

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Izzedine, Hassan; Perazella, Mark A

2015-12-01

A bidirectional relationship has been observed for kidney disease and cancer. On the one hand, cancer is an important complication noted in kidney disease as well as a major cause of morbidity and mortality in this group. On the other hand, improved cancer treatment has prolonged survival, but also increased the development of acute and chronic kidney disease. The combination of cancer and kidney disease makes it challenging for clinicians to provide comprehensive and safe therapies for this group of patients. As such, clinicians caring for this group must develop expertise and become competent in the practice of a newly evolving subspecialty of nephrology known as 'onco-nephrology'. This brief narrative review will focus on the cancer risk in patients with underlying kidney disease, the therapies such as erythropoiesis-stimulating agents on cancer progression and other outcomes, and the appropriate dosing of anti-cancer agents in patients with underlying kidney disease. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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

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

2009-08-01

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

Are word-of-mouth communications contributing to a shortage of nephrology nurses?

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Wolfe, William A

2014-01-01

Nephrology nurse shortages have historically been viewed as a subset of the overall nursing supply in the United States. Not-here-to-fore considered as a contributing factor are the effects of word-of-mouth and Internet-based word-of-mouth communications from nurses who have had disappointing work experiences in hemodialysis clinics. This article discusses the potential effects of word-of-mouse communications and posits that negative word-of-mouse communications may discourage new and experienced nurses from considering the specialty of nephrology nursing, thus contributing to a nephrology nursing shortage.

Pain Management in CKD: A Guide for Nephrology Providers.

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Koncicki, Holly M; Unruh, Mark; Schell, Jane O

2017-03-01

Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems. Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.

Ethical conflicts reported by Certified Nephrology Nurses (CNNs) practicing in dialysis settings.

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Redman, B K; Hill, M N; Fry, S T

1997-02-01

The purpose of the investigators was to describe and classify ethical conflicts experienced by Certified Nephrology Nurses (CNNs) practicing in dialysis settings in four eastern states and the District of Columbia, and to explore associated demographic, educational, and practice setting factors associated with these ethical conflicts. A descriptive survey design was used. All members of the American Nephrology Nurses Association (ANNA) who were CNNs working in Maryland, Virginia, and the District of Columbia, and a random sample of those in New York State and Pennsylvania were contacted. Those CNNs working in dialysis settings were asked to complete the Demographic Data Form and the Moral Conflict Questionnaire developed by Fry (1990). Eighty-eight met inclusion criteria, agreed to participate, and described ethical conflicts. By far the most common practice context for the described ethical conflicts were decisions about discontinuation or initiation of dialysis (69%). Participants were clear about the moral problem and ethical principles involved. Participants reported being involved in serious ethical conflicts about patient care. Since two-thirds were not resolved, further research should investigate whether existing mechanisms in practice settings for resolution of ethical conflicts are not working or are not being used by nurses.

The biobank for the molecular classification of kidney disease: research translation and precision medicine in nephrology.

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Muruve, Daniel A; Mann, Michelle C; Chapman, Kevin; Wong, Josee F; Ravani, Pietro; Page, Stacey A; Benediktsson, Hallgrimur

2017-07-26

Advances in technology and the ability to interrogate disease pathogenesis using systems biology approaches are exploding. As exemplified by the substantial progress in the personalized diagnosis and treatment of cancer, the application of systems biology to enable precision medicine in other disciplines such as Nephrology is well underway. Infrastructure that permits the integration of clinical data, patient biospecimens and advanced technologies is required for institutions to contribute to, and benefit from research in molecular disease classification and to devise specific and patient-oriented treatments. We describe the establishment of the Biobank for the Molecular Classification of Kidney Disease (BMCKD) at the University of Calgary, Alberta, Canada. The BMCKD consists of a fully equipped wet laboratory, an information technology infrastructure, and a formal operational, ethical and legal framework for banking human biospecimens and storing clinical data. The BMCKD first consolidated a large retrospective cohort of kidney biopsy specimens to create a population-based renal pathology database and tissue inventory of glomerular and other kidney diseases. The BMCKD will continue to prospectively bank all kidney biopsies performed in Southern Alberta. The BMCKD is equipped to perform molecular, clinical and epidemiologic studies in renal pathology. The BMCKD also developed formal biobanking procedures for human specimens such as blood, urine and nucleic acids collected for basic and clinical research studies or for advanced diagnostic technologies in clinical care. The BMCKD is guided by standard operating procedures, an ethics framework and legal agreements with stakeholders that include researchers, data custodians and patients. The design and structure of the BMCKD permits its inclusion in a wide variety of research and clinical activities. The BMCKD is a core multidisciplinary facility that will bridge basic and clinical research and integrate precision

Pediatric nephrology practice in Jordan

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Kamal Akl

2017-01-01

Full Text Available The practice of pediatric nephrology in a developing country such as Jordan is governed by social, cultural, and economic issues. The prevalence of consanguinity contributes to the emergence of rare heredofamilial disorders and congenital anomalies of the kidneys and urinary tract. Epigenetic factors modify underlying genetic defect predisposing to symptomatic crystalluria. Future research should be directed at prevention.

Medical student attitudes toward kidney physiology and nephrology: a qualitative study.

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Roberts, John K; Sparks, Matthew A; Lehrich, Ruediger W

2016-11-01

Interest in nephrology among trainees is waning in the USA. Early perceptions and attitudes to subject matter can be linked to the quality of pre-clinical curricula. We wanted to explore these attitudes in the setting of modern curriculum redesign. We utilized Q methodology to understand first-year medical student attitudes after an innovative kidney physiology curriculum redesign that focuses on blending multiple learning methods. First-year medical students were invited to take a Q sort survey at the conclusion of a kidney physiology course. Students prioritized statements related to their understanding of kidney physiology, learning preferences, preferred course characteristics, perceived clinical relevance of kidney physiology, and interest in nephrology as a career. Factor analysis was performed to identify different student viewpoints. At the conclusion of our modified course, all students (n = 108) were invited to take the survey and 44 (41%) Q sorts were returned. Two dominant viewpoints were defined according to interest in nephrology. The Potentials are students who understand kidney physiology, perceive kidney physiology as clinically relevant, attend class sessions, utilize videos, and are willing to shadow a nephrologist. The Uninterested are students who are less satisfied with their kidney physiology knowledge, prefer to study alone with a textbook, avoid lectures, and are not interested in learning about nephrology. In an updated renal physiology course, students that use multiple learning methods also have favorable attitudes toward learning kidney physiology. Thus, modern curriculum changes that accommodate a variety of learning styles may promote positive attitudes toward nephrology.

[Transplant Surgeon Meets Nephrologist: Important Nephrological Aspects Before and After Kidney or Liver Transplantation].

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Vondran, F W R; Wintterle, S; Bräsen, J H; Haller, H; Klempnauer, J; Richter, N; Lehner, F; Schiffer, M

2017-04-01

In cases of chronic renal insufficiency, successful kidney transplantation is the method of choice to restore patients' health, well-being and physical fitness. The interdisciplinary collaboration of nephrologists and transplant surgeons has always been a prerequisite for the successful pre-, peri- and post-transplant care of renal transplant patients. The same holds true for liver transplant patients. Here the nephrologist is often involved in cases requiring pre- or post-transplant dialysis as well as in decision making for combined liver-kidney transplantation. This review focuses on nephrological aspects in patient care before and after kidney and liver transplantation. Georg Thieme Verlag KG Stuttgart · New York.

Results of the 2014-2015 Canadian Society of Nephrology workforce survey.

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Ward, David R; Manns, Braden; Gil, Sarah; Au, Flora; Kappel, Joanne E

2016-01-01

Nephrology was previously identified as a subspecialty with few Canadian employment opportunities, and in recent years, fewer trainees are choosing nephrology. The objective of this study is to better understand the current Canadian adult nephrology workforce and the expected workforce trends over the next 5 years. This is an online self-administered survey. This study is set in Canada. Survey participants are Canadian adult nephrologists, including self-identified division heads. The measurements of this study are demographics, training, current practice characteristics, work hours, and projected workforce needs. Survey questions were based on previous workforce surveys. Ethics approval was obtained through the University of Saskatchewan. The survey was piloted in both English and French and modified based on the feedback to ensure that responses accurately reflected the information desired. It was circulated to all identified Canadian nephrologists via an anonymous e-mail link for self-administration. Categorical data was aggregated, and free-text answers were thematically analyzed. Additional descriptive analysis was conducted by all authors. Five hundred ninety-two Canadian nephrologists were contacted and 48 % responded, with representation from all Canadian provinces. One third of the respondents were female, and the largest age cohort was 41-50 years. Most nephrologists are trained in Canada and 61 % completed additional training. The majority of the respondents (69.1 %) began working as a nephrologist immediately upon completion of fellowship training. Younger nephrologists reported more challenges in finding a job. Eighty percent of responding nephrologists were satisfied with their current work hours, 13.1 % will reduce work hours within 3 years, an additional 8.2 % will reduce work hours within 5 years, and a further 14.2 % will reduce work hours within 10 years. Nephrology division heads forecasted the number of clinical and academic

The core business of caring: a nursing oxymoron?

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Shields, Linda

2014-01-01

Nursing has always regarded caring as its core business. The historical record about caring in nursing is non-specific, and little direct evidence exists about caring as part of nursing. Caring is not restricted to nursing, is possibly influenced by public perceptions of nursing, and can be subverted for maleficent ends. This paper discusses these points, and then moves to explain how caring fares in the Australian health care system. Australia has been blighted by a "cultural cringe" which sees anything from overseas as more valuable than anything Australian. This is as true for nursing, and caring within that, as for any other aspect of Australian life. However, Australia has one of the best health care systems in the world, and nursing as a profession is a world leader. The argument of this paper is that the core business of caring could be under threat in Australia unless nurses recognize their particularly good contribution to the profession and subsequent patient/client care, and celebrate that. Examples are taken from the United Kingdom where there is a crisis of caring within nursing and health. These are used to explain how Australian nursing can avoid the pitfalls and retain caring as its core business.

The future management of nephrology and dialysis.

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Graziani, Giorgio; Vanni, Elena

2003-01-01

This is a report of a combined experience of a nephrologist, who had been previously working for many years in a public hospital, and a business planning manager coming from a financial administration department of a multinational company. The Istituto Clinico Humanitas is a multi-specialist hospital accreditated with the National Health System, containing 473 beds available: 398 inpatient, 28 intensive care and 47 day hospital beds. Human resources include approximately 250 medical doctors, 500 nurses and ancillary workers. In 2002 the hospital treated about 17,500 inpatients, 18,450 day hospital patients, nearly 18,600 surgical interventions and 470,000 outpatients examinations and tests were performed. The detailed clinical activity of the general medicine and the nephrology units in 2002, the role of the scientific direction and that of the Humanitas Foundation have been presented. The work experience, in particular the advantages and disavantages of public versus private environment, represents another important topic of this paper.

Assessing achievement in nephrology training: using clinic chart audits to quantitatively screen competency.

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Yuan, Christina M; Prince, Lisa K; Zwettler, Amy J; Nee, Robert; Oliver, James D; Abbott, Kevin C

2014-11-01

Entrustable professional activities (EPAs) are complex tasks representing vital physician functions in multiple competencies, used to demonstrate trainee development along milestones. Managing a nephrology outpatient clinic has been proposed as an EPA for nephrology fellowship training. Retrospective cohort study of nephrology fellow outpatient clinic performance using a previously validated chart audit tool. Outpatient encounter chart audits for training years 2008-2009 through 2012-2013, corresponding to participation in the Nephrology In-Training Examination (ITE). A median of 7 auditors (attending nephrologists) audited a mean of 1,686±408 (SD) charts per year. 18 fellows were audited; 12, in both of their training years. Proportion of chart audit and quality indicator deficiencies. Longitudinal deficiency and ITE performance. Among fellows audited in both their training years, chart audit deficiencies were fewer in the second versus the first year (5.4%±2.0% vs 17.3%±7.0%; PITE score less than the 25th percentile for second-year fellows (P=0.03), with no significant association for first-year fellows. Auditor-reported deficiencies declined between the first and second halves of the year (17.0% vs 11.1%; PITE and the nephrology subspecialty board examination. Published by Elsevier Inc.

Core competencies of the entrepreneurial leader in health care organizations.

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Guo, Kristina L

2009-01-01

The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes.

A Nephrology Fellows' Communication Skills Course: An Educational Quality Improvement Report.

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Cohen, Robert A; Jackson, Vicki A; Norwich, Diana; Schell, Jane O; Schaefer, Kristen; Ship, Amy N; Sullivan, Amy M

2016-08-01

Nephrology fellows need expertise navigating challenging conversations with patients throughout the course of advanced kidney disease. However, evidence shows that nephrologists receive inadequate training in this area. This study assessed the effectiveness of an educational quality improvement intervention designed to enhance fellows' communication with patients who have advanced kidney disease. Quality improvement project. Full-day annual workshops (2013-2014) using didactics, discussion, and practice with simulated patients. Content focused on delivering bad news, acknowledging emotion, discussing care goals in dialysis decision making when prognosis is uncertain, and addressing dialysis therapy withdrawal and end of life. Participants were first-year nephrology fellows from 2 Harvard-affiliated training programs (N=26). Study assessed the effectiveness of an intervention designed to enhance fellows' communication skills. Primary outcomes were changes in self-reported patient communication skills, attitudes, and behaviors related to discussing disease progression, prognostic uncertainty, dialysis therapy withdrawal, treatments not indicated, and end of life; responding to emotion; eliciting patient goals and values; and incorporating patient goals into recommendations. Surveys measured prior training, pre- and postcourse perceived changes in skills and values, and reported longer term (3-month) changes in communication behaviors, using both closed- and open-ended items. Response rates were 100% (pre- and postsurveys) and 68% (follow-up). Participants reported improvement in all domains, with an overall mean increase of 1.1 (summed average scores: precourse, 2.8; postcourse, 3.9 [1-5 scale; 5 = "extremely well prepared"]; Pskills taught, such as "Ask-Tell-Ask" and using open-ended questions. Self-reported data may overestimate actual changes; small sample size and the programs' affiliation with a single medical school may limit generalizability. A day

Results of the 2014–2015 Canadian Society of Nephrology Workforce Survey

Directory of Open Access Journals (Sweden)

David R. Ward

2016-05-01

Full Text Available Background: Nephrology was previously identified as a subspecialty with few Canadian employment opportunities, and in recent years, fewer trainees are choosing nephrology. Objective: The objective of this study is to better understand the current Canadian adult nephrology workforce and the expected workforce trends over the next 5 years. Design: This is an online self-administered survey. Setting: This study is set in Canada. Survey participants: Survey participants are Canadian adult nephrologists, including self-identified division heads. Measurements: The measurements of this study are demographics, training, current practice characteristics, work hours, and projected workforce needs. Methods: Survey questions were based on previous workforce surveys. Ethics approval was obtained through the University of Saskatchewan. The survey was piloted in both English and French and modified based on the feedback to ensure that responses accurately reflected the information desired. It was circulated to all identified Canadian nephrologists via an anonymous e-mail link for self-administration. Categorical data was aggregated, and free-text answers were thematically analyzed. Additional descriptive analysis was conducted by all authors. Results: Five hundred ninety-two Canadian nephrologists were contacted and 48 % responded, with representation from all Canadian provinces. One third of the respondents were female, and the largest age cohort was 41–50 years. Most nephrologists are trained in Canada and 61 % completed additional training. The majority of the respondents (69.1 % began working as a nephrologist immediately upon completion of fellowship training. Younger nephrologists reported more challenges in finding a job. Eighty percent of responding nephrologists were satisfied with their current work hours, 13.1 % will reduce work hours within 3 years, an additional 8.2 % will reduce work hours within 5 years, and a further 14.2 % will reduce work

[Historical Archives of Italian Nephrology. The history of instrumentation in nephrology. Part II: microscope and haemodialyzer].

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Timio, M

2003-01-01

Medicine in the technological era acquired many of the characteristics that concurrently marked other fields. So, by adopting procedures based on information obtained with instruments and devices, medicine developed an approach to illness that transformed it into a special form of technology. The collective effect of instrumentation deserves consideration and offers the historian opportunities for interpreting the interaction between physician and his patients in other than scientific and technological terms. The very construction of instruments and devices depends on the Author's ideas assembled with the basic theories of the time. For instance, at the end of the nineteenth century, when medical instruments became essential, the bacterial origin of diseases revolutionised their construction and application. In this context, the invention and use of the microscope became an outstanding feature of the clinical approach by disclosing the cellular universe. The microscope had become crucial in locating some major causes of physical suffering and death in man, and was considered the pre-eminent diagnostic instrument in medicine. In the nephrological field, the microscope drew the physician into a universe of physical changes that were concealed to the naked eye. The microscope made possible the verification of some of Bright's brilliant ideas, something that helped physicians classify glomerulonephritis. Many nephrologists confessed "how few things are established in this subject (nephrology) and how many more difficulties are established, we have learned by experience with the microscope". The modesty of this claim is striking. In nephrology, as in other fields, the admission of ignorance proved to be the beginning of wisdom. This wisdom, based on the admission of ignorance and assembled through the commitment and ingenuity of the pioneers of the dialysis treatment, led to the treatment of end-stage renal disease and the guarantee of success. The technique of

Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.

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Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

2009-10-01

This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.

Preventive Nephrology - Proposed Options in Childhood Nephropathy

African Journals Online (AJOL)

Three children with renal disorders managed at the University of Ilorin Teaching Hospital are reported as case studies to underscore the need for preventive nephrology . The first case illustrates the inevitability of rapidly progressive renal failure when remedial management desired in the early stages of the nephropathy is ...

Nephrology and astrology--is there a link?

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Hughes, S

1990-07-01

Astrologers presume a link between the susceptibility of particular organs to disease and signs of the Zodiac. A simple test of the positive connection between renal disease and the sign of Libra was undertaken by studying the birth dates of consecutive nephrology in-patient admissions. No significant link was found on analysis, thus disproving the traditional astrologers' claims.

Iranian Nephrology and Urology Research Output in the Past Two Decades: A Bibliographic Analysis of Medline Database.

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Einollahi, Behzad; Motalebi, Mohsen; Taghipour, Mehrdad; Ebrahimi, Mehrdad

2015-09-01

We performed a bibliometric search to evaluate the number of papers published in the field of nephrology and urology by Iranian researchers in the past two decades. We did an online search in abstract/title part of articles with 129 keywords such as kidney, renal, hemodialysis, transplant, nephrology, glomerulonephritis, ureteral, nephrolithiasis, and etc. Endnote software version 7 was used to search articles published in PubMed database from November 1993 to November 2013. Those articles in which Iran was the affiliation of at least one of the authors were selected. These articles in the field of nephrology and urology were analyzed regarding the name of originated institution, field of study, total number of publications, type of study, collaboration rate of Iranian nephrologist and urologists for every year, annual sharing of Iranian articles in five journals with highest impact factor (IF) and journal IF. The total number of publications in the field of nephrology and urology was 3,771 (average of 189 papers per year). Most of the Iranian nephrology and urology papers were from the capital city, Tehran (50.03%). There was an increasing trend in the number of publications over the years. Most papers were about transplantation (44.6%), nephrology (20.9%) and hemodialysis (16.4%). Of all, 53.7% were retrospective articles, whereas the proportion of clinical trials was relatively small (10.8%). Although Iranian publications in the field of nephrology and urology have had a considerable and significant increase in the recent years amongst the Middle Eastern countries, there is a wide distance to be a science exporter country.

Exploring the uncharted territory of social media: the next frontier of medical education in nephrology.

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Desai, Tejas; Sridharan, Sivakumar; Parada, Xavier; Claure-Del Granado, Rolando; Orantes, Carlos; Madariaga, Hector; Penmatsa, Krishnam Raju; Basu, Gopal; Arce Amare, Fernanda

2018-04-01

Social media is gaining popularity amongst both medical educators and life-long learners. One of the most popular social media platforms used by the medical community is Twitter, which is popular amongst physicians, students and patients, and particularly in medical societies. Major international and regional societies commonly use Twitter to amplify their reach beyond what their live annual meetings can achieve. There has been a unique and notable effort by Nephrology societies to craft a structured social media strategy that results in the broadest reach to the community of nephrology providers. We report on the first three such experiments performed by three separate nephrology organizations.

Web-based nephropathology teaching modules and user satisfaction: the nephrology on-demand experience.

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Desai, Tejas; Talento, Romualdo; Christiano, Cynthia; Ferris, Maria; Hewan-Lowe, Karlene

2011-01-01

Nephropathology is an integral component of nephrology education. Online teaching sites provide valuable educational materials to learners, but learner satisfaction has not been measured. We developed a nephropathology website and measured learners' satisfaction. The Nephrology On-Demand Histopathology website (http://blog.ecu.edu/sites/nephrologyondemand/?page_id=4502) provided nephropathologic specimens with explanations. Users were asked to complete a Likert-based survey (1-strongly agree . . . 5-strongly disagree) regarding four key areas of content quality: accuracy, currency, objectivity, and usefulness. Learners of all training levels perceived the content quality favorably. The mean (±SD) for accuracy was 1.70 (0.89), currency 1.62 (0.90), objectivity 1.80 (1.01), and usefulness 1.72 (0.95). Nephrology On-Demand Histopathology is a well-received teaching tool to learners of all training levels. Educators may consider using it, as well as other online nephropathology sites, as adjunctive teaching tools.

A call to arms: economic barriers to optimal dialysis care.

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McFarlane, P A; Mendelssohn, D C

2000-01-01

Epidemic growth rates and the enormous cost of dialysis pressure end-stage renal disease (ESRD) delivery systems around the world. Payers of dialysis services can constrain costs through (1) limiting access to dialysis, (2) reducing the quality of dialysis, and (3) placing constraints on modality distribution. In order to secure the necessary resources for ESRD care, we propose that the nephrology community consider the following suggestions: First, future leaders in dialysis should acquire additional advanced training in innovative pathways such as health care economics, business and health care administration, and health care policy. Second, the international nephrology community must strongly engage in ongoing advocacy for accessible, high quality, cost-effective care.Third, efforts should be made to better define and then implement optimal dialysis modality distributions that maximize patient outcomes but limit unnecessary costs. Fourth, industry should be encouraged to lower the unit cost of dialysis, allowing for improved access to dialysis, especially in developing countries. Fifth, research should be encouraged that seeks to identify measures that will reduce dialysis costs but will not impair quality of care. Finally, early referral of patients with progressive renal disease to nephrology clinics, empowerment of informed patient choice of dialysis modality, and proper and timely access creation should be encouraged and can be expected to help limit overall expenditures. Ongoing efforts in these areas by the nephrology community will be essential if we are to overcome the challenges of ESRD growth in this new decade.

How core nursing textbooks inform holistic spiritual care.

Science.gov (United States)

2016-08-01

National and international health and nursing guidelines recommend that staff attend to patients' spiritual and religious needs, which suggests that spiritual care is an important aspect of holistic care. However, many nurses lack knowledge of the subject, and it is unclear whether core textbooks provide the information they need.

[A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

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Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu

2015-12-01

Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

A pilot investigation of food insecurity among children seen in an outpatient pediatric nephrology clinic

Directory of Open Access Journals (Sweden)

Michelle C. Starr

2018-06-01

Full Text Available Food insecurity (FI is common - affecting one in six American households with children. FI is defined as limited or uncertain availability of nutritionally adequate and safe foods. Awareness of food insecurity and its impact on health has increased since the American Academy of Pediatrics 2015 policy statement, “Promoting Food Security for All Children.” Though FI is frequently addressed in general pediatric primary care, it is not routinely identified in patients with chronic medical problems. Patients with complex care needs, prescription medication, or restrictive nutritional requirements may be at higher risk of food insecurity. The prevalence of FI in patients with chronic disease, including pediatric patients with kidney disease, remains unknown. We sought to determine the prevalence of FI among our pediatric nephrology clinic patients with a cross-sectional screening pilot study. Nearly 35% of 118 children seen in our pediatric nephrology outpatient clinic lived in food insecure households, a prevalence rate more than double the general pediatric population (16%. Barriers to food security were variable; common themes included challenges with restricted diet and available food, identifying and accessing community resources, and not qualifying for support. For physicians, dietitians, and other health providers that counsel patients with kidney disease on dietary interventions, it is important to be aware of food security status. To our knowledge, this is the first study to assess the prevalence of food insecurity in pediatric patients with kidney disease. Further studies of food insecurity and social determinants of heath in this patient population are needed. Keywords: Kidney disease, Pediatrics, Child, Healthcare utilization, Food insecurity, Nutritional status

Perception of physicians about medical education received during their Nephrology residency training in Peru.

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Herrera-Añazco, Percy; Bonilla-Vargas, Luis; Hernandez, Adrian V; Silveira-Chau, Manuela

2015-01-01

In Peru there are different hospitals and university programs for training of specialists in nephrology. To assess the perception of physicians who attend such programs. We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.

Do e-mail alerts of new research increase knowledge translation? A "Nephrology Now" randomized control trial.

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Tanna, Gemini V; Sood, Manish M; Schiff, Jeffrey; Schwartz, Daniel; Naimark, David M

2011-01-01

As the volume of medical literature increases exponentially, maintaining current clinical practice is becoming more difficult. Multiple, Internet-based journal clubs and alert services have recently emerged. The purpose of this study is to determine whether the use of the e-mail alert service, Nephrology Now, increases knowledge translation regarding current nephrology literature. Nephrology Now is a nonprofit, monthly e-mail alert service that highlights clinically relevant articles in nephrology. In 2007-2008, the authors randomized 1,683 subscribers into two different groups receiving select intervention articles, and then they used an online survey to assess both groups on their familiarity with the articles and their acquisition of knowledge. Of the randomized subscribers, 803 (47.7%) completed surveys, and the two groups had a similar number of responses (401 and 402, respectively). The authors noted no differences in baseline characteristics between the two groups. Familiarity increased as a result of the Nephrology Now alerts (0.23 ± 0.087 units on a familiarity scale; 95% confidence interval [CI]: 0.06-0.41; P = .007) especially in physicians (multivariate odds ratio 1.83; P = .0002). No detectable improvement in knowledge occurred (0.03 ± 0.083 units on a knowledge scale; 95% CI: -0.13 to 0.20; P = .687). An e-mail alert service of new literature improved a component of knowledge translation--familiarity--but not knowledge acquisition in a large, randomized, international population.

Blood specimen labelling errors: Implications for nephrology nursing practice.

Science.gov (United States)

Duteau, Jennifer

2014-01-01

Patient safety is the foundation of high-quality health care, as recognized both nationally and worldwide. Patient blood specimen identification is critical in ensuring the delivery of safe and appropriate care. The practice of nephrology nursing involves frequent patient blood specimen withdrawals to treat and monitor kidney disease. A critical review of the literature reveals that incorrect patient identification is one of the major causes of blood specimen labelling errors. Misidentified samples create a serious risk to patient safety leading to multiple specimen withdrawals, delay in diagnosis, misdiagnosis, incorrect treatment, transfusion reactions, increased length of stay and other negative patient outcomes. Barcode technology has been identified as a preferred method for positive patient identification leading to a definitive decrease in blood specimen labelling errors by as much as 83% (Askeland, et al., 2008). The use of a root cause analysis followed by an action plan is one approach to decreasing the occurrence of blood specimen labelling errors. This article will present a review of the evidence-based literature surrounding blood specimen labelling errors, followed by author recommendations for completing a root cause analysis and action plan. A failure modes and effects analysis (FMEA) will be presented as one method to determine root cause, followed by the Ottawa Model of Research Use (OMRU) as a framework for implementation of strategies to reduce blood specimen labelling errors.

[Assessment of epidemiological profile of patients and their difficulties for the first query in the screening ambulatory of Nephrology UNIFESP-EPM].

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Padovani, Cícera Sebastiana da Silva

2012-01-01

The aim of this study was to evaluate the epidemiologic profile of patients and difficulties of patients referred by basic health units (UBS) or other hospitals, outpatient screening of the Division of Nephrology, Hospital São Paulo (UNIFESP) for evaluation and treatment kidney disease. From February to September 2009, has been evaluated 341 patients referred from UBS in São Paulo and other parts of the Country. Of these patients, 26% (86/341) required for new tests to confirm the diagnosis doubtful for referrals, incomplete, or because of the waiting period for the care and exams, which ranged from one week to three years, and part of them did not bring any kind of examination for the evaluation, 12% (45/341) returned for follow-up at the unit location, 13% (46/341) were referred for treatment site closest to their residence, 47% (164/341) for our sub-specialty Clinics of Nephrology (HSP): 24% (82/341) uremia, 8% (27/341) with polycystic kidney disease, 7% (23/341) for hypertension, 4% (16/341) renal Lithiasis and 4% (16/341) nephritis. Our results suggest investments investment in infrastructure in the training of officials of UBS and HSP, reorganization of central references for better management and referral of patients, humanization of care and training of health professionals for outpatient care at UBS in preventive work and basic monitoring of patients, particularly those with diabetes mellitus and hypertension, which can lead to the development of chronic kidney disease (CKD).

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Consensus Workshop

Science.gov (United States)

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C.; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C.; O’Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C.

2017-01-01

Evidence-informed decision-making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient-centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis. Key stakeholders including eight patients/caregivers and 47 health professionals (nephrologists, policy makers, industry, researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations; flexibility to consider evolving priorities over time; deconstruction of language and meaning for conceptual consistency and clarity; understanding of potential overlap and associations between outcomes; and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive and validated outcome measures that could be used in clinical care (quality ndicators) and trials (including pragmatic trials), and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment, and improved patient outcomes. PMID:27497527

Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

Directory of Open Access Journals (Sweden)

Usama Elewa

Full Text Available Arterial stiffness, as measured by pulse wave velocity (PWV, is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5% patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV - (upper limit of the age-adjusted PWV values for the general population. Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

What Are We Doing? A Survey of United States Nephrology Fellowship Program Directors.

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Liebman, Scott E; Moore, Catherine A; Monk, Rebeca D; Rizvi, Mahrukh S

2017-03-07

Interest in nephrology has been declining in recent years. Long work hours and a poor work/life balance may be partially responsible, and may also affect a fellowship's educational mission. We surveyed nephrology program directors using a web-based survey in order to define current clinical and educational practice patterns and identify areas for improvement. Our survey explored fellowship program demographics, fellows' workload, call structure, and education. Program directors were asked to estimate the average and maximum number of patients on each of their inpatient services, the number of patients seen by fellows in clinic, and to provide details regarding their overnight and weekend call. In addition, we asked about number of and composition of didactic conferences. Sixty-eight out of 148 program directors responded to the survey (46%). The average number of fellows per program was approximately seven. The busiest inpatient services had a mean of 21.5±5.9 patients on average and 33.8±10.7 at their maximum. The second busiest services had an average and maximum of 15.6±6.0 and 24.5±10.8 patients, respectively. Transplant-only services had fewer patients than other service compositions. A minority of services (14.5%) employed physician extenders. Fellows most commonly see patients during a single weekly continuity clinic, with a typical fellow-to-faculty ratio of 2:1. The majority of programs do not alter outpatient responsibilities during inpatient service time. Most programs (approximately 75%) divided overnight and weekend call responsibilities equally between first year and more senior fellows. Educational practices varied widely between programs. Our survey underscores the large variety in workload, practice patterns, and didactics at different institutions and provides a framework to help improve the service/education balance in nephrology fellowships. Copyright © 2017 by the American Society of Nephrology.

Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians.

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Tick, Heather; Chauvin, Sheila W; Brown, Michael; Haramati, Aviad

2015-11-01

The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain. Wiley Periodicals, Inc.

Clostridium Difficile Infection in the Nephrology Ward

Directory of Open Access Journals (Sweden)

Sylwia Dudzicz

2017-11-01

Full Text Available Clostridium difficile is currently the most frequently identified pathogen causing antibiotic-associated diarrhea and the main cause of nosocomial diarrhea. In recent years, increases incidence of infection, severe infection, recurrent infection and mortality from Clostridium difficile infection (CDI have been observed. This may be a consequence of excessive antibiotic use and spread of the hypervirulent epidemic BI/NAP1/027 strain of Clostridium difficile. The main risk factors for CDI are: antibiotic therapy, previous hospitalizations and number of comorbid conditions. Prevention of CDI mainly is focused in two directions: reducing the exposure of patients to the disease pathogen by intensifying hygiene measures, and reducing the impact of risk factors. A meta-analyses of clinical studies (observational, cohort and case control showed significantly higher risk of CDI and CDI recurrence in patients with chronic kidney disease and increased mortality risk in chronic kidney disease patients with CDI comparing those without CDI. Increased risk of CDI in patients with chronic kidney disease can be caused by: frequent antibiotic therapy associated with numerous infections resulting in intestinal microflora dysfunction, frequent hospitalizations, older age of the patients and an impaired immune system. Among preventative measures against CDI, the use of probiotics were also studied. In patients hospitalized in nephrology ward highly significant reduction of the CDI incidence was observed after the introduction of Lactobacillus plantarum 299v as CDI prophylaxis. Therefore, the use of Lactobacillus plantarum 299v seems to be a promising method of CDI prevention in chronic kidney disease patients hospitalized in nephrology ward.

Profile and scientific production of CNPq researchers in Nephrology and Urology.

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Oliveira, Eduardo A; Pécoits-Filho, Roberto; Quirino, Isabel G; Oliveira, Maria Christina; Martelli, Daniela Reis; Lima, Leonardo S; Martelli, Hercílio

2011-03-01

This study aimed at evaluating the profile and scientific production of researchers in Nephrology and Urology, receiving grants in the area of Clinical Medicine from the Brazilian National Research Council. The standardized online curriculum vitae (Curriculum Lattes) of 39 researchers in Medicine receiving grants in the 2006-2008 triennium were included in the analysis. The variables analyzed were: gender, affiliation, time from completion of the PhD program, scientific production, and supervision of undergraduate students, and master's and PhD programs. Males (74.4%) and category 2 grants (56.4%) predominated. The following three Brazilian states are responsible for 90% of the researchers: São Paulo (28; 71.8%); Rio Grande do Sul (4; 10.3%); and Minas Gerais (3; 7.7%). Four institutions are responsible for 70% of the researchers: UNIFESP (14; 36%); USP (8; 20.5%); UFMG (3, 7.7%); and UNICAMP (3; 7.7%). Considering the academic career, the assessed researchers published 3,195 articles in medical journals, with a median of 75 articles per researcher (QI = 52-100). The researchers received a total of 25,923 citations at the database Web of Science®, with a median of 452 citations per researcher (QI = 161-927). The average number of citations per article was 13.8 citations (SD = 11.6). The Southeastern region of Brazil concentrates researchers in Nephrology and Urology. Our study has shown an increase in the scientific production of most researchers in the last five years. By knowing the profile of researchers in Nephrology and Urology, more effective strategies to encourage the scientific production and the demand for resources to finance research projects can be defined.

Electronic strategies for information and research: cyberNephrology/cyberMedicine in the emerging world.

Science.gov (United States)

Solez, Kim; Hales, Michele; Katz, Sheila Moriber

2005-09-01

Communication and medicine have evolved together. Internet resources now provide an unprecedented opportunity to provide health assistance to the developing world. The International Society of Nephrology Informatics Commission and National Kidney Foundation cyberNephrology initiative (http://www.cybernephrology.org) have created e-mail discussion groups (e.g., NEPHROL, NEPHKIDS, and so forth) and online texts and web resources (e.g., the Schrier Atlas: http://www.kidneyatlas.org) that are, in many respects, ahead of other areas of medicine. On the other hand, nephrology is quite behind in its embrace of some specific communications initiatives that could benefit emerging nations: the Health InterNetwork Access to Research Initiative program, which provides free full-text access to medical journals and books in poorer countries; the Global Health Network Supercourse, which provides specially designed online lectures for the developing world; and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings. The intent of many educational ventures in nephrology, particularly in the clinical practice guideline realm (National Kidney Foundation Kidney Disease Outcomes Quality Initiative, Kidney Disease Improving Global Outcomes, and so forth), is not just to disseminate information but to change human behavior: physician practice and referral patterns, patient compliance, and so forth. Concepts from the worlds of marketing and entertainment, where the science of changing human behavior is highly evolved, can be used to create high-impact, educational offerings to promote health. They can also be highly beneficial to share Internet educational innovations and future vision across boundaries of medical specialties, which is part of the intent of the cyberMedicine joint venture (http://www.cyber-medicine.org).

Efficacy and Safety Data of Subsequent Entry Biologics Pertinent to Nephrology Practice: A Systematic Review

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Judith Genevieve Marin

2014-12-01

Full Text Available Background: Subsequent entry biologics (SEBs may soon be a reality in Canadian nephrology practice. Understanding the worldwide experience with these agents will be valuable to Canadian clinicians. Objectives: To compare the efficacy and safety data between SEBs used in nephrology practice and their reference biologic. Design: Systematic review. Sources of information: Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, Cochrane Central Register of Controlled Trials. Patients: Adult patients with chronic kidney disease (CKD. Methods: Our systematic review follows the process outlined by Cochrane Reviews. For efficacy data, all randomized controlled trials (RCTs, quasi-RCTs and observational trials in nephrology practice were included. For safety data, case series, case reports, review articles in nephrology practice and pharmacovigilance programs were included as well. Results: Only epoetin SEBs trials were published in the literature. Ten studies involving three different epoetin SEBs (epoetin zeta, HX575 and epoetin theta were included. The mean epoetin dose used did not differ significantly between the SEBs and the reference product. For epoetin zeta and epoetin theta, the mean hemoglobin levels achieved in the studies were similar between the SEBs and the reference epoetin. The HX 575 studies reported a mean absolute change in hemoglobin within the predefined equivalence margin, when compared with the reference biologic. In terms of safety data, 2 cases of pure-red-cell aplasia were linked to the subcutaneous administration of HX 575. Otherwise, the rate of adverse drug reactions was similar when epoetin SEBs were compared with the reference biologic. Limitations: Our analysis is limited by the paucity of information available on SEB use in nephrology with the exception of epoetin SEBs. Methodological flaw was found in one of the epoetin zeta studies which accounted for 45% of pooled

Incorporating the Six Core Elements of Health Care Transition Into a Medicaid Managed Care Plan: Lessons Learned From a Pilot Project.

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McManus, Margaret; White, Patience; Pirtle, Robin; Hancock, Catina; Ablan, Michael; Corona-Parra, Raquel

2015-01-01

This pediatric-to-adult health care transition pilot project describes the process and results of incorporating the "Six Core Elements of Health Care Transition (2.0)" into a Medicaid managed care plan with a group of 35 18-23 year olds who have chronic mental health, developmental, and complex medical conditions. The pilot project demonstrated an effective approach for customizing and delivering recommended transition services. At the start of the 18-month project, the Medicaid plan was at the basic level (1) of transition implementation of the Six Core Elements with no transition policy, member transition readiness assessment results, health care transition plans of care, updated medical summaries, transfer package for the adult-focused provider, and assurance of transfer completion and consumer feedback. At the conclusion of the pilot project, the plan scored at level 3 on each core element. The primary reason for not scoring at the highest level (4) was because the transition elements have not been incorporated into services for all enrollees within the plan. Future efforts in managed care will benefit from starting the transition process much earlier (ages 12-14), expanding the role of nurse care managers and participating pediatric and adult-focused clinicians in transition, and offering payment incentives to clinicians to implement the Six Core Elements of Health Care Transition. Copyright © 2015 Elsevier Inc. All rights reserved.

New magnetic resonance imaging methods in nephrology

Science.gov (United States)

Zhang, Jeff L.; Morrell, Glen; Rusinek, Henry; Sigmund, Eric; Chandarana, Hersh; Lerman, Lilach O.; Prasad, Pottumarthi Vara; Niles, David; Artz, Nathan; Fain, Sean; Vivier, Pierre H.; Cheung, Alfred K.; Lee, Vivian S.

2013-01-01

Established as a method to study anatomic changes, such as renal tumors or atherosclerotic vascular disease, magnetic resonance imaging (MRI) to interrogate renal function has only recently begun to come of age. In this review, we briefly introduce some of the most important MRI techniques for renal functional imaging, and then review current findings on their use for diagnosis and monitoring of major kidney diseases. Specific applications include renovascular disease, diabetic nephropathy, renal transplants, renal masses, acute kidney injury and pediatric anomalies. With this review, we hope to encourage more collaboration between nephrologists and radiologists to accelerate the development and application of modern MRI tools in nephrology clinics. PMID:24067433

The National Institute of Diabetes and Digestive and Kidney Diseases Central Repositories: a valuable resource for nephrology research.

Science.gov (United States)

Rasooly, Rebekah S; Akolkar, Beena; Spain, Lisa M; Guill, Michael H; Del Vecchio, Corey T; Carroll, Leslie E

2015-04-07

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repositories, part of the National Institutes of Health (NIH), are an important resource available to researchers and the general public. The Central Repositories house samples, genetic data, phenotypic data, and study documentation from >100 NIDDK-funded clinical studies, in areas such as diabetes, digestive disease, and liver disease research. The Central Repositories also have an exceptionally rich collection of studies related to kidney disease, including the Modification of Diet in Renal Disease landmark study and recent data from the Chronic Renal Insufficiency Cohort and CKD in Children Cohort studies. The data are carefully curated and linked to the samples from the study. The NIDDK is working to make the materials and data accessible to researchers. The Data Repositories continue to improve flexible online searching tools that help researchers identify the samples or data of interest, and NIDDK has created several different paths to access the data and samples, including some funding initiatives. Over the past several years, the Central Repositories have seen steadily increasing interest and use of the stored materials. NIDDK plans to make more collections available and do more outreach and education about use of the datasets to the nephrology research community in the future to enhance the value of this resource. Copyright © 2015 by the American Society of Nephrology.

Consensus development of core competencies in intensive and critical care medicine training in China

OpenAIRE

Hu, Xiaoyun; Xi, Xiuming; Ma, Penglin; Qiu, Haibo; Yu, Kaijiang; Tang, Yaoqing; Qian, Chuanyun; Fang, Qiang; Wang, Yushan; Yu, Xiangyou; Xu, Yuan; Du, Bin

2016-01-01

Background The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. Methods We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professio...

Association between Duration of Predialysis Care and Mortality after Dialysis Start.

Science.gov (United States)

Liu, Ping; Quinn, Robert R; Oliver, Matthew J; Ronksley, Paul E; Hemmelgarn, Brenda R; Quan, Hude; Hiremath, Swapnil; Bello, Aminu K; Blake, Peter G; Garg, Amit X; Johnson, John; Verrelli, Mauro; Zacharias, James M; Abd ElHafeez, Samar; Tonelli, Marcello; Ravani, Pietro

2018-03-05

Early nephrology referral is recommended for people with CKD on the basis of observational studies showing that longer nephrology care before dialysis start (predialysis care) is associated with lower mortality after dialysis start. This association may be observed because predialysis care truly reduces mortality or because healthier people with an uncomplicated course of disease will have both longer predialysis care and lower risk for death. We examined whether the survival benefit of longer predialysis care exists after accounting for the potential confounding effect of disease course that may also be affected by predialysis care. We performed a retrospective cohort study and used data from 3152 adults with end stage kidney failure starting dialysis between 2004 and 2014 in five Canadian dialysis programs. We obtained duration of predialysis care from the earliest nephrology outpatient visit to dialysis start; markers of disease course, including inpatient or outpatient dialysis start and residual kidney function around dialysis start; and all-cause mortality after dialysis start. The percentages of participants with 0, 1-119, 120-364, and ≥365 days of predialysis care were 23%, 8%, 10%, and 59%, respectively. When we ignored markers of disease course as in previous studies, longer predialysis care was associated with lower mortality (hazard ratio 120-364 versus 0-119 days , 0.60; 95% confidence interval, 0.46 to 0.78]; hazard ratio ≥365 versus 0-119 days , 0.60; 95% confidence interval, 0.51 to 0.71; standard Cox model adjusted for demographics and laboratory and clinical characteristics). When we additionally accounted for markers of disease course using the inverse probability of treatment weighted Cox model, this association was weaker and no longer significant (hazard ratio 120-364 versus 0-119 days , 0.84; 95% confidence interval, 0.60 to 1.18; hazard ratio ≥365 versus 0-119 days , 0.88; 95% confidence interval, 0.69 to 1.13). The association between

Dysfunction of the Lower Urinary Tract in Renal Transplant Children with Nephrological Disease

NARCIS (Netherlands)

Weide, M.J.A. van der; Cornelissen, E.A.M.; Achterberg, T. van; Smits, J.P.J.M.; Feitz, W.F.J.

2006-01-01

- OBJECTIVES: To investigate the relationship between dysfunction of the lower urinary tract after renal transplantation and renal transplant function in children with an underlying nephrologic disease. - METHODS: The research group consisted of 21 renal transplant children (12 girls and 9 boys,

Consensus development of core competencies in intensive and critical care medicine training in China.

Science.gov (United States)

Hu, Xiaoyun; Xi, Xiuming; Ma, Penglin; Qiu, Haibo; Yu, Kaijiang; Tang, Yaoqing; Qian, Chuanyun; Fang, Qiang; Wang, Yushan; Yu, Xiangyou; Xu, Yuan; Du, Bin

2016-10-16

The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies. The output from the online survey was edited and then reviewed by a nominal group of 13 intensive care professionals to identify each competence for importance. The resulting list was then recirculated in the nominal group for iterative rating. The online survey yielded a list of 199 competencies for nominal group reviewing. After five rounds of rating, 129 competencies entered the final set defined as core competencies. We have generated a set of core competencies using a consensus technique which can serve as an indicator for training program development.

Medical Ethics in Nephrology: A Jewish Perspective

Directory of Open Access Journals (Sweden)

Allon J. Friedman

2016-04-01

Full Text Available Jewish medical ethics is arguably the oldest recorded system of bioethics still in use. It should be of interest to practicing nephrologists because of its influence on the ethical systems of Christianity, Islam, and Western secular society; because of the extensive written documentation of rabbinical response in addressing a broad range of bioethical dilemmas; and in understanding the values of patients who choose to adhere to religious Jewish law. The goal of this review is to provide a brief overview of the basic principles underlying mainstream traditional Jewish medical ethics, apply them to common clinical scenarios experienced in nephrology practice, and contrast them with that of secular medical ethics.

Understanding the concept and challenges of palliative care medicine

African Journals Online (AJOL)

MJP

2015-06-25

Jun 25, 2015 ... 2 Nephrology Unit, Department of Internal Medicine, Federal Medical Centre Umuahia, Abia ... Key words: Palliative care, pain control, hospice, spirituality, cancer, end-stage organ ... surgeons, nurses, pharmacists, laboratory.

Geriatric core competencies for family medicine curriculum and enhanced skills: care of elderly.

Science.gov (United States)

Charles, Lesley; Triscott, Jean A C; Dobbs, Bonnie M; McKay, Rhianne

2014-06-01

There is a growing mandate for Family Medicine residency programs to directly assess residents' clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit.

Core competencies in sexual and reproductive health for the interprofessional primary care team.

Science.gov (United States)

Cappiello, Joyce; Levi, Amy; Nothnagle, Melissa

2016-05-01

A primary care workforce that is well prepared to provide high-quality sexual and reproductive health (SRH) care has the potential to enhance access to care and reduce health disparities. This project aimed to identify core competencies to guide SRH training across the primary care professions. A six-member interprofessional expert working group drafted SRH competencies for primary care team members. Primary care providers including family physicians, nurses, nurse practitioners and certified nurse midwives, physician assistants and pharmacists were invited to participate in a three-round electronic Delphi survey. In each round, participants voted by email to retain, eliminate or revise each competency, with their suggested edits to the competencies incorporated by the researchers after each round. Fifty providers from six professions participated. In Round 1, 17 of 33 draft competencies reached the 75% predetermined agreement level to be accepted as written. Five were combined, reducing the total number to 28. Based on Round 2 feedback, 21 competencies were reworded, and 2 were combined. In Round 3, all 26 competencies reached at least 83.7% agreement, with 9 achieving 100% agreement. The 33 core competencies encompass professional ethics and reproductive justice, collaboration, SRH services and conditions affecting SRH. These core competencies will be disseminated and adapted to each profession's scope of practice to inform required curricula. SRH competencies for primary care can inform the required curricula across professions, filling the gap between an established standard of care necessary to meet patient needs and the outcomes of that care. Copyright © 2015 Elsevier Inc. All rights reserved.

Toward population management in an integrated care model.

Science.gov (United States)

Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

2013-01-01

Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel.

International use of an academic nephrology World Wide Web site: from medical information resource to business tool.

Science.gov (United States)

Abbott, Kevin C; Oliver, David K; Boal, Thomas R; Gadiyak, Grigorii; Boocks, Carl; Yuan, Christina M; Welch, Paul G; Poropatich, Ronald K

2002-04-01

Studies of the use of the World Wide Web to obtain medical knowledge have largely focused on patients. In particular, neither the international use of academic nephrology World Wide Web sites (websites) as primary information sources nor the use of search engines (and search strategies) to obtain medical information have been described. Visits ("hits") to the Walter Reed Army Medical Center (WRAMC) Nephrology Service website from April 30, 2000, to March 14, 2001, were analyzed for the location of originating source using Webtrends, and search engines (Google, Lycos, etc.) were analyzed manually for search strategies used. From April 30, 2000 to March 14, 2001, the WRAMC Nephrology Service website received 1,007,103 hits and 12,175 visits. These visits were from 33 different countries, and the most frequent regions were Western Europe, Asia, Australia, the Middle East, Pacific Islands, and South America. The most frequent organization using the site was the military Internet system, followed by America Online and automated search programs of online search engines, most commonly Google. The online lecture series was the most frequently visited section of the website. Search strategies used in search engines were extremely technical. The use of "robots" by standard Internet search engines to locate websites, which may be blocked by mandatory registration, has allowed users worldwide to access the WRAMC Nephrology Service website to answer very technical questions. This suggests that it is being used as an alternative to other primary sources of medical information and that the use of mandatory registration may hinder users from finding valuable sites. With current Internet technology, even a single service can become a worldwide information resource without sacrificing its primary customers.

The core of love when caring for patients suffering from addiction.

Science.gov (United States)

Thorkildsen, Kari M; Eriksson, Katie; Råholm, Maj-Britt

2015-06-01

Drug addiction is a serious health problem. The aim of this study was to gain an understanding of the core of love when caring for patients suffering from addiction. The study had a hermeneutical approach. Four nurses working at a detoxification unit were interviewed. Data were interpreted using a hermeneutical text interpretation based on Gadamer's hermeneutics. The results revealed the core of love in four dimensions: love as an inner driving force, searching for the human being behind the addiction, faith in the inner power of human beings and love as a movement of giving and receiving. The hermeneutical interpretation revealed the core of love as sacrifice, showing that sacrifice is an ethical dimension and that sacrifice involves searching for the patient's ontological suffering. Sacrifice is connected to faith, and faith in love is decisive for a life without drugs. Sacrifice involves being mutual gifts to one another, a self-reinforcing motion of sacrifice that energizes the nurses to go on with their work. © 2014 Nordic College of Caring Science.

An exploration of the extent of inclusion of spirituality and spiritual care concepts in core nursing textbooks.

Science.gov (United States)

Timmins, Fiona; Murphy, Maryanne; Neill, Freda; Begley, Thelma; Sheaf, Greg

2015-01-01

Holistic care that encompasses a spiritual dimension is an expectation in modern healthcare (Rothman, 2009). Increasing attention is being paid to the role of nurses in providing spiritual care to patients. However nurses lack specific skills and expertise in this area (Lundmark, 2006; Timmins, 2010; RCN, 2011), and the extent to which their undergraduate education prepares them for this role is unclear. There is often an absence of clear direction about what to teach undergraduate nursing students. The extent to which core textbooks direct student studies in this area is not known. There is some evidence that some of these fundamental core textbooks provide insufficient direction (Pesut, 2008), thus gaps in knowledge and care provision in this field could be exacerbated. The aim of this study is to examine the extent to which spiritual care concepts are addressed in core nursing textbooks. Five hundred and forty three books were sampled from the Nursing and Midwifery Core Collection list (UK) (Tomlinsons, 2010) representing 94% of the total (n=580). A survey, the Spirituality Textbook Analysis Tool (STAT), was developed and used to collect data. One hundred and thirty of the books included content related to spirituality and religion. However there was little consistency in the core nursing textbooks with regard to direction for providing spiritual care. Thirty eight percent of the books defined spiritual care and 36% provided an outline of the role of the nurse in providing this. While some books advocated the assessment of patients' spiritual needs (32%) few referred specifically to assessment tools. It is essential that nurses are adequately prepared to address the spiritual needs of patients. While there are numerous spiritual care texts that deal solely with this issue for nurses, there is an argument emerging that core nursing texts used by nursing students ought to encompass spiritual care elements. Lack of specific focus on this field, by these key

Is Doubling of Serum Creatinine a Valid Clinical 'Hard' Endpoint in Clinical Nephrology Trials?

NARCIS (Netherlands)

Lambers Heerspink, H. J.; Perkovic, V.; de Zeeuw, D.

2011-01-01

The composite of end stage renal disease (ESRD), doubling of serum creatinine and (renal) death, is a frequently used endpoint in randomized clinical trials in nephrology. Doubling of serum creatinine is a well-accepted part of this endpoint because a doubling of serum creatinine reflects a large

Continuing Professional Development Evaluation: Two Rapid Review Courses inNephrology and Rheumatology

Directory of Open Access Journals (Sweden)

Abdullah Shehab

2012-09-01

Full Text Available Objectives: Continuing professional development (CPD is anovel approach to increase professional knowledge and skills. The aim of this study is to explore participants’ characteristics and to understand participants’ views on two rapid review courses (RRCs as part of CPD program, and to assess healthcare providers’ views about the use of internet for accessing medical information.Methods: Data were collected from 150 participants who attended an RRC in Nephrology and Rheumatology as part of an ongoing CME program.Results: Participants’ response rate was 92% and 84.4% in Nephrology and Rheumatology RRCs, respectively. Participants’ Mean Age±SD were 39±2.1 and 41±2.1 years in the Nephrology and Rheumatology courses, respectively. Demographic variables, i.e., age, gender, and specialization showed a significant (p<0.01 impact on the learning objectives of the program. Further, participants reported that the course material had a significant (p<0.02 impacton their knowledge. Finding new medical information was the primary motive to search the internet among all participants. About half of the subjects reported knowledge of their preferred medical education sites and had access at their clinical setup. Barriers to internet use included lack of specific information, difficulty to download contents, and excessive material. Professional association websites, online journals, and CME programs were the most frequently searched sources of information. Most of the subjects reported significant (p<0.02 barriers to find medical resources on the internet and to adequately utilize the currently available medical search engines available in the healthcare system.Conclusion: A discipline specific and integrated CPD programmay have provided dual benefit such as accredited CME hours and a significant change in the participants’ knowledge. There is a need to increase Internet accessibility and capacity in the current healthcare facilities. Future CPD

Enfermera Nefrológica: de la formación básica a la formación especialista Nephrology Nursing: From basic training to specialist training

Directory of Open Access Journals (Sweden)

Marta Isabel San Juan Miguelsanz

2012-09-01

Full Text Available Introducción: La Enfermería Nefrológica desempeña sus funciones en un área definida de la asistencia que determina la necesidad de una capacitación específica que asegure la calidad de los cuidados que realiza. Ante la ausencia de formación postgraduada reglada, la mayoría de las enfermeras aprenden realizando cursos de formación continuada y, fundamentalmente, en el puesto de trabajo. Objetivos: Conocer si en las unidades de Nefrología de Castilla y León se realiza una formación específica de las enfermeras de nueva incorporación y si en estas unidades han desarrollado algún programa específico de formación de enfermeras. Material y método: Se realiza un estudio descriptivo cuantitativo transversal realizado entre los meses de octubre de 2011 y marzo de 2012. La recogida de datos se realizó vía telefónica, mediante entrevista abierta. Para el registro y análisis estadístico se utilizó el programa Microsoft Office Excel de Windows XP. Los resultados se expresan en valores totales, porcentajes y media aritmética. Resultados: En Castilla y León realizan formación de enfermeras el 61% de las unidades de nefrología, siguiendo un programa específico un 64% de ellas, destacando que entre estas unidades hay un hospital y el resto son centros concertados. Discusión: En ausencia de una especialidad reglada y con miras a ofrecer a la sociedad profesionales enfermeros cualificados para el ámbito laboral, las enfermeras nefrológicas han buscado la manera de mejorar la formación de los profesionales desarrollando, en algunos casos, programas específicos en las propias unidades.Introduction: Nephrology Nursing carries out its functions in a defined area of care which determines the need for specific skills to ensure the quality of the care provided. In the absence of regulated postgraduate training, most nurses learn through continuous training courses and, fundamentally, on the job. Objectives: To find out whether the

Significant Independent Predictors of Vitamin D Deficiency in Inpatients and Outpatients of a Nephrology Unit

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Recep Bentli

2013-01-01

Full Text Available Aims. Kidney disease was found to be a major risk factor for vitamin D deficiency in a population study of patients hospitalized. The aims of the study were to describe the prevalence of vitamin D deficiency inpatients and outpatients in a nephrology department during fall and to evaluate effect of assessing serum 25-hydroxyvitamin D (25(OHD levels and previous supplementation of cholecalciferol on vitamin D status. Methods. We studied 280 subjects in total, between October and January. The subjects were recruited from the following two groups: (a inpatients and (b outpatients in nephrology unit. We examined previous documentary evidence of vitamin D supplementation of the patients. Results. The prevalence of vitamin D deficiency among these 280 patients was 62,1% (174 patients. Fifty-three patients (18.9% had severe vitamin D deficiency, 121 patients (43.2% moderate vitamin D deficiency, and 66 patients (23.6% vitamin D insufficiency. In logistic regression analysis female gender, not having vitamin D supplementation history, low serum albumin, and low blood urea nitrogen levels were significant independent predictors of vitamin D deficiency while no association of vitamin D deficiency with diabetes mellitus, serum creatinine, eGFR, and being hospitalized was found. Conclusion. Vitamin D deficiency, seems to be an important problem in both inpatients and outpatients of nephrology. Monitoring serum 25(OHD concentrations regularly and replacement of vitamin D are important. Women in Turkey are at more risk of deficiency and may therefore need to consume higher doses of vitamin D.

Analysis and synthesis of nuclear medical letters in the field of nephrological diseases

International Nuclear Information System (INIS)

Kley, K.H.

1979-01-01

The task of this study consisted in providing the conditions for the automized issue of nuclear nephrological medical letters based on the nuclear medical polyclinic Marburg Selex system working for 8 years now. Part of the task was to develop the structure and coding of the medical letter content appropriately for EDP documentation, as in the Selex system all data for medical letter acquisition are simultaneously acquired on a data carrier for EDP documentation. The analysis of commonly provided medical letters also exhibited in this field the known weaknesses: especially insufficient systematics and the all-over information of interfering redundances. The work describes in detail how the required thesaurus has been worked out and structured into obligatory and optional rough and detailed components. A general form was developed for the findings of paired organs and the special form for nuclear nephrological medical letters was adapted to it. Of the auxiliaries worked out for the doctor in setting up the working instructions to operate the Selex system, scriptate leaflet, short vocabulary album; the two former are presented fully and the latter with typical examples. The result of this work can basically also be applied to other hardware. (orig.) [de

[Artificial intelligence--the knowledge base applied to nephrology].

Science.gov (United States)

Sancipriano, G P

2005-01-01

The idea that efficacy efficiency, and quality in medicine could not be reached without sorting the huge knowledge of medical and nursing science is very common. Engineers and computer scientists have developed medical software with great prospects for success, but currently these software applications are not so useful in clinical practice. The medical doctor and the trained nurse live the 'information age' in many daily activities, but the main benefits are not so widespread in working activities. Artificial intelligence and, particularly, export systems charm health staff because of their potential. The first part of this paper summarizes the characteristics of 'weak artificial intelligence' and of expert systems important in clinical practice. The second part discusses medical doctors' requirements and the current nephrologic knowledge bases available for artificial intelligence development.

Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

Directory of Open Access Journals (Sweden)

José L. Teruel

2015-10-01

Full Text Available Healthcare for patients with advanced chronic kidney disease (ACKD on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2. The median patient follow-up time (until death or until 31 December 2014 was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50% died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams.

Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

Science.gov (United States)

Teruel, José L.; Rexach, Lourdes; Burguera, Victor; Gomis, Antonio; Fernandez-Lucas, Milagros; Rivera, Maite; Diaz, Alicia; Collazo, Sergio; Liaño, Fernando

2015-01-01

Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2). The median patient follow-up time (until death or until 31 December 2014) was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50%) died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams. PMID:27417813

International Society of Nephrology-Hydration and Kidney Health Initiative - Expanding Research and Knowledge.

Science.gov (United States)

Moist, Louise M; Clark, William F; Segantini, Luca; Damster, Sandrine; Le Bellego, Laurent; Wong, Germaine; Tonelli, Marcello

2016-01-01

The purpose of this manuscript is to describe a collaborative research initiative to explore the role of hydration in kidney health. Our understanding of the effects of hydration in health and disease is surprisingly limited, particularly when we consider the vital role of hydration in basic human physiology. Recent initiatives and research outcomes have challenged the global medical community to expand our knowledge about hydration, including the differences between water, sugared beverages and other consumables. Identification of the potential mechanisms contributing to the benefits of hydration has stimulated the global nephrology community to advance research regarding hydration for kidney health. Hydration and kidney health has been a focus of research for several research centers with a rapidly expanding world literature and knowledge. The International Society of Nephrology has collaborated with Danone Nutricia Research to promote development of kidney research initiatives, which focus on the role of hydration in kidney health and the global translation of this new information. This initiative supports the use of existing data in different regions and countries to expand dialogue among experts in the field of hydration and health, and to increase scientific interaction and productivity with the ultimate goal of improving kidney health. © 2016 The Author(s) Published by S. Karger AG, Basel.

Intra-operative hemodialysis during liver transplantation: an expanded role of the nephrology nurse.

Science.gov (United States)

Henson, Angela; Carpenter, Sally

2010-01-01

Hemodialysis is widely acknowledged as a treatment option to stabilize acute medical conditions where biochemistry management is paramount. One of the most challenging situations is during liver transplantation, when patients with moderate renal dysfunction are likely to become acutely acidotic. For nephrology nurses, this extended role requires increased knowledge, advanced skills, and a high level of communication with unfamiliar team members. With appropriate procedures and a supportive environment, delivering such a service is feasible.

Development of the Competency Assessment Tool-Mental Health, an instrument to assess core competencies for mental health care workers.

Science.gov (United States)

Clasen, Carla; Meyer, Cheryl; Brun, Carl; Mase, William; Cauley, Kate

2003-01-01

As the focus on accountability in health care increases, there has been a corresponding emphasis on establishing core competencies for health care workers. This article discusses the development of an instrument to establish core competencies for workers in inpatient mental health settings. Twenty-six competencies were identified and rated by mental health care personnel on two subscales: the importance of the competency and how much behavioral health care workers could benefit from training on the competency. The reliability of the scale and its contributions to the training, retention and recruitment of direct care workers for behavioral health are discussed.

Meeting Report: International nephrology days - In honor of the 75(th) anniversary of acad. Momir Polenakovic and 50 years of scientific work, 26-27 September 2014.

Science.gov (United States)

Spasovski, G

2015-01-01

The International Nephrology Days in honor of the 75(th) anniversary of Academician Momir Polenakovic and 50 years of his scientific work were held in the Macedonian Academy of Sciences and Arts (MASA) on 26 and 27 September 2014. Organizers of the meeting were the Macedonian Academy of Sciences and Arts and the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO). The days were programmed with the VII Macedonian-Croatian Nephrology Meeting and the Continuing Medical Education (CME) Course on "Renal Replacement Therapy - when & how - update on the outcome and cost-efficacy" organized by the MSNDTAO in cooperation with the European Renal Association (ERA-EDTA). Prominent academicians, researchers and nephrologists from Europe and neighboring countries contributed with their lectures and discussion at this scientific event. On September 26, 2014 the opening talk was given by Acad. V. Kambovski, President of the MASA, about the Life and Work of Academician Momir Polenakovic. In honor of his anniversary and valuable scientific opus, during the meeting Acad. Momir Polenakovic was awarded with Certificate of the European Renal Association (ERA-EDTA) for his significant role in the development of nephrology in the Balkan region and couple of other diplomas and acknowledgement. Prof. Polenakovic is founder of the MSNDTAO and his lifetime honorary president.

Core competencies for health professionals' training in pediatric behavioral sleep care: a Delphi study.

Science.gov (United States)

Boerner, Katelynn E; Coulombe, J Aimée; Corkum, Penny

2015-01-01

The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks.

[Census of the renal and dialysis units by Italian Society of Nephrology: structure and organization for renal patient assistance in Italy (2014-2015)].

Science.gov (United States)

Quintaliani, Giuseppe; Di Luca, Marina; Di Napoli, Anteo; Viglino, Giusto; Postorino, Maurizio; Amore, Alessandro; Andrulli, Simeone; Bellasi, Antonio; Brunori, Giuliano; Buongiorno, Erasmo; Castellino, Santina; D'Amelio, Alessandro; De Nicola, Luca; Gesualdo, Loreto; Di Landro, Domenico; Feriozzi, Sandro; Strippoli, Giovanni; Teatini, Ugo; Santoro, Antonio

2016-01-01

Given the public health challenge and burden of chronic kidney disease, the Italian Society of Nephrology (SIN) promoted a census of the renal and dialysis units to analyse structural and human resources, organizational aspects, activities and workload referring to the year 2014. An online questionnaire, including 64 items exploring structural and human resources, organization aspects, activities and epidemiological data referred to 2014, was sent to chiefs of any renal or dialysis unit. 615 renal units were identified. From these 615 units, 332 were public renal centres (of which 318 centres answered to the census) and 283 were private dialysis centres (of which 113 centres answered to the census). The results show 6 public renal units pmp. Renal biopsies were 4624 (81 pmp). The nephrology beds are about 41 pmp. There are 7.304 nurses working in HD wards, 1.692 in the nephrology wards and only 613 for outpatients clinics. The benchmark data derived from this census show interesting comparisons between centres, regions and groups of regions. These data realised the clinical management of renal disease in Italy.

A national survey to define a new core curriculum to prepare physicians for managed care practice.

Science.gov (United States)

Meyer, G S; Potter, A; Gary, N

1997-08-01

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of

[Integration of a psychologist into Nephrology-Dialysis-Hypertension Operative Unit: from needs evaluation to the definition of an intervention model].

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Monica, Ratti Maria; Delli Zotti, Giulia Bruna; Spotti, Donatella; Sarno, Lucio

2014-01-01

Chronic Kidney Disease (CKD) and the dialytic treatment cause a significant psychological impact on patients, their families and on the medical-nursing staff too. The psychological aspects linked to the chronic condition of Kidney Disease generate the need to integrated a psychologist into the healthcare team of the Nephrology, Dialysis and Hypertension Operative Unit, in order to offer a specific and professional support to the patient during the different stages of the disease, to their caregivers and to the medical team. The aim of this collaboration project between Nephrology and Psychology is to create a global and integrated healthcare model. It does not give attention simply to the physical dimension of patients affected by CKD, but also to the emotional-affective, cognitive and social dimensions and to the health environment.

An exploration of the extent of inclusion of spirituality and spiritual care concepts in core nursing textbooks.

LENUS (Irish Health Repository)

Timmins, Fiona

2015-01-01

Holistic care that encompasses a spiritual dimension is an expectation in modern healthcare (Rothman, 2009). Increasing attention is being paid to the role of nurses in providing spiritual care to patients. However nurses lack specific skills and expertise in this area (Lundmark, 2006; Timmins, 2010; RCN, 2011), and the extent to which their undergraduate education prepares them for this role is unclear. There is often an absence of clear direction about what to teach undergraduate nursing students. The extent to which core textbooks direct student studies in this area is not known. There is some evidence that some of these fundamental core textbooks provide insufficient direction (Pesut, 2008), thus gaps in knowledge and care provision in this field could be exacerbated.

Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System.

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Nee, Robert; Fisher, Evan; Yuan, Christina M; Agodoa, Lawrence Y; Abbott, Kevin C

2017-01-01

Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types. © 2017 S. Karger AG, Basel.

The public’s preferences for establishing nephrology facilities in Greenland

DEFF Research Database (Denmark)

Kjaer, T.; Bech, M.; Kronborg, C.

2013-01-01

in which they were asked to consider the trade-offs of establishing nephrology facilities in Greenland as opposed to the current situation. This involved trading off the benefits of having such facilities in their home country against the costs of the intervention. Besides including a payment attribute...... robust. Establishing facilities in Greenland therefore would appear to be welfare-improving, deriving positive net benefits. Despite the relatively narrow policy focus, we believe that our findings provide some insight into individuals' preferences for decentralization of public services and on citizens...... facilities in Greenland were preferred to the current treatment in Denmark. The welfare estimate from the DCE, at DKK 18.74 million, exceeds the estimated annual costs of establishing treatment facilities for patients with chronic renal failure. Given the estimated confidence interval this result seems...

Clinical practice breastfeeding recommendations for primary care: applying a tri-core breastfeeding conceptual model.

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Busch, Deborah W; Logan, Kathleen; Wilkinson, Ashley

2014-01-01

Promotional practice efforts are needed in primary care to support and foster breastfeeding as the first and natural choice of nutrition for all infants regardless of race, ethnicity, educational, or income demographics in the United States. Societal awareness is increasing with regard to the significant protective qualities that human milk bestows upon public health. An estimated 75% of American mothers attempt to breastfeed, but according to the Centers for Disease Control and Prevention, just 13% are able to exclusively breastfeed by 6 months. Early identification of lactation issues is crucial to establishing and sustaining breastfeeding for the first 6 to 12 months of the child's life and beyond. We propose a set of primary care guidelines, applying a Tri-Core Model approach, to promote and foster breastfeeding efforts in the postpartum period. Breastfeeding promotion is a fundamental public health endeavor, and pediatric nurse practitioners and other advanced practice registered nurses (APRNs) are uniquely qualified to become specialists and experts in lactation care and management. Lactation support, which should be an integral facet of an APRN's practice and education, will aid in improving national breastfeeding rates and patient care outcomes. Application of the Tri-Core Model approach will help APRNs develop and implement evidence-based practice efforts that incorporate the mother-baby dyad and other multiprofessionals who are vested in successful breastfeeding outcomes. The goal of pediatric health care is provide safe and effective health care to all infants, children, and adolescents, and lactation care is an integral and crucial component of this effort. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa

Science.gov (United States)

Collins, Pamela Y.; Musisi, Seggane; Frehywot, Seble; Patel, Vikram

2015-01-01

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders. PMID:25783229

Physician-Assisted Suicide and Euthanasia in the Intensive Care Unit: A Dialogue on Core Ethical Issues

Science.gov (United States)

Goligher, Ewan C.; Ely, E. Wesley; Sulmasy, Daniel P.; Bakker, Jan; Raphael, John; Volandes, Angelo E.; Patel, Bhavesh M.; Payne, Kate; Hosie, Annmarie; Churchill, Larry; White, Douglas B.; Downar, James

2016-01-01

Objective Many patients are admitted to the intensive care unit at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia (PAS/E) holds implications for the practice of critical care medicine. The objective of this manuscript is to explore core ethical issues related to PAS/E from the perspective of healthcare professionals and ethicists on both sides of the debate. Synthesis We identified four issues highlighting the key areas of ethical tension central to evaluating PAS/E in medical practice: (1) the benefit or harm of death itself, (2) the relationship between PAS/E and withholding or withdrawing life support, (3) the morality of a physician deliberately causing death, and (4) the management of conscientious objection related to PAS/E in the critical care setting. We present areas of common ground as well as important unresolved differences. Conclusions We reached differing positions on the first three core ethical questions and achieved significant agreement on how critical care clinicians should manage conscientious objections related to PAS/E. The alternative positions presented in this paper may serve to promote open and informed dialogue within the critical care community. PMID:28098622

Optimizing care for Canadians with diabetic nephropathy in 2015.

Science.gov (United States)

Lloyd, Alissa; Komenda, Paul

2015-06-01

Diabetic chronic kidney disease (CKD) is the cause of kidney failure in approximately 35% of Canadian patients requiring dialysis. Traditionally, only a minority of patients with type 2 diabetes and CKD progress to kidney failure because they die of a cardiovascular event first. However, with contemporary therapies for diabetes and cardiovascular disease, this may no longer be true. The classic description of diabetic CKD is the development of albuminuria followed by progressive kidney dysfunction in a patient with longstanding diabetes. Many exciting candidate agents are under study to halt the progression of diabetic CKD; current therapies center on optimizing glycemic control, renin angiotensin system inhibition, blood pressure control and lipid management. Lifestyle modifications, such as salt and protein restriction as well as smoking cessation, may also be of benefit. Unfortunately, these accepted therapies do not entirely halt the progression of diabetic CKD. Also unfortunately, the presence of CKD in general is under-recognized by primary care providers, which can lead to late referral, missed opportunities for preventive care and inadvertent administration of potentially harmful interventions. Not all patients require referral to nephrology for diagnosis and management, but modern risk-prediction algorithms, such as the kidney failure risk equation, may help to guide referral appropriateness and dialysis modality planning in subspecialty nephrology multidisciplinary care clinics. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Weight management strategies for those with chronic kidney disease - a consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting.

Science.gov (United States)

Lambert, Kelly; Beer, Jo; Dumont, Ruth; Hewitt, Katie; Manley, Karen; Meade, Anthony; Salamon, Karen; Campbell, Katrina

2017-07-25

Develop a consensus report to guide dietetic management of overweight or obese individuals with Chronic Kidney Disease (CKD). Six statements relating weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥ 75% agreement. The recommendations were developed via a mini Delphi process. Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian. This article is protected by copyright. All rights reserved.

Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals.

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Schultz, Carl H; Koenig, Kristi L; Whiteside, Mary; Murray, Rick

2012-03-01

The training of medical personnel to provide care for disaster victims is a priority for the physician community, the federal government, and society as a whole. Course development for such training guided by well-accepted standardized core competencies is lacking, however. This project identified a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by the specific target audience (emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel) to ensure they can treat the injuries and illnesses experienced by victims of disasters regardless of cause. The core competencies provide a blueprint for the development or refinement of disaster training courses. This expert consensus project, supported by a grant from the Robert Wood Johnson Foundation, incorporated an all-hazard, comprehensive emergency management approach addressing every type of disaster to minimize the effect on the public's health. An instructional systems design process was used to guide the development of audience-appropriate competencies and performance objectives. Participants, representing multiple academic and provider organizations, used a modified Delphi approach to achieve consensus on recommendations. A framework of 19 content categories (domains), 19 core competencies, and more than 90 performance objectives was developed for acute medical care personnel to address the requirements of effective all-hazards disaster response. Creating disaster curricula and training based on the core competencies and performance objectives identified in this article will ensure that acute medical care personnel are prepared to treat patients and address associated ramifications/consequences during any catastrophic event. Copyright © 2012 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Scientific publications in nephrology and urology journals from Chinese authors in East Asia: a 10-year survey of the literature.

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Xu, Jing; Mao, Zhi-Guo; Kong, Mei; Hu, Liang-Hao; Ye, Chao-Yang; Xu, Cheng-Gang; Rong, Shu; Sun, Li-Jun; Wu, Jun; Dai, Bing; Chen, Dong-Ping; Zhu, Yu-Xian; Zhang, Yi-Xiang; Zhang, Yu-Qiang; Zhao, Xue-Zhi; Mei, Chang-Lin

2011-04-08

Diseases of the kidneys and genitourinary tract are common health problems that affect people of all ages and demographic backgrounds. In this study, we compared the quantity and quality of nephrological and urological articles published in international journals from the three major regions of China: the mainland (ML), Hong Kong (HK), and Taiwan (TW). Nephrological and urological articles originating from ML, TW, and HK that were published in 61 journals from 1999-2008 were retrieved from the PubMed database. We recorded the numbers of total articles, clinical trials, randomized controlled trials, case reports, impact factors (IF), citations, and articles published in the leading general-medicine journals. We used these data to compare the quantity and quality of publication output from the three regions. The total number of articles increased significantly from 1999 to 2008 in the three regions. The number of articles from ML has exceeded that from HK since 2004, and surpassed that from TW in 2008. Publications from TW had the highest accumulated IF, total citations of articles, and the most articles published in leading general-medicine journals. However, HK publications had the highest average IF. Although ML produced the largest quantity of articles, it exhibited the lowest quality among the three regions. The number of nephrological and urological publications originating from the three major regions of China increased significantly from 1999 to 2008. The annual number of publications by ML researchers exceeded those from TW and HK. However, the quality of articles from TW and HK was higher than that from ML.

Caring for Migrants and Refugees With End-Stage Kidney Disease in Europe.

Science.gov (United States)

Van Biesen, Wim; Vanholder, Raymond; Ernandez, Thomas; Drewniak, Daniel; Luyckx, Valerie

2018-05-01

With the number of migrants and refugees increasing globally, the nephrology community is increasingly confronted with issues relating to the management of end-stage kidney disease in this population, including medical, logistical, financial, and moral-ethical questions. Beginning with data for the state of affairs regarding refugees in Europe and grounded in moral reasoning theory, this Policy Forum Perspective contends that to improve care for this specific population, there is a need for: (1) clear demarcations of responsibilities across the societal (macro), local (meso), and individual (micro) levels, such that individual providers are aware of available resources and able to provide essential medical care while societies and local communities determine the general approach to dialysis care for refugees; (2) additional data and evidence to facilitate decision making based on facts rather than emotions; and (3) better information and education in a broad sense (cultural sensitivity, legal rights and obligations, and medical knowledge) to address specific needs in this population. Although the nephrology community cannot leverage a change in the geopolitical framework, we are in a position to generate accurate data describing the dimensions of care of refugee or migrant patients with end-stage kidney disease to advocate for a holistic approach to treatment for this unique patient population. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Making the CARE Comprehensive Geriatric Assessment as the Core of a Total Mobile Long Term Care Support System in China.

Science.gov (United States)

Cui, Yanyan; Gong, Dongwei; Yang, Bo; Chen, Hua; Tu, Ming-Hsiang; Zhang, Chaonan; Li, Huan; Liang, Naiwen; Jiang, Liping; Chang, Polun

2018-01-01

Comprehensive Geriatric Assessments (CGAs) have been recommended to be used for better monitoring the health status of elder residents and providing quality care. This study reported how our nurses perceived the usability of CGA component of a mobile integrated-care long term care support system developed in China. We used the Continuity Assessment Record and Evaluation (CARE), developed in the US, as the core CGA component of our Android-based support system, in which apps were designed for all key stakeholders for delivering quality long term care. A convenience sample of 18 subjects from local long term care facilities in Shanghai, China were invited to assess the CGA assessment component in terms of Technology Acceptance Model for Mobile based on real field trial assessment. All (100%) were satisfied with the mobile CGA component. 88.9% perceived the system was easy to learn and use. 99.4% showed their willingness to use for their work. We concluded it is technically feasible to implement a CGA-based mobile integrated care support system in China.

Clinical data integration model. Core interoperability ontology for research using primary care data.

Science.gov (United States)

Ethier, J-F; Curcin, V; Barton, A; McGilchrist, M M; Bastiaens, H; Andreasson, A; Rossiter, J; Zhao, L; Arvanitis, T N; Taweel, A; Delaney, B C; Burgun, A

2015-01-01

This article is part of the Focus Theme of METHODS of Information in Medicine on "Managing Interoperability and Complexity in Health Systems". Primary care data is the single richest source of routine health care data. However its use, both in research and clinical work, often requires data from multiple clinical sites, clinical trials databases and registries. Data integration and interoperability are therefore of utmost importance. TRANSFoRm's general approach relies on a unified interoperability framework, described in a previous paper. We developed a core ontology for an interoperability framework based on data mediation. This article presents how such an ontology, the Clinical Data Integration Model (CDIM), can be designed to support, in conjunction with appropriate terminologies, biomedical data federation within TRANSFoRm, an EU FP7 project that aims to develop the digital infrastructure for a learning healthcare system in European Primary Care. TRANSFoRm utilizes a unified structural / terminological interoperability framework, based on the local-as-view mediation paradigm. Such an approach mandates the global information model to describe the domain of interest independently of the data sources to be explored. Following a requirement analysis process, no ontology focusing on primary care research was identified and, thus we designed a realist ontology based on Basic Formal Ontology to support our framework in collaboration with various terminologies used in primary care. The resulting ontology has 549 classes and 82 object properties and is used to support data integration for TRANSFoRm's use cases. Concepts identified by researchers were successfully expressed in queries using CDIM and pertinent terminologies. As an example, we illustrate how, in TRANSFoRm, the Query Formulation Workbench can capture eligibility criteria in a computable representation, which is based on CDIM. A unified mediation approach to semantic interoperability provides a

Qualitative research in CKD: an overview of methods and applications.

Science.gov (United States)

Tong, Allison; Winkelmayer, Wolfgang C; Craig, Jonathan C

2014-09-01

There recently has been a paradigm shift in health care policies and research toward greater patient centeredness. A core tenet of patient-centered care is that patients' needs, values, and preferences are respected in clinical decision making. Qualitative research methods are designed to generate insights about patients' priorities, values, and beliefs. However, in the past 5 years (2008-2013), only 23 (0.4%) of the 6,043 original articles published in the top 5 nephrology journals (assessed by impact factor) were qualitative studies. Given this observation, it seems important to promote awareness and better understanding within the nephrology community about qualitative research and how the findings can contribute to improving the quality and outcomes of care for patients with chronic kidney disease. This article outlines examples of how qualitative research can generate insight into the values and preferences of patients with chronic kidney disease, provides an overview of qualitative health research methods, and discusses practical applications for research, practice, and policy. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Inhibiting core fucosylation attenuates glucose-induced peritoneal fibrosis in rats.

Science.gov (United States)

Li, Longkai; Shen, Nan; Wang, Nan; Wang, Weidong; Tang, Qingzhu; Du, Xiangning; Carrero, Juan Jesus; Wang, Keping; Deng, Yiyao; Li, Zhitong; Lin, Hongli; Wu, Taihua

2018-06-01

Ultrafiltration failure is a major complication of long-term peritoneal dialysis, resulting in dialysis failure. Peritoneal fibrosis induced by continuous exposure to high glucose dialysate is the major contributor of ultrafiltration failure, for which there is no effective treatment. Overactivation of several signaling pathways, including transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor (PDGF) pathways, contribute to the development of peritoneal fibrosis. Therefore, simultaneously blocking multiple signaling pathways might be a potential novel method of treating peritoneal fibrosis. Previously, we showed that core fucosylation, an important posttranslational modification of the TGF-β1 receptors, can regulate the activation of TGF-β1 signaling in renal interstitial fibrosis. However, it remains unclear whether core fucosylation affects the progression of peritoneal fibrosis. Herein, we show that core fucosylation was enriched in the peritoneal membrane of rats accompanied by peritoneal fibrosis induced by a high glucose dialysate. Blocking core fucosylation dramatically attenuated peritoneal fibrosis in the rat model achieved by simultaneously inactivating the TGF-β1 and PDGF signaling pathways. Next the protective effects of blocking core fucosylation and imatinib (a selective PDGF receptor inhibitor) on peritoneal fibrosis were compared and found to exhibit a greater inhibitory effect over imatinib alone, suggesting that blocking activation of multiple signaling pathways may have superior inhibitory effects on the development of peritoneal fibrosis. Thus, core fucosylation is essential for the development of peritoneal fibrosis by regulating the activation of multiple signaling pathways. This may be a potential novel target for drug development to treat peritoneal fibrosis. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Analysis of Clostridium difficile infections in patients hospitalized at the nephrological ward in Poland

Directory of Open Access Journals (Sweden)

Agata Kujawa-Szewieczek

2016-05-01

Full Text Available Background: Few studies have evaluated the incidence and risk factors of Clostridium difficile infection (CDI in the adult Polish population, in particular in solid organ recipients hospitalized at the nephrological ward.Aim: The aim of this study was to analyze Clostridium difficile infections (CDI among patients hospitalized in the Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice.Material/Methods: Thirty-seven patients with Clostridium difficile infection diagnosed between October 2011 and November 2013 (26 months, identified among a total of 3728 patients hospitalized in this department during this period, were included in this retrospective, single-center study. The CDI definition was based on the current recommendations of the European Society of Clinical Microbiology and Infectious Diseases.Results: The observation period was divided into two 13-month intervals. Increased incidence (of borderline significance of CDI in the second period compared to the first period was observed (1.33% vs 0.65% respectively; p=0.057. Patients after kidney (n=11, kidney and pancreas (n=2 and liver (n=5 transplantation represented 48% of the analyzed CDI patients, and in half of these patients (50% CDI symptoms occurred within the first 3 months after transplantation. Clostridium difficile infection leads to irreversible deterioration of graft function in 38% of kidney recipients. Most incidents of CDI (70% were identified as nosocomial infection.Conclusions: 1. Clostridium difficile infection is particularly common among patients in the early period after solid organ transplantation. 2. Clostridium difficile infection may lead to irreversible deterioration of transplanted kidney function.

Unravelling current sexual care in chronic kidney disease: perspective of social workers.

Science.gov (United States)

van Ek, Gaby F; Keurhorst, Dirry; Krouwel, Esmée M; Nicolai, Melianthe P J; Den Ouden, Marjolein E M; Elzevier, Henk W; Putter, Hein; Pelger, Rob C M; Den Oudsten, Brenda L

2018-03-01

Fifty to eighty percent of patients suffering from chronic kidney disease (CKD) experience a form of sexual dysfunction (SD), even after renal transplantation. Despite this, inquiring about SD is often not included in the daily practice of renal care providers. This paper explores the perspectives of renal social workers regarding sexual care for patients and evaluates their practice, attitude towards responsibility and knowledge of SD. A cross-sectional study was conducted using a 41-item online survey. Seventy-nine members of the Dutch Federation of Social Workers Nephrology. It was revealed that 60% of respondents discussed SD with a fifth of their patients. Frequency of discussion was associated with experience (p = 0.049), knowledge (p = 0.001), supplementary education (p = 0.006), and the availability of protocols on sexual care (p = 0.007). Main barriers towards discussing SD consisted of 'culture and religion' (51.9%), 'language and ethnicity' (49.4%), and 'presence of a third person' (45.6%). Sufficient knowledge of SD was present in 28% of respondents. The responsibility for discussion was 96% nephrologists and 81% social workers. This study provides evidence that a part of Dutch nephrology social workers do not provide sexual care regularly, due to insufficient experience and sexual knowledge, absence of privacy and protocols and barriers based on cultural diversity. According to the respondents the responsibility for this aspect of care should be multidisciplinary. Recommendations include a need for further education on the topic, private opportunities to discuss SD and multidisciplinary guidelines on sexual care. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

The understanding of core pharmacological concepts among health care students in their final semester.

Science.gov (United States)

Aronsson, Patrik; Booth, Shirley; Hägg, Staffan; Kjellgren, Karin; Zetterqvist, Ann; Tobin, Gunnar; Reis, Margareta

2015-12-29

The overall aim of the study was to explore health care students´ understanding of core concepts in pharmacology. An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students´ understanding of core concepts. Non-parametric statistics were employed. The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions. These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.

Clinic teaching made easy: a prospective study of the American Academy of Dermatology core curriculum in primary care learners.

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McCleskey, Patrick E

2013-08-01

Dermatology instruction for primary care learners is limited, and the American Academy of Dermatology (AAD) has developed a new core curriculum for dermatology. This study sought to prospectively evaluate short-term knowledge acquisition and long-term knowledge retention after using the AAD core curriculum during a clinical dermatology clerkship. Resident physicians and physician assistant students performing clerkships at military dermatology clinics were given access to the AAD core curriculum teaching modules before their public availability. Knowledge acquisition was measured with pretests and posttests, and a follow-up quiz was given up to a year after the dermatology rotation to assess knowledge retention. In all, 82 primary care learners met inclusion criteria. Knowledge improved significantly from pretest to posttest (60.1 vs 77.4, P dermatology clerkship. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Stable isotope 15N-urea and clinical research in nephrology

International Nuclear Information System (INIS)

Sugino, Nobuhiro; Arai, Junko; Akimoto, Mitsuko; Miwa, Toichiro; Takuma, Takehide

1990-01-01

Stable isotope 15 N-compound, 15 N-urea, is useful marker to investigate nitrogen metabolism in clinical nephrology, particularly in chronic renal failure or dialysis. 15 N-urea incorporation into plasma albumin in addition to plasma 15 N disappearance was studied in 6 patients with endstage chronic renal failure. As a result, only minor fraction of administered 15 N-urea was incorporated into albumin in this study. In addition, it was also confirmed that high energy diet may promote protein synthesis through 15 N incorporation to plasma amino acids, such as alanine, in these patients with low protein meal. Therefore, administration of 15 N-compound to human subjects may contribute to provide us the important informations on nitrogen metabolism. For instance, urea kinetics are described in the endstage chronic renal failure in this review. However, less expensive 15 N-compounds should be provided and more simple but accurate measurement of 15 N activity should be developed for the further clinical application of the stable isotope. (author)

A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes.

LENUS (Irish Health Repository)

Egan, Aoife M

2017-04-01

The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational (pre-existing) diabetes mellitus.

Geriatric Core Competencies for Family Medicine Curriculum and Enhanced Skills: Care of Elderly

OpenAIRE

Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne

2014-01-01

Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel...

Improving performance on core processes of care.

Science.gov (United States)

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

Role of genetics in the development of pediatric nephrology

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M. S. Ignatova

2015-01-01

Full Text Available Generalized data on the role of medical genetics in the development of pediatric nephrology are given on the basis of the authors’ observations and modern literature. It is shown that the introduction of genetic researches into the practice of a pediatric nephrologist can change the view of the etiology of many diseases, decipher the essence of a number of nephropathies, the cause of which was unclear, and reduce the number of idiopathic diseases. This is particularly important for the determination of therapeutic tactics and the emergence of new pathogenic agents that can improve prognosis and quality of life in patients in a number of genetic diseases. Particular attention is drawn to hereditary nephropathy accompanied by hematuria and particularly to Alport syndrome characterized by a progressive course. The development of genetics and clinical introduction of its advances have recently led to the identification of a new nosological entity — hereditary C3 glomerulonephritis as a result of CFHR5 gene mutation. Thanks to the development of genetic technologies, new genetic kidney diseases are certain to be disclosed in the next future. 

Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan

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Cheng Skye H

2010-01-01

Full Text Available Abstract Background Although performance measurement for assessing care quality is an emerging area, a system for measuring the quality of cancer care at the hospital level has not been well developed. The purpose of this study was to develop organization-based core measures for colorectal cancer patient care and apply these measures to compare hospital performance. Methods The development of core measures for colorectal cancer has undergone three stages including a modified Delphi method. The study sample originated from 2004 data in the Taiwan Cancer Database, a national cancer data registry. Eighteen hospitals and 5585 newly diagnosed colorectal cancer patients were enrolled in this study. We used indicator-based and case-based approaches to examine adherences simultaneously. Results The final core measure set included seventeen indicators (1 pre-treatment, 11 treatment-related and 5 monitoring-related. There were data available for ten indicators. Indicator-based adherence possesses more meaningful application than case-based adherence for hospital comparisons. Mean adherence was 85.8% (79.8% to 91% for indicator-based and 82.8% (77.6% to 88.9% for case-based approaches. Hospitals performed well (>90% for five out of eleven indicators. Still, the performance across hospitals varied for many indicators. The best and poorest system performance was reflected in indicators T5-negative surgical margin (99.3%, 97.2% - 100.0% and T7-lymph nodes harvest more than twelve(62.7%, 27.6% - 92.2%, both of which related to surgical specimens. Conclusions In this nationwide study, quality of colorectal cancer care still shows room for improvement. These preliminary results indicate that core measures for cancer can be developed systematically and applied for internal quality improvement.

A clinical clerkship collaborative program in Taiwan: Acquiring core clinical competencies through patient care responsibility

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Yong A. Wang

2016-06-01

Conclusion: This pilot collaborative program presented a successful model for clinical education in the teaching of core clinical competencies through direct patient care responsibilities at the clerkship stage. It is hoped that the project will become a catalyst for medical education reform in Taiwan and regions with similar traditions.

Swine as a model in renal physiology and nephrology: an overview

International Nuclear Information System (INIS)

Terris, J.M.

1986-01-01

Swine have become an important animal model in many areas of biomedical research for a variety of reasons. They are suited for studies in nephrology and renal physiology because they are the only mammal, with the exception of the dwarf water buffalo, which has been shown to have kidneys morphologically similar to the human. Maturational characteristics of fetal and neonatal kidney are similar to those of the newborn human infant. Therefore, studies to evaluate the pyeloureteral dynamics of human like multipapillary kidneys or developmental studies related to the newborn human cannot be conducted adequately in any other mammal. The following overview addresses the morphology and pelvic and ureteral dynamics of swine and human kidneys, maturation of renal hemodynamics in the neonate, renal function and the effects of anesthesia and diruetics on renal function in the pig. Additionally, the use of swine in other areas of interest to the nephrologist and renal physiologist are considered, eg, renal response to exercise, irradiation therapy, kidney preservation and renal transplantation

Impact of chronic kidney disease management in primary care.

Science.gov (United States)

Meran, S; Don, K; Shah, N; Donovan, K; Riley, S; Phillips, A O

2011-01-01

The introduction of eGFR reporting and publication of national CKD guidelines has led to major challenges in primary and secondary care, leading to an increase in the number of referrals to nephrology clinics. We have shown that introduction of a renal patient care pathway reduces nephrology referrals and enables managed discharges of CKD patients to primary care. The aim of this article is to examine the outcome of patients discharged to primary care to find out if there is an associated risk with increased discharge supported by the patient pathway. The study was carried out within a single NHS Trust covering a population of 560,000. All patients discharged from the trust's renal outpatient clinic between June 2007 and July 2008 were identified. Patient notes and the local laboratory database systems were used to determine the source and timing of tests. A total of 31 new referrals and 57 regular follow-ups were discharged during this period. The median age of discharge was 67.5 years. Most subjects (60%) had CKD stage 3 at the time of discharge. A total of 23% of discharges were categorized as CKD stages 1, 2 or normal and 17% of patients had CKD stage 4. Overall, 93% had stable eGFRs prior to discharge, 77.5% of patients had blood pressure within threshold (140/90 according to UK CKD guidelines) and 97.7% of patients had haemoglobins >10 g/dl. Post-discharge 83% of patients had eGFRs recorded by their general practitioner and 92.6% of these were measured within appropriate time frames as per CKD guidelines. The majority of patients (82%) had either improved or stable eGFR post-discharge and only three patients had a significant decline in their eGFR. These data indicate that selected CKD patients can be appropriately discharged from secondary care and adequately monitored in primary care. Furthermore, we have shown that this was a safe practice for patients.

Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making.

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Brown, Edwina A; Bekker, Hilary L; Davison, Sara N; Koffman, Jonathan; Schell, Jane O

2016-10-07

Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs. Copyright © 2016 by the American Society of Nephrology.

Evaluating Community Health Advisor (CHA) Core Competencies: The CHA Core Competency Retrospective Pretest/Posttest (CCCRP).

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Story, Lachel; To, Yen M

2016-05-01

Health care and academic systems are increasingly collaborating with community health advisors (CHAs) to provide culturally relevant health interventions that promote sustained community transformation. Little attention has been placed on CHA training evaluation, including core competency attainment. This study identified common CHA core competencies, generated a theoretically based measure of those competencies, and explored psychometric properties of that measure. A concept synthesis revealed five CHA core competencies (leadership, translation, guidance, advocacy, and caring). The CHA Core Competency Retrospective Pretest/Posttest (CCCRP) resulted from that synthesis, which was administered using multiple approaches to individuals who previously received CHA training (N= 142). Exploratory factor analyses revealed a two-factor structure underlying the posttraining data, and Cronbach's alpha indicated high internal consistency. This study suggested some CHA core competencies might be more interrelated than previously thought, and two major competencies exist rather than five and supported the CCCRP's use to evaluate core competency attainment resulting from training. © The Author(s) 2014.

Case-based debates: an innovative teaching tool in nephrology education.

Science.gov (United States)

Jhaveri, Kenar D; Chawla, Arun; Shah, Hitesh H

2012-01-01

Medical educators have called for new teaching methods and materials that supplement the traditional lecture format, and education in a range of health professions, including medicine, nursing, and pharmacy, is using a game-based approach to teach learners. Here, we describe a novel teaching tool in a case-based debate using the game format. Two teams of first- and second-year nephrology fellows participated in a PowerPoint game-based debate about which tests to order to diagnose transplant-related case. Our pilot study assessed the participant acceptance of case-based debate sessions and rewards system, and participant perceptions of using this approach to teach fellows and residents the importance of each test ordered and its cost-effectiveness in medicine. Each test ordered requires an explanation and has a point value attached to it (based on relevance and cost of positive and negative test results). The team that comes up with the diagnosis with most points wins the game. A faculty member leads a short concluding discussion. Subjective evaluations found these case-based debates to be highly entertaining and thought-provoking and to enhance self-directed learning.

Stable isotope sup 15 N-urea and clinical research in nephrology

Energy Technology Data Exchange (ETDEWEB)

Sugino, Nobuhiro; Arai, Junko; Akimoto, Mitsuko; Miwa, Toichiro; Takuma, Takehide (Tokyo Women' s Medical Coll. (Japan))

1990-08-01

Stable isotope {sup 15}N-compound, {sup 15}N-urea, is useful marker to investigate nitrogen metabolism in clinical nephrology, particularly in chronic renal failure or dialysis. {sup 15}N-urea incorporation into plasma albumin in addition to plasma {sup 15}N disappearance was studied in 6 patients with endstage chronic renal failure. As a result, only minor fraction of administered {sup 15}N-urea was incorporated into albumin in this study. In addition, it was also confirmed that high energy diet may promote protein synthesis through {sup 15}N incorporation to plasma amino acids, such as alanine, in these patients with low protein meal. Therefore, administration of {sup 15}N-compound to human subjects may contribute to provide us the important informations on nitrogen metabolism. For instance, urea kinetics are described in the endstage chronic renal failure in this review. However, less expensive {sup 15}N-compounds should be provided and more simple but accurate measurement of {sup 15}N activity should be developed for the further clinical application of the stable isotope. (author).

Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study

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de Irala Jokin

2007-09-01

Full Text Available Abstract Background The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF, before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses. Methods Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101% as the cut-off value. Multivariate non-conditional logistic and linear regression models were used. Results A ≥ 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p Conclusion In this cohort, patients who had presented an increment in serum level of creatinine of ≥ 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a

[Italian health centers and Web Marketing strategy: necessary improvements, even in nephrology].

Science.gov (United States)

Rinaldi Miliani, Maria; Barracca, Antonio; Quintaliani, Giuseppe

2017-09-28

The complete digitalization of the health system is an objective that Italy, from 2014, is pursuing with great difficulty, spurred by the many European initiatives dedicated to it. Despite the social and cultural background seems to be clearly ready for an application of the renewal strategies, e-Health and m-Health are struggling to get off the ground throughout the territory. The main difficulties are find at local level and don't spare any medical discipline, nephrology included. The characteristics of the official websites belonging to the local health centers demonstrate it. Today, these institutions are still sparsely present on Social Media or in the Italian Smart Mobile Technology landscape. The article illustrates the main features of the phenomenon and calls for reflection on the necessity to accelerate the digital innovation of the communication with patients. This is a possible strategy for reducing chronicity through prevention, and, potentially, for decreasing health costs. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

The National Institute of Diabetes and Digestive and Kidney Diseases Central Repositories: A Valuable Resource for Nephrology Research

Science.gov (United States)

Akolkar, Beena; Spain, Lisa M.; Guill, Michael H.; Del Vecchio, Corey T.; Carroll, Leslie E.

2015-01-01

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repositories, part of the National Institutes of Health (NIH), are an important resource available to researchers and the general public. The Central Repositories house samples, genetic data, phenotypic data, and study documentation from >100 NIDDK-funded clinical studies, in areas such as diabetes, digestive disease, and liver disease research. The Central Repositories also have an exceptionally rich collection of studies related to kidney disease, including the Modification of Diet in Renal Disease landmark study and recent data from the Chronic Renal Insufficiency Cohort and CKD in Children Cohort studies. The data are carefully curated and linked to the samples from the study. The NIDDK is working to make the materials and data accessible to researchers. The Data Repositories continue to improve flexible online searching tools that help researchers identify the samples or data of interest, and NIDDK has created several different paths to access the data and samples, including some funding initiatives. Over the past several years, the Central Repositories have seen steadily increasing interest and use of the stored materials. NIDDK plans to make more collections available and do more outreach and education about use of the datasets to the nephrology research community in the future to enhance the value of this resource. PMID:25376765

Mineral metabolism in European children living with a renal transplant: a European society for paediatric nephrology/european renal association-European dialysis and transplant association registry study

NARCIS (Netherlands)

Bonthuis, Marjolein; Busutti, Marco; van Stralen, Karlijn J.; Jager, Kitty J.; Baiko, Sergey; Bakkaloğlu, Sevcan; Battelino, Nina; Gaydarova, Maria; Gianoglio, Bruno; Parvex, Paloma; Gomes, Clara; Heaf, James G.; Podracka, Ludmila; Kuzmanovska, Dafina; Molchanova, Maria S.; Pankratenko, Tatiana E.; Papachristou, Fotios; Reusz, György; Sanahuja, Maria José; Shroff, Rukshana; Groothoff, Jaap W.; Schaefer, Franz; Verrina, Enrico

2015-01-01

Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal

Participatory action inquiry using baccalaureate nursing students: The inclusion of integrative health care modalities in nursing core curriculum.

Science.gov (United States)

Chan, Roxane Raffin; Schaffrath, Michelle

2017-01-01

Nurses, nursing educators and students support the inclusion of integrative health care (IHC) into nursing core curriculum as a way to create nurses who deliver nursing care to the full extent of their scope of practice and advance evidenced based IHC. Because of the holistic nature of IHC modalities, research to investigate appropriate teaching strategies and potential efficacy of learning IHC in the baccalaureate core curriculum requires a holistic approach. Therefore a phenomenological exploration using participatory action inquiry was conducted at a large Midwestern university. Eighteen first year nursing students were selected as co-researchers. Their experiences in learning and delivering three 15 min IHC interventions (foot reflexology, lavender aromatherapy and mindful breathing) in an acute care setting were captured using reflexive journaling and participation in structured and organic communicative spaces. Of the patients approached, 67% accepted to receive one or more IHC modalities (147/219). Using van Manen's model for holistic data reduction three themes emerged: The experience of presence, competency and unexpected results. Learning IHC modalities is best supported by a self-reflective process that is constructed and modeled by a nurse faculty member with experience in delivering IHC modalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

AN OVERVIEW OF NURSES' MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM: HOW IS EUROPE DOING?

Science.gov (United States)

de Barbieri, Ilaria; Baumann, Jacqueline; Casal, Maria Cruz; Gurevich, Andrey; Pancirova, Jitka; Poulia, Kalliopi-Anna; Riemann, Aase

2015-09-01

Nurses have an important role to play in the management of secondary hyperparathyroidism (SHPT). An online survey conducted by the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) in conjunction with Amgen (Europe) GmbH surveyed nephrology nurses' knowledge of secondary hyperparathyroidism, treatment targets, current treatments, patient adherence and nephrology nurse training education needs. The survey's aim was to establish common practices being used by nurses in the management of secondary hyperparathyroidism and to identify nephrology nurses' training and educational needs in order to improve patient care. Descriptive study. An online survey of multiple choice and closed questions. A sample of nephrology nurses from Spain, Italy, France and the Netherlands. A total of 111 nurses completed the questionnaire (98% response rate, 82% of which were fully completed). Collected data revealed that there were specific aspects of SHPT patient management where nurses lacked confidence, despite the majority of respondents having 15 years nephrology nursing experience. These aspects included explaining the disorder and therapies to patients, managing side effects of drugs and appreciating the significance of controlling biochemical targets. Over 40% of the respondents felt they did not have sufficient training to support patients who were non-compliant. Nursing skills are integral to SHPT patient management as part of the multidisciplinary approach. The nurse's role is particularly important in patient assessment and monitoring, and in the provision of patient education and support, particularly with treatment adherence. Nephrology nurses who are better informed about SHPT and who receive training on practical patient care may improve the care of patients. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease, Hong Kong, June 29, 2004

NARCIS (Netherlands)

Li, Philip Kam-Tao; Weening, Jan J.; Dirks, John; Lui, Sing Leung; Szeto, Cheuk Chun; Tang, Sydney; Atkins, Robert C.; Mitch, William E.; Chow, Kai Ming; D'Amico, Giuseppe; Freedman, Barry I.; Harris, David C.; Hooi, Lai-Seong; de Jong, Paul E.; Kincaid-Smith, Priscilla; Lai, Kar Neng; Lee, Evan; Li, Fu-Keung; Lin, Shan-Yan; Lo, Wai-Kei; Mani, M. K.; Mathew, Timothy; Murakami, Mutsumi; Qian, Jia-Qi; Ramirez, Sylvia; Reiser, Thomas; Tomino, Yasuhiko; Tong, Matthew K.; Tsang, Wai-Kay; Tungsanga, Kriang; Wang, Haiyan; Wong, Andrew K.; Wong, Kim Ming; Yang, Wu-Chang; de Zeeuw, Dick; Yu, Alex W.; Remuzzi, Giuseppe

2005-01-01

This report summarizes the discussions of the International Society of Nephrology (ISN) 2004 Consensus Workshop on Prevention of Progression of Renal Disease, which was held in Hong Kong on June 29, 2004. Three key areas were discussed during the workshop: (1) screening for chronic kidney disease;

Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents.

Science.gov (United States)

Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Belzile, Eric; Vu, Minh

2014-07-01

The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents. The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM - defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations. Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia. CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.

The proposed Nelson Mandela Children's Hospital, Johannesburg: providing the best care for children in the developing world.

Science.gov (United States)

Bolton, Keith

2011-01-01

Construction will soon commence on the Nelson Mandela Children's Hospital (NMCH) in Johannesburg, South Africa. The Hospital will have 250-300 beds and will provide tertiary and quaternary care to children in specific Centers of Excellence. Admission to this referral facility will be based entirely on medical needs. The disciplines that are catered for include Paediatric surgery, oncology, nephrology, cardiology, intensive care and imaging. The NMCH will be South Africa's first "Private Hospital - Not for Gain". Funding for capital expenditure is currently being raised by the Trust. Operational expenditure will come from the Department of Health, private insurers and neighbouring governments.

Simplifying anemia management in hemodialysis patients: ESAs administered at longer dosing intervals can enhance opportunities to provide patient-focused care.

Science.gov (United States)

Schiller, Brigitte; Besarab, Anatole

2011-08-01

To review issues and challenges in caring for hemodialysis patients with anemia of chronic kidney disease, specifically focusing on the effects of longer erythropoiesis-stimulating agent (ESA) dosing intervals on processes of care. PubMed searches were performed limited to the last 10 years to February 2011, focusing on articles in English that were 'clinical trials,' assessed processes of care, measured associations of hemoglobin (Hb) with outcomes, and explored/analyzed extended dosing intervals of ESAs in hemodialysis patients and recommendations for increasing the quality of care of these patients. Some limitations included the fact that a meta-analysis was not conducted; many studies were associative and therefore unable to prove causality; and none of the clinical trials directly compared the impact of more frequent or less frequent ESA dosing strategies on patient care and outcomes. Progress over the past several decades has been substantial; however, unmet needs remain and there is room for improvement in efficiencies of care. Many patients fail to meet Hb targets, and nephrology professionals' time is consumed with preparing, administering, and monitoring therapy. Direct interaction between patients and care providers has been lost as attention has shifted to 'cost-effective' (not necessarily patient-centered) ways to deliver care. Use of ESAs at longer dosage intervals represents one opportunity to improve efficiency of care. Newer ESAs have been developed for less frequent dosing. Once-monthly dosing decreases time spent administering/monitoring therapy and allows nephrology professionals to provide comprehensive renal care, wherein the patient rather than task-oriented processes becomes the primary focus. A fragmented, uncoordinated care-delivery model heightens the urgency to systematically address issues related to delivery of care and improve efficiencies in anemia management as part of the patient-centered approach. ESAs designed for administration

Frequency of Metabolic Risk Factors in Children with Urinary Tract Stones Referred to Hamadan Pediatric Nephrology Clinic

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H.E. Momtaz

2012-07-01

Full Text Available Introduction & Objective: Urinary stones are among the most common complaints referred to nephrologist and urologists. Although incidence of urolithiasis is low in children compared to adults and only 7% of all urinary stones are diagnosed before the age of 16 but stones are detected more frequently in pediatric age group in recent years. Metabolic derangements, infection, neurogenic bladder and urinary obstruction are major risk factors of urolithiasis. Common metabolic risk factors of urolithiasis in children are hypercalciuria, uricosuria, hypocitraturia, hyperoxaluria, metabolic acidosis and cystinuria. There are many clinical studies about the frequency of these metabolic risk factors with different results reflecting difference in diet, geographic area and genetics in study populations. In this study we tried to evaluate the frequency of metabolic causes of urinary stones in children referred to Hamadan pediatric nephrology clinic.Materials & Methods: In this cross sectional-descriptive study 156 patients referred due to urinary stones to pediatric nephrology clinic underwent thorough metabolic evaluations including: serum calcium,phosphorus, uric acid, creatinine and non fasting random urine sample for calcium, creatinine , uric acid , oxalate, citrate and cystine . urine solute: creatinine ratios were calculated and compared with normative data.Results: Of 156 patients 136(87.2% had metabolic derangements including: hyperuricosuria in 71 (45.5%, hypercalciuria in 41(26.3%, hypocitraturia in 26 (16.7%, hyperoxaluria in 16(10.3%,cystinuria in 1(0.6% and metabolic acidosis in 39 (25%.Conclusion: High rate of metabolic derangement in pediatric urinary stone patients mandates proper metabolic evaluation in all of them. hyperuricosuria was the most common metbolic finding instead of hypercalciuria in this study. This could be due to differences in diet, geographic area and genetic background in various populations.(Sci J Hamadan Univ Med Sci

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

Science.gov (United States)

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

Health care-seeking behavior among patients with chronic kidney disease: A cross-sectional study of patients presenting at a single teaching hospital in Lagos

Directory of Open Access Journals (Sweden)

Babawale Taslim Bello

2015-01-01

Full Text Available Introduction: Health care-seeking behavior of individuals determines how early they present for appropriate care. In patients with chronic kidney disease (CKD, late presentation to the nephrologist is associated with poor outcomes. This study aims to describe the health care-seeking behavior of patients with CKD attending the nephrology outpatient clinic of a teaching hospital located in Lagos, Nigeria. Materials and Methods: This was a cross-sectional survey conducted on 104 consecutive adult patients with CKD, presenting for the first time at the nephrology outpatient clinic of a teaching hospital located in Lagos, South West Nigeria. Information was retrieved from the study participants using a structured interviewer-administered questionnaire, entered into an Excel spreadsheet, and analyzed using Epi Info® statistical software version 7.0. Results: Overall, 74 (71.2% patients sought help, first from a trained health care provider, and their health care-seeking behavior was adjudged to be appropriate. Compared to patients with appropriate health care-seeking behavior, those with inappropriate health care-seeking behavior had a lower mean age (40.4 ± 13.7 years vs 47.3 ± 15.6 years;P = 0.03, were less likely to see their illness as a medical problem (46.7% vs 67.6%;P = 0.04, more likely to have a monthly income less than N25,000 ($150 (80.0% vs 59.5%;P = 0.04, and have received below tertiary level education (20.0% vs 48.6%; P < 0.01. They were also more likely to have consulted more than one health care provider before being referred to our clinic. The factors predicting inappropriate health care-seeking behavior were education below the tertiary level and age less than 45 years. Conclusion: Though health care-seeking behavior was appropriate in majority of our patients with CKD, there remains a need for improved public health awareness.

The British Columbia Nephrologists' Access Study (BCNAS) - a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations.

Science.gov (United States)

Schachter, Michael E; Romann, Alexandra; Djurdev, Ognjenka; Levin, Adeera; Beaulieu, Monica

2013-08-29

Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.

Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial.

Science.gov (United States)

Dziedzic, K S; Healey, E L; Porcheret, M; Afolabi, E K; Lewis, M; Morden, A; Jinks, C; McHugh, G A; Ryan, S; Finney, A; Main, C; Edwards, J J; Paskins, Z; Pushpa-Rajah, A; Hay, E M

2018-01-01

To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression. 525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3). Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months. ISRCTN06984617. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Changing Nephrology Nurses' Beliefs about the Value of Evidence-Based Practice and Their Ability to Implement in Clinical Practice.

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Hain, Debra; Haras, Mary S

2015-01-01

A rapidly evolving healthcare environment demands sound research evidence to inform clinical practice and improve patient outcomes. Over the past several decades, nurses have generated new knowledge by conducting research studies, but it takes time for this evidence to be implemented in practice. As nurses strive to be leaders and active participants in healthcare redesign, it is essential that they possess the requisite knowledge and skills to engage in evidence-based practice (EBP). Professional nursing organizations can make substantial contributions to the move healthcare quality forward by providing EBP workshops similar to those conducted by the American Nephrology Nurses'Association.

Inpatient Dialysis Unit Project Development: Redesigning Acute Hemodialysis Care.

Science.gov (United States)

Day, Jennifer

2017-01-01

Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit. Copyright© by the American Nephrology Nurses Association.

Advance care planning in CKD/ESRD: an evolving process.

Science.gov (United States)

Holley, Jean L

2012-06-01

Advance care planning was historically considered to be simply the completion of a proxy (health care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that advance care planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical care, prepare for death, and clarify goals of care. Some advance directives, notably designated health care proxy documents, remain appropriate expressions of advance care planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as advance directives, their completion, when appropriate, is an integral component of advance care planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that advance care planning discussions adapt to a patient's situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to advance care planning in this population and are events each nephrologist will at some time confront. Advance care planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.

Health Care Team

Science.gov (United States)

... Social Worker Most nephrology social workers have a master's degree in clinical social work and are licensed or ... typing tests, educating patients and families about the risks and benefits of donation and transplantation, scheduling the ...

Integrating kidney transplantation into value-based care for people with renal failure.

Science.gov (United States)

Hippen, Benjamin E; Maddux, Franklin W

2018-01-01

Healthcare reimbursement is increasingly tied to value instead of volume, with special attention paid to resource-intensive populations such as patients with renal disease. To this end, Medicare has sponsored pilot projects to encourage providers to develop care coordination and population health management strategies to provide quality care while reducing resource utilization. In this Personal Viewpoint essay, we argue in favor of expanding one such pilot project-the Comprehensive ESRD Care (CEC) initiative-to include patients with advanced chronic kidney disease and kidney transplant recipients. The implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) offers a time-sensitive incentive for transplant centers in particular to align with extant CECs. An "expanded" CEC model proffers opportunity for robust cooperation between general nephrology practices, dialysis providers, and transplant centers to develop care coordination strategies for all patients with renal disease, realign incentives for all clinical stakeholders to increase kidney transplantation rates, and reduce total costs of care. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

In vitro generation of renal tubular epithelial cells from fibroblasts: implications for precision and regenerative medicine in nephrology.

Science.gov (United States)

Wyatt, Christina M; Dubois, Nicole

2017-02-01

Prior efforts to generate renal epithelial cells in vitro have relied on pluripotent or bone marrow-derived mesenchymal stem cells. A recent publication in Nature Cell Biology describes the generation of induced tubular epithelial cells from fibroblasts, potentially offering a novel platform for personalized drug toxicity screening and in vitro disease modeling. This report serves as a promising proof of principle study and opens future research directions, including the optimization of the reprogramming process, efficient translation to adult human fibroblasts, and the generation of highly specific functional renal cell types. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

20 years since the establishment of the BANTAO association (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs).

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Polenakovic, Momir; Nenov, Dimitar; Basci, Ali; Djukanovic, Ljubica; Tsakiris, Dimitris; Nesic, Vida; Schiller, Adalbert; Spasovski, Goce; Klinkmann, Horst; Vienken, Joerg; Falkenhagen, Dieter; Ivanovich, Peter

2013-01-01

The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was born in Ohrid on October 9, 1993. The war in former Yugoslavia negatively affected the development of nephrology and also the connections among the nephrologists from the Balkans. However, there was willingness for further mutual collaboration between the nephrologists from the Balkans. The war in Yugoslavia created hate among people, between the newly established countries, and there were problems with the recognition of the names of the new countries, and so, the nephrologists decided to apply the ancient principle of using the names of the cities, instead of the countries, as the founders of the Association. The main goal of BANTAO is to promote scientific and technical cooperation in the fields of renal disease and artificial organs between the regions on the Balkan Peninsula and the world, to give an opportunity for exchange of experience and knowledge among the experts in the area and to engage in collaborative projects in order to demonstrate that cooperation is possible even on the turbulent Balkan Peninsula. The I BANTAO congress was held in Varna from September 22 to 24th, 1995 (President--D. Nenov, Varna). The II congress of BANTAO was held from September 6th to 10th, 1997 in Struga, (President--M. Polenakovic, Skopje). The III BANTAO congress was held in Belgrade from September 18th to 20th, 1998 (President--Lj. Djukanović, Belgrade). The IV congress of BANTAO was held in Izmir from 14th to 16th November 1999 (President--A. Akcicek, Izmir). The V Congress of BANTAO was held in Thessaloniki from September 30th to October 3rd, 2001 (President--P. Stathakis, Athens). The VI Congress of BANTAO was held for the second time in Varna from 6th to 9th October 2003 (President--D. Nenov, Varna). The VII congress of BANTAO was held from September 8th to 11th, 2005 in Ohrid, (President--M. Polenakovic, Skopje). The VIII BANTAO congress was held in Belgrade, 16

The British Columbia Nephrologists’ Access Study (BCNAS) – a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations

Science.gov (United States)

2013-01-01

Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable. PMID:23988113

Ambulatory Care after Acute Kidney Injury: An Opportunity to Improve Patient Outcomes

Directory of Open Access Journals (Sweden)

Samuel A. Silver

2015-10-01

Full Text Available Purpose of review: Acute kidney injury (AKI is an increasingly common problem among hospitalized patients. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, outpatient follow-up with a nephrologist within 90 days of hospital discharge has been associated with enhanced survival. However, most patients who survive an AKI episode do not receive any follow-up nephrology care. This narrative review describes the experience of two new clinical programs to care for AKI patients after hospital discharge: the Acute Kidney Injury Follow-up Clinic for adults (St. Michael's Hospital and University Health Network, Toronto, Canada and the AKI Survivor Clinic for children (Cincinnati Children's Hospital, USA. Sources of information: MEDLINE, PubMed, ISI Web of Science Findings: These two ambulatory clinics have been in existence for close to two (adult and four (pediatric years, and were developed separately and independently in different populations and health systems. The components of both clinics are described, including the target population, referral process, medical interventions, patient education activities, and follow-up schedule. Common elements include targeting patients with KDIGO stage 2 or 3 AKI, regular audits of the inpatient nephrology census to track eligible patients, medication reconciliation, and education on the long-term consequences of AKI. Limitations: Despite the theoretical benefits of post-AKI follow-up and the clinic components described, there is no high quality evidence to prove that the interventions implemented in these clinics will reduce morbidity or mortality. Therefore, we also present a plan to evaluate the adult AKI Follow-up Clinic in order to determine if it can improve clinical outcomes compared to patients with AKI who do not

Unmet core needs for self-determination in HIV-infected women of color in medical care.

Science.gov (United States)

Quinlivan, E B; Messer, L C; Roytburd, K; Blickman, A

2017-05-01

The levels of satisfaction of the core self-determination needs (relatedness, autonomy and competence) among HIV-infected women of color as well as the association between need fulfillment and patient characteristics were examined. Having less than a high-school education was associated with lowest need satisfaction: autonomy (β = -1.90; 95%CI = -3.20, -0.60), relatedness (β = -2.70; 95%CI = -4.30, -1.10) and competency (β = -2.50; 95%CI = -3.60, -1.30). Each additional point increase in affective symptoms of depression was associated with decrements in need satisfaction (-.61 autonomy, -.68 relatedness and -.59 competency). Relatedness satisfaction was lower with higher responses on all three measures of violence (psychological abuse: β = -0.13, 95%CI = -0.19 to -0.07; adult traumatic experiences: β = -0.24, 95%CI = -0.35 to -0.13 and childhood traumatic experiences: β = -0.24, 95%CI = -0.40 to -0.08). Interventions that address core self-determination needs, and the characteristics that influence them, may enhance the motivation for self-care of HIV-infected women.

Multisystemic engagement & nephrology based educational intervention: a randomized controlled trial protocol on the kidney team at home-study

Directory of Open Access Journals (Sweden)

Ismail Sohal Y

2012-07-01

Full Text Available Abstract Background Living donor kidney transplantation (LDKT is the most successful form of renal replacement therapy in terms of wait time and survival rates. However, we observed a significant inequality in the number of LDKT performed between the Dutch and the non-Dutch patients. The objective of this study is to adapt, implement and test an educational home-based intervention to contribute to the reduction of this inequality. Our aim is to establish this through guided communication together with the social network of the patients in an attempt that well-informed decisions regarding renal replacement therapy can be made: Multisystemic Engagement & Nephrology. This manuscript is a detailed description of the Kidney Team At Home-study protocol. Methods and design All patients (>18 yrs that are referred to the pre-transplantation outpatient clinic are eligible to participate in the study. Patients will be randomly assigned to either an experimental or a control group. The control group will continue to receive standard care. The experimental group will receive standard care plus a home-based educational intervention. The intervention consists of two sessions at the patient’s home, an initial session with the patient and a second session for which individuals from their social network are invited to take part. Based on the literature and behavioural change theories we hypothesize that reducing hurdles in knowledge, risk perception, subjective norm, self-efficacy, and communication contribute to well-informed decision making and reducing inequality in accessing LDKT programs. A change in these factors is consequently our primary outcome-measure. Based on power calculations, we aim to include 160 patients over a period of two years. Discussion If we are able to show that this home-based group educational intervention contributes to 1 achieving well-informed decision regarding treatment and 2 reducing the inequality in LDKT, the quality of life

Core Values in Nursing Care Based on the Experiences of Nurses Engaged in Neonatal Nursing: A Text-mining Approach for Analyzing Reflection Records

Science.gov (United States)

Watanabe, Hiromi; Okuda, Reiko; Hagino, Hiroshi

2018-01-01

Background Strong feelings about and enthusiasm for nursing care are reflected in nurses’ thoughts and behaviors in clinical practice and affect their profession. This study was conducted to identify the characteristics of core values in nursing care based on the experiences of nurses engaged in neonatal nursing through a process for recognizing the conceptualization of nursing. Methods We conceptualized nursing care in 43 nurses who were involved in neonatal nursing using a reflection sheet. We classified descriptions on a sheet based on the Three-Staged Recognition scheme and analyzed them using a text-mining approach. Results Nurses involved in neonatal nursing recognized that they must take care of the “child,” “mother,” and “family.” Important elements of nursing in nurses with less than 5 years versus 5 or more years of neonatal nursing experience were classified into seven clusters, respectively. These elements were mainly related to family members in both groups. In nurses with less than 5 years of experience, four clusters of one-way communication by nurses were observed in the analysis of the key elements in nursing. On the other hand, five clusters of mutual relationships between patients, their family members, and nurses were observed in nurses with 5 or more years of experience. Conclusion In conclusion, the core value of nurses engaged in neonatal nursing is family-oriented nursing. Nurses with 5 or more years of neonatal nursing experience understand patients and their family members well through establishing relationships and providing comfort and safety while taking care of them. PMID:29599621

Planning for health care transitions: results from the 2005-2006 National Survey of Children With Special Health Care Needs.

Science.gov (United States)

Lotstein, Debra S; Ghandour, Reem; Cash, Amanda; McGuire, Elizabeth; Strickland, Bonnie; Newacheck, Paul

2009-01-01

Many youth with special health care needs have difficulties transferring to adult medical care. To address this, the Maternal and Child Health Bureau has made receipt of transition services a core performance outcome for community-based systems of care for youth with special health care needs. In this article we describe the results for the transition core outcome from the 2005-2006 National Survey of Children With Special Health Care Needs. We also describe changes in the measurement strategy for this outcome since the first National Survey of Children With Special Health Care Needs in 2001. In the nationally representative, cross-sectional 2005-2006 National Survey of Children With Special Health Care Needs, parent or guardian respondents of 18198 youth with special health care needs (aged 12-17) were asked if they have had discussions with their child's health care providers about (1) future adult providers, (2) future adult health care needs, (3) changes in health insurance, and (4) encouraging their child to take responsibility for his or her care. All 4 components had to be met for the youth to meet the overall transition core outcome. Those who had not had transition discussions reported if such discussions would have been helpful. Overall, 41% of youth with special health care needs met the core performance outcome for transition. Forty-two percent had discussed shifting care to an adult provider, 62% discussed their child's adult health care needs, and 34% discussed upcoming changes in health insurance. Most (78%) respondents said that providers usually or always encourage their child to take responsibility for his or her health. Non-Hispanic black or Hispanic race/ethnicity, lower income level, not speaking English, and not having a medical home reduced the odds of meeting the transition core outcome. Current performance on the transition core outcome leaves much room for improvement. Many parents feel that having transition-related discussions with their

NURSING PROCESS, ACCORDING TO THE CONCEPTUAL MODEL OF WANDA HORTA, APPLIED TO A FAMILY MET BY THE REGIONAL CORE OF HOME CARE, DISTRITO FEDERAL.

OpenAIRE

Prince Vangeris Silva Fernandes de Lima; Ana Karoliny Couto Nascimento; Hellen Cristina Seganfredo; Isabella Cristina Ribeiro; Anne Caroline Coelho Leal Árias Amorim; Elioenai Dornelles Alves

2014-01-01

The case report describes the nursing care, systematized according to the conceptual model of Wanda Horta, who was dismissed to a family accompanied by a core team of Regional home care, an administrative region of the Federal District through prioritization, based on the scale of Cascavel, a member of this for such a public service. The context part according to reports from the Discipline community health nursing in ' 02 and ' Stage, mandatory mode sold to students from the undergraduat...

Graphite core stability during 'care and maintenance' and 'safe storage'

International Nuclear Information System (INIS)

Wickham, A.J.; Marsden, B.J.; Sellers, R.M.; Pilkington, N.J.

1998-01-01

The current decommissioning strategy for the graphite-moderated reactors operated by Magnox Electric plc, Nuclear Electric Ltd and Scottish Nuclear Ltd is to delay dismantling and to initiate a monitored period of care and maintenance followed by a period of safe storage totaling up to 135 years. This philosophy has the considerable advantage of permitting the majority of radionuclides to decay, thereby minimising personnel dose during dismantling which itself will require far less complex remote-handling equipment. It also defers the disposal of the graphite and other components so that the provision of a deep land-based repository can be achieved. A comprehensive review of all relevant data on the chemical, physical and mechanical properties of the graphite and its potential reactions, including radioactivity transport, has been undertaken in order to demonstrate that there are no potential mechanisms which might lead to degradation of the core during the storage period. It is concluded that no significant experimental work is necessary to support the safe storage philosophy although, since the ingress of rainwater over long periods of time cannot be assumed incredible, a number of anomalies in chemical leaching rates may be worthy of re-examination. No other potential chemical reactions, such as the radiolytic formation of nitric acid leading to corrosion problems, are considered significant. (author)

The Healthy People 2010 outcomes for the care of children with special health care needs: an effective national policy for meeting mental health care needs?

Science.gov (United States)

Spears, Amanda P

2010-05-01

To assess the effectiveness of the Maternal and Child Health Bureau's (MCHB) Six Core Outcomes for children with special health care needs (CSHCN) as indicators in measuring the degree to which mental health care needs are met. This study analyzes data from the 2001 National Survey of Children with Special Health Care Needs for 9,748 CSHCN who needed mental health care. Bivariate and logistic analyses were employed to investigate the impact of the MCHB's Six Core Outcomes on the probability of having an unmet need for mental health services. Of the 2.3 million CSHCN in the U.S. who needed mental health care in 2001, almost one-fifth did not receive all of the mental health services that they needed. Ultimately, eight Outcomes and sub-categories of Outcomes were considered. Sixty-one percent of CSHCN with a need for mental health care had care that fulfills six of the eight considered Outcomes. Logistic analysis indicates that individual fulfillment of each of the Core Outcomes and fulfillment of additional Outcomes have a significant association with reducing the probability of having an unmet mental health care need for CSHCN. This study is the first attempt to apply the Six Core Outcomes to meeting the needs for mental health care among CSHCN. Estimates of unmet need for mental health care suggest that efforts can be made to improve access for CSHCN. The initial estimates generated by this study indicate that the MCHB Outcomes are important in meeting children's mental health needs and are important indicators for informing MCHB policy.

Clinical transformation: the key to green nephrology.

Science.gov (United States)

Connor, Andrew; Mortimer, Frances; Tomson, Charles

2010-01-01

Climate change represents a major global public health threat. The very provision of healthcare itself has a significant untoward effect on the environment, to which kidney care is likely to contribute disproportionately. In this article we describe the four principles we believe will underpin a successful transformation to lower carbon kidney care: disease prevention, patient empowerment, lean service delivery and the preferential use of low-carbon technologies. We illustrate their application and their co-benefits, such as improvements in patient care and reductions in cost, with examples. Copyright © 2010 S. Karger AG, Basel.

'Skills for growing up': supporting autonomy in young people with kidney disease.

Science.gov (United States)

Sattoe, Jane N T; Hilberink, Sander R; Peeters, Mariëlle A C; van Staa, AnneLoes

2014-06-01

End-stage kidney disease (ESKD) may interfere with children's developmental task of acquiring autonomy and participation. The Skills for Growing Up tool encourages normal development towards independence and autonomy during paediatric rehabilitation. This study aimed to adapt this self-management tool for use in paediatric nephrology, and to test whether its use is feasible in daily practice. A Delphi study was conducted among patients, their parents, professionals and experts to adjust the tool for use in nephrology. Feasibility was studied through individual and group interviews with professionals in all Dutch paediatric nephrology centres. Agreement was reached on the areas of social participation and medical management of ESKD. Compared with the original, the new instrument holds considerable more attention for autonomy in the renal healthcare area; for example, dealing with medication and transplantation. Professionals used and appreciated the tool, but the paper form was seen to limit feasibility. Making the tool available online is important. The challenge for professionals is to move beyond the focus on medical management and to consider developmental tasks when coaching their patients into adulthood. The Skills for Growing Up-Nephrology (SGU-N) tool is a promising instrument for use by professionals in paediatric nephrology. Its use can help young people achieving autonomy and may contribute to their successful transition to adulthood and adult care. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.

HYDRATE CORE DRILLING TESTS

Energy Technology Data Exchange (ETDEWEB)

John H. Cohen; Thomas E. Williams; Ali G. Kadaster; Bill V. Liddell

2002-11-01

formation comprised of coarse, large-grain sand in ice. Results with this core showed that the viscosity of the drilling fluid must also be carefully controlled. When coarse sand was being cored, the core barrel became stuck because the drilling fluid was not viscous enough to completely remove the large grains of sand. These tests were very valuable to the project by showing the difficulties in coring permafrost or hydrates in a laboratory environment (as opposed to a field environment where drilling costs are much higher and the potential loss of equipment greater). Among the conclusions reached from these simulated hydrate coring tests are the following: Frozen hydrate core samples can be recovered successfully; A spring-finger core catcher works best for catching hydrate cores; Drilling fluid can erode the core and reduces its diameter, making it more difficult to capture the core; Mud must be designed with proper viscosity to lift larger cuttings; and The bottom 6 inches of core may need to be drilled dry to capture the core successfully.

Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review

Science.gov (United States)

2013-01-01

Background Several organizations and individual authors have been proposing quality indicators for the assessment of clinical care in HIV/AIDS patients. Nevertheless, the definition of a consensual core set of indicators remains controversial and its practical use is largely limited. This study aims not only to identify and characterize these indicators through a systematic literature review but also to propose a parsimonious model based on those most used. Methods MEDLINE, SCOPUS, Cochrane databases and ISI Web of Knowledge, as well as official websites of organizations dealing with HIV/AIDS care, were searched for articles and information proposing HIV/AIDS clinical care quality indicators. The ones that are on patient’s perspective and based on services set were excluded. Data extraction, using a predefined data sheet based on Cochrane recommendations, was done by one of the authors while a second author rechecked the extracted data for any inconsistency. Results A total of 360 articles were identified in our search query but only 12 of them met the inclusion criteria. We also identified one relevant site. Overall, we identified 65 quality indicators for HIV/AIDS clinical care distributed as following: outcome (n=15) and process-related (n=50) indicators; generic (n=36) and HIV/AIDS disease-specific (n=29) indicators; baseline examinations (n=19), screening (n=9), immunization (n=4), prophylaxis (n=5), HIV monitoring (n=16), and therapy (=12) indicators. Conclusions There are several studies that set up HIV clinical care indicators, with only a part of them useful to assess the HIV clinical care. More importantly, HIV/AIDS clinical care indicators need to be valid, reliable and most of all feasible. PMID:23809537

Development and Integration of Professional Core Values Among Practicing Clinicians.

Science.gov (United States)

McGinnis, Patricia Quinn; Guenther, Lee Ann; Wainwright, Susan F

2016-09-01

The physical therapy profession has adopted professional core values, which define expected values for its members, and developed a self-assessment tool with sample behaviors for each of the 7 core values. However, evidence related to the integration of these core values into practice is limited. The aims of this study were: (1) to gain insight into physical therapists' development of professional core values and (2) to gain insight into participants' integration of professional core values into clinical practice. A qualitative design permitted in-depth exploration of the development and integration of the American Physical Therapy Association's professional core values into physical therapist practice. Twenty practicing physical therapists were purposefully selected to explore the role of varied professional, postprofessional, and continuing education experiences related to exposure to professional values. The Core Values Self-Assessment and résumé sort served as prompts for reflection via semistructured interviews. Three themes were identified: (1) personal values were the foundation for developing professional values, which were further shaped by academic and clinical experiences, (2) core values were integrated into practice independent of practice setting and varied career paths, and (3) participants described the following professional core values as well integrated into their practice: integrity, compassion/caring, and accountability. Social responsibility was an area consistently identified as not being integrated into their practice. The Core Values Self-Assessment tool is a consensus-based document developed through a Delphi process. Future studies to establish reliability and construct validity of the tool may be warranted. Gaining an in-depth understanding of how practicing clinicians incorporate professional core values into clinical practice may shed light on the relationship between core values mastery and its impact on patient care. Findings may

Core instrumentation and pre-operational procedures for core conversion HEU to LEU

International Nuclear Information System (INIS)

1984-02-01

This report is intended for the reactor operator, to be used as a manual or checklist for general guidance on pre-startup activities that need to be addressed in preparation for conversion to Low Enriched Fuel (LEU). All nuclear, thermodynamic and safety calculations should have been performed prior to this stage of the core conversion process. During these calculations and certainly before ordering the new LEU fuel elements the reactor operator needs to very carefully consider additional important factors concerning the new fuel: fuel reliability, reliability of fuel fabricator, reprocessing contract or fuel element storage and disposal, economics of the new fuel cycle. At this stage, too, a preoperational experimental programme has to be developed and presented to the regulatory authorities for approval. This experimental programme could lead to additional requirements on: in-core instrumentation, out-of-core instrumentation or additional experimental devices. Detailed instructions on specific tests and measurements are not provided in this report since much information on the subject is available in the open literature

The core content of clinical ultrasonography fellowship training.

Science.gov (United States)

Lewiss, Resa E; Tayal, Vivek S; Hoffmann, Beatrice; Kendall, John; Liteplo, Andrew S; Moak, James H; Panebianco, Nova; Noble, Vicki E

2014-04-01

The purpose of developing a core content for subspecialty training in clinical ultrasonography (US) is to standardize the education and qualifications required to provide oversight of US training, clinical use, and administration to improve patient care. This core content would be mastered by a fellow as a separate and unique postgraduate training, beyond that obtained during an emergency medicine (EM) residency or during medical school. The core content defines the training parameters, resources, and knowledge of clinical US necessary to direct clinical US divisions within medical specialties. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear in future examinations. This article describes the development of the core content and presents the core content in its entirety. © 2014 by the Society for Academic Emergency Medicine.

Gap analysis: a method to assess core competency development in the curriculum.

Science.gov (United States)

Fater, Kerry H

2013-01-01

To determine the extent to which safety and quality improvement core competency development occurs in an undergraduate nursing program. Rapid change and increased complexity of health care environments demands that health care professionals are adequately prepared to provide high quality, safe care. A gap analysis compared the present state of competency development to a desirable (ideal) state. The core competencies, Nurse of the Future Nursing Core Competencies, reflect the ideal state and represent minimal expectations for entry into practice from pre-licensure programs. Findings from the gap analysis suggest significant strengths in numerous competency domains, deficiencies in two competency domains, and areas of redundancy in the curriculum. Gap analysis provides valuable data to direct curriculum revision. Opportunities for competency development were identified, and strategies were created jointly with the practice partner, thereby enhancing relevant knowledge, attitudes, and skills nurses need for clinical practice currently and in the future.

Korrelasjon mellom core styrke, core stabilitet og utholdende styrke i core

OpenAIRE

Berg-Olsen, Andrea Marie; Fugelsøy, Eivor; Maurstad, Ann-Louise

2010-01-01

Formålet med studien var å se hvilke korrelasjon det er mellom core styrke, core stabilitet og utholdende styrke i core. Testingen bestod av tre hoveddeler hvor vi testet core styrke, core stabilitet og utholdende styrke i core. Innenfor core styrke og utholdende styrke i core ble tre ulike tester utført. Ved måling av core stabilitet ble det gjennomført kun en test. I core styrke ble isometrisk abdominal fleksjon, isometrisk rygg ekstensjon og isometrisk lateral fleksjon testet. Sit-ups p...

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

Science.gov (United States)

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

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

Minimum Requirements for Core Competency in Pediatric Pharmacy Practice.

Science.gov (United States)

Boucher, Elizabeth A; Burke, Margaret M; Johnson, Peter N; Klein, Kristin C; Miller, Jamie L

2015-01-01

Colleges of pharmacy provide varying amounts of didactic and clinical hours in pediatrics resulting in variability in the knowledge, skills, and perceptions of new graduates toward pediatric pharmaceutical care. The Pediatric Pharmacy Advocacy Group (PPAG) endorses the application of a minimum set of core competencies for all pharmacists involved in the care of hospitalized children.

Nephrology, a newly rich speciality, is looking for an illustrious ancestry: what about a famous grandfather?

Science.gov (United States)

Diamandopoulos, A A; Goudas, P C

2000-01-01

Nephrology is a newborn speciality compared to the other medical specialities. However, the study of the urinary tract's physiology and pathology had begun simultaneously with the birth of medicine. The scientific revolution of the renaissance and enlightenment eras caused an intense contestation of earlier theories and methods as if all knowledge had evolved suddenly from parthenogenesis after the dark (?) medieval years and human intellect suddenly exploded to huge intelligence quotients after the 15th century while before that humans were mentally deprived. Indeed most of the scientific knowledge did evolve impressively during renaissance and enlightenment years but not through parthenogenesis. Some observations, discoveries and inventions of this era were actually reobservations, rediscoveries and reinventions. Such an example is that of the experiments of Sanctorius Santorii of the 16th century AD and of Erasistratus of the 3rd century BC. Sanctorius and Erasistratus carried out an experiment with the same basic principles, similar methodology and proportional results with an almost 2000 years lag phase. With our paper we wish to give credit to earlier researchers of physiological and medical knowledge who, despite the lack of technological support, often concluded in extremely accurate observations. Copyright 2000 S. Karger AG, Basel

[Modifications in health and welfare jobs transferred to thirty-five participating "core cities"].

Science.gov (United States)

Hara, Kunio; Hoshiko, Michiko; Ishitake, Tatsuya

2010-06-01

The aim of this study was to determine modifications in health and welfare jobs transferred to thirty-five participating "core cities. We focused on health and welfare jobs in the following sectors: (1) local welfare; (2) health care; (3) city planning; (4) environmental protection; (5) education; and (6) urban revitalization. We developed a self-report questionnaire regarding implementation of administrative jobs transferred from prefectures to the core cities with attention to affects of changes in the jobs on the city administrative efficiency and the health of both the citizens and the city officials. The questionnaire, consisting of 27 multiple-choice and 12 open-ended questions, was forwarded via e-mail to lead city officials of the thirty-five core cities in mid-February 2008. Twenty-seven cities responded to the questionnaire in mid-March 2008 (collection rate: 77%). The core cities incorporated almost all the jobs transferred from the prefectures, in spite of some limitations regarding time taken for delivering assistive equipment to disabled children, implementing wider administrative plans and establishing educational centers. Almost all core cities answered that they implemented their jobs independently, autonomously and systematically. Seventeen out of 27 core cities established new health care centers during the transition period and increased their number of staff. The majority of these 17 answered that establishment of organizations directly providing services to citizens contributed to improvement in the efficiency of the administrative jobs. The core cities incorporated almost all the jobs transferred from the prefectures in spite of some limitations. The core cities which established their new health care centers during this transition period increased their number of staff to address modifications to the work load.

Guideline for dialysate quality of Spanish Society of Nephrology (second edition, 2015).

Science.gov (United States)

Pérez-García, Rafael; García Maset, Rafael; Gonzalez Parra, Emilio; Solozábal Campos, Carlos; Ramírez Chamond, Rafael; Martín-Rabadán, Pablo; Sobrino Pérez, Pedro Enrique; Gallego Pereira, Ovidio; Dominguez, Jon; de la Cueva Matute, Enrique; Ferllen, Ricardo

2016-01-01

A Best Practice Guideline about Dialysis fluid purity was developed under the leadership of the Spanish Society of Nephrology in 2004. The second edition revised Guideline considered new evidences and International Standard. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. This Guideline is based on the ISO13959, European Pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis, literature reviews, according to their level of evidence, and the opinion of the expert Spanish group. Two levels of quality of water were defined: purified water and high purified water (ultra pure) and for dialysate: ultra pure dialysate. Regular use of ultra pure dialysate is recommended for all type of hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anaemia and amiloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (4.1.2), conductivity, microbial and endotoxins (4.1.1): Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (anexos). For microbiological monitoring, R2A medium is recommended, incubated during 7-14 days at a temperature of 17-23°C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Research and development of in-core transducers at the CIAE

International Nuclear Information System (INIS)

Huang Yucai; Liu Yupu; Jia Guozhen; Liu Lianping

1996-01-01

In this paper, R and D of in-core transducers at the CIAE are briefly summarized. With the construction and commissioning of PWR nuclear power plant in China, fuel rod behaviour need to be studied carefully. As conventional transducers cannot meet the requirements of in-core applications, R and D of in-core transducers are developed. Since 1980's, several kinds of in-core transducers have been successfully fabricated and tested under the conditions simulating PWR. At present, in-pile tests of the transducers combining with the studies of individual behaviour of PWR fuel rod are being planned at the CIAE. (author). 11 refs, 12 figs, 4 tabs

Specialist physician knowledge of chronic kidney disease: A comparison of internists and family physicians in West Africa

Directory of Open Access Journals (Sweden)

Emmanuel I. Agaba

2012-05-01

Full Text Available Background: Postgraduate training is aimed at equipping the trainee with the necessary skills to practise as an expert. Non-nephrology specialist physicians render the bulk of pre-end-stage renal disease care for patients with chronic kidney disease (CKD. We sought to ascertain the knowledge of CKD amongst non-nephrology specialist physicians who serve as trainers and examiners for a training, accrediting and certifying body in postgraduate medicine in West Africa. We also compared the knowledge of family physicians and non-nephrology internists. Methods: Self-administered questionnaires were distributed to non-nephrology specialist physicians who serve as examiners for the West African College of Physicians. Results: Only 19 (27.5% of the respondents were aware of the Kidney Disease Outcomes Quality Initiatives guidelines for CKD management. Twenty five (36.2% of the respondents had adequate knowledge of CKD. There was no significant difference in the proportion of family physicians and non-nephrology internists who had adequate knowledge of CKD (27.3% vs. 40.4% respectively; p = 0.28. Hypertension and diabetes mellitus were identified by all of the physicians as risk factors for CKD. Non-nephrology internists more frequently identified systemic lupus erythematosus as a risk factor for CKD, urinalysis with microscopy as a laboratory test for CKD evaluation, and bone disease as a complication of CKD than family physicians. Conclusion: There is a lack of adequate CKD knowledge amongst non-nephrology specialist physicians, since many of them are unaware of the CKD management guidelines. Educational efforts are needed to improve the knowledge of CKD amongst non-nephrology specialist physicians. Guidelines on CKD need to be widely disseminated amongst these physicians.

Quality Measures for Dialysis: Time for a Balanced Scorecard.

Science.gov (United States)

Kliger, Alan S

2016-02-05

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. Copyright © 2016 by the American Society of Nephrology.

Turnover Intentions of Employees With Informal Eldercare Responsibilities: The Role of Core Self-Evaluations and Supervisor Support.

Science.gov (United States)

Greaves, Claire E; Parker, Stacey L; Zacher, Hannes; Jimmieson, Nerina L

2015-12-01

As longevity increases, so does the need for care of older relatives by working family members. This research examined the interactive effect of core self-evaluations and supervisor support on turnover intentions in two samples of employees with informal caregiving responsibilities. Data were obtained from 57 employees from Australia (Study 1) and 66 employees from the United States and India (Study 2). Results of Study 1 revealed a resource compensation effect, that is, an inverse relationship between core self-evaluations and turnover intentions when supervisor care support was low. Results of Study 2 extended these findings by demonstrating resource boosting effects. Specifically, there was an inverse relationship between core self-evaluations and subsequent turnover intentions for those with high supervisor work and care support. In addition, employees' satisfaction and emotional exhaustion from their work mediated the inverse relationship between core self-evaluations and subsequent turnover intentions when supervisor work support and care support were high. Overall, these findings highlight the importance of employee- and supervisor-focused intervention strategies in organizations to support informal caregivers. © The Author(s) 2016.

NURSING PROCESS, ACCORDING TO THE CONCEPTUAL MODEL OF WANDA HORTA, APPLIED TO A FAMILY MET BY THE REGIONAL CORE OF HOME CARE, DISTRITO FEDERAL.

Directory of Open Access Journals (Sweden)

Prince Vangeris Silva Fernandes de Lima

2014-05-01

Full Text Available The case report describes the nursing care, systematized according to the conceptual model of Wanda Horta, who was dismissed to a family accompanied by a core team of Regional home care, an administrative region of the Federal District through prioritization, based on the scale of Cascavel, a member of this for such a public service. The context part according to reports from the Discipline community health nursing in ' 02 and ' Stage, mandatory mode sold to students from the undergraduate program in nursing, University of Brasilia. At this juncture, described the history and nursing diagnoses, a welfare plan, as well as the prescription, the evolution and prognosis of nursing. In the residence there was the importance of specific health care provided not only by the nurse, but for the entire multidisciplinary team, customers with chronic clinical pictures and aggravated, but stable, that demand care that exceed those offered by primary health care. Seeking the completeness of the care, professionals and students involved started for the opportunity to visualize and better understand the patterns of relationships established between the client, family and healthcare professionals, with an emphasis on how the actors involved in this scenario mobilized in support of ailing client.

Measuring Beam Quality of Hollow Core Photonic Crystal Fibers

DEFF Research Database (Denmark)

Shephard, J.D.; Roberts, John; Jones, J.D.C.

2006-01-01

In this paper, the authors measure the quality of the delivered beam from hollow core photonic crystal fibers (HC-PCFs). The$M^2$parameter is determined, and the near- to far-field transition is examined. The influence on these properties due to the presence of a core surround mode is evaluated.......17 for the same output beam. This highlights the need for careful consideration when measuring and describing the beam quality delivered by these novel photonic fibers....

Assessment of assembly homogenized two-steps core dynamic calculations using direct whole core transport solutions

International Nuclear Information System (INIS)

Hursin, Mathieu; Downar, Thomas J.; Yoon, Joo Il; Joo, Han Gyu

2016-01-01

Highlights: • Reactivity initiated accident analysis with direct whole core transient transport code. • Comparison with usual “two steps” procedure. • Effect of effective delayed neutron fraction definition on energy deposition in the fuel. • Effect of homogenized few-group cross sections generation at the assembly level on energy deposition in the fuel. • Effect of effective fuel temperature definition on energy deposition in the fuel. - Abstract: The impact of the approximations in the “two-steps” procedure used in the current generation of nodal simulators for core transient calculations is assessed by using a higher order solution obtained from a direct, whole core, transient transport calculation. A control rod ejection accident in an idealized minicore is analyzed with PARCS, which uses the two-steps procedure and DeCART which provides the higher order solution. DeCART is used as lattice code to provide the homogenized cross sections and kinetics parameters to PARCS. The approximations made by using (1) the homogenized few-group cross sections and kinetic parameters generated at the assembly level, (2) an effective delayed neutrons fraction, (3) an effective fuel temperature and (4) the few-group formulation are investigated in terms of global and local core power behavior. The results presented in the paper show that the current two-steps procedure produces sufficiently accurate transient results with respect to the direct whole core calculation solution, provided that its parameters are carefully generated using the prescriptions described in the present article.

Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.

Science.gov (United States)

Hamm, Larry F; Sanderson, Bonnie K; Ades, Philip A; Berra, Kathy; Kaminsky, Leonard A; Roitman, Jeffrey L; Williams, Mark A

2011-01-01

Cardiac rehabilitation/secondary prevention (CR/SP) services are typically delivered by a multidisciplinary team of health care professionals. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that to provide high-quality services, it is important for these health care professionals to possess certain core competencies. This update to the previous statement identifies 10 areas of core competencies for CR/SP health care professionals and identifies specific knowledge and skills for each core competency. These core competency areas are consistent with the current list of core components for CR/SP programs published by the AACVPR and the American Heart Association and include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues.

Innovative reactor core: potentialities and design

International Nuclear Information System (INIS)

Artioli, C.; Petrovich, Carlo; Grasso, Giacomo

2010-01-01

Gen IV nuclear reactors are considered a very attractive answer for the demand of energy. Because public acceptance they have to fulfil very clearly the requirement of sustainable development. In this sense a reactor concept, having by itself a rather no significant interaction with the environment both on the front and back end ('adiabatic concept'), is vital. This goal in mind, a new way of designing such a core has to be assumed. The starting point must be the 'zero impact'. Therefore the core will be designed having as basic constraints: a) fed with only natural or depleted Uranium, and b) discharges only fission products. Meantime its potentiality as a net burner of Minor Actinide has to be carefully estimated. This activity, referred to the ELSY reactor, shows how to design such an 'adiabatic' core and states its reasonable capability of burning MA legacy in the order of 25-50 kg/GW e y. (authors)

Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum.

Science.gov (United States)

Tapia, Nicole M; Milewicz, Allen; Whitney, Stephen E; Liang, Michael K; Braxton, Carla C

2014-06-01

Although the Accreditation Council for Graduate Medical Education has defined 6 core competencies required of resident education, no consensus exists on best practices for reaching resident proficiency. Surgery programs must develop resourceful methods to incorporate learning. While patient care and medical knowledge are approached with formal didactics and traditional Halstedian educational formats, other core competencies are presumed to be learned on the job or emphasized in conferences. To test the hypothesis that our residents lack a foundation in several of the nonclinical core competencies and to seek to develop a formal curriculum that can be integrated into our current didactic time, with minimal effect on resident work hours and rest hours. Anonymous Likert-type scale needs assessment survey requesting residents within a large single general surgery residency program to rate their understanding, working knowledge, or level of comfort on the following 10 topics: negotiation and conflict resolution; leadership styles; health care legislation; principles of quality delivery of care, patient safety, and performance improvement; business of medicine; clinical practice models; role of advocacy in health care policy and government; personal finance management; team building; and roles of innovation and technology in health care delivery. Proportions of resident responses scored as positive (agree or strongly agree) or negative (disagree or strongly disagree). In total, 48 surgery residents (70%) responded to the survey. Only 3 topics (leadership styles, team building, and roles of innovation and technology in health care delivery) had greater than 70% positive responses, while 2 topics (negotiation and conflict resolution and principles of quality delivery of care, patient safety, and performance improvement) had greater than 60% positive responses. The remaining topics had less than 40% positive responses, with the least positive responses on the topics

Documentary System for Process of Radiopharmacy of the Nuclear Medicine Service of the Institute of Nephrology 'Dr. Abelardo Buch Lopez'

International Nuclear Information System (INIS)

Mesa Dueñas, Niurka; Zayas Crespo, Francisco; Peña Tornet, Adela; Serra Águila, Rolando

2016-01-01

Radiopharmacy is one of the key processes within a Nuclear Medicine Service and its adequate management, therefore, contributes to improve the quality of diagnostics and therapies provided by these departments. In the paper the documentary system developed for the radiopharmacy process of the Department of Nuclear Medicine of the Institute of Nephrology D r. Abelardo Buch Lopez , as part of the Quality Management System, which has been implemented since 2015. Also described are the tools developed in Excel to guarantee the operation, monitoring and measurement of control variables and indicators of this process. The information of the reception activities of the generators, freeze-dried kit and materials; Elution and quality control of the 99 Mo- 99m Tc generator; Marking and quality control of radiopharmaceuticals; Dispensing and delivery of the dose for administration are those managed by these tools.

Phase III study of the European Organisation for Research and Treatment of Cancer satisfaction with cancer care core questionnaire (EORTC PATSAT-C33) and specific complementary outpatient module (EORTC OUT-PATSAT7).

Science.gov (United States)

Brédart, A; Anota, A; Young, T; Tomaszewski, K A; Arraras, J I; Moura De Albuquerque Melo, H; Schmidt, H; Friend, E; Bergenmar, M; Costantini, A; Vassiliou, V; Hureaux, J; Marchal, F; Tomaszewska, I M; Chie, W-C; Ramage, J; Beaudeau, A; Conroy, T; Bleiker, E; Kulis, D; Bonnetain, F; Aaronson, N K

2018-01-01

Advances in cancer care delivery require revision and further development of questionnaires assessing patients' perceived quality of care. This study pre-tested the revised EORTC satisfaction with cancer care core questionnaire applicable in both the cancer inpatient and outpatient settings, and its new, outpatient-specific complementary module. The process of revision, development of the extended application, and pre-testing of these questionnaires was based on phases I to III of the "EORTC Quality of Life Group Module Development Guidelines." In phase III, patients in 11 countries in four European regions, South America and Asia completed provisional versions of the questionnaires. Fifty-seven relevant issues selected from literature reviews and input from experts were operationalized into provisional items, and subsequently translated into ten languages. Assessment of understanding, acceptability, redundancy and relevance by patients (n = 151) from oncology inpatient wards, and outpatient chemotherapy, radiotherapy and consultation settings, led to retention of, deletion of and merging of 40, 14 and 6 items respectively. Cronbach's alpha coefficients for hypothesized questionnaire scales were above 0.80. Our results provide preliminary support for the 33-item EORTC Satisfaction with cancer care core questionnaire and the 7-item complementary module specific for the outpatient care setting. A large scale phase IV cross-cultural psychometric study is now underway. © 2017 John Wiley & Sons Ltd.

Parental style and vulnerability to depression: the role of core beliefs.

Science.gov (United States)

Shah, R; Waller, G

2000-01-01

This study considers the potential role of core beliefs (unconditional schema-level representations) in the relationship between recalled parenting in childhood and major depression in adulthood, comparing a group of depressed outpatients (N = 60) with a healthy community sample (N = 67). The depressed group were differentiated by poorer perceived parenting (low care and high overprotection) and by three unhealthy core beliefs (defectiveness/shame, self-sacrifice, and insufficient self-control). Among nonclinical participants, it appears that vulnerability to harm beliefs act as a partial mediator of the relationship between poor paternal care and the development of depressive features. In contrast, a broader set of core beliefs appears to mediate the relationship of maternal bonding and paternal overprotection with depressive symptoms among the depressed group. The findings suggest that clinical work with adults with major depression might need to take account of parental style. Where parents are reported to be uncaring or overprotective, cognitive-behavioral therapy might need to include a schema-focused component.

Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure : A Meta-analysis

NARCIS (Netherlands)

Tangri, Navdeep; Grams, Morgan E.; Levey, Andrew S.; Coresh, Josef; Appel, Lawrence J.; Astor, Brad C.; Chodick, Gabriel; Collins, Allan J.; Djurdjev, Ognjenka; Elley, Raina; Evans, Marie; Garg, Amit X.; Hallan, Stein I.; Nicer, Lesley A.; Ito, Sadayoshi; Jee, Sun Ha; Kovesdy, Csaba P.; Kronenberg, Florian; Heerspink, Hiddo J. Lambers; Marks, Angharad; Nadkarni, Girish N.; Navaneethan, Sankar D.; Nelson, Robert G.; Titze, Stephanie; Sarnak, Mark J.; Stengel, Benedicte; Woodward, Mark; Iseki, Kunitoshi

2016-01-01

IMPORTANCE Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations were previously developed and validated in 2 Canadian cohorts. Validation in other regions and in CKD populations not under the care of a

[Patients' opinions and expectations about the dialysis care process].

Science.gov (United States)

Prieto, M A; Escudero, M J; Suess, A; March, J C; Ruiz, A; Danet, A

2011-01-01

To determine the experiences and needs of patients on dialysis, in order to identify critical points of the care process and develop proposals for improvement. Qualitative study using semistructured interviews with 22 patients on hemodialysis and peritoneal dialysis, from the Andalusian Health Service. Discourse analysis, using the SERVQUAL model. Triangulation of results. The diagnostic stage is described as the hardest moment as it requires acceptance of the disease. During hemodialysis, we see both positive adaptation and the perception of a diminished quality of life. The technique of peritoneal dialysis is evaluated positively, enabling greater independence, despite requiring more responsibility for self care. The contact with patients' organizations or the provision of a counseling service are valued as an aid in the process. With respect to different dimensions of the SERVQUAL model, human treatment and professional competence are valued. The critical points are lack of coordination, malfunctioning of transportation and lack of transparency in the management of waiting lists. Shortcomings in dealing with informal caregivers and the level of knowledge of professionals from areas other than Nephrology, also appear as deficiencies. The main proposals for improving the dialysis process are: attention to psychosocial aspects, the improvement of organizational aspects such as transport, and greater attention to informal caregivers.

Challenges in conducting clinical trials in nephrology

DEFF Research Database (Denmark)

Baigent, Colin; Herrington, William G; Coresh, Josef

2017-01-01

Despite the high costs of treatment of people with kidney disease and associated comorbid conditions, the amount of reliable information available to guide the care of such patients is very limited. Some treatments have been assessed in randomized trials, but most such trials have been too small ...

Clinical caring science as a scientific discipline.

Science.gov (United States)

Rehnsfeldt, Arne; Arman, Maria; Lindström, Unni Å

2017-09-01

Clinical caring science will be described from a theory of science perspective. The aim of this theoretical article to give a comprehensive overview of clinical caring science as a human science-based discipline grounded in a theory of science argumentation. Clinical caring science seeks idiographic or specific variations of the ontology, concepts and theories, formulated by caring science. The rationale is the insight that the research questions do not change when they are addressed in different contexts. The academic subject contains a concept order with ethos concepts, core and basic concepts and practice concepts that unites systematic caring science with clinical caring science. In accordance with a hermeneutic tradition, the idea of the caring act is based on the degree to which the theory base is hermeneutically appropriated by the caregiver. The better the ethos, essential concepts and theories are understood, the better the caring act can be understood. In order to understand the concept order related to clinical caring science, an example is given from an ongoing project in a disaster context. The concept order is an appropriate way of making sense of the essence of clinical caring science. The idea of the concept order is that concepts on all levels need to be united with each other. A research project in clinical caring science can start anywhere on the concept order, either in ethos, core concepts, basic concepts, practice concepts or in concrete clinical phenomena, as long as no parts are locked out of the concept order as an entity. If, for example, research on patient participation as a phenomenon is not related to core and basic concepts, there is a risqué that the research becomes meaningless. © 2016 Nordic College of Caring Science.

Perceived core competency achievements of fellowship and non-fellowship-trained early career pediatric hospitalists.

Science.gov (United States)

Librizzi, Jamie; Winer, Jeffrey C; Banach, Laurie; Davis, Aisha

2015-06-01

The pediatric hospital medicine (PHM) core competencies were established in 2010 to identify the specific knowledge base and skill set needed to provide the highest quality of care for hospitalized children. The objectives of this study were to examine the perceived core competency achievements of fellowship-trained and non-fellowship-trained early career pediatric hospitalists and identify perceived gaps in our current training models. An anonymous Web-based survey was distributed in November 2013. Hospitalists within 5 years of their residency graduation reported their perceived competency in select PHM core competencies. χ(2) and multiprobit regression analyses were utilized. One hundred ninety-seven hospitalists completed the survey and were included; 147 were non-fellowship-trained and 50 were PHM fellowship graduates or current PHM fellows. Both groups reported feeling less than competent in sedation and aspects of business practice. Non-fellowship-trained hospitalists also reported mean scores in the less than competent range in intravenous access/phlebotomy, technology-dependent emergencies, performing Plan-Do-Study-Act process and root cause analysis, defining basic statistical terms, and identifying research resources. Non-fellowship-trained hospitalists reported mean competency scores greater than fellowship-trained hospitalists in pain management, newborn care, and transitions in care. Early career pediatric hospitalists report deficits in several of the PHM core competencies, which should be considered when designing PHM-specific training in the future. Fellowship-trained hospitalists report higher levels of perceived competency in many core areas. © 2015 Society of Hospital Medicine.

Core competencies for safeguarding young people in care

NARCIS (Netherlands)

Walpot, Mirjam; Riis Hansen, Gitte; Moentjes, Gwendy; Bernaards, Claire

2017-01-01

Since October 2015, four European universities of applied sciences and three youth care organisations in Belgium, Denmark, Netherlands and Scotland, have been working as partners to develop education and training for (future) professionals. The goal of this partnership is to help (future)

Nanobody-Based Apolipoprotein E Immunosensor for Point-of-Care Testing.

Science.gov (United States)

Ren, Xiang; Yan, Junrong; Wu, Dan; Wei, Qin; Wan, Yakun

2017-09-22

Alzheimer's disease (AD) biomarkers can reflect the neurochemical indicators used to estimate the risk in clinical nephrology. Apolipoprotein E (ApoE) is an early biomarker for AD in clinical diagnosis. In this research, through bactrian camel immunization, lymphocyte isolation, RNA extraction, and library construction, ApoE-specific Nbs with high affinity were successfully separated from an immune phage display nanobody library. Herein, a colorimetric immunosensor was developed for the point-of-care testing of ApoE by layer-by-layer nanoassembly techniques and novel nanobodies (Nbs). Using highly oriented Nbs as the capture and detection antibodies, an on-site immunosensor was developed by detecting the mean gray value of fade color due to the glutaraldehyde@3-aminopropyltrimethoxysilane oxidation by H 2 O 2 . The detection limit of AopE is 0.42 pg/mL, and the clinical analysis achieves a good performance. The novel easily operated immunosensor may have potential application in the clinical diagnosis and real-time monitoring for AD.

Pattern of nosocomial infection in two intensive care units of a tertiary care hospital in karachi

International Nuclear Information System (INIS)

Rizvi, M.F.; Hassan, Y.; Abdullah, M.; Shakeel, J.; Memon, A.R.; Razvi, M.F.; Saleem, S.; Shakeel, J.

2007-01-01

To determine the pattern of nosocomial infections in two ICUs' of a teaching hospital in terms of frequency, common sites of infection, the pathogens involved and the antibiotic sensitivity patterns. It was conducted in two medical ICUs (Neurology and Nephrology) of a public tertiary care hospital. Data was collected prospectively on patients suspected to have developed nosocomial infection after 48 hours of admission to the ICU according to objective. There were 101 cases of suspected nosocomial infection out of a total of 254 patients. The frequency of nosocomial infection was 39.7%. UTI developed in 44.6%, while 27% had blood stream infection, and 21% had pneumonia. Each of the three major sites of infection was strongly associated with the use of invasive devices. Escherichia (E.) coli was the most common organism isolated followed by Pseudomonas aeruginosa and Klebsiella. E. coli and Klebsiella showed a maximum sensitivity to Imipenem followed by Tazocin (pipericillin + tazobactam). Pseudomonas aeruginosa was sensitive to Amikacin and Fosfomycin. The high frequency of nosocomial infection suggests that more strict measures regarding invasive devices should be taken in future to control the infection and limit the emergence of antibiotic resistant organisms. (author)

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

Science.gov (United States)

Douglas, Clint; Booker, Catriona; Fox, Robyn; Windsor, Carol; Osborne, Sonya; Gardner, Glenn

2016-07-01

To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. A modified Delphi study. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. © 2016 John Wiley & Sons Ltd.

Factors associated with the Journal Impact Factor (JIF for Urology and Nephrology Journals

Directory of Open Access Journals (Sweden)

Joseph M. Sewell

2015-12-01

Full Text Available Purpose: The Journal Impact Factor (JIF is an index used to compare a journal's quality among academic journals and it is commonly used as a proxy for journal quality. We sought to examine the JIF in order to elucidate the main predictors of the index while generating awareness among scientific community regarding need to modify the index calculation in the attempt to turn it more accurate. Materials and Methods: Under the Urology and Nephrology category in the Journal Citations Report Website, the top 17 Journals by JIF in 2011 were chosen for the study. All manuscripts’ abstracts published from 2009-2010 were reviewed; each article was categorized based on its research design (Retrospective, Review, etc. T and correlation tests were performed for categorical and continuous variables respectively. The JIF was the dependent variable. All variables were then included in a multivariate model. Results: 23,012 articles from seventeen journals were evaluated with a median of 1,048 (range=78-6,342 articles per journal. Journals with a society affiliation were associated with a higher JIF (p=0.05. Self-citations (rho=0.57, p=0.02, citations for citable articles (rho=0.73, p=0.001, citations to non-citable articles (rho=0.65, p=0.0046, and retrospective studies (rho=-0.51, p=0.03 showed a strong correlation. Slight modifications to include the non-citable articles in the denominator yield drastic changes in the JIF and the ranking of the journals. Conclusion: The JIF appears to be closely associated with the number of citable articles published. A change in the formula for calculating JIF to include all types of published articles in the denominator would result in a more accurate representation.

Evaluating the core microbiota in complex communities: A systematic investigation.

Science.gov (United States)

Astudillo-García, Carmen; Bell, James J; Webster, Nicole S; Glasl, Bettina; Jompa, Jamaluddin; Montoya, Jose M; Taylor, Michael W

2017-04-01

The study of complex microbial communities poses unique conceptual and analytical challenges, with microbial species potentially numbering in the thousands. With transient or allochthonous microorganisms often adding to this complexity, a 'core' microbiota approach, focusing only on the stable and permanent members of the community, is becoming increasingly popular. Given the various ways of defining a core microbiota, it is prudent to examine whether the definition of the core impacts upon the results obtained. Here we used complex marine sponge microbiotas and undertook a systematic evaluation of the degree to which different factors used to define the core influenced the conclusions. Significant differences in alpha- and beta-diversity were detected using some but not all core definitions. However, findings related to host specificity and environmental quality were largely insensitive to major changes in the core microbiota definition. Furthermore, none of the applied definitions altered our perception of the ecological networks summarising interactions among bacteria within the sponges. These results suggest that, while care should still be taken in interpretation, the core microbiota approach is surprisingly robust, at least for comparing microbiotas of closely related samples. © 2017 Society for Applied Microbiology and John Wiley & Sons Ltd.

[The development of a caring curriculum in nursing].

Science.gov (United States)

Kuo, Chien-Lin; Lee-Hsieh, Jane; Wang, Pi-Ling

2007-08-01

Caring is the essence of nursing and the core of nursing education. This paper describes the experience of developing a caring curriculum in a five-year junior college nursing program which included three core courses in caring, in the hope of stimulating further dialogue with fellow educators and cultivating students' caring competencies. The first course was Introduction to Caring, which gave students an understanding of basic concepts of caring, along with the opportunity to practice and experience caring by caring for oneself, one's family and one's peers. The second course was Application of Caring Concepts, which enabled students to learn about caring models, especially the dynamic caring model, and expanded their knowledge of caring behaviors from interpersonal caring to caring for society. The third course was Professional Caring, which explained professional caring and related caring theories, and introduced the caring model used in nursing in Taiwan, showing students how to practice caring in clinical situations. The participating teachers used the action research method to plan, design, implement, and evaluate the caring curriculum. These teachers set the teaching objectives and developed course materials by working together in workshops and participating in teachers' caring groups. They adopted various teaching strategies, such as role modeling, dialogue, caring groups, confirmation, literature, film, caring action projects, reflection, and journaling, which have been proven to be effective at raising students' learning motivation and caring performance.

Quality of chronic kidney disease management in primary care: a retrospective study.

Science.gov (United States)

Van Gelder, Vincent A; Scherpbier-De Haan, Nynke D; De Grauw, Wim J C; Vervoort, Gerald M M; Van Weel, Chris; Biermans, Marion C J; Braspenning, Jozé C C; Wetzels, Jack F M

2016-01-01

Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model. Quality of care for chronic kidney disease patients in primary care can be improved. In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic

A clinico-pathological study of lupus nephritis based on the International Society of Nephrology-Renal Pathology Society 2003 classification system.

Science.gov (United States)

Satish, Suchitha; Deka, Pallavi; Shetty, Manjunath Sanjeev

2017-01-01

Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Renal involvement is a major determinant of the prognosis of SLE. The histological classification of LN is a key factor in determining the renal survival of patients with LN. Prompt recognition and treatment of renal disease are important, as early response to therapy is correlated with better outcome and renal biopsy plays an important role in achieving this. The objective of this study was to correlate the clinical and laboratory findings with histopathological classes of LN as per the 2003 International Society of Nephrology-Renal Pathology Society (ISN/RPS) classification system. Fifty-six patients with SLE, undergoing a renal biopsy for renal dysfunction were studied. The comparison of data from multiple groups was made by Pearson's Chi-square test and between two groups by independent samples t -test. The values of P renal biopsy. Since renal morphology may predict long-term prognosis, and no clinical or laboratory feature uniformly predicts prognosis, it is important to study the constellation of features in LN for better patient management.

Core Hunter 3: flexible core subset selection.

Science.gov (United States)

De Beukelaer, Herman; Davenport, Guy F; Fack, Veerle

2018-05-31

Core collections provide genebank curators and plant breeders a way to reduce size of their collections and populations, while minimizing impact on genetic diversity and allele frequency. Many methods have been proposed to generate core collections, often using distance metrics to quantify the similarity of two accessions, based on genetic marker data or phenotypic traits. Core Hunter is a multi-purpose core subset selection tool that uses local search algorithms to generate subsets relying on one or more metrics, including several distance metrics and allelic richness. In version 3 of Core Hunter (CH3) we have incorporated two new, improved methods for summarizing distances to quantify diversity or representativeness of the core collection. A comparison of CH3 and Core Hunter 2 (CH2) showed that these new metrics can be effectively optimized with less complex algorithms, as compared to those used in CH2. CH3 is more effective at maximizing the improved diversity metric than CH2, still ensures a high average and minimum distance, and is faster for large datasets. Using CH3, a simple stochastic hill-climber is able to find highly diverse core collections, and the more advanced parallel tempering algorithm further increases the quality of the core and further reduces variability across independent samples. We also evaluate the ability of CH3 to simultaneously maximize diversity, and either representativeness or allelic richness, and compare the results with those of the GDOpt and SimEli methods. CH3 can sample equally representative cores as GDOpt, which was specifically designed for this purpose, and is able to construct cores that are simultaneously more diverse, and either are more representative or have higher allelic richness, than those obtained by SimEli. In version 3, Core Hunter has been updated to include two new core subset selection metrics that construct cores for representativeness or diversity, with improved performance. It combines and outperforms the

Vortex cores and vortex motion in superconductors with anisotropic Fermi surfaces

Energy Technology Data Exchange (ETDEWEB)

Galvis, J.A. [Laboratorio de Bajas Temperaturas, Departamento de Física de la Materia Condensada, Instituto de Ciencia de Materiales Nicolás Cabrera, Condensed Matter Physics Center (IFIMAC), Facultad de Ciencias, Universidad Autónoma de Madrid, E-28049 Madrid (Spain); Departamento de Ciencias Naturales, Facultad de ingeniería y Ciencias Básicas, Universidad Central, Bogotá (Colombia); National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310 (United States); Herrera, E.; Guillamón, I.; Vieira, S. [Laboratorio de Bajas Temperaturas, Departamento de Física de la Materia Condensada, Instituto de Ciencia de Materiales Nicolás Cabrera, Condensed Matter Physics Center (IFIMAC), Facultad de Ciencias, Universidad Autónoma de Madrid, E-28049 Madrid (Spain); Unidad Asociada de Altos Campos Magnéticos y Bajas Temperaturas, UAM, CSIC, Madrid (Spain); Suderow, H., E-mail: hermann.suderow@uam.es [Laboratorio de Bajas Temperaturas, Departamento de Física de la Materia Condensada, Instituto de Ciencia de Materiales Nicolás Cabrera, Condensed Matter Physics Center (IFIMAC), Facultad de Ciencias, Universidad Autónoma de Madrid, E-28049 Madrid (Spain); Unidad Asociada de Altos Campos Magnéticos y Bajas Temperaturas, UAM, CSIC, Madrid (Spain)

2017-02-15

Highlights: • The observation of vortex cores is reviewed, with emphasis in new experiments. • Vortex cores are follow superconducting gap and Fermi surface shapes. • The vortex core shape influences vortex dynamics. - Abstract: Explaning static and dynamic properties of the vortex lattice in anisotropic superconductors requires a careful characterization of vortex cores. The vortex core contains Andreev bound states whose spatial extension depends on the anisotropy of the electronic band-structure and superconducting gap. This might have an impact on the anisotropy of the superconducting properties and on vortex dynamics. Here we briefly summarize basic concepts to understand anisotropic vortex cores and review vortex core imaging experiments. We further discuss moving vortex lattices and the influence of vortex core shape in vortex motion. We find vortex motion in highly tilted magnetic fields. We associate vortex motion to the vortex entry barrier and the screening currents at the surface. We find preferential vortex motion along the main axis of the vortex lattice. After travelling integers of the intervortex distance, we find that vortices move more slowly due to the washboard potential of the vortex lattice.

Vortex cores and vortex motion in superconductors with anisotropic Fermi surfaces

International Nuclear Information System (INIS)

Galvis, J.A.; Herrera, E.; Guillamón, I.; Vieira, S.; Suderow, H.

2017-01-01

Highlights: • The observation of vortex cores is reviewed, with emphasis in new experiments. • Vortex cores are follow superconducting gap and Fermi surface shapes. • The vortex core shape influences vortex dynamics. - Abstract: Explaning static and dynamic properties of the vortex lattice in anisotropic superconductors requires a careful characterization of vortex cores. The vortex core contains Andreev bound states whose spatial extension depends on the anisotropy of the electronic band-structure and superconducting gap. This might have an impact on the anisotropy of the superconducting properties and on vortex dynamics. Here we briefly summarize basic concepts to understand anisotropic vortex cores and review vortex core imaging experiments. We further discuss moving vortex lattices and the influence of vortex core shape in vortex motion. We find vortex motion in highly tilted magnetic fields. We associate vortex motion to the vortex entry barrier and the screening currents at the surface. We find preferential vortex motion along the main axis of the vortex lattice. After travelling integers of the intervortex distance, we find that vortices move more slowly due to the washboard potential of the vortex lattice.

Improving Care Teams' Functioning: Recommendations from Team Science.

Science.gov (United States)

Fiscella, Kevin; Mauksch, Larry; Bodenheimer, Thomas; Salas, Eduardo

2017-07-01

Team science has been applied to many sectors including health care. Yet there has been relatively little attention paid to the application of team science to developing and sustaining primary care teams. Application of team science to primary care requires adaptation of core team elements to different types of primary care teams. Six elements of teams are particularly relevant to primary care: practice conditions that support or hinder effective teamwork; team cognition, including shared understanding of team goals, roles, and how members will work together as a team; leadership and coaching, including mutual feedback among members that promotes teamwork and moves the team closer to achieving its goals; cooperation supported by an emotionally safe climate that supports expression and resolution of conflict and builds team trust and cohesion; coordination, including adoption of processes that optimize efficient performance of interdependent activities among team members; and communication, particularly regular, recursive team cycles involving planning, action, and debriefing. These six core elements are adapted to three prototypical primary care teams: teamlets, health coaching, and complex care coordination. Implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief. Training should be based on assessment of needs and tasks and the use of simulations and feedback, and it should extend to live action. Teamlets represent a potential launch point for team development and diffusion of teamwork principles within primary care practices. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Core Support for the New Economy

Directory of Open Access Journals (Sweden)

Neva Goodwin

2017-03-01

Full Text Available This paper proposes an income guarantee called Core Support (CS, defined as compensation for household activities such as childcare, food preparation, care of elderly or ill persons in the home, and maintenance of the home and of household vehicles and appliances. The immediate goals of the proposal are to highlight, through compensation, the reality that the productive activities carried on in households are of essential importance for the whole economy and society, and to enable the people who carry out these essential activities to do so without having to short-change the care work because of the need to earn money through the market. The CS concept builds on literature on Basic Income Guarantees (BIG and on feminist economics, which tends to be skeptical of BIG proposals. By addressing intra-household allocations, CS shows how a basic income system can promote a more caring democracy and a more partnership-oriented socioeconomic system that rewards the essential work of care. Appendix A surveys seven ways by which such a program could be financed.

Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the Neonatal Intensive Care Unit. Part A: Background and Rationale. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN.

Science.gov (United States)

Milette, Isabelle; Martel, Marie-Josée; Ribeiro da Silva, Margarida; Coughlin McNeil, Mary

2017-06-01

The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.

Validating the CORE-10 as a mental health screening tool for prisoners

OpenAIRE

Lewis, Gwen

2016-01-01

Background: Few mental health screening tools have been validated with prisoners and existing tools, do not assess severity of need in line with contemporary stepped care service models. \\ud \\ud Aims: The current research aims to assess the CORE-10’s psychometric reliability, validity and predictive accuracy as a screening tool for common (primary care) and severe (secondary care) mental health problems in prisoners. \\ud \\ud Method: Cross –sectional study of 150 prisoners. All participants co...

Dementia skills for all: a core competency framework for the workforce in the United Kingdom.

Science.gov (United States)

Tsaroucha, Anna; Benbow, Susan Mary; Kingston, Paul; Le Mesurier, Nick

2013-01-01

One of the biggest challenges facing health and social care in the United Kingdom is the projected increase in the number of older people who require dementia care. The National Dementia Strategy (Department of Health, 2009) emphasizes the critical need for a skilled workforce in all aspects of dementia care. In the West Midlands, the Strategic Health Authority commissioned a project to develop a set of generic core competencies that would guide a competency based curriculum to meet the demands for improved dementia training and education. A systematic literature search was conducted to identify relevant frameworks to assist with this work. The core competency framework produced and the methods used for the development of the framework are presented and discussed.

Analysis Of Core Management For The Transition Cores Of RSG-GAS Reactor To Full-Silicide Core

International Nuclear Information System (INIS)

Malem Sembiring, Tagor; Suparlina, Lily; Tukiran

2001-01-01

The core conversion of RSG-GAS reactor from oxide to silicide core with meat density of 2.96 g U/cc is still doing. At the end of 2000, the reactor has been operated for 3 transition cores which is the mixed core of oxide-silicide. Based on previous work, the calculated core parameter for the cores were obtained and it is needed 10 transition cores to achieve a full-silicide core. The objective of this work is to acquire the effect of the increment of the number of silicide fuel on the core parameters such as excess reactivity and shutdown margin. The measurement of the core parameters was carried out using the method of compensation of couple control rods. The experiment shows that the excess reactivity trends lower with the increment of the number of silicide fuel in the core. However, the shutdown margin is not change with the increment of the number of silicide fuel. Therefore, the transition cores can be operated safety to a full-silicide core

Patient-centered care: an opportunity to accomplish the "Three Aims" of the National Quality Strategy in the Medicare ESRD program.

Science.gov (United States)

O'Hare, Ann M; Armistead, Nancy; Schrag, Wendy L Funk; Diamond, Louis; Moss, Alvin H

2014-12-05

In light of mounting federal government debt and levels of Medicare spending that are widely viewed as unsustainable, commentators have called for a transformation of the United States health care system to deliver better care at lower costs. This article presents the priorities of the Coalition for Supportive Care of Kidney Patients for how clinicians might achieve this transformation for patients with advanced CKD and their families. The authors suspect that much of the high-intensity, high-cost care currently delivered to patients with advanced kidney disease may be unwanted and that the "Three Aims" put forth by the National Quality Strategy of better care for the individual, better health for populations, and reduced health care costs may be within reach for patients with CKD and ESRD. This work describes the coalition's vision for a more patient-centered approach to the care of patients with kidney disease and argues for more concerted efforts to align their treatments with their goals, values, and preferences. Key priorities to achieve this vision include using improved prognostic models and decision science to help patients, their families, and their providers better understand what to expect in the future; engaging patients and their families in shared decision-making before the initiation of dialysis and during the course of dialysis treatment; and tailoring treatment strategies throughout the continuum of their care to address what matters most to individual patients. Copyright © 2014 by the American Society of Nephrology.

Core-to-core uniformity improvement in multi-core fiber Bragg gratings

Science.gov (United States)

Lindley, Emma; Min, Seong-Sik; Leon-Saval, Sergio; Cvetojevic, Nick; Jovanovic, Nemanja; Bland-Hawthorn, Joss; Lawrence, Jon; Gris-Sanchez, Itandehui; Birks, Tim; Haynes, Roger; Haynes, Dionne

2014-07-01

Multi-core fiber Bragg gratings (MCFBGs) will be a valuable tool not only in communications but also various astronomical, sensing and industry applications. In this paper we address some of the technical challenges of fabricating effective multi-core gratings by simulating improvements to the writing method. These methods allow a system designed for inscribing single-core fibers to cope with MCFBG fabrication with only minor, passive changes to the writing process. Using a capillary tube that was polished on one side, the field entering the fiber was flattened which improved the coverage and uniformity of all cores.

Athabasca tar sand reservoir properties derived from cores and logs

International Nuclear Information System (INIS)

Woodhouse, R.

1976-01-01

Log interpretation parameters for the Athabasca Tar Sand Lease No. 24 have been determined by careful correlation with Dean and Stark core analysis data. Significant expansion of Athabasca cores occurs as overburden pressure is removed. In the more shaly sands the core analysis procedures remove adsorbed water from the clays leading to further overestimation of porosity and free water volume. Log interpretation parameters (R/sub w/ = 0.5 ohm . m and m = n = 1.5) were defined by correlation with the weight of tar as a fraction of the weight of rock solids (grain or dry weight fraction of tar). This quantity is independent of the water content of the cores, whereas porosity and the weight of tar as a fraction of the bulk weight of fluids plus solids (bulk weight fraction) are both dependent on water content. Charts are provided for the conversion of bulk weight fraction of fluids to porosity; grain weight fraction of fluids to porosity; log derived porosity and core grain weight tar to water saturation. Example results show that the core analysis grain weight fraction of tar is adequately matched by the log analyses. The log results provide a better representation of the reservoir fluid volumes than the core analysis data

Care of children with disabilities in Primary Health Care

Directory of Open Access Journals (Sweden)

Thaís Giudice Schultz

2016-07-01

Full Text Available Objective: This article describes an experience report that aimed to present perceptions on the care of children with disabilities in the Family Health Strategy (FHS, showing its limits and potentials based on the experience of participation in the program ‘PET-Saúde’. Method: Data were collected from field notes which recorded the monitoring of the care process offered to children with disabilities by the FHS teams. The study was conducted in a health facility in the city of Rio de Janeiro for one year. Results: Content analysis results listed the two main themes that composed the issues of concern for child care in this experience: the coordination of health care and the family and community orientation as the core for child care in the FHS. Conclusion: Despite the weakness in compliance with these categories, which are principles and fundamentals of the FHS, this is a privileged space with regard to care practices for children with disabilities.

Exploring the development of a cultural care framework for European caring science.

Science.gov (United States)

Albarran, John; Rosser, Elizabeth; Bach, Shirley; Uhrenfeldt, Lisbeth; Lundberg, Pranee; Law, Kate

2011-01-01

The aim of this paper is to discuss the development of a cultural care framework that seeks to inform and embrace the philosophical ideals of caring science. Following a review of the literature that identified a lack of evidence of an explicit relationship between caring science and cultural care, a number of well-established transcultural care frameworks were reviewed. Our purpose was to select one that would resonate with underpinning philosophical values of caring science and that drew on criteria generated by the European Academy of Caring Science members. A modified framework based on the work of Giger and Davidhizar was developed as it embraced many of the values such as humanism that are core to caring science practice. The proposed caring science framework integrates determinants of cultural lifeworld-led care and seeks to provide clear directions for humanizing the care of individuals. The framework is offered to open up debate and act as a platform for further academic enquiry.

Integrated care: a comprehensive bibliometric analysis and literature review

Directory of Open Access Journals (Sweden)

Xiaowei Sun

2014-06-01

Full Text Available Introduction: Integrated care could not only fix up fragmented health care but also improve the continuity of care and the quality of life. Despite the volume and variety of publications, little is known about how ‘integrated care’ has developed. There is a need for a systematic bibliometric analysis on studying the important features of the integrated care literature.Aim: To investigate the growth pattern, core journals and jurisdictions and identify the key research domains of integrated care.Methods: We searched Medline/PubMed using the search strategy ‘(delivery of health care, integrated [MeSH Terms] OR integrated care [Title/Abstract]’ without time and language limits. Second, we extracted the publishing year, journals, jurisdictions and keywords of the retrieved articles. Finally, descriptive statistical analysis by the Bibliographic Item Co-occurrence Matrix Builder and hierarchical clustering by SPSS were used.Results: As many as 9090 articles were retrieved. Results included: (1 the cumulative numbers of the publications on integrated care rose perpendicularly after 1993; (2 all documents were recorded by 1646 kinds of journals. There were 28 core journals; (3 the USA is the predominant publishing country; and (4 there are six key domains including: the definition/models of integrated care, interdisciplinary patient care team, disease management for chronically ill patients, types of health care organizations and policy, information system integration and legislation/jurisprudence.Discussion and conclusion: Integrated care literature has been most evident in developed countries. International Journal of Integrated Care is highly recommended in this research area. The bibliometric analysis and identification of publication hotspots provides researchers and practitioners with core target journals, as well as an overview of the field for further research in integrated care.

E-core transverse flux machine with integrated fault detection system

DEFF Research Database (Denmark)

Rasmussen, Peter Omand; Runólfsson, Gunnar; Thorsdóttir, Thórunn Ágústa

2011-01-01

extent also thermal. Since the E-core transverse flux-machine belongs to the family of the SRMs it has unique properties of intervals without current in the windings. By careful investigation of the voltage and current in these intervals a very simple method to detect single and partial turn short...... circuit faults have been developed. For other types of machines the single and partial turn short circuit is very difficult to deal with and requires normally very comprehensive detection and calculation schemes. The developed detection algorithm combined with the E-core transverse flux machine...

Health Care Reform, Care Coordination, and Transformational Leadership.

Science.gov (United States)

Steaban, Robin Lea

2016-01-01

This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.

CHARACTERIZING AND MODELING FERRITE-CORE PROBES

International Nuclear Information System (INIS)

Sabbagh, Harold A.; Murphy, R. Kim; Sabbagh, Elias H.; Aldrin, John C.

2010-01-01

In this paper, we accurately and carefully characterize a ferrite-core probe that is widely used for aircraft inspections. The characterization starts with the development of a model that can be executed using the proprietary volume-integral code, VIC-3D(c), and then the model is fitted to measured multifrequency impedance data taken with the probe in freespace and over samples of a titanium alloy and aluminum. Excellent results are achieved, and will be discussed.

Coupling between core and cladding modes in a helical core fiber with large core offset

International Nuclear Information System (INIS)

Napiorkowski, Maciej; Urbanczyk, Waclaw

2016-01-01

We analyzed the effect of resonant coupling between core and cladding modes in a helical core fiber with large core offset using the fully vectorial method based on the transformation optics formalism. Our study revealed that the resonant couplings to lower order cladding modes predicted by perturbative methods and observed experimentally in fibers with small core offsets are in fact prohibited for larger core offsets. This effect is related to the lack of phase matching caused by elongation of the optical path of the fundamental modes in the helical core. Moreover, strong couplings to the cladding modes of the azimuthal modal number much higher than predicted by perturbative methods may be observed for large core offsets, as the core offset introduces higher order angular harmonics in the field distribution of the fundamental modes. Finally, in contrast to previous studies, we demonstrate the existence of spectrally broad polarization sensitive couplings to the cladding modes suggesting that helical core fibers with large core offsets may be used as broadband circular polarizers. (paper)

Core outcome sets in women's and newborn health: a systematic review.

Science.gov (United States)

Duffy, Jmn; Rolph, R; Gale, C; Hirsch, M; Khan, K S; Ziebland, S; McManus, R J

2017-09-01

Variation in outcome collection and reporting is a serious hindrance to progress in our specialty; therefore, over 80 journals have come together to support the development, dissemination, and implementation of core outcome sets. This study systematically reviewed and characterised registered, progressing, or completed core outcome sets relevant to women's and newborn health. Systematic search using the Core Outcome Measures in Effectiveness Trial initiative and the Core Outcomes in Women's and Newborn Health initiative databases. Registry entries, protocols, systematic reviews, and core outcome sets. Descriptive statistics to describe characteristics and results. There were 49 core outcome sets registered in maternal and newborn health, with the majority registered in 2015 (n = 22; 48%) or 2016 (n = 16; 32%). Benign gynaecology (n = 8; 16%) and newborn health (n = 3; 6%) are currently under-represented. Twenty-four (52%) core outcome sets were funded by international (n = 1; core outcome sets were completed: reconstructive breast surgery (11 outcomes), preterm birth (13 outcomes), epilepsy in pregnancy (29 outcomes), and maternity care (48 outcomes). The quantitative, qualitative, and consensus methods used to develop core outcome sets varied considerably. Core outcome sets are currently being developed across women's and newborn health, although coverage of topics is variable. Development of further infrastructure to develop, disseminate, and implement core outcome sets is urgently required. Forty-nine women's and newborn core outcome sets registered. 50% funded. 7 protocols, 20 systematic reviews, and 4 core outcome sets published. @coreoutcomes @jamesmnduffy. © 2017 Royal College of Obstetricians and Gynaecologists.

Evaluation of In-Core Fuel Management for the Transition Cores of RSG-GAS Reactor to Full-Silicide Core

International Nuclear Information System (INIS)

S, Tukiran; MS, Tagor; P, Surian

2003-01-01

The core conversion of RSG-GAS reactor from oxide to silicide core with meat density of 2.96 gU/cc has been done. The core-of RSG-GAS reactor has been operated full core of silicide fuels which is started with the mixed core of oxide-silicide start from core 36. Based on previous work, the calculated core parameter for the cores were obtained and it is needed 9 transition cores (core 36 - 44) to achieve a full-silicide core (core 45). The objective of this work is to acquire the effect of the increment of the number of silicide fuel on the core parameters. Conversion core was achieved by transition cores mixed oxide-silicide fuels. Each transition core is calculated and measured core parameter such as, excess reactivity and shutdown margin. Calculation done by Batan-EQUIL-2D code and measurement of the core parameters was carried out using the method of compensation of couple control rods. The results of calculation and experiment shows that the excess reactivity trends lower with the increment of the number of silicide fuel in the core. However, the shutdown margin is not change with the increment of the number of silicide fuel. Therefore, the transition cores can be operated safely to a full-silicide core

Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery

OpenAIRE

Trosman, Julia R.; Carlos, Ruth C.; Simon, Melissa A.; Madden, Debra L.; Gradishar, William J.; Benson, Al B.; Rapkin, Bruce D.; Weiss, Elisa S.; Gareen, Ilana F.; Wagner, Lynne I.; Khan, Seema A.; Bunce, Mikele M.; Small, Art; Weldon, Christine B.

2016-01-01

Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. W...

Neutron spectrum effects on TRU recycling in Pb-Bi cooled fast reactor core

International Nuclear Information System (INIS)

Kim, Yong Nam; Kim, Jong Kyung; Park, Won Seok

2003-01-01

This study is intended to evaluate the dependency of TRU recycling characteristics on the neutron spectrum shift in a Pb-Bi cooled core. Considering two Pb-Bi cooled cores with the soft and the hard spectrum, respectively, various characteristics of the recycled core are carefully examined and compared with each other. Assuming very simplified fuel cycle management with the homogeneous and single region fuel loading, the burnup calculations are performed until the recycled core reached to the (quasi-) equilibrium state. The mechanism of TRU recycling toward the equilibrium is analyzed in terms of burnup reactivity and the isotopic compositions of TRU fuel. In the comparative analyses, the difference in the recycling behavior between the two cores is clarified. In addition, the basic safety characteristics of the recycled core are also discussed in terms of the Doppler coefficient, the coolant loss reactivity coefficient, and the effective delayed neutron fraction

Core competencies for pain management: results of an interprofessional consensus summit.

Science.gov (United States)

Fishman, Scott M; Young, Heather M; Lucas Arwood, Ellyn; Chou, Roger; Herr, Keela; Murinson, Beth B; Watt-Watson, Judy; Carr, Daniel B; Gordon, Debra B; Stevens, Bonnie J; Bakerjian, Debra; Ballantyne, Jane C; Courtenay, Molly; Djukic, Maja; Koebner, Ian J; Mongoven, Jennifer M; Paice, Judith A; Prasad, Ravi; Singh, Naileshni; Sluka, Kathleen A; St Marie, Barbara; Strassels, Scott A

2013-07-01

The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain. Wiley Periodicals, Inc.

Thermal Margin Calculation of the CAREM-25 Core

International Nuclear Information System (INIS)

Mazufri, C.M

2000-01-01

During the operation in steady state and anticipated operational transient of a nuclear reactor it is necessary to avoid the damage in the fuel elements induced by thermal or hydraulic effects.To satisfy that design bases safety limits are established and calculation methodologies are defined to verify them.In the particular case of the reactor CAREM-25 reactor where the core is cooled by natural circulation, it is not adequate to use directly the same calculation methodologies from typical PWR and BWR.The low cooling flow rate and not having channels in the fuel elements (open-channel fuels) produce that most of the models and computer programs typically used must be carefully validated.As result of that process, an adequate calculation procedure for this reactor type was developed.In the present work, the thermal-hydraulic design criteria of the core and the design bases, the uncertainties factors, and the thermal margin results of the core are described.Despite that the methodology of DNBR calculation is under a validation process and considering the available calculation tools, it is possible to assure that the core fulfills the safety regulations in steady state conditions

Neodymium-YAG laser core through urethrotomy in obliterative posttraumatic urethral strictures after failed initial urethroplasty.

Science.gov (United States)

Dogra, P N; Nabi, G

2002-01-01

To assess the feasibility, problems and results of Nd-YAG laser core through urethrotomy in the management of failed urethroplasty for posttraumatic bulbomembranous urethral strictures. 61 patients with obliterative posttraumatic urethral strictures were treated by Nd-YAG laser core through urethrotomy between May 1997 to April 2000. Of these, 5 patients had failed end-to-end urethroplasty done as an initial procedure at various periods of time. The procedure was performed as day care and patients were discharged within 6 h of procedure. At 24-30 months of follow-up, all patients are voiding well and are continent. Auxiliary procedures were required in 2 cases. Nd-YAG laser core through urethrotomy is a feasible day care option for patients of obliterative urethral strictures following failed initial urethroplasty with successful outcome. Copyright 2002 S. Karger AG, Basel

A novel Internet-based blended learning programme providing core competency in clinical research.

Science.gov (United States)

Tsugihashi, Yukio; Kakudate, Naoki; Yokoyama, Yoko; Yamamoto, Yosuke; Mishina, Hiroki; Fukumori, Norio; Nakamura, Fumiaki; Takegami, Misa; Ohno, Shinya; Wakita, Takafumi; Watanabe, Kazuhiro; Yamaguchi, Takuhiro; Fukuhara, Shunichi

2013-04-01

We developed a novel Internet-based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme. This study was conducted at Kyoto University and seven satellite campuses from September 2009 to March 2010. A total of 176 health care professionals who had never attempted to attain core competency in clinical research were enrolled. The participants were supplied with a novel programme comprising the following four strategies: online live lectures at seven satellite campuses, short examinations after each lecture, an Internet-based feedback system and an end-of-course examination. We assessed the proportion of attendance at the lectures as the main outcome. In addition, we evaluated interaction via the feedback system and scores for end-of-course examination. Of the 176 participants, 134 (76%) reported working more than 40 hours per week. The mean proportion of attendance over all 23 lectures was 82%. A total of 156 (89%) participants attended more than 60% of all lectures and were eligible for the end-of-course examination. A total of the participants accessed the feedback system 3564 times and asked 284 questions. No statistically significant differences were noted in the end-of-course scores among medical doctors, pharmacists, registered nurses and other occupations. We developed an Internet-based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation. © 2011 Blackwell Publishing Ltd.

Earth's inner core: Innermost inner core or hemispherical variations?

NARCIS (Netherlands)

Lythgoe, K. H.; Deuss, A.|info:eu-repo/dai/nl/412396610; Rudge, J. F.; Neufeld, J. A.

2014-01-01

The structure of Earth's deep inner core has important implications for core evolution, since it is thought to be related to the early stages of core formation. Previous studies have suggested that there exists an innermost inner core with distinct anisotropy relative to the rest of the inner core.

Dependence of Core and Extended Flux on Core Dominance ...

Indian Academy of Sciences (India)

Abstract. Based on two extragalactic radio source samples, the core dominance parameter is calculated, and the correlations between the core/extended flux density and core dominance parameter are investi- gated. When the core dominance parameter is lower than unity, it is linearly correlated with the core flux density, ...

Improving Medical Care With Electronic Interventions Based on Automated Text and Phone Messages

Science.gov (United States)

2017-09-21

General Medicine; Maternal Health; Pediatric Health; Neurology; Psychiatry; Emergency Medicine; Internal Medicine; Nephrology; Wellness; Mobile Health; Surgery; Mental Health; Chronic Obstructive Pulmonary Disease; Diabetes Mellitus; CHF; Depression; Breast Feeding; PostPartum Depression; Perinatal Mood and Anxiety Disorder

Recurrent Acute Tonsillitis, The 'Core' Issue

Directory of Open Access Journals (Sweden)

Saikat Samaddar

2016-04-01

Full Text Available Introduction: Today bacteriological and patho-anatomical considerations too are taken into account while treating a case of tonsillitis. Past decade has seen the rise of resistance amongst the common pathogens, as well as rise in the number of unusual offenders. Determination of the true offending organism and prescribing an antibiotic as per the sensitivity pattern is of utmost importance.  Materials and Method: A prospective longitudinal study was conducted in a tertiary care hospital in Kolkata. The study population consisted of patients presenting with recurrent attacks of acute tonsillitis. Determination of throat swab micro flora, ASO titre and core tissue microflora was done and correlated statistically. Result: There was poor correlation between throat swab and core tissue microflora. Positive predictive value of throat swab was 10%. Pseudomonas is the predominant flora harbouring tonsillar core in our study population. Amoxicillin the most commonly prescribed antibiotic stands out to be the most resistant one. No statistical significance could be reached comparing streptococcal tonsillitis with ASO titre. Discussion: The real pathology within the tonsil core is not always reflected in routine throat swab and bacteriology of recurrent tonsillitis may differ in different regions. ASO titre estimation adds up to the economic burden if rheumatic fever is not suspected. Judicious use of antibiotics based on true sensitivity pattern is encouraged. In the era of antibiotics Tonsillectomy still holds an important position in the management of recurrent attacks. Conclusion: Pseudomonas was found to be the most common pathogen in recurrent acute tonsillitis. Core tissue study remains the Gold standard in identifying the pathogenic organism. Oral third generation Cephalosporin was the most efficacious antibiotic for recurrent tonsillitis in our study population.

On-line core monitoring with CORE MASTER / PRESTO

International Nuclear Information System (INIS)

Lindahl, S.O.; Borresen, S.; Ovrum, S.

1986-01-01

Advanced calculational tools are instrumental in improving reactor plant capacity factors and fuel utilization. The computer code package CORE MASTER is an integrated system designed to achieve this objective. The system covers all main activities in the area of in-core fuel management for boiling water reactors; design, operation support, and on-line core monitoring. CORE MASTER operates on a common data base, which defines the reactor and documents the operating history of the core and of all fuel bundles ever used

GPs' views on managing advanced chronic kidney disease in primary care: a qualitative study.

Science.gov (United States)

Tonkin-Crine, Sarah; Santer, Miriam; Leydon, Geraldine M; Murtagh, Fliss E M; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

2015-07-01

Chronic kidney disease (CKD) has become a significant part of the GP's workload since the introduction of the National Institute for Health and Care Excellence guidelines in 2008. Patients with advanced CKD (stages G4 and G5) often have comorbidities, varied disease progression, and are likely to be older. GPs may experience difficulties with management decisions for patients with advanced CKD, including when to refer to nephrology. To explore GPs' views of managing patients with advanced CKD and referral to secondary care. Qualitative study with GPs in four areas of England: London, Bristol, Birmingham, and Stevenage. Semi-structured interviews with 19 GPs. Transcribed interviews were thematically analysed. GPs had little experience of managing patients with advanced CKD, including those on dialysis or having conservative care (treatment without dialysis or a transplant), and welcomed guidance. Some GPs referred patients based on renal function alone and some used wider criteria including age and multimorbidity. GPs reported a tension between national guidance and local advice, and some had learnt from experience that patients were discharged back to primary care. GPs with more experience of managing CKD referred patients later, or sometimes not at all, if there were no additional problems and if dialysis was seen as not in the patient's interests. GPs want guidance on managing older patients with advanced CKD and comorbidities, which better incorporates agreement between local and national recommendations to clarify referral criteria. GPs are not generally aware of conservative care programmes provided by renal units, however, they appear happy to contribute to such care or alternatively, lead conservative management with input from renal teams. © British Journal of General Practice 2015.

Restraint system for core elements of a reactor core

International Nuclear Information System (INIS)

Class, G.

1975-01-01

In a nuclear reactor, a core element bundle formed of a plurality of side-by-side arranged core elements is surrounded by restraining elements that exert a radially inwardly directly restraining force generating friction forces between the core elements in a restraining plane that is transverse to the core element axes. The adjoining core elements are in rolling contact with one another in the restraining plane by virtue of rolling-type bearing elements supported in the core elements. (Official Gazette)

Caring to Care: Applying Noddings' Philosophy to Medical Education.

Science.gov (United States)

Balmer, Dorene F; Hirsh, David A; Monie, Daphne; Weil, Henry; Richards, Boyd F

2016-12-01

The authors argue that Nel Noddings' philosophy, "an ethic of caring," may illuminate how students learn to be caring physicians from their experience of being in a caring, reciprocal relationship with teaching faculty. In her philosophy, Noddings acknowledges two important contextual continuities: duration and space, which the authors speculate exist within longitudinal integrated clerkships. In this Perspective, the authors highlight core features of Noddings' philosophy and explore its applicability to medical education. They apply Noddings' philosophy to a subset of data from a previously published longitudinal case study to explore its "goodness of fit" with the experience of eight students in the 2012 cohort of the Columbia-Bassett longitudinal integrated clerkship. In line with Noddings' philosophy, the authors' supplementary analysis suggests that students (1) recognized caring when they talked about "being known" by teaching faculty who "cared for" and "trusted" them; (2) responded to caring by demonstrating enthusiasm, action, and responsibility toward patients; and (3) acknowledged that duration and space facilitated caring relations with teaching faculty. The authors discuss how Noddings' philosophy provides a useful conceptual framework to apply to medical education design and to future research on caring-oriented clinical training, such as longitudinal integrated clerkships.

Nurses' Time Use in Forensic Psychiatry: Core Interventions Outlined in the Finnish Clinical Practice Guideline on Schizophrenia.

Science.gov (United States)

Tenkanen, Helena; Taskinen, Helena; Kontio, Raija; Repo-Tiihonen, Eila; Tiihonen, Jari; Kinnunen, Juha

2016-01-01

Forensic psychiatric nurses are key in implementing the core interventions outlined in the clinical practice guideline on schizophrenia. This study endeavors to ascertain how these were implemented in routine practice in forensic psychiatry by measuring how nurses use their time. Data were collected from registered nurses and practical mental nurses in all forensic psychiatric facilities in Finland using self-report diary forms for 1 week. In total, nurses used 20% of their weekly working hours on core interventions. The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the following core interventions: (a) care planning with physicians, (b) pharmacotherapy, and (c) basic clinical care. Nurses' qualifications, types of facilities and units, working experience, gender, and staffing levels explained the time used on core interventions. In summary, forensic psychiatric inpatients received insufficient appropriate nursing services according to the relevant guideline regarding schizophrenia. Furthermore, managerial recommendations need to restructure nurses' time use to increase the proportion of productive working hours spent with patients.

The experiences of Batswana families regarding hospice care of ...

African Journals Online (AJOL)

M. F. Makhele & F. M. Mulaudzi * Fhumulani Mavis Mulaudzi is an associate professor and Head of Department at the University of Pretoria. She has published widely on Indigenous knowledge system. She received South African Women in Science award in 2011 for indigenous knowledge system. mavis.mulaudzi@up.ac.za

2012-06-20

Jun 20, 2012 ... The Batswana had mixed feelings about hospice care, because their beliefs on patient care .... Family-centred care is a core value of the Batswana. Although ... HIV/AIDS has adversely affected the socio-economic status of many countries ... The construction of these hospices evoked mixed feelings among.

[Epidemiological trends 1992-2007 in a neonatal intensive care unit].

Science.gov (United States)

Feria-Kaiser, Carina; Vargas, Mario H; Furuya, María E Y

2013-01-01

progressive advances in neonatal care are expected to change the epidemiological profile of patients and conditions seen in neonatal intensive care units (NICU). Thus, the objective of this study was to identify such changes in a NICU in Mexico City. retrospectively, we analyzed age, gender, weight at admission, hospital stay,diagnoses at discharge and cause of death in 5,192 patients admitted from 1992-2007. in the study period,patients were admitted at a progressively older age (median of 3 days old in 1992 to 9 in 2007; rS = 0.87) and lower weight (2,800-2,343 g; rS = –0.56), while length of hospital stay was stable (approximately, 9 days). Over 90% patients had cardiological, digestive and/or pulmonary diseases, and most patients (71.4%) had conditions for which a surgical approach is the usual treatment. Cardiological and neurologic problems increased (rS = 0.86 and 0.85, respectively),while pulmonary diseases decreased (rS = –0.79). Mortality and autopsy rate diminished from 26 to 15% (rS = –0.80),and from 32.5 to 10.7% (rS = –0.53), respectively. Conditions more frequently associated with death were urologic/nephrologic and infectious diseases. epidemiological patterns in our NICU are clearly changing, and thus searching for similar time trends in other NICU is warranted.

EFFECTS OF CORE STABILIZATION PROGRAM AND CONVENTIONAL EXERCISES IN THE MANAGEMENT OF PATIENTS WITH CHRONIC MECHANICAL LOW BACK PAIN

Directory of Open Access Journals (Sweden)

Suresh Babu Reddy .A

2015-04-01

Full Text Available Background: Conventional back care exercises are advocated to treat the pain and to strengthen the involved muscles. There will be possibility of the pain getting recurred due to disproportionate balance and stability in the muscles. The core stabilization is major trend in rehabilitation, it aims at improving stability during functional activities, balance, flexibility, strength training and effectively manage the pain as well. Objective: To find the efficacy of the concept of core stabilization when compared to conventional back care exercises in patients with chronic mechanical low back pain. Methods: Forty patients with chronic Mechanical Low back pain were selected through purposive sampling and were randomly assigned into control group who received conventional back exercises and SWD (n=20, experimental group who received core stabilization and SWD (n=20. Both the groups received SWD, along with conventional back exercises for one group and core stabilization for the other group three days a week for 6 weeks. The treatment outcome was assessed using visual analogue scale, Rolland Morris Disability Questionnaire and Lumbar range of motion using goniometer. Results: After a 6 weeks training period the core stabilization group scored significantly higher than the conventional group for VAS (p=0.05 RMDQ (p=0.05 whereas ROM improved higher in conventional group (p=0.05. Conclusion: After the treatment sessions Core stabilization group registered a significant improvement when compared to conventional back care exercises in improving function and in relieving pain.

Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis.

Science.gov (United States)

Neu, Alicia M; Richardson, Troy; Lawlor, John; Stuart, Jayne; Newland, Jason; McAfee, Nancy; Warady, Bradley A

2016-06-01

The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative aims to reduce peritonitis rates in pediatric chronic peritoneal dialysis patients by increasing implementation of standardized care practices. To assess this, monthly care bundle compliance and annualized monthly peritonitis rates were evaluated from 24 SCOPE centers that were participating at collaborative launch and that provided peritonitis rates for the 13 months prior to launch. Changes in bundle compliance were assessed using either a logistic regression model or a generalized linear mixed model. Changes in average annualized peritonitis rates over time were illustrated using the latter model. In the first 36 months of the collaborative, 644 patients with 7977 follow-up encounters were included. The likelihood of compliance with follow-up care practices increased significantly (odds ratio 1.15, 95% confidence interval 1.10, 1.19). Mean monthly peritonitis rates significantly decreased from 0.63 episodes per patient year (95% confidence interval 0.43, 0.92) prelaunch to 0.42 (95% confidence interval 0.31, 0.57) at 36 months postlaunch. A sensitivity analysis confirmed that as mean follow-up compliance increased, peritonitis rates decreased, reaching statistical significance at 80% at which point the prelaunch rate was 42% higher than the rate in the months following achievement of 80% compliance. In its first 3 years, the SCOPE Collaborative has increased the implementation of standardized follow-up care and demonstrated a significant reduction in average monthly peritonitis rates. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Core addiction medicine competencies for doctors: An international consultation on training.

Science.gov (United States)

Ayu, Astri Parawita; El-Guebaly, Nady; Schellekens, Arnt; De Jong, Cor; Welle-Strand, Gabrielle; Small, William; Wood, Evan; Cullen, Walter; Klimas, Jan

2017-01-01

Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology. We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.

Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis

NARCIS (Netherlands)

Tangri, N.; Grams, M.E.; Levey, A.S.; Coresh, J.; Appel, L.J.; Astor, B.C.; Chodick, G.; Collins, A.J.; Djurdjev, O.; Elley, C.R.; Evans, M.; Garg, A.X.; Hallan, S.I.; Inker, L.A.; Ito, S.; Jee, S.H.; Kovesdy, C.P.; Kronenberg, F.; Heerspink, H.J.; Marks, A.; Nadkarni, G.N.; Navaneethan, S.D.; Nelson, R.G.; Titze, S.; Sarnak, M.J.; Stengel, B.; Woodward, M.; Iseki, K.; Wetzels, J.F.M.; et al.,

2016-01-01

IMPORTANCE: Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations, including such factors as age, sex, estimated glomerular filtration rate, and calcium and phosphate concentrations, were previously

Comparing the performance of the public, social security and private health subsystems in Argentina by core dimensions of primary health care.

Science.gov (United States)

Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

2016-06-01

Most Latin American health systems are comprised of public (PubS), social security (SSS) and private (PrS) subsystems. These subsystems coexist, causing health care fragmentation and population segmentation. To estimate the extent of subsystem cross-coverage in a geographically bounded population (Rosario city) and to compare the subsystems' performance on primary health care (PHC) dimensions. Through a cross-sectional, interviewer-administered survey to a representative sample (n = 822) of the Rosario population, we measured the percentage of cross-coverage (people with usual source of care in one subsystem but also covered by another subsystem) and the health services' performance by core PHC dimensions, as reported by each subsystem's usual users. We compared the subsystems' performance using chi-square analysis and one-way analysis of variance testing. We analyzed whether the observed differences were coherent with the predominant institutional and organizational features of each subsystem. Overall, 39.3% of the population was affiliated with the PubS, 44.8% with the SSS and 15.9% with the PrS. Cross-coverage was reported by 40.6% of respondents. The performance of the PubS was weak on accessibility but strong on person-and-community-oriented care, the opposite of the PrS. The SSS combined the strengths of the other two subsystems. Rosario's health system has a high percentage of cross-coverage, contributing to issues of fragmentation, segmentation, financial inequity and inefficiency. The overall performance of the SSS was better than that of the PrS and PubS, though each subsystem had a particular performance pattern with areas of strength and weakness that were consistent with their institutional and organizational profiles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A Delphi study to identify the core components of nurse to nurse handoff.

Science.gov (United States)

O'Rourke, Jennifer; Abraham, Joanna; Riesenberg, Lee Ann; Matson, Jeff; Lopez, Karen Dunn

2018-03-08

The aim of this study was to identify the core components of nurse-nurse handoffs. Patient handoffs involve a process of passing information, responsibility and control from one caregiver to the next during care transitions. Around the globe, ineffective handoffs have serious consequences resulting in wrong treatments, delays in diagnosis, longer stays, medication errors, patient falls and patient deaths. To date, the core components of nurse-nurse handoff have not been identified. This lack of identification is a significant gap in moving towards a standardized approach for nurse-nurse handoff. Mixed methods design using the Delphi technique. From May 2016 - October 2016, using a series of iterative steps, a panel of handoff experts gave feedback on the nurse-nurse handoff core components and the content in each component to be passed from one nurse to the next during a typical unit-based shift handoff. Consensus was defined as 80% agreement or higher. After three rounds of participant review, 17 handoff experts with backgrounds in clinical nursing practice, academia and handoff research came to consensus on the core components of handoff: patient summary, action plan and nurse-nurse synthesis. This is the first study to identify the core components of nurse-nurse handoff. Subsequent testing of the core components will involve evaluating the handoff approach in a simulated and then actual patient care environment. Our long-term goal is to improve patient safety outcomes by validating an evidence-based handoff framework and handoff curriculum for pre-licensure nursing programmes that strengthen the quality of their handoff communication as they enter clinical practice. © 2018 John Wiley & Sons Ltd.

Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit

Science.gov (United States)

Fishman, Scott M; Young, Heather M; Lucas Arwood, Ellyn; Chou, Roger; Herr, Keela; Murinson, Beth B; Watt-Watson, Judy; Carr, Daniel B; Gordon, Debra B; Stevens, Bonnie J; Bakerjian, Debra; Ballantyne, Jane C; Courtenay, Molly; Djukic, Maja; Koebner, Ian J; Mongoven, Jennifer M; Paice, Judith A; Prasad, Ravi; Singh, Naileshni; Sluka, Kathleen A; St Marie, Barbara; Strassels, Scott A

2013-01-01

Objective The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. Methods An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. Results The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. Conclusions These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain. PMID:23577878

The cost of caring for young children

OpenAIRE

Rosenbaum, Dan T.; Ruhm, Christopher J.

2005-01-01

This study examines the "cost burden" of child care, defined as day care expenses divided by after-tax income. Data are from the wave 10 core and child care topical modules to the 1996 Survey of Income and Program Participation. We estimate that the average child under six years of age lives in a family that spends 4.9 percent of after-tax income on day care. However, this conceals wide variation: 63 percent of such children reside in families with no child care expenses and 10 percent are in...

Understanding the mobile internet to develop the next generation of online medical teaching tools.

Science.gov (United States)

Desai, Tejas; Christiano, Cynthia; Ferris, Maria

2011-01-01

Healthcare providers (HCPs) use online medical information for self-directed learning and patient care. Recently, the mobile internet has emerged as a new platform for accessing medical information as it allows mobile devices to access online information in a manner compatible with their restricted storage. We investigated mobile internet usage parameters to direct the future development of mobile internet teaching websites. Nephrology On-Demand Mobile (NOD(M)) (http://www.nephrologyondemand.org) was made accessible to all mobile devices. From February 1 to December 31, 2010, HCP use of NOD(M) was tracked using code inserted into the root files. Nephrology On-Demand received 15,258 visits, of which approximately 10% were made to NOD(M), with the majority coming from the USA. Most access to NOD(M) was through the Apple iOS family of devices and cellular connections were the most frequently used. These findings provide a basis for the future development of mobile nephrology and medical teaching tools.

77 FR 41273 - Core Values and Characteristics of the Department

Science.gov (United States)

2012-07-13

... single worker plays a critical role in supporting the overall strategic vision and mission of the agency..., most importantly, become an enduring part of the VA culture. The ``I CARE'' logo will be prominently... all the time, the Core Values and Characteristics are meant to endure. There are no immediate plans to...

Core content for training in venous and lymphatic medicine.

Science.gov (United States)

Zimmet, Steven E; Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F

2014-10-01

The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Knowledge attitude and practice (kap) of chronic kidneys disease among medical officers of teaching hospitals of lahore

International Nuclear Information System (INIS)

Anees, M.; Mumtaz, A.

2014-01-01

This study was conducted to determine the knowledge, attitude and practice (KAP) about kidney diseases among medical officers working in different hospitals of Lahore.Doctors working on the medical floors of different tertiary care teaching hospitals (Mayo Hospital (MH), Sir Ganga Ram Hospital (SGRH), Service Institute of Medical Sciences (SIMS), Fatima Memoral Hospitals (FMH), Lahore General Hospitals (LGH), Shalamar Hospital (SH), Jinnah hospital (JH)) of Lahore were included in the study. Each doctor was given a questionnaire comprising of 28 questions. Each participant was given 10-15 minutes for completing the questionnaire at the spot. Categorization of doctors according to the KAP score was done as poor ( 70%).Results: One hundred eighty five doctors participated in the study who fulfilled the criteria. In this study majority 134 (62.6%) of the doctors were not taught about nephrology during their graduation which was statistically significant. Most of the doctors either had some knowledge or didn't know about procedures done in nephrology. Majority of the doctors 208(97.2%) know that nephrology deals with medical diseases of the kidney which was statistically significant. Most of the doctors 138(64.5) feel that nephrology services are insufficient in their hospital. More than 90% doctors want that kidney diseases should be taught during MBBS curriculum and separate nephrology department should be established which was statistically significant. Most of the doctors don't know the management of hyperkalemia very well. About 90% of the doctors know that there are five stages of CKD. Majority of the doctors know that ACE inhibitors are used in hypertension and diabetic nephropathy. They also know that urine complete examination help in early detection of diabetic nephropathy which was statistically significant.Conclusion:Most of the doctors have poor to average knowledge and practice about kidney diseases. Most of the doctors think that nephrology services are

CORE STABILIZATION PROGRAM AND CONVENTIONAL EXERCISES IN THE PATIENTS WITH LOW BACK PAIN-A COMPARATIVE STUDY

Directory of Open Access Journals (Sweden)

Dr. Venkata Naga Prahalada Karnati

2015-02-01

Full Text Available Background: Conventional back care exercises are advocated to treat the pain and to strengthen the involved muscles. There will always be the possibility of the pain getting recurred due to disproportionate balance and stability in the muscles. The core stabilization is major trend in rehabilitation. It aims at improving stability during functional activities, balance, flexibility, strength training and effectively manage the pain as well. Methods: Forty patients with chronic Mechanical Low back pain were randomly assigned into control group that received conventional back exercises and SWD (n=20, experimental group received core stabilization and SWD (n=20. Both the groups received SWD, along with conventional back exercises for one-group and core stabilization for the other group 3 days a week for 6 weeks .The treatment outcome was assessed using visual analogue scale, Rolland Morris Disability Questionnaire and Lumbar range of motion by using goniometer. Results: After a 6 week training period the core stabilization group scored significantly higher than the conventional group for VAS (p=0.05 and RMDQ (p=0.05 where as ROM improved higher in conventional group (p=0.05 Conclusion: After the treatment sessions Core stabilization group registered a significant improvement when compared to conventional back care exercises in improving function and in relieving pain.

Linkage in the chain of care: a grounded theory of professional cooperation between antenatal care, postpartum care and child health care

Directory of Open Access Journals (Sweden)

Mia Barimani

2008-12-01

Full Text Available Purpose: The purpose of this article is to present a Swedish study exploring health care professionals’ cooperation in the chain of care for expectant and new parents between antenatal care (AC, postpartum care (PC and child health care (CHC. Furthermore, the rationale was to conceptualise barriers and facilitators of cooperation in order to generate a comprehensive theoretical model which may explain variations in the care providers’ experiences. Methods: Thirty-two midwives and CHC nurses were interviewed in five focus group – and two individual interviews in a suburb of a large Swedish city. Grounded Theory was applied as the research methodology. Results: One core category was discerned: linkage in the chain of care, including six categories with subcategories. Despite the fact that midwives as well as CHC nurses have common visions about linkage, cooperation is not achieved because of interacting barriers that have different influences on the three links in the chain. Conclusions: Barriers to linkage are lack of professional gain, link perspective and first or middle position in the chain, while facilitators are chain perspective, professional gain and last position in the chain. As the last link, CHC nurses promote a linkage most strongly and have the greatest gain from such linking.

Core lifter

Energy Technology Data Exchange (ETDEWEB)

Pavlov, N G; Edel' man, Ya A

1981-02-15

A core lifter is suggested which contains a housing, core-clamping elements installed in the housing depressions in the form of semirings with projections on the outer surface restricting the rotation of the semirings in the housing depressions. In order to improve the strength and reliability of the core lifter, the semirings have a variable transverse section formed from the outside by the surface of the rotation body of the inner arc of the semiring aroung the rotation axis and from the inner a cylindrical surface which is concentric to the outer arc of the semiring. The core-clamping elements made in this manner have the possibility of freely rotating in the housing depressions under their own weight and from contact with the core sample. These semirings do not have weakened sections, have sufficient strength, are inserted into the limited ring section of the housing of the core lifter without reduction in its through opening and this improve the reliability of the core lifter in operation.

Side core lifter

Energy Technology Data Exchange (ETDEWEB)

Edelman, Ya A

1982-01-01

A side core lifter is proposed which contains a housing with guide slits and a removable core lifter with side projections on the support section connected to the core receiver. In order to preserve the structure of the rock in the core sample by means of guaranteeing rectilinear movement of the core lifter in the rock, the support and core receiver sections are hinged. The device is equipped with a spring for angular shift in the core-reception part.

Core mechanics and configuration behavior of advanced LMFBR core restraint concepts

International Nuclear Information System (INIS)

Fox, J.N.; Wei, B.C.

1978-02-01

Core restraint systems in LMFBRs maintain control of core mechanics and configuration behavior. Core restraint design is complex due to the close spacing between adjacent components, flux and temperature gradients, and irradiation-induced material property effects. Since the core assemblies interact with each other and transmit loads directly to the core restraint structural members, the core assemblies themselves are an integral part of the core restraint system. This paper presents an assessment of several advanced core restraint system and core assembly concepts relative to the expected performance of currently accepted designs. A recommended order for the development of the advanced concepts is also presented

Implementation of primary health care - package or process ...

African Journals Online (AJOL)

After establishing the commitment of the government to comprehensive primary health care (PHC), the Department of Health and provinces are now faced with the challenge of implementation. An important response has come with the recent proposed'core package of primary health care services'.' After consultation with ...

Creating value-focused healthcare delivery systems: Part three--Core competencies.

Science.gov (United States)

Beveridge, R N

1997-01-01

Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost

Zásady ošetřovatelské péče o dítě s akutním ledvinovým selháním

OpenAIRE

HOLUBCOVÁ, Eliška

2014-01-01

The thesis principles of nursing care for a child with renal failure is engaged in nursing activities in nephrology and cardiology intensive care unit of a hospital in Prague - Motol. Acute renal failure is defined as a condition where there is a sudden , usually reversible renal impairment, which were totally wrong , or very little damage. Besides the medical approach to this disease in acute renal failure urgently needed highly skilled nursing care. When nursing care for sick children teamw...

Infrastructure for Personalized Medicine at Partners HealthCare

Directory of Open Access Journals (Sweden)

Scott T. Weiss

2016-02-01

Full Text Available Partners HealthCare Personalized Medicine (PPM is a center within the Partners HealthCare system (founded by Massachusetts General Hospital and Brigham and Women’s Hospital whose mission is to utilize genetics and genomics to improve the care of patients in a cost effective manner. PPM consists of five interconnected components: (1 Laboratory for Molecular Medicine (LMM, a CLIA laboratory performing genetic testing for patients world-wide; (2 Translational Genomics Core (TGC, a core laboratory providing genomic platforms for Partners investigators; (3 Partners Biobank, a biobank of samples (DNA, plasma and serum for 50,000 Consented Partners patients; (4 Biobank Portal, an IT infrastructure and viewer to bring together genotypes, samples, phenotypes (validated diagnoses, radiology, and clinical chemistry from the electronic medical record to Partners investigators. These components are united by (5 a common IT system that brings researchers, clinicians, and patients together for optimal research and patient care.

Internal medicine rounding practices and the Accreditation Council for Graduate Medical Education core competencies.

Science.gov (United States)

Shoeb, Marwa; Khanna, Raman; Fang, Margaret; Sharpe, Brad; Finn, Kathleen; Ranji, Sumant; Monash, Brad

2014-04-01

The Accreditation Council for Graduate Medical Education (ACGME) has established the requirement for residency programs to assess trainees' competencies in 6 core domains (patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice). As attending rounds serve as a primary means for educating trainees at academic medical centers, our study aimed to identify current rounding practices and attending physician perceived capacity of different rounding models to promote teaching within the ACGME core competencies. We disseminated a 24-question survey electronically using educational and hospital medicine leadership mailing lists. We assessed attending physician demographics and the frequency with which they used various rounding models, as defined by the location of the discussion of the patient and care plan: bedside rounds (BR), hallway rounds (HR), and card-flipping rounds (CFR). Using the ACGME framework, we assessed the perceived educational value of each model. We received 153 completed surveys from attending physicians representing 34 institutions. HR was used most frequently for both new and established patients (61% and 43%), followed by CFR for established patients (36%) and BR for new patients (22%). Most attending physicians indicated that BR and HR were superior to CFR in promoting the following ACGME competencies: patient care, systems-based practice, professionalism, and interpersonal skills. HR is the most commonly employed rounding model. BR and HR are perceived to be valuable for teaching patient care, systems-based practice, professionalism, and interpersonal skills. CFR remains prevalent despite its perceived inferiority in promoting teaching across most of the ACGME core competencies. © 2014 Society of Hospital Medicine.

How cores grow by pebble accretion. I. Direct core growth

Science.gov (United States)

Brouwers, M. G.; Vazan, A.; Ormel, C. W.

2018-03-01

Context. Planet formation by pebble accretion is an alternative to planetesimal-driven core accretion. In this scenario, planets grow by the accretion of cm- to m-sized pebbles instead of km-sized planetesimals. One of the main differences with planetesimal-driven core accretion is the increased thermal ablation experienced by pebbles. This can provide early enrichment to the planet's envelope, which influences its subsequent evolution and changes the process of core growth. Aims: We aim to predict core masses and envelope compositions of planets that form by pebble accretion and compare mass deposition of pebbles to planetesimals. Specifically, we calculate the core mass where pebbles completely evaporate and are absorbed before reaching the core, which signifies the end of direct core growth. Methods: We model the early growth of a protoplanet by calculating the structure of its envelope, taking into account the fate of impacting pebbles or planetesimals. The region where high-Z material can exist in vapor form is determined by the temperature-dependent vapor pressure. We include enrichment effects by locally modifying the mean molecular weight of the envelope. Results: In the pebble case, three phases of core growth can be identified. In the first phase (Mcore mixes outwards, slowing core growth. In the third phase (Mcore > 0.5M⊕), the high-Z inner region expands outwards, absorbing an increasing fraction of the ablated material as vapor. Rainout ends before the core mass reaches 0.6 M⊕, terminating direct core growth. In the case of icy H2O pebbles, this happens before 0.1 M⊕. Conclusions: Our results indicate that pebble accretion can directly form rocky cores up to only 0.6 M⊕, and is unable to form similarly sized icy cores. Subsequent core growth can proceed indirectly when the planet cools, provided it is able to retain its high-Z material.

Comparison of facility characteristics between SCTF Core-I and Core-II

International Nuclear Information System (INIS)

Adachi, Hiromichi; Iwamura, Takamichi; Sobajima, Makoto; Ohnuki, Akira; Abe, Yutaka; Murao, Yoshio.

1990-08-01

The Slab Core Test Facility (SCTF) was constructed to investigate two-dimensional thermal-hydraulics in the core and fluid behavior of carryover water out of the core including its feed-back effect to the core behavior mainly during the reflood phase of a large break loss-of-coolant accident (LOCA) of a pressurized water reactor (PWR). Since three simulated cores are used in the SCTF Test Program and the design of these three cores are slightly different one by one, repeatability test is required to justify a direct comparison of data obtained with different cores. In the present report, data of Test S2-13 (Run 618) obtained with SCTF Core-II were compared with those of Test S1-05 (Run 511) obtained with the Core-I, which were performed under the forced-flooding condition. Thermal-hydraulic behaviors in these two tests showed quite similar characteristics of both system behavior and two-dimensional core behaviors. Therefore, the test data obtained from the two cores can be compared directly with each other. After the turnaround of clad temperatures, however, some differences were found in upper plenum water accumulation and resultant two-dimensional core cooling behaviors such as quench front propagation from bottom to top of the core. (author)

Occupational Therapy experience in family care in a primary health care service

Directory of Open Access Journals (Sweden)

Gisele Baissi

2013-08-01

Full Text Available Occupational therapy is presented as the core knowledge involved in the remodeling and strengthening of Primary Health Care in the Brazilian Unified Health Care System (Sistema Único de Saúde – SUS. In this study, we aimed to describe the interventions in the process of occupational therapy in supervised family care in a primary health care service in the municipality of Várzea Paulista, São Paulo state. In this case study, the moments of care were described and analyzed in light of narratives on the supervised practice of occupational therapy with a family. The results showed forms of intervention that characterize the process of occupational therapy focused on family health needs in favor of creativity and the role for changes in health practices in everyday life. Through the accomplishment of occupational activities directed to self-care, Occupational Therapy can aid families to cope with daily life adversity.

Helping Children and Youth with Attention-Deficit/Hyperactivity Disorder: Systems of Care

Science.gov (United States)

... is why only qualified health care or mental health care providers can diagnose ADHD, and why it is important that supports be in place to bridge differences in language and culture. The Core Values of Systems of Care Although ...

Temporal Change of Seismic Earth's Inner Core Phases: Inner Core Differential Rotation Or Temporal Change of Inner Core Surface?

Science.gov (United States)

Yao, J.; Tian, D.; Sun, L.; Wen, L.

2017-12-01

Since Song and Richards [1996] first reported seismic evidence for temporal change of PKIKP wave (a compressional wave refracted in the inner core) and proposed inner core differential rotation as its explanation, it has generated enormous interests in the scientific community and the public, and has motivated many studies on the implications of the inner core differential rotation. However, since Wen [2006] reported seismic evidence for temporal change of PKiKP wave (a compressional wave reflected from the inner core boundary) that requires temporal change of inner core surface, both interpretations for the temporal change of inner core phases have existed, i.e., inner core rotation and temporal change of inner core surface. In this study, we discuss the issue of the interpretation of the observed temporal changes of those inner core phases and conclude that inner core differential rotation is not only not required but also in contradiction with three lines of seismic evidence from global repeating earthquakes. Firstly, inner core differential rotation provides an implausible explanation for a disappearing inner core scatterer between a doublet in South Sandwich Islands (SSI), which is located to be beneath northern Brazil based on PKIKP and PKiKP coda waves of the earlier event of the doublet. Secondly, temporal change of PKIKP and its coda waves among a cluster in SSI is inconsistent with the interpretation of inner core differential rotation, with one set of the data requiring inner core rotation and the other requiring non-rotation. Thirdly, it's not reasonable to invoke inner core differential rotation to explain travel time change of PKiKP waves in a very small time scale (several months), which is observed for repeating earthquakes in Middle America subduction zone. On the other hand, temporal change of inner core surface could provide a consistent explanation for all the observed temporal changes of PKIKP and PKiKP and their coda waves. We conclude that

Fe-based nanocrystalline powder cores with ultra-low core loss

Energy Technology Data Exchange (ETDEWEB)

Wang, Xiangyue, E-mail: wangxiangyue1986@163.com [China Iron and Steel Research Institute Group, Beijing 100081 (China); Center of Advanced Technology and Materials Co., Ltd., Beijing 100081 (China); Lu, Zhichao; Lu, Caowei; Li, Deren [China Iron and Steel Research Institute Group, Beijing 100081 (China); Center of Advanced Technology and Materials Co., Ltd., Beijing 100081 (China)

2013-12-15

Melt-spun amorphous Fe{sub 73.5}Cu{sub 1}Nb{sub 3}Si{sub 15.5}B{sub 7} alloy strip was crushed to make flake-shaped fine powders. The passivated powders by phosphoric acid were mixed with organic and inorganic binder, followed by cold compaction to form toroid-shaped bonded powder-metallurgical magnets. The powder cores were heat-treated to crystallize the amorphous structure and to control the nano-grain structure. Well-coated phosphate-oxide insulation layer on the powder surface decreased the the core loss with the insulation of each powder. FeCuNbSiB nanocrystalline alloy powder core prepared from the powder having phosphate-oxide layer exhibits a stable permeability up to high frequency range over 2 MHz. Especially, the core loss could be reduced remarkably. At the other hand, the softened inorganic binder in the annealing process could effectively improve the intensity of powder cores. - Highlights: • Fe-based nanocrystalline powder cores were prepared with low core loss. • Well-coated phosphate-oxide insulation layer on the powder surface decreased the core loss. • Fe-based nanocrystalline powder cores exhibited a stable permeability up to high frequency range over 2 MHz. • The softened inorganic binder in the annealing process could effectively improve the intensity of powder cores.

Accountable Care Organizations: Integrated Care Meets Market Power.

Science.gov (United States)

Scheffler, Richard M

2015-08-01

Will accountable care organizations (ACOs) deliver high-quality care at lower costs? Or will their potential market power lead to higher prices and lower quality? ACOs appear in various forms and structures with financial and clinical integration at their core; however, the tools to assess their quality and the incentive structures that will determine their success are still evolving. Both market forces and regulatory structures will determine how these outcomes emerge. This introduction reviews the evidence presented in this special issue to tackle this thorny trade-off. In general the evidence is promising, but the full potential of ACOs to improve the health care delivery system is still uncertain. This introductory review concludes that the current consensus is to let ACOs grow, anticipating that they will make a contribution to improve our poor-quality and high-cost delivery system. Copyright © 2015 by Duke University Press.

In-core Instrument Subcritical Verification (INCISV) - Core Design Verification Method - 358

International Nuclear Information System (INIS)

Prible, M.C.; Heibel, M.D.; Conner, S.L.; Sebastiani, P.J.; Kistler, D.P.

2010-01-01

According to the standard on reload startup physics testing, ANSI/ANS 19.6.1, a plant must verify that the constructed core behaves sufficiently close to the designed core to confirm that the various safety analyses bound the actual behavior of the plant. A large portion of this verification must occur before the reactor operates at power. The INCISV Core Design Verification Method uses the unique characteristics of a Westinghouse Electric Company fixed in-core self powered detector design to perform core design verification after a core reload before power operation. A Vanadium self powered detector that spans the length of the active fuel region is capable of confirming the required core characteristics prior to power ascension; reactivity balance, shutdown margin, temperature coefficient and power distribution. Using a detector element that spans the length of the active fuel region inside the core provides a signal of total integrated flux. Measuring the integrated flux distributions and changes at various rodded conditions and plant temperatures, and comparing them to predicted flux levels, validates all core necessary core design characteristics. INCISV eliminates the dependence on various corrections and assumptions between the ex-core detectors and the core for traditional physics testing programs. This program also eliminates the need for special rod maneuvers which are infrequently performed by plant operators during typical core design verification testing and allows for safer startup activities. (authors)

Waves in the core and mechanical core-mantle interactions

DEFF Research Database (Denmark)

Jault, D.; Finlay, Chris

2015-01-01

This Chapter focuses on time-dependent uid motions in the core interior, which can beconstrained by observations of the Earth's magnetic eld, on timescales which are shortcompared to the magnetic diusion time. This dynamics is strongly inuenced by the Earth's rapid rotation, which rigidies...... the motions in the direction parallel to the Earth'srotation axis. This property accounts for the signicance of the core-mantle topography.In addition, the stiening of the uid in the direction parallel to the rotation axis gives riseto a magnetic diusion layer attached to the core-mantle boundary, which would...... otherwisebe dispersed by Alfven waves. This Chapter complements the descriptions of large-scaleow in the core (8.04), of turbulence in the core (8.06) and of core-mantle interactions(8.12), which can all be found in this volume. We rely on basic magnetohydrodynamictheory, including the derivation...

A core design study for 'zero-sodium-void-worth' cores

International Nuclear Information System (INIS)

Kawashima, Masatoshi; Suzuki, Masao; Hill, R.N.

1992-01-01

Recently, a number of low sodium-void-worth metal-fueled core design concepts have been proposed; to provide for flexibility in transuranic nuclide management strategy, core designs which exhibit a wide range of breeding characteristics have been developed. Two core concepts, a flat annular (transuranic burning) core and an absorber-type parfait (transuranic self-sufficient) core, are selected for this study. In this paper, the excess reactivity management schemes applied in the two designs are investigated in detail. In addition, the transient effect of reactivity insertions on the parfait core design is assessed. The upper and lower core regions in the parfait design are neutronically decoupled; however, the common coolant channel creates thermalhydraulic coupling. This combination of neutronic and thermalhydraulic characteristics leads to unique behavior in anticipated transient overpower events. (author)

Dialysis Exercise Team: The Way to Sustain Exercise Programs in Hemodialysis Patients

OpenAIRE

Alessandro Capitanini; Sara Lange; Claudia D'Alessandro; Emilio Salotti; Alba Tavolaro; Maria E. Baronti; Domenico Giannese; Adamasco Cupisti

2014-01-01

Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involv...

k-core covers and the core

NARCIS (Netherlands)

Sanchez-Rodriguez, E.; Borm, Peter; Estevez-Fernandez, A.; Fiestras-Janeiro, G.; Mosquera, M.A.

This paper extends the notion of individual minimal rights for a transferable utility game (TU-game) to coalitional minimal rights using minimal balanced families of a specific type, thus defining a corresponding minimal rights game. It is shown that the core of a TU-game coincides with the core of

Using social media to create a professional network between physician-trainees and the American Society of Nephrology.

Science.gov (United States)

Shariff, Afreen I; Fang, Xiangming; Desai, Tejas

2013-07-01

Twitter is the fastest growing social media network. It offers participants the ability to network with other individuals. Medical societies are interested in helping individuals network to boost recruitment, encourage collaboration, and assist in job placement. We hypothesized that the American Society of Nephrology (ASN) successfully used Twitter to create a network between participants and itself to stay connected with its members. Tweets from 3 Twitter networking sessions during Kidney Week 2011 were analyzed for content. These messages were used to create a network between all participants of the networking sessions. The network was analyzed for strength and influence by calculating clustering coefficients (CC) and eigenvector centrality (EC) scores, respectively. Eight moderators and 9 trainees authored 376 Twitter messages. Most tweets by trainees (64%) and moderators (61%) discussed 1 of 3 themes: networking, education, or navigating Kidney Week 2011. A total of 25 online network connections were established during the 3 sessions; 20% were bidirectional. The CC for the network was 0.300. All moderators formed at least 1 connection, but 7 of the 9 trainees failed to make any connections. ASN made 5 unidirectional and 0 bidirectional connections with a low EC of 0.108. ASN was unable to form powerful connections with trainees through Twitter, but medical societies should not be discouraged by the results reported in this investigation. As societies become more familiar with Twitter and understand the mechanisms to develop connections, these societies will have a greater influence within increasingly stronger networks. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Telemedicine: Development of a distance care system for pre-dialysis chronic kidney disease patients.

Science.gov (United States)

Fernandes, Natália Maria da Silva; Bastos, Marcus Gomes; Oliveira, Nivalda A C de; Costa, Alex do Vale; Bernardino, Heder Soares

2015-01-01

The focus in the treatment of CKD is to prevent its progression through optimal medical control. The large number of patients with CKD has pressed nephrologists to assess more patients into ever-smaller periods of consultation. The use of light technologies as a promising form of health care. The internet offers the opportunity to manipulate the doctor in his professional contact with the user. To develop a web system to attend the patients with CKD not on dialysis and clinically stable stages at distance. Developed a system using the Java language, MySQL database and PrimeFaces framework; available on a Glassfish application server. The initial access is performed by the nephrologist, which registers the patients with their personal information and access data. After being registered, the patient (or family doctor) can enter the data of your query and these will be following, passed on to the nephrologist for evaluation. The form with the data of interest is pre-determined, but there is possibility to add free-form information. The system enables, in addition, there is exchange of messages between doctors and patients. In addition, users receive messages via e-mail alerting them of their duties. Confidentiality is guaranteed by individual passwords for doctors and patients. This tool will enable to increase the coverage area of nephrologists, reduce costs and bring the patient to the primary care physician, using the Family Health Program as an interface between the patient and the nephrology secondary care.

Core Addiction Medicine Competencies for Doctors, An International Consultation on Training.

LENUS (Irish Health Repository)

Ayu, Astri Parawita

2017-07-18

Despite the high prevalence of substance use disorders, associated comorbidities and the evidence-base upon which to base clinical practice, most health systems have not invested in standardised training of healthcare providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, we undertook this study to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education.

Maternity care: a narrative overview of what women expect across their care continuum.

Science.gov (United States)

Clark, Kim; Beatty, Shelley; Reibel, Tracy

2015-04-01

to provide a narrative overview of the values schema underpinning women׳s expectations of public maternity-care services using an episodes-of-care framework. focus-group discussions and in-depth interviews were undertaken with Western Australian women who had opted for public maternity care to determine the values schema apparent in their expectations of their care. public maternity-care services in metropolitan (i.e. Armadale, Osborne Park and Rockingham) and regional (i.e. Broome, Geraldton, Bunbury) Western Australia. women interviewed were found to have consistent values schema underpinning their maternity-care expectations and evaluations. the current study suggests that while women׳s choices and experiences of maternity care may differ on a range of dimensions, the values schema underlying their care expectations and subsequent evaluations are similar. The study findings resonate with past Australian research regarding women׳s expectations of public maternity care, but complement it by providing a coherent narrative of core underpinning stage-specific values schema. These may assist maternity-care policy makers, practitioners and researchers seeking to better understand and comprehensively respond to women׳s maternity-care expectations. Copyright © 2015 Elsevier Ltd. All rights reserved.

45 CFR 1355.40 - Foster care and adoption data collection.

Science.gov (United States)

2010-10-01

... § 1355.40 Foster care and adoption data collection. (a) Scope of the data collection system. (1) Each... children who enter foster care prior to October 1, 1995 and who are still in the system, core data elements... of foster care data reports. (1) For each child, a computer generated transaction date must reflect...

Burnout among middle-grade doctors of tertiary care hospital in Saudi Arabia.

Science.gov (United States)

Agha, Adnan; Mordy, Ayedh; Anwar, Eram; Saleh, Noha; Rashid, Imran; Saeed, Mona

2015-01-01

Burnout Syndrome is a mental condition caused by chronic exposure to work related stress and is identified by the presence of any of the three distinct elements of emotional exhaustion, depersonalization and lack of personal accomplishment. Middle grade doctors are the backbone of any tertiary care hospital / medical institution, partaking in unscheduled and inpatient care. The aim of this study was to assess the presence of burnout syndrome in the middle grade doctors in a tertiary care hospital in Saudi Arabia. The study was conducted at the Armed Forces Hospital Southern Region, Khamis Mushyt, from August to October 2012 in departments with at least fifty inpatient admissions per month and with at least five middle grade (Resident, Registrar and Senior Registrar) doctors. The departments were Obstetrics and Gynecology, Internal Medicine, Pediatrics, Emergency, General Surgery and Nephrology. This was a cross sectional descriptive and analytical study using the Maslach Burnout Inventory-Health Services Survey and a self-reported stressor-identifying questionnaire to ascertain possible precursors of, or contributing factors to, Burnout Syndrome. A total of 96 proformas/questionnaires were collected anonymously to maintain confidentiality and burnout syndrome was identified in as high as 88.5% of the respondents with high emotional exhaustion in 68.8%, high depersonalization in 63.6% and low personal accomplishment in 38.5%. The authors concluded that burnout syndrome is high among the middle-grade doctors in this medical facility and that urgent steps are needed to address this problem to ensure that these physicians remain physically and mentally healthy.

Safety aspects of the RECH-1 core conversion

International Nuclear Information System (INIS)

Wetherby, Jaime Riesle

1998-01-01

When the RECH-1 research reactor joined the core conversion program for low enrichment fuel, the need to review some safety related aspects, which are currently under way with different degrees of progress, became apparent. The mentioned aspects can be grouped into: evaluation of the technical specifications of the new fuel elements: the technical specifications were carefully verified and contrasted with the recommendations of the IAEA and with those of manufacturers which are widely known for their expertise. (author)

Colistin Pharmacokinetics in Burn Patients During Continuous Venovenous Hemofiltration

Science.gov (United States)

2015-01-01

Bethesda, Maryland, USAc; University of the Incarnate Word, Feik School of Pharmacy, San Antonio, Texas, USAd; Uniformed Services University of the Health ...survey of renal replacement therapy prescribing prac- tice for acute kidney injury in Malaysian intensive care units. Nephrology (Carlton) 19:507–512

Core catcher for nuclear reactor core meltdown containment

International Nuclear Information System (INIS)

Driscoll, M.J.; Bowman, F.L.

1978-01-01

A bed of graphite particles is placed beneath a nuclear reactor core outside the pressure vessel but within the containment building to catch the core debris in the event of failure of the emergency core cooling system. Spray cooling of the debris and graphite particles together with draining and flooding of coolant fluid of the graphite bed is provided to prevent debris slump-through to the bottom of the bed

The Core Competencies for General Orthopaedic Surgeons.

Science.gov (United States)

Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

2017-01-18

With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These

Health information technology: help or hindrance?

Science.gov (United States)

Ketchersid, Terry

2014-07-01

The practice of medicine in general and nephrology in particular grows increasingly complex with each passing year. In parallel with this trend, the purchasers of health care are slowly shifting the reimbursement paradigm from one based on rewarding transactions, or work performed, to one that rewards value delivered. Within this context, the health-care value equation is broadly defined as quality divided by costs. Health information technology has been widely recognized as 1 of the foundations for delivering better care at lower costs. As the largest purchaser of health care in the world, the Centers for Medicare and Medicaid Services has deployed a series of interrelated programs designed to spur the adoption and utilization of health information technology. This review examines our known collective experience in the practice of nephrology to date with several of these programs and attempts to answer the following question: Is health information technology helping or hindering the delivery of value to the nation's health-care system? Through this review, it was concluded overall that the effect of health information technology appears positive; however, it cannot be objectively determined because of the infancy of its utilization in the practice of medicine. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of percutaneous kidney biopsy complications in ambulatory patients- a two year review from a tertiary care centre

International Nuclear Information System (INIS)

Mansoor, K.; Azam, N.; Hashim, R.

2016-01-01

Objective: To evaluate the complications of percutaneous kidney biopsy in ambulatory patients in a tertiary care centre over a two year period. Study Design: Cross sectional, descriptive. Place and Duration of Study: The study was carried out at the Department of Nephrology Military Hospital, Rawalpindi from Jan 2008 to Jan 2010. Material and Methods: Patients referred to the Nephrology Department for kidney biopsy were considered for inclusion in the study provided they did not have any contraindications to the procedure and had a normotensive state with BP <130/90 mm Hg and a normal coagulation profile including partial thromboplastin time, prothrombin time, bleeding time and platelet count. Patients with an evidence of malignancy, congenital anomalies of kidneys on ultrasound examination or a skin disorder affecting the likely site of biopsy were excluded. Results: A total of 100 patients who merited standard indications for kidney biopsy were included in the study. Average age was 45.53 years (+1 SD = 10.96) with age range of 25 years to 75 years. There were 83 males (83 percent) and 17 females (17 percent) with male to female ratio of 4.9:1. Microscopic hematuria occurred in 82 (82 percent) patients. Gross hematuria occurred in 12 (12 percent) patients. Decrease in hemoglobin level by 1 g/dL or more occurred in 35 (35 percent). There was no episode of hypotension secondary to severe bleeding. No patient required transfusion. Surgery was not required in any patient for controlling bleeding. Death was not recorded among the reported complications. Conclusion: Percutaneous kidney biopsy can be safely conducted as an outpatient procedure with an observation time of 12 hours post-biopsy to watch for any complications. (author)

Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues.

Science.gov (United States)

Goligher, Ewan C; Ely, E Wesley; Sulmasy, Daniel P; Bakker, Jan; Raphael, John; Volandes, Angelo E; Patel, Bhavesh M; Payne, Kate; Hosie, Annmarie; Churchill, Larry; White, Douglas B; Downar, James

2017-02-01

Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting. We present areas of common ground and important unresolved differences. We reached differing positions on the first three core ethical questions and achieved unanimity on how critical care clinicians should manage conscientious objections related to physician-assisted suicide and euthanasia. The alternative positions presented in this article may serve to promote open and informed dialogue within the critical care community.

Demonstration of the usefulness of a theoretical framework for humanising care with reference to a residential aged care service in Australia.

Science.gov (United States)

Borbasi, Sally; Galvin, Kathleen T; Adams, Trevor; Todres, Les; Farrelly, Brona

2013-03-01

To demonstrate the usefulness of a theoretical framework for humanising care of dementia patients. The term humanisation of care has been increasingly used to describe an approach to health care that is informed by core dimensions of what it means to be human. Recent developments in dementia care highlight the importance of maintaining personhood in people with dementia. A conceptual framework is proposed by which the humanisation of care can be understood and applied. Eight dimensions that articulate core features of what needs to be attended to in order for a person to feel more deeply 'met' as a human being are discussed. Evidence from an evaluative study of a dementia outreach service is used to illustrate the usefulness of the humanising framework. Case study examples demonstrate the value of this framework by describing how a dementia outreach service enables care staff in residential aged care facilities to change their focus in the provision of care to residents with dementia. Each of the eight dimensions of humanisation/dehumanisation is used to illustrate how the dementia outreach service team have led to the improvements in resident care. Positive outcomes can be achieved by providing humanised care to residents with dementia. The paper highlights the potential for the humanising framework to be used in dementia care and shows how the framework can be helpfully translated into practice so that carers are supported to adopt an inclusive view of care delivery. A comprehensive framework, grounded in a strong philosophical foundation, can name a breadth of criteria for humanly sensitive care and can be translated into practice in such a way as to potentially transform the provision of care to residents in residential aged care facilities. © 2012 Blackwell Publishing Ltd.

Integrated care in the daily work: coordination beyond organisational boundaries.

Science.gov (United States)

Petrakou, Alexandra

2009-07-09

In this paper, integrated care in an inter-organisational cooperative setting of in-home elderly care is studied. The aim is to explore how home care workers coordinate their daily work, identify coordination issues in situ and discuss possible actions for supporting seamless and integrated elderly care at home. The empirical findings are drawn from an ethnographic workplace study of the cooperation and coordination taking place between home care workers in a Swedish county. Data were collected through observational studies, interviews and group discussions. The paper identifies a need to support two core issues. Firstly, it must be made clear how the care interventions that are currently defined as 'self-treatment' by the home health care should be divided. Secondly, the distributed and asynchronous coordination between all care workers involved, regardless of organisational belonging must be better supported. Integrated care needs to be developed between organisations as well as within each organisation. As a matter of fact, integrated care needs to be built up beyond organisational boundaries. Organisational boundaries affect the planning of the division of care interventions, but not the coordination during the home care process. During the home care process, the main challenge is the coordination difficulties that arise from the fact that workers are distributed in time and/or space, regardless of organisational belonging. A core subject for future practice and research is to develop IT tools that reach beyond formal organisational boundaries and processes while remaining adaptable in view of future structure changes.

Reconceptualizing the core of nurse practitioner education and practice.

Science.gov (United States)

Burman, Mary E; Hart, Ann Marie; Conley, Virginia; Brown, Julie; Sherard, Pat; Clarke, Pamela N

2009-01-01

The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice. Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education. The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current master's programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program. Ultimately, our vision is for NP care to be consistently "different," yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.

Exploiting nonlinear dynamics in a coupled-core fluxgate magnetometer

International Nuclear Information System (INIS)

Bulsara, Adi R; In, Visarath; Kho, Andy; Longhini, Patrick; Neff, Joe; Anderson, Gregory; Obra, Christopher; Palacios, Antonio; Baglio, Salvatore; Ando, Bruno

2008-01-01

Unforced bistable dynamical systems having dynamics of the general form τ F x-dot (t)=-∇ x U(x) cannot oscillate (i.e. switch between their stable attractors). However, a number of such systems subject to carefully crafted coupling schemes have been shown to exhibit oscillatory behavior under carefully chosen operating conditions. This behavior, in turn, affords a new mechanism for the detection and quantification of target signals having magnitude far smaller than the energy barrier height in the potential energy function U(x) for a single (uncoupled) element. The coupling-induced oscillations are a feature that appears to be universal in systems described by bi- or multi-stable potential energy functions U(x), and are being exploited in a new class of dynamical sensors being developed by us. In this work we describe one of these devices, a coupled-core fluxgate magnetometer (CCFM), whose operation is underpinned by this dynamic behavior. We provide an overview of the underlying dynamics and, also, quantify the performance of our test device; in particular, we provide a quantitative performance comparison to a conventional (single-core) fluxgate magnetometer via a 'resolution' parameter that embodies the device sensitivity (the slope of its input–output transfer characteristic) as well as the noise floor

Drilling equipment for difficult coring conditions: a new type of core lifter and triple tube core barrel

Energy Technology Data Exchange (ETDEWEB)

Robinson, J B

1968-08-01

Although considerable improvements in diamond drilling equipment have been made since the early 1950's, deficiencies in existing equipment led to the development of a new type core lifter and special 20 ft triple tube core barrel designed to operate in bad coring conditions. It is claimed that although developed essentially for coal drilling, the new equipment could be adapted to other fields of diamond drilling with the cost advantage of increased life of the core lifter.

Towards an International Framework for Recommendations of Core Competencies in Nursing and Inter-Professional Informatics: The TIGER Competency Synthesis Project.

Science.gov (United States)

Hübner, Ursula; Shaw, Toria; Thye, Johannes; Egbert, Nicole; Marin, Heimar; Ball, Marion

2016-01-01

Informatics competencies of the health care workforce must meet the requirements of inter-professional process and outcome oriented provision of care. In order to help nursing education transform accordingly, the TIGER Initiative deployed an international survey, with participation from 21 countries, to evaluate and prioritise a broad list of core competencies for nurses in five domains: 1) nursing management, 2) information technology (IT) management in nursing, 3) interprofessional coordination of care, 4) quality management, and 5) clinical nursing. Informatics core competencies were found highly important for all domains. In addition, this project compiled eight national cases studies from Austria, Finland, Germany, Ireland, New Zealand, the Philippines, Portugal, and Switzerland that reflected the country specific perspective. These findings will lead us to an international framework of informatics recommendations.

Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care

DEFF Research Database (Denmark)

Nørgaard, Birgitte; Kofoed, Poul-Erik; Ohm Kyvik, Kirsten

2012-01-01

Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:  Despite the fact that communication has become a core topic in health care, patients still experience the information provided...... as insufficient or incorrect and a lack of involvement. Objective:  To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:  The study was designed as an intervention study...... offering professionals training in communicating with patients and colleagues. The outcome was measured by assessing patients' experience of quality of care. Data were collected by means of a questionnaire and analysed using a linear regression model. Approval was obtained from the Danish Data Protection...

Quality and Safety as a Core Leadership Competency.

Science.gov (United States)

Bleich, Michael R

2018-05-01

A leader's toolbox of competencies comprises knowledge, skills, and abilities in clinical care, finance, human resource management, and more. As essential as these are, a strong command of quality and safety competencies is sovereign in leading and managing, ensuring an optimal patient experience. Four core areas of quality and safety competencies are presented: systems science, knowledge workers, implementation science and big data, and quality safety tools and techniques. J Contin Educ Nurs. 2018;49(5):200-202. Copyright 2018, SLACK Incorporated.

Neutron dynamics of fast-spectrum dedicated cores for waste transmutation

International Nuclear Information System (INIS)

Massara, S.

2002-04-01

Among different scenarios achieving minor actinide transmutation, the possibility of double strata scenarios with critical, fast spectrum, dedicated cores must be checked and quantified. In these cores, the waste fraction has to be at the highest level compatible with safety requirements during normal operation and transient conditions. As reactivity coefficients are poor in such critical cores (low delayed neutron fraction and Doppler feed-back, high coolant void coefficient), their dynamic behaviour during transient conditions must be carefully analysed. Three nitride-fuel configurations have been analysed: two liquid metal-cooled (sodium and lead) and a particle-fuel helium-cooled one. A dynamic code, MAT4 DYN, has been developed during the PhD thesis, allowing the study of loss of flow, reactivity insertion and loss of coolant accidents, and taking into account two fuel geometries (cylindrical and spherical) and two thermal-hydraulics models for the coolant (incompressible for liquid metals and compressible for helium). Dynamics calculations have shown that if the fuel nature is appropriately chosen (letting a sufficient margin during transients), this can counterbalance the bad state of reactivity coefficients for liquid metal-cooled cores, thus proving the interest of this kind of concept. On the other side, the gas-cooled core dynamics is very badly affected by the high value of the helium void coefficient (which is a consequence of the choice of a hard spectrum), this effect being amplified by the very low thermal inertia of particle-fuel design. So, a new kind of concept should be considered for a helium-cooled fast-spectrum dedicated core. (authors)

Characterizing the Core via K-Core Covers

NARCIS (Netherlands)

Sanchez, S.M.; Borm, P.E.M.; Estevez, A.

2013-01-01

This paper extends the notion of individual minimal rights for a transferable utility game (TU-game) to coalitional minimal rights using minimal balanced families of a specific type, thus defining a corresponding minimal rights game. It is shown that the core of a TU-game coincides with the core of

New approaches to trials in glomerulonephritis.

Science.gov (United States)

Craig, Jonathan C; Tong, Allison; Strippoli, Giovanni F M

2017-01-01

Randomized controlled trials are required to reliably identify interventions to improve the outcomes for people with glomerulonephritis (GN). Unfortunately, although easier, observational studies are inherently unreliable even though the findings of both study designs agree most of the time. Currently there are ∼790 trials in GN, but suboptimal design and reporting, together with small sample sizes, mean that they may not be reliable for decision making. If the history is somewhat bleak, the future looks bright, with recent initiatives to improve the quality, size and relevance of clinical trials in nephrology, including greater patient engagement, trial networks, core outcome sets, registry-based trials and adaptive designs. Given the current state of the evidence informing the care of people with GN, disruptive technologies and pervasive culture change is required to ensure that the potential of trials to improve the health of people with this complex condition is to be realized. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Determination of PWR core water level using ex-core detectors signals

International Nuclear Information System (INIS)

Bernal, Alvaro; Abarca, Agustin; Miro, Rafael; Verdu, Gumersindo

2013-01-01

The core water level provides relevant neutronic and thermalhydraulic information of the reactor such as power, k eff and cooling ability; in fact, core water level monitoring could be used to predict LOCA and cooling reduction which may deal with core damage. Although different detection equipment is used to monitor several parameters such as the power, core water level monitoring is not an evident task. However, ex-core detectors can measure the fast neutrons leaking the core and several studies demonstrate the existence of a relationship between fast neutron leakage and core water level due to the shielding effect of the water. In addition, new ex-core detectors are being developed, such as silicon carbide semiconductor radiation detectors, monitoring the neutron flux with higher accuracy and in higher temperatures conditions. Therefore, a methodology to determine this relationship has been developed based on a Monte Carlo calculation using MCNP code and applying variance reduction with adjoint functions based on the adjoint flux obtained with the discrete ordinates code TORT. (author)

Critical Thoughts About the Core Entrustable Professional Activities in Undergraduate Medical Education.

Science.gov (United States)

Krupat, Edward

2018-03-01

The Core Entrustable Professional Activities for Entering Residency (Core EPAs) have taken a strong hold on undergraduate medical education (UME). This Perspective questions their value added and considers the utility of the Core EPAs along two separate dimensions: (1) the ways they change the content and focus of the goals of UME; and (2) the extent to which entrustable professional activity (EPA)-based assessment conforms to basic principles of measurement theory as practiced in the social sciences. Concerning content and focus, the author asks whether the 13 Core EPAs frame UME too narrowly, putting competencies into the background and overlooking certain aspirational, but important and measurable, objectives of UME. The author also discusses the unevenness of EPAs in terms of their breadth and their developmental status as core activities. Regarding measurement and assessment, the author raises concerns that the EPA metric introduces layers of inference that may cause distortions and hinder accuracy and rater agreement. In addition, the use of weak anchors and multidimensional scales is also of concern. The author concludes with a proposal for reframing the Core EPAs and Accreditation Council for Graduate Medical Education competencies into broadly defined sets of behaviors, referred to as "Tasks of Medicine," and calls for the development of a systematic and longitudinal research agenda. The author asserts that "slowing down when you should" applies to medical education as well as patient care, and calls for a reevaluation of the Core EPAs before further commitment to them.

ACGME core competency training, mentorship, and research in surgical subspecialty fellowship programs.

Science.gov (United States)

Francesca Monn, M; Wang, Ming-Hsien; Gilson, Marta M; Chen, Belinda; Kern, David; Gearhart, Susan L

2013-01-01

To determine the perceived effectiveness of surgical subspecialty training programs in teaching and assessing the 6 ACGME core competencies including research. Cross-sectional survey. ACGME approved training programs in pediatric urology and colorectal surgery. Program Directors and recent trainees (2007-2009). A total of 39 program directors (60%) and 57 trainees (64%) responded. Both program directors and recent trainees reported a higher degree of training and mentorship (75%) in patient care and medical knowledge than the other core competencies (pinterpersonal and communication, and professionalism training were perceived effective to a lesser degree. Specifically, in the areas of teaching residents and medical students and team building, program directors, compared with recent trainees, perceived training to be more effective, (p = 0.004, p = 0.04). Responses to questions assessing training in systems based practice ubiquitously identified a lack of training, particularly in financial matters of running a practice. Although effective training in research was perceived as lacking by recent trainees, 81% reported mentorship in this area. According to program directors and recent trainees, the most effective method of teaching was faculty supervision and feedback. Only 50% or less of the recent trainees reported mentorship in career planning, work-life balance, and job satisfaction. Not all 6 core competencies and research are effectively being taught in surgery subspecialty training programs and mentorship in areas outside of patient care and research is lacking. Emphasis should be placed on faculty supervision and feedback when designing methods to better incorporate all 6 core competencies, research, and mentorship. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills.

Science.gov (United States)

Schmidt, Jessica N; Kendall, John; Smalley, Courtney

2015-11-01

Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution. We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images. Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%. Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation.

A core syllabus for the teaching of neuroanatomy to medical students.

Science.gov (United States)

Moxham, Bernard; McHanwell, Stephen; Plaisant, Odile; Pais, Diogo

2015-09-01

There is increasingly a call for clinical relevance in the teaching of biomedical sciences within all health care courses. However, this presupposes that there is a clear understanding of what can be considered core material within the curricula. To date, the anatomical sciences have been relatively poorly served by the development of core syllabuses, particularly for specialized core syllabuses such as neuroanatomy. One of the aims of the International Federation of Associations of Anatomists (IFAA) and of the European Federation for Experimental Morphology (EFEM) is to formulate, on an international scale, core syllabuses for all branches of the anatomical sciences using Delphi Panels consisting of anatomists, scientists, and clinicians to initially evaluate syllabus content. In this article, the findings of a Delphi Panel for neuroanatomy are provided. These findings will subsequently be published on the IFAA website to enable anatomical (and other cognate learned) societies and individual anatomists, clinicians, and students to freely comment upon, and elaborate and amend, the syllabuses. The aim is to set internationally recognized standards and thus to provide guidelines concerning neuroanatomical knowledge when engaged in course development. © 2015 Wiley Periodicals, Inc.

Rotary core drills

Energy Technology Data Exchange (ETDEWEB)

1967-11-30

The design of a rotary core drill is described. Primary consideration is given to the following component parts of the drill: the inner and outer tube, the core bit, an adapter, and the core lifter. The adapter has the form of a downward-converging sleeve and is mounted to the lower end of the inner tube. The lifter, extending from the adapter, is split along each side so that it can be held open to permit movement of a core. It is possible to grip a core by allowing the lifter to assume a closed position.

Metallic nanoshells with semiconductor cores: optical characteristics modified by core medium properties.

Science.gov (United States)

Bardhan, Rizia; Grady, Nathaniel K; Ali, Tamer; Halas, Naomi J

2010-10-26

It is well-known that the geometry of a nanoshell controls the resonance frequencies of its plasmon modes; however, the properties of the core material also strongly influence its optical properties. Here we report the synthesis of Au nanoshells with semiconductor cores of cuprous oxide and examine their optical characteristics. This material system allows us to systematically examine the role of core material on nanoshell optical properties, comparing Cu(2)O core nanoshells (ε(c) ∼ 7) to lower core dielectric constant SiO(2) core nanoshells (ε(c) = 2) and higher dielectric constant mixed valency iron oxide nanoshells (ε(c) = 12). Increasing the core dielectric constant increases nanoparticle absorption efficiency, reduces plasmon line width, and modifies plasmon energies. Modifying the core medium provides an additional means of tailoring both the near- and far-field optical properties in this unique nanoparticle system.

Proteomics Core

Data.gov (United States)

Federal Laboratory Consortium — Proteomics Core is the central resource for mass spectrometry based proteomics within the NHLBI. The Core staff help collaborators design proteomics experiments in a...

The Geriatric ICF Core Set reflecting health-related problems in community-living older adults aged 75 years and older without dementia: development and validation.

Science.gov (United States)

Spoorenberg, Sophie L W; Reijneveld, Sijmen A; Middel, Berrie; Uittenbroek, Ronald J; Kremer, Hubertus P H; Wynia, Klaske

2015-01-01

The aim of the present study was to develop a valid Geriatric ICF Core Set reflecting relevant health-related problems of community-living older adults without dementia. A Delphi study was performed in order to reach consensus (≥70% agreement) on second-level categories from the International Classification of Functioning, Disability and Health (ICF). The Delphi panel comprised 41 older adults, medical and non-medical experts. Content validity of the set was tested in a cross-sectional study including 267 older adults identified as frail or having complex care needs. Consensus was reached for 30 ICF categories in the Delphi study (fourteen Body functions, ten Activities and Participation and six Environmental Factors categories). Content validity of the set was high: the prevalence of all the problems was >10%, except for d530 Toileting. The most frequently reported problems were b710 Mobility of joint functions (70%), b152 Emotional functions (65%) and b455 Exercise tolerance functions (62%). No categories had missing values. The final Geriatric ICF Core Set is a comprehensive and valid set of 29 ICF categories, reflecting the most relevant health-related problems among community-living older adults without dementia. This Core Set may contribute to optimal care provision and support of the older population. Implications for Rehabilitation The Geriatric ICF Core Set may provide a practical tool for gaining an understanding of the relevant health-related problems of community-living older adults without dementia. The Geriatric ICF Core Set may be used in primary care practice as an assessment tool in order to tailor care and support to the needs of older adults. The Geriatric ICF Core Set may be suitable for use in multidisciplinary teams in integrated care settings, since it is based on a broad range of problems in functioning. Professionals should pay special attention to health problems related to mobility and emotional functioning since these are the most

Evaluating the MEDLINE Core Clinical Journals filter: data-driven evidence assessing clinical utility.

Science.gov (United States)

Klein-Fedyshin, Michele; Ketchum, Andrea M; Arnold, Robert M; Fedyshin, Peter J

2014-12-01

MEDLINE offers the Core Clinical Journals filter to limit to clinically useful journals. To determine its effectiveness for searching and patient-centric decision making, this study compared literature used for Morning Report in Internal Medicine with journals in the filter. An EndNote library with references answering 327 patient-related questions during Morning Report from 2007 to 2012 was exported to a file listing variables including designated Core Clinical Journal, Impact Factor, date used and medical subject. Bradford's law of scattering was applied ranking the journals and reflecting their clinical utility. Recall (sensitivity) and precision of the Core Morning Report journals and non-Core set was calculated. This study applied bibliometrics to compare the 628 articles used against these criteria to determine journals impacting decision making. Analysis shows 30% of clinically used articles are from the Core Clinical Journals filter and 16% of the journals represented are Core titles. When Bradford-ranked, 55% of the top 20 journals are Core. Articles sources used. Among the 63 Morning Report subjects, 55 have <50% precision and 41 have <50% recall including 37 subjects with 0% precision and 0% recall. Low usage of publications within the Core Clinical Journals filter indicates less relevance for hospital-based care. The divergence from high-impact medicine titles suggests clinically valuable journals differ from academically important titles. With few subjects demonstrating high recall or precision, the MEDLINE Core Clinical Journals filter may require a review and update to better align with current clinical needs. © 2014 John Wiley & Sons, Ltd.

A Survey of Managed Care Education at Optometry Schools.

Science.gov (United States)

Soroka, Mort; Reis, Lesley

2003-01-01

Studied the courses and topics offered at schools of optometry and the total hours devoted to managed care. Responses from the 17 schools of optometry reveal significant variations in curricular coverage of managed care, although a core set of materials was found to exist that could be the basis for more standard curriculum. (SLD)

Development and psychometric evaluation of the Core Nurse Resource Scale.

Science.gov (United States)

Simpson, Michelle R

2010-11-01

To examine the factor structure, internal consistency reliability and concurrent-related validity of the Core Nurse Resource Scale. A cross-sectional survey study design was used to obtain a sample of 149 nurses and nursing staff [Registered Nurse (RNs), Licensed Practical Nurse (LPNs) and Certified Nursing Assistant (CNAs)] working in long-term care facilities. Exploratory factor analysis, Cronbach's alpha and bivariate correlations were used to evaluate validity and reliability. Exploratory factor analysis yielded a scale with 18 items on three factors, accounting for 52% of the variance in scores. Internal consistency reliability for the composite and Core Nurse Resource Scale factors ranged from 0.79 to 0.91. The Core Nurse Resource Scale composite scale and subscales correlated positively with a measure of work engagement (r=0.247-0.572). The initial psychometric evaluation of the Core Nurse Resource Scale demonstrates it is a sound measure. Further validity and reliability assessment will need to be explored and assessed among nurses and other nursing staff working in other practice settings. The intent of the Core Nurse Resource Scale is to evaluate the presence of physical, psychological and social resources of the nursing work environment, to identify workplaces at risk for disengaged (low work engagement) nursing staff and to provide useful diagnostic information to healthcare administrators interested in interventions to improve the nursing work environment. © 2010 The Author. Journal compilation © 2010 Blackwell Publishing Ltd.

Facilitating the formation of accountable care organizations in rural areas.

Science.gov (United States)

Baloh, Jure; Zhu, Xi; Vaughn, Tom; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Nattinger, Matthew

2014-07-01

This Policy Brief presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries. Doing so provides considerations for provider organizations contemplating creating rural-based ACOs. Key Findings. (1) Previous organizational integration and risk-sharing experience facilitated ACO formation. (2) Use of an electronic health record system fostered core ACO capabilities, including care coordination and population health management. (3) Partnerships across the care continuum supported utilization of local health care resources.

A core performance study on an actinide recycling 'zero-sodium-void worth' core

International Nuclear Information System (INIS)

Kawashima, M.; Nakagawa, M.; Yamaoka, M.; Kasahara, F.

1994-01-01

A core performance study was made for an absorber-type parfait core (A-APC) as one of 'Zero-sodium-void-worth' core concepts. This evaluation study pursued different two aspects; one for transuranic (TRU) management strategy, and another for a loss-of-coolant anticipated transient behavior considering the unique core configuration. The results indicated that this core has a large flexibility for actinide recycling in terms of self-sufficiency and minor actinide burning. The result also showed that this core has kept a large mitigation potential for ULOF events as well as a simple flat core concept, reflecting detailed three dimensional core bowing behavior for the A-APC configuration. (author)

Integrated care in the daily work: coordination beyond organisational boundaries

Directory of Open Access Journals (Sweden)

Alexandra Petrakou

2009-07-01

Full Text Available Objectives: In this paper, integrated care in an inter-organisational cooperative setting of in-home elderly care is studied. The aim is to explore how home care workers coordinate their daily work, identify coordination issues in situ and discuss possible actions for supporting seamless and integrated elderly care at home. Method: The empirical findings are drawn from an ethnographic workplace study of the cooperation and coordination taking place between home care workers in a Swedish county. Data were collected through observational studies, interviews and group discussions. Findings: The paper identifies a need to support two core issues. Firstly, it must be made clear how the care interventions that are currently defined as ‘self-treatment’ by the home health care should be divided. Secondly, the distributed and asynchronous coordination between all care workers involved, regardless of organisational belonging must be better supported. Conclusion: Integrated care needs to be developed between organisations as well as within each organisation. As a matter of fact, integrated care needs to be built up beyond organisational boundaries. Organisational boundaries affect the planning of the division of care interventions, but not the coordination during the home care process. During the home care process, the main challenge is the coordination difficulties that arise from the fact that workers are distributed in time and/or space, regardless of organisational belonging. A core subject for future practice and research is to develop IT tools that reach beyond formal organisational boundaries and processes while remaining adaptable in view of future structure changes.

Preliminaries on core image analysis using fault drilling samples; Core image kaiseki kotohajime (danso kussaku core kaisekirei)

Energy Technology Data Exchange (ETDEWEB)

Miyazaki, T; Ito, H [Geological Survey of Japan, Tsukuba (Japan)

1996-05-01

This paper introduces examples of image data analysis on fault drilling samples. The paper describes the following matters: core samples used in the analysis are those obtained from wells drilled piercing the Nojima fault which has moved in the Hygoken-Nanbu Earthquake; the CORESCAN system made by DMT Corporation, Germany, used in acquiring the image data consists of a CCD camera, a light source and core rotation mechanism, and a personal computer, its resolution being about 5 pixels/mm in both axial and circumferential directions, and 24-bit full color; with respect to the opening fractures in core samples collected by using a constant azimuth coring, it was possible to derive values of the opening width, inclination angle, and travel from the image data by using a commercially available software for the personal computer; and comparison of this core image with the BHTV record and the hydrophone VSP record (travel and inclination obtained from the BHTV record agree well with those obtained from the core image). 4 refs., 4 figs.

Application of the Intervention Mapping Framework to Develop an Integrated Twenty-first Century Core Curriculum-Part Two: Translation of MPH Core Competencies into an Integrated Theory-Based Core Curriculum.

Science.gov (United States)

Corvin, Jaime A; DeBate, Rita; Wolfe-Quintero, Kate; Petersen, Donna J

2017-01-01

In the twenty-first century, the dynamics of health and health care are changing, necessitating a commitment to revising traditional public health curricula to better meet present day challenges. This article describes how the College of Public Health at the University of South Florida utilized the Intervention Mapping framework to translate revised core competencies into an integrated, theory-driven core curriculum to meet the training needs of the twenty-first century public health scholar and practitioner. This process resulted in the development of four sequenced courses: History and Systems of Public Health and Population Assessment I delivered in the first semester and Population Assessment II and Translation to Practice delivered in the second semester. While the transformation process, moving from traditional public health core content to an integrated and innovative curriculum, is a challenging and daunting task, Intervention Mapping provides the ideal framework for guiding this process. Intervention mapping walks the curriculum developers from the broad goals and objectives to the finite details of a lesson plan. Throughout this process, critical lessons were learned, including the importance of being open to new ideologies and frameworks and the critical need to involve key-stakeholders in every step of the decision-making process to ensure the sustainability of the resulting integrated and theory-based curriculum. Ultimately, as a stronger curriculum emerged, the developers and instructors themselves were changed, fostering a stronger public health workforce from within.

Principles and core functions of integrated child health information systems.

Science.gov (United States)

Hinman, Alan R; Atkinson, Delton; Diehn, Tonya Norvell; Eichwald, John; Heberer, Jennifer; Hoyle, Therese; King, Pam; Kossack, Robert E; Williams, Donna C; Zimmerman, Amy

2004-11-01

Infants undergo a series of preventive and therapeutic health interventions and activities. Typically, each activity includes collection and submission of data to a dedicated information system. Subsequently, health care providers, families, and health programs must query each information system to determine the child's status in a given area. Efforts are underway to integrate information in these separate information systems. This requires specifying the core functions that integrated information systems must perform.

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

Science.gov (United States)

Kuis, Esther E; Goossensen, Anne

2017-08-01

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

Using forum play to prevent abuse in health care organizations: A qualitative study exploring potentials and limitations for learning.

Science.gov (United States)

Brüggemann, A Jelmer; Persson, Alma

2016-01-01

Abuse in health care organizations is a pressing issue for caregivers. Forum play, a participatory theater model, has been used among health care staff to learn about and work against abuse. This small-scale qualitative study aims to explore how forum play participants experience the potentials and limitations of forum play as an educational model for continued professional learning at a hospital clinic. Fifteen of 41 members of staff of a Swedish nephrology clinic, primarily nurses, voluntarily participated in either one or two forum play workshops, where they shared experiences and together practiced working against abuse in everyday health care situations. Interviews were conducted after the workshops with 14 of the participants, where they were asked to reflect on their own and others' participation or nonparticipation, and changes in their individual and collective understanding of abuse in health care. Before the workshops, the informants were either hesitant or very enthusiastic toward the drama-oriented form of learning. Afterward, they all agreed that forum play was a very effective way of individual as well as collective learning about abuse in health care. However, they saw little effect on their work at the clinic, primarily understood as a consequence of the fact that many of their colleagues did not take part in the workshops. This study, based on the analysis of forum play efforts at a single hospital clinic, suggests that forum play can be an innovative educational model that creates a space for reflection and learning in health care practices. It might be especially fruitful when a sensitive topic, such as abuse in health care, is the target of change. However, for the effects to reach beyond individual insights and a shared understanding among a small group of participants, strategies to include all members of staff need to be explored.

Sidewall coring shell

Energy Technology Data Exchange (ETDEWEB)

Edelman, Ya A; Konstantinov, L P; Martyshin, A N

1966-12-12

A sidewall coring shell consists of a housing and a detachable core catcher. The core lifter is provided with projections, the ends of which are situated in another plane, along the longitudinal axis of the lifter. The chamber has corresponding projections.

From ethics of care to psychology of care - Reconnecting ethics of care to contemporary moral psychology

Directory of Open Access Journals (Sweden)

Aner eGovrin

2014-10-01

Full Text Available Moral psychology once regarded ethics of care as a promising theory. However, there is evidence to suggest that nowadays moral psychology completely ignores ethics of care’s various insights. Moreover, ethics of care’s core concepts – compassion, dependence, and the importance of early relations to moral development– are no longer considered to be relevant to the development of new theories in the field. In this paper, I will firstly discuss some of the reasons which, over recent years, have contributed to the marginalization of the role of ethics of care in moral psychology. Next, I will show that ethics of care’s most promising idea centered on the care given to an infant and the importance of that care to the development of moral thinking. In this context, I will be describing the implications of John Bowlby’s attachment theories, infant research, findings in moral psychology and neuroscience. I will argue that ethics of care needs to be radically re-thought and replaced by a psychology of care, an attachment approach to moral judgment, which would establish the centrality of the caregiver’s role in moral development. The philosophical implications of this approach to the understanding of the 'rationalists’’ and ‘intuitionists’’ debate about the true nature of moral judgment is also discussed.

Are Undergraduate Nurses Taught Palliative Care during Their Training?

Science.gov (United States)

Lloyd-Williams, Mari; Field, David

2002-01-01

Responses from 46 of 108 nurse educators in the United Kingdom indicated that diploma students received a mean of 7.8 hours and degree students 12.2 hours of palliative care training. Although 82% believed it should be a core component, 67% had difficulty finding qualified teachers. Palliative care knowledge was not formally assessed in most…

Fostering dignity in the care of nursing home residents through slow caring

DEFF Research Database (Denmark)

Lohne, Vibeke; Høy, Bente; Lillestø, Britt

2017-01-01

Background: Physical impairment and dependency on others may be a threat to dignity. Research questions: The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents. Research design: This study has...... personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach....... a hermeneutic design. Participants and research context: In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study. Ethical considerations: This study has been evaluated and approved by the Regional Ethical Committees and the Social Science Data...

2014 Child and Adult Health Care Quality Measures

Data.gov (United States)

U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2014 reporting. Dataset contains...

2016 Child and Adult Health Care Quality Measures

Data.gov (United States)

U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2016 reporting. Source: Mathematica...

2015 Child and Adult Health Care Quality Measures

Data.gov (United States)

U.S. Department of Health & Human Services — Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2015 reporting. Source: Mathematica...

Electromagnetically driven westward drift and inner-core superrotation in Earth's core.

Science.gov (United States)

Livermore, Philip W; Hollerbach, Rainer; Jackson, Andrew

2013-10-01

A 3D numerical model of the earth's core with a viscosity two orders of magnitude lower than the state of the art suggests a link between the observed westward drift of the magnetic field and superrotation of the inner core. In our model, the axial electromagnetic torque has a dominant influence only at the surface and in the deepest reaches of the core, where it respectively drives a broad westward flow rising to an axisymmetric equatorial jet and imparts an eastward-directed torque on the solid inner core. Subtle changes in the structure of the internal magnetic field may alter not just the magnitude but the direction of these torques. This not only suggests that the quasi-oscillatory nature of inner-core superrotation [Tkalčić H, Young M, Bodin T, Ngo S, Sambridge M (2013) The shuffling rotation of the earth's inner core revealed by earthquake doublets. Nat Geosci 6:497-502.] may be driven by decadal changes in the magnetic field, but further that historical periods in which the field exhibited eastward drift were contemporaneous with a westward inner-core rotation. The model further indicates a strong internal shear layer on the tangent cylinder that may be a source of torsional waves inside the core.

Improving the calculated core stability by the core nuclear design optimization

International Nuclear Information System (INIS)

Partanen, P.

1995-01-01

Three different equilibrium core loadings for TVO II reactor have been generated in order to improve the core stability properties at uprated power level. The reactor thermal power is assumed to be uprated from 2160 MW th to 2500 MW th , which moves the operating point after a rapid pump rundown where the core stability has been calculated from 1340 MW th and 3200 kg/s to 1675 MW th and 4000 kg/s. The core has been refuelled with ABB Atom Svea-100 -fuel, which has 3,64% w/o U-235 average enrichment in the highly enriched zone. PHOENIX lattice code has been used to provide the homogenized nuclear constants. POLCA4 static core simulator has been used for core loadings and cycle simulations and RAMONA-3B program for simulating the dynamic response to the disturbance for which the stability behaviour has been evaluated. The core decay ratio has been successfully reduced from 0,83 to 0,55 mainly by reducing the power peaking factors. (orig.) (7 figs., 1 tab.)

Core Values | NREL

Science.gov (United States)

Core Values Core Values NREL's core values are rooted in a safe and supportive work environment guide our everyday actions and efforts: Safe and supportive work environment Respect for the rights physical and social environment Integrity Maintain the highest standard of ethics, honesty, and integrity

Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice

Directory of Open Access Journals (Sweden)

D. Hallas

2015-01-01

Full Text Available Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP program at New York University College of Nursing (NYUCN have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice.

Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

Science.gov (United States)

Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

2015-01-01

In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

Science.gov (United States)

Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

2015-01-01

In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

Remote Patient Management for Home Dialysis Patients

Directory of Open Access Journals (Sweden)

Eric L. Wallace

2017-11-01

Full Text Available Remote patient management (RPM offers renal health care providers and patients with end-stage kidney disease opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten health care providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities for, barriers to, and system requirements of RPM as it applies to the home dialysis patient. Although improved outcomes and cost-effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM have been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and on the evidence needed for optimized implementation to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and health care providers.

Seismic core shroud

International Nuclear Information System (INIS)

Puri, A.; Mullooly, J.F.

1981-01-01

A core shroud is provided, comprising: a coolant boundary, following the shape of the core boundary, for channeling the coolant through the fuel assemblies; a cylindrical band positioned inside the core barrel and surrounding the coolant boundary; and support members extending from the coolant boundary to the band, for transferring load from the coolant boundary to the band. The shroud may be assembled in parts using automated welding techniques, and it may be adjusted to fit the reactor core easily

Examining the scope of multibusiness health care firms: implications for strategy and financial performance.

Science.gov (United States)

Noorein Inamdar, S

2007-08-01

Use theory and data to examine the scope of corporate strategies for multibusiness health care firms, also known as organized or integrated health care delivery systems. Data are from the 2000 HIMSS Analytics Annual Survey of integrated health care delivery systems (IHDS), which provides complete information on businesses owned by IHDS. Scope defined as the breadth and type of businesses in which a firm chooses to compete is measured across seven separate business areas: (1) health plans, (2) ambulatory, (3) acute, (4) subacute, (5) home health, (6) other related nonpatient care businesses, and (7) external collaborations. Theories on strategy and organizational configurations along with measures of scope and a novel dataset were used to classify 796 firms into five mutually exclusive groups. The bases for classification were two competitive dimensions of scope: (1) breadth of businesses and (2) mix of existing core businesses versus new noncore businesses. Unit of analysis is the multibusiness health care firm. Sample consists of 796 firms, defined as nonprofit organizations that own two or more direct patient care businesses in two or more separate areas across the health care value chain. Firms were clustered into five mutually exclusive organizational configurations with unique scope characteristics revealing a new taxonomy of corporate strategies. Analysis of the scope variables revealed five strategic types (along with the number of firms and distinguishing features of each strategy) defined as follows: (1) Core Service Provider (340 firms with the smallest scope providing core set of patient care services), (2) Mission Based (52 firms with the next smallest scope offering core set of services to underserved populations), (3) Contractor (266 firms with medium scope and contracting with physician groups), (4) Health Plan Focus (83 firms with large scope and providing health plans), and (5) Entrepreneur (55 firms with the largest scope offering both a core set

[caCORE: core architecture of bioinformation on cancer research in America].

Science.gov (United States)

Gao, Qin; Zhang, Yan-lei; Xie, Zhi-yun; Zhang, Qi-peng; Hu, Zhang-zhi

2006-04-18

A critical factor in the advancement of biomedical research is the ease with which data can be integrated, redistributed and analyzed both within and across domains. This paper summarizes the Biomedical Information Core Infrastructure built by National Cancer Institute Center for Bioinformatics in America (NCICB). The main product from the Core Infrastructure is caCORE--cancer Common Ontologic Reference Environment, which is the infrastructure backbone supporting data management and application development at NCICB. The paper explains the structure and function of caCORE: (1) Enterprise Vocabulary Services (EVS). They provide controlled vocabulary, dictionary and thesaurus services, and EVS produces the NCI Thesaurus and the NCI Metathesaurus; (2) The Cancer Data Standards Repository (caDSR). It provides a metadata registry for common data elements. (3) Cancer Bioinformatics Infrastructure Objects (caBIO). They provide Java, Simple Object Access Protocol and HTTP-XML application programming interfaces. The vision for caCORE is to provide a common data management framework that will support the consistency, clarity, and comparability of biomedical research data and information. In addition to providing facilities for data management and redistribution, caCORE helps solve problems of data integration. All NCICB-developed caCORE components are distributed under open-source licenses that support unrestricted usage by both non-profit and commercial entities, and caCORE has laid the foundation for a number of scientific and clinical applications. Based on it, the paper expounds caCORE-base applications simply in several NCI projects, of which one is CMAP (Cancer Molecular Analysis Project), and the other is caBIG (Cancer Biomedical Informatics Grid). In the end, the paper also gives good prospects of caCORE, and while caCORE was born out of the needs of the cancer research community, it is intended to serve as a general resource. Cancer research has historically

A flexible tactile sensitive sheet using a hetero-core fiber optic sensor

Science.gov (United States)

Fujino, S.; Yamazaki, H.; Hosoki, A.; Watanabe, K.

2014-05-01

In this report, we have designed a tactile sensitive sheet based on a hetero-core fiber-optic sensor, which realize an areal sensing by using single sensor potion in one optical fiber line. Recently, flexible and wide-area tactile sensing technology is expected to applied to acquired biological information in living space and robot achieve long-term care services such as welfare and nursing-care and humanoid technology. A hetero-core fiber-optic sensor has several advantages such as thin and flexible transmission line, immunity to EMI. Additionally this sensor is sensitive to moderate bending actions with optical loss changes and is independent of temperature fluctuation. Thus, the hetero-core fiber-optic sensor can be suitable for areal tactile sensing. We measure pressure characteristic of the proposed sensitive sheet by changing the pressure position and pinching characteristic on the surface. The proposed tactile sensitive sheet shows monotonic responses on the whole sensitive sheet surface although different sensitivity by the position is observed at the sensitive sheet surface. Moreover, the tactile sensitive sheet could sufficiently detect the pinching motion. In addition, in order to realize the discrimination between pressure and pinch, we fabricated a doubled-over sensor using a set of tactile sensitive sheets, which has different kinds of silicon robbers as a sensitive sheet surface. In conclusion, the flexible material could be given to the tactile sensation which is attached under proposed sensitive sheet.

Mapping the literature of health care chaplaincy.

Science.gov (United States)

Johnson, Emily; Dodd-McCue, Diane; Tartaglia, Alexander; McDaniel, Jennifer

2013-07-01

This study examined citation patterns and indexing coverage from 2008 to 2010 to determine (1) the core literature of health care chaplaincy and (2) the resources providing optimum coverage for the literature. Citations from three source journals (2008-2010 inclusive) were collected and analyzed according to the protocol created for the Mapping the Literature of Allied Health Professions Project. An analysis of indexing coverage by five databases was conducted. A secondary analysis of self-citations by source journals was also conducted. The 3 source journals--Chaplaincy Today, the Journal of Health Care Chaplaincy, and the Journal of Pastoral Care and Counseling--ranked as the top 3 journals in Zone 1 and provided the highest number of most frequently cited articles for health care chaplaincy. Additional journals that appeared in this highly productive zone covered the disciplines of medicine, psychology, nursing, and religion, which were also represented in the Zones 2 and 3 journals. None of the databases provided complete coverage for the core journals; however, MEDLINE provided the most comprehensive coverage for journals in Zones 1 and 2, followed by Academic Search Complete, CINAHL, PsycINFO, and ATLA. Self-citations for the source journals ranged from 9% to 16%. Health care chaplaincy draws from a diverse body of inter-professional literature. Libraries wishing to provide access to journal literature to support health care chaplaincy at their institutions will be best able to do this by subscribing to databases and journals that cover medical, psychological, nursing, and religion- or spirituality-focused disciplines.

Analysis of core and core barrel heat-up under conditions simulating severe reactor accidents

International Nuclear Information System (INIS)

Chellaiah, S.; Viskanta, R.; Ranganathan, P.; Anand, N.K.

1987-01-01

This paper reports on the development of a model for estimating the temperature distributions in the reactor core, core barrel, thermal shield and reactor pressure vessel of a PWR during an undercooling transient. A number of numerical calculations simulating the core uncovering of the TMI-2 reactor and the subsequent heat-up of the core have been performed. The results of the calculations show that the exothermic heat release due to Zircaloy oxidation contributes to the sharp heat-up of the core. However, the core barrel temperature rise which is driven by the temperature increase of the edge of the core (e.g., the core baffle) is very modest. The maximum temperature of the core barrel never exceeded 610 K (at a system pressure of 68 bar) after a 75 minute simulation following the start of core uncovering

Visual-stratigraphic dating of the GISP2 ice core: Basis, reproducibility, and application

Science.gov (United States)

Alley, R. B.; Shuman, C. A.; Meese, D. A.; Gow, A. J.; Taylor, K. C.; Cuffey, K. M.; Fitzpatrick, J. J.; Grootes, P. M.; Zielinski, G. A.; Ram, M.; Spinelli, G.; Elder, B.

1997-11-01

Annual layers are visible in the Greenland Ice Sheet Project 2 ice core from central Greenland, allowing rapid dating of the core. Changes in bubble and grain structure caused by near-surface, primarily summertime formation of hoar complexes provide the main visible annual marker in the Holocene, and changes in "cloudiness" of the ice correlated with dustiness mark Wisconsinan annual cycles; both markers are evident and have been intercalibrated in early Holocene ice. Layer counts are reproducible between different workers and for one worker at different times, with 1% error over century-length times in the Holocene. Reproducibility is typically 5% in Wisconsinan ice-age ice and decreases with increasing age and depth. Cumulative ages from visible stratigraphy are not significantly different from independent ages of prominent events for ice older than the historical record and younger than approximately 50,000 years. Visible observations are not greatly degraded by "brittle ice" or many other core-quality problems, allowing construction of long, consistently sampled time series. High accuracy requires careful study of the core by dedicated observers.

Overview of core designs and requirements/criteria for core restraint systems

International Nuclear Information System (INIS)

Sutherland, W.H.

1984-09-01

The requirements and lifetime criteria for the design of a Liquid Metal Fast Breeder Reactor (LMFBR) Core Restraint System are presented. A discussion of the three types of core restraint systems used in LMFBR core design is given. Details of the core restraint system selected for FFTF are presented and the reasons for this selection given. Structural analysis procedures being used to manage the FFTF assembly irradiations are discussed. Efforts that are ongoing to validate the calculational methods and lifetime criteria are presented

Theoretical Investigation of Inter-core Crosstalk Properties in Homogeneous Trench-Assisted Multi-Core Fibers

DEFF Research Database (Denmark)

Ye, Feihong; Morioka, Toshio; Tu, Jiajing

2014-01-01

We derive analytical expressions for inter-core crosstalk, its dependence on core pitch and wavelength in homogeneous trench-assisted multi-core fibers. They are in excellent agreement with numerical simulation results.......We derive analytical expressions for inter-core crosstalk, its dependence on core pitch and wavelength in homogeneous trench-assisted multi-core fibers. They are in excellent agreement with numerical simulation results....

Conservative care for ESRD in the United Kingdom: a national survey.

Science.gov (United States)

Okamoto, Ikumi; Tonkin-Crine, Sarah; Rayner, Hugh; Murtagh, Fliss E M; Farrington, Ken; Caskey, Fergus; Tomson, Charles; Loud, Fiona; Greenwood, Roger; O'Donoghue, Donal J; Roderick, Paul

2015-01-07

Conservative kidney management (CKM) has been developed in the United Kingdom (UK) as an alternative to dialysis for older patients with stage 5 CKD (CKD5) and multiple comorbidities. This national survey sought to describe the current scale and pattern of delivery of conservative care in UK renal units and identify their priorities for its future development. A survey on practice patterns of CKM for patients age 75 and older with CKD5 was sent to clinical directors of all 71 adult renal units in the UK in March 2013. Sixty-seven units (94%) responded. All but one unit reported providing CKM for some patients. Terminology varied, although "conservative management" was the most frequently used term (46%). Lack of an agreed-upon definition of when a patient is receiving CKM made it difficult to obtain meaningful data on the numbers of such patients. Fifty-two percent provided the number of CKM patients age ≥ 75 years in 2012; the median was 45 per unit (interquartile range [IQR], 20-83). The median number of symptomatic CKM patients who would otherwise have started dialysis was eight (IQR, 4.5-22). CKM practice patterns varied: 35% had a written guideline, 23% had dedicated CKM clinics, 45% had dedicated staff, and 50% provided staff training on CKM. Most units (88%) provided primary care clinicians with information/advice regarding CKM. Eighty percent identified a need for better evidence comparing outcomes on CKM versus dialysis, and 65% considered it appropriate to enter patients into a randomized trial. CKM is provided in almost all UK renal units, but scale and organization vary widely. Lack of common terminology and definitions hinders the development and assessment of CKM. Many survey respondents expressed support for further research comparing outcomes with conservative care versus dialysis. Copyright © 2015 by the American Society of Nephrology.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Neutronic design of mixed oxide-silicide cores for the core conversion of rsg-gas reactor

International Nuclear Information System (INIS)

Sembiring, Tagor Malem; Tukiran; Pinem surian; Febrianto

2001-01-01

The core conversion of rsg-gas reactor from an all-oxide (U 3 O 8 -Al) core, through a series of mixed oxide-silicide core, to an all-silicide (U 3 Si 2 -Al) core for the same meat density of 2.96 g U/cc is in progress. The conversion is first step of the step-wise conversion and will be followed by the second step that is the core conversion from low meat density of silicide core, through a series of mixed lower-higher density of silicide core, to an all-higher meat density of 3.55 g/cc core. Therefore, the objectives of this work is to design the mixed cores on the neutronic performance to achieve safety a first full-silicide core for the reactor with the low uranium meat density of 2.96gU/cc. The neutronic design of the mixed cores was performed by means of Batan-EQUIL-2D and Batan-3DIFF computer codes for 2 and 3 dimension diffusion calculation, respectively. The result shows that all mixed oxide-silicide cores will be feasible to achieve safety a fist full-silicide core. The core performs the same neutronic core parameters as those of the equilibrium silicide core. Therefore, the reactor availability and utilization during the core conversion is not changed

Homeless people's access to primary care physiotherapy services: an exploratory, mixed-method investigation using a follow-up qualitative extension to core quantitative research.

Science.gov (United States)

Dawes, Jo; Deaton, Stuart; Greenwood, Nan

2017-06-30

The purpose of this study was to appraise referrals of homeless patients to physiotherapy services and explore perceptions of barriers to access. This exploratory mixed-method study used a follow-up qualitative extension to core quantitative research design. Over 9 months, quantitative data were gathered from the healthcare records of homeless patients referred to physiotherapy by a general practitioner (GP) practice, including the number of referrals and demographic data of all homeless patients referred. Corresponding physiotherapy records of those people referred to physiotherapy were searched for the outcome of their care. Qualitative semi-structured telephone interviews, based on the quantitative findings, were carried out with staff involved with patient care from the referring GP practice and were used to expand insight into the quantitative findings. Two primary care sites provided data for this study: a GP practice dedicated exclusively to homeless people and the physiotherapy department receiving their referrals. Quantitative data from the healthcare records of 34 homeless patient referrals to physiotherapy were collected and analysed. In addition, five staff involved in patient care were interviewed. 34 referrals of homeless people were made to physiotherapy in a 9-month period. It was possible to match 25 of these to records from the physiotherapy department. Nine (36%) patients did not attend their first appointment; seven (28%) attended an initial appointment, but did not attend a subsequent appointment and were discharged from the service; five (20%) completed treatment and four patients (16%) had ongoing treatment. Semi-structured interviews revealed potential barriers preventing homeless people from accessing physiotherapy services, the complex factors being faced by those making referrals and possible ways to improve physiotherapy access. Homeless people with musculoskeletal problems may fail to access physiotherapy treatment, but opportunities

Overview of core designs and requirements/criteria for core restraint systems

International Nuclear Information System (INIS)

Sutherland, W.H.

1984-01-01

The requirements and lifetime criteria for the design of a Liquid Metal Fast Breeder Reactor (LMFBR) Core Restraint System is presented. A discussion of the three types of core restraint systems used in LMFBR core design is given. Details of the core restraint system selected for FFTF are presented and the reasons for this selection given. Structural analysis procedures being used to manage the FFTF assembly irradiations are discussed. Efforts that are ongoing to validate the calculational methods and lifetime criteria are presented. (author)

Interdisciplinary Transgender Veteran Care: Development of a Core Curriculum for VHA Providers

Science.gov (United States)

Shipherd, Jillian C.; Kauth, Michael R.; Firek, Anthony F.; Garcia, Ranya; Mejia, Susan; Laski, Sandra; Walden, Brent; Perez-Padilla, Sonia; Lindsay, Jan A.; Brown, George; Roybal, Lisa; Keo-Meier, Colton L.; Knapp, Herschel; Johnson, Laura; Reese, Rebecca L.; Byne, William

2016-01-01

Abstract Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network–Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge. PMID:29159298

Nuclear reactor core flow baffling

International Nuclear Information System (INIS)

Berringer, R.T.

1979-01-01

A flow baffling arrangement is disclosed for the core of a nuclear reactor. A plurality of core formers are aligned with the grids of the core fuel assemblies such that the high pressure drop areas in the core are at the same elevations as the high pressure drop areas about the core periphery. The arrangement minimizes core bypass flow, maintains cooling of the structure surrounding the core, and allows the utilization of alternative beneficial components such as neutron reflectors positioned near the core

Accounting for health-care outcomes: implications for intensive care unit practice and performance.

Science.gov (United States)

Sorensen, Roslyn; Iedema, Rick

2010-08-01

The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. Fractures were evident within clinical units, between clinical units and between clinical and managerial domains. These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts of accountability. Managers must conceptualize health services as an interconnected entity within which self-directed teams negotiate and agree objectives, collect and review performance data and define collective practice. Organically developing regimens of care within and across specialist clinical units, such as in ICUs, directly impact upon health service performance and accountability.

What does the Development of the European Core Curriculum for Cardiovascular Nurses Mean for Australia?

Science.gov (United States)

Neubeck, Lis; Lin, Stella Hsi-Man; Ferry, Cate; Gallagher, Robyn

2016-04-01

A core curriculum for the continuing professional development of nurses has recently been published by the Council on Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. This core curriculum was envisaged to bridge the educational gap between qualification as a nurse and an advance practice role. In addition, the shared elements and international consensus on core themes creates a strong pathway for nursing career development that is directly relevant to Australia. Education programs for nurses in Australia must meet the mandatory standards of the Australian Nursing and Midwifery Accreditation Council (ANMAC), but without a national core curriculum, there can be considerable variation in the content of such courses. The core curriculum is developed to be adapted locally, allowing the addition of nationally relevant competencies, for example, culturally appropriate care of Aboriginal and Torres Strait Islander individuals. Two existing specialist resources could be utilised to deliver a tailored cardiovascular core curriculum; the Heart Education Assessment and Rehabilitation Toolkit (HEART) online (www.heartonline.org.au) and HeartOne (www.heartone.com.au). Both resources could be further enhanced by incorporating the core curriculum. The release of the European core curriculum should be viewed as a call to action for Australia to develop a core curriculum for cardiovascular nurses. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Development of new core competencies for Taiwanese Emergency Medical Technicians.

Science.gov (United States)

Chang, Yu-Tung; Tsai, Kuang-Chau; Williams, Brett

2018-01-01

Core competencies are considered the foundation for establishing Emergency Medical Technician (EMT) and paramedic curricula, and for ensuring performance standards in the delivery of prehospital care. This study surveyed EMT instructors and medical directors to identify the most desirable core competencies for all levels of EMTs in Taiwan. A principal components analysis with Varimax rotation was conducted. An online questionnaire was distributed to obtain perspectives of EMT instructors and medical directors on the most desirable core competencies for EMTs. The target population was EMT training-course instructors and medical directors of fire departments in Taiwan. The questionnaire comprised 61 competency items, and multiple-choice and open-ended questions were used to obtain respondents' perspectives of the Taiwanese EMT training and education system. The results identified three factors at EMT-1 and EMT-2 levels and five factors at the EMT-Paramedic level. The factors for EMT-1 and EMT-2 were similar, and those for EMT-Paramedics identified further comprehensive competence perspectives. The key factors that appear to influence the development of the Taiwanese Emergency Medical Services (EMS) education system are the attitude of authorities, the licensure system, and legislation. The findings present new core competencies for the Taiwanese EMT system and provide capacity to redesign curricula and reconsider roles for EMT-1 and EMT-2 technicians. At the EMT-Paramedic level, the findings demonstrate the importance of incorporating competency standards in the current skills-based curriculum. Moreover, the core-competencies gap that exists between Taiwanese EMT-1s, EMT-2s, and EMT-Paramedics and internationally recognized core competencies needs to be addressed. By identifying the key factors that potentially impact the development of the EMS education system, such as the attitude of authorities, the licensure system, and legislation, these findings will inform

Social Work and Interprofessional Education in Health Care: A Call for Continued Leadership

Science.gov (United States)

Jones, Barbara; Phillips, Farya

2016-01-01

A report from the Interprofessional Education Collaborative and another from the Institute of Medicine cite working as part of interdisciplinary teams as a core proficiency area for improving health care. This article discusses the core competencies of interprofessional education and the essential role for social workers as leaders and…

Canadian Chronic Kidney Disease Clinics: A National Survey of Structure, Function and Models of Care

Directory of Open Access Journals (Sweden)

Adeera Levin

2014-11-01

Full Text Available Background: The goals of care for patients with chronic kidney disease (CKD are to delay progression to end stage renal disease, reduce complications, and to ensure timely transition to dialysis or transplantation, while optimizing independence. Recent guidelines recommend that multidisciplinary team based care should be available to patients with CKD. While most provinces fund CKD care, the specific models by which these outcomes are achieved are not known. Funding for clinics is hospital or program based. Objectives: To describe the structure and function of clinics in order to understand the current models of care, inform best practice and potentially standardize models of care. Design: Prospective cross sectional observational survey study. Setting, Patients/Participants: Canadian nephrology programs in all provinces. Methods and Measurements: Using an open-ended semi-structured questionnaire, we surveyed 71 of 84 multidisciplinary adult CKD clinics across Canada, by telephone and with written semi-structured questionnaires; (June 2012 to November 2013. Standardized introductory scripts were used, in both English and French. Results: CKD clinic structure and models of care vary significantly across Canada. Large variation exists in staffing ratios (Nephrologist, dieticians, pharmacists and nurses to patients, and in referral criteria. Dialysis initiation decisions were usually made by MDs. The majority of clinics (57% had a consistent model of care (the same Nephrologist and nurse per patient, while others had patients seeing a different nephrologist and nurses at each clinic visit. Targets for various modality choices varied, as did access to those modalities. No patient or provider educational tools describing the optimal time to start dialysis exist in any of the clinics. Limitations: The surveys rely on self reporting without validation from independent sources, and there was limited involvement of Quebec clinics. These are relative

A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

Science.gov (United States)

Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

2010-10-01

This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p competencies of patient care (R = 0.49, p competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

Parental perspectives on the financial impact of caring for a child with CKD.

Science.gov (United States)

Medway, Meredith; Tong, Allison; Craig, Jonathan C; Kim, Siah; Mackie, Fiona; McTaggart, Steven; Walker, Amanda; Wong, Germaine

2015-03-01

The economic consequences of chronic kidney disease (CKD) are severe for adult patients and their households, but the out-of-pocket expenses and economic burden of CKD and how this affects the caregivers of children with kidney disease are unclear. This study aims to describe parental perspectives on the financial impact of caring for a child with CKD. Face-to-face semistructured interviews. Parents of children with CKD from 3 pediatric nephrology centers in Australia. Transcripts were analyzed thematically. 27 parents of 26 children participated. We identified 5 themes: loss of freedom and control (prioritizing care, limiting occupational opportunities, and appreciating socioeconomic advantage), burden of sole responsibility (inability to rely on others, lack of respite, increased separation of family roles, and self-reliance), adapting for survival (vigilant budgeting, redefining normality and expectations, rechanneling resources to basic needs, and negotiating work flexibility), instability of circumstances (depleted capacity to work, unpredictability of child's health, burden of travel-related costs, imposition of debt, and domestic upheaval), and struggle in seeking support ("falling through the cracks" and unmet information needs). Few participants were fathers (n=5), and results may not be transferable to non-English-speaking caregivers because these participants were excluded. Parents focused their resources and attention on meeting the complex needs of their child. Inability to sustain employment due to focus on their child's care and both medical and nonmedical expenses were major contributors to the financial impact, with financial stress compounded by difficulties accessing government support. As a result, parents experienced profound financial and social instability and physical and psychological fatigue and exercised extreme financial vigilance. Increased access to respite and domestic support and financial and psychosocial interventions are suggested

Espaço de cores

Directory of Open Access Journals (Sweden)

Claudia Feitosa-Santana

2006-01-01

Full Text Available O artigo apresenta definições para os termos espaço de cores e sistemas de cores; classifica, de acordo com David Brainard (2003, os sistemas de cores em dois grupos: aparência de cores e diferenças de cores. Dentre os diversos sistemas de cores existentes, o artigo descreve dois deles: o sistema de cores Munsell &– um dos mais utilizados entre os sistemas de aparência de cores &– e a descrição do sistema de cores CIE 1931 &– um dos mais utilizados dentre os sistemas de diferença de cores. Faz-se uma retrospectiva histórica da busca por espaços de cores que representem a percepção de cores humana assim como as diversas reconstruções de espaços de cores por métodos eletrofisiológicos ou psicofísicos. Muitas dessas reconstruções utilizam a escala multidimensional (mds. O artigo também introduz a possibilidade da reconstrução dos espaços de cores de pacientes com discromatopsia adquirida como uma distorção do espaço de indivíduos tricromatas normais.

Core antigen and circulating anti-core antibody in hepatitis B infection

Energy Technology Data Exchange (ETDEWEB)

Howard, C R; Zuckerman, A J [London School of Hygiene and Tropical Medicine (UK)

1977-02-01

Core antigen was obtained from the sera of persistent chronic carriers of hepatitis B virus by centrifugation and treatment with Nonidet P40 and 2-mercaptoethanol. The separated core antigen was radiolabelled and identified as a nucleoprotein structure of buoyant density 1.36 g/cm/sup 3/ and possessing an isoelectric point of 4.4. This material was employed in a radioimmnoassay procedure of high sensitivity for the detection of core antibody. In a series of sera from patients with acute type B hepatitis, core antibody was demonstrated 2 to 3 weeks after the onset of jaundice during the period of surface antigenaemia. The presence of core antibody may therefore provide an accurate serological marker for the detection of active or recent virus replication in future epidemiological studies of hepatitis B infection.

Internal core tightener

International Nuclear Information System (INIS)

Brynsvold, G.V.; Snyder, H.J. Jr.

1976-01-01

An internal core tightener is disclosed which is a linear actuated (vertical actuation motion) expanding device utilizing a minimum of moving parts to perform the lateral tightening function. The key features are: (1) large contact areas to transmit loads during reactor operation; (2) actuation cam surfaces loaded only during clamping and unclamping operation; (3) separation of the parts and internal operation involved in the holding function from those involved in the actuation function; and (4) preloaded pads with compliant travel at each face of the hexagonal assembly at the two clamping planes to accommodate thermal expansion and irradiation induced swelling. The latter feature enables use of a ''fixed'' outer core boundary, and thus eliminates the uncertainty in gross core dimensions, and potential for rapid core reactivity changes as a result of core dimensional change. 5 claims, 12 drawing figures

Developing an undergraduate curriculum in Special Care Dentistry - by consensus.

LENUS (Irish Health Repository)

Dougall, A

2013-02-01

It has been reported that healthcare providers often lack the skills set to provide care for people with disabilities, leading to inequalities in health and reduced access to health care. Newly graduating dentists are likely to see a significant number of patients with special healthcare needs in the course of their practicing lives. However, there is evidence of national and international variation in the availability of education and training at the undergraduate level in this important, emerging area. The quality and content of undergraduate education in Special Care Dentistry has been shown to correlate with students\\' confidence and their expressed willingness, towards providing care for patients with special healthcare needs in their future practice. The aim of this study was to use information from a three-round Delphi process, continued into a face-to-face meeting, to establish consensus on what constitutes the essential core knowledge, skills and attitudes required by a newly qualified dentist so that they are able to deliver patient care to diverse populations following graduation. A high level of agreement was established amongst an international panel of experts from 30 countries. The final core items identified by the panel showed a paradigm shift away from the traditional emphasis on medical diagnosis within a curriculum towards an approach based on the International Classification of Functioning (ICF) with patient-centred treatment planning for people with disabilities and special healthcare needs according to function or environment. Many of the core skills identified by the panel are transferable across a curriculum and should encourage a person-centred approach to treatment planning based on the function, needs and wishes of the patient rather than their specific diagnosis.

Ultrasound-guided percutaneous core needle biopsy of splenic lesions

Energy Technology Data Exchange (ETDEWEB)

Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

2017-05-15

To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

Ultrasound-guided percutaneous core needle biopsy of splenic lesions

International Nuclear Information System (INIS)

Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu

2017-01-01

To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications

Pediatric hospital medicine core competencies: development and methodology.

Science.gov (United States)

Stucky, Erin R; Ottolini, Mary C; Maniscalco, Jennifer

2010-01-01

Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed. In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM. The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care. These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. (c) 2010 Society of Hospital Medicine.

Application Service Providers (ASP Adoption in Core and Non-Core Functions

Directory of Open Access Journals (Sweden)

Aman Y.M. Chan

2009-10-01

Full Text Available With the further improvement in internet bandwidth, connection stability and data transmission security, a new wave of Application Service Providers (ASP is on his way. The recent booming on some models such as Software Application as Service (SaaS and On-Demand in 2008, has led to emergence of ASP model in core business functions. The traditional IS outsourcing covers the non-core business functions that are not critical to business performance and competitive advantages. Comparing with traditional IS outsourcing, ASP is a new phenomenon that can be considered as an emerging innovation as it covers both core and non-core business functions. Most of the executives do not comprehend the difference and similarity between traditional IS outsourcing and ASP mode. Hence, we propose to conduct a research so as to identify the determinants (cost benefit, gap in IS capability complementing the company's strategic goal, and trust to ASP's service and security level and moderating factors (management's attitude in ownership & control, and company aggressiveness of ASP adoption decision in both core and non-core business functions.

Reactor core

International Nuclear Information System (INIS)

Azekura, Kazuo; Kurihara, Kunitoshi.

1992-01-01

In a BWR type reactor, a great number of pipes (spectral shift pipes) are disposed in the reactor core. Moderators having a small moderating cross section (heavy water) are circulated in the spectral shift pipes to suppress the excess reactivity while increasing the conversion ratio at an initial stage of the operation cycle. After the intermediate stage of the operation cycle in which the reactor core reactivity is lowered, reactivity is increased by circulating moderators having a great moderating cross section (light water) to extend the taken up burnup degree. Further, neutron absorbers such as boron are mixed to the moderator in the spectral shift pipe to control the concentration thereof. With such a constitution, control rods and driving mechanisms are no more necessary, to simplify the structure of the reactor core. This can increase the fuel conversion ratio and control great excess reactivity. Accordingly, a nuclear reactor core of high conversion and high burnup degree can be attained. (I.N.)

Overlap and Nonoverlap Between the ICF Core Sets for Hearing Loss and Otology and Audiology Intake Documentation.

Science.gov (United States)

van Leeuwen, Lisette M; Merkus, Paul; Pronk, Marieke; van der Torn, Marein; Maré, Marcel; Goverts, S Theo; Kramer, Sophia E

The International Classification of Functioning Disability and Health (ICF) Core Sets for Hearing Loss (HL) were developed to serve as a standard for the assessment and reporting of the functioning and health of patients with HL. The aim of the present study was to compare the content of the intake documentation currently used in secondary and tertiary hearing care settings in the Netherlands with the content of the ICF Core Sets for HL. Research questions were (1) to what extent are the ICF Core Sets for HL represented in the Dutch Otology and Audiology intake documentation? (2) are there any extra ICF categories expressed in the intake documentation that are currently not part of the ICF Core Sets for HL, or constructs expressed that are not part of the ICF? Multicenter patient record study including 176 adult patients from two secondary, and two tertiary hearing care settings. The intake documentation was selected from anonymized patient records. The content was linked to the appropriate ICF category from the whole ICF classification using established linking rules. The extent to which the ICF Core Sets for HL were represented in the intake documentation was determined by assessing the overlap between the ICF categories in the Core Sets and the list of unique ICF categories extracted from the intake documentation. Any extra constructs that were expressed in the intake documentation but are not part of the Core Sets were described as well, differentiating between ICF categories that are not part of the Core Sets and constructs that are not part of the ICF classification. In total, otology and audiology intake documentation represented 24 of the 27 Brief ICF Core Set categories (i.e., 89%), and 60 of the 117 Comprehensive ICF Core Set categories (i.e., 51%). Various ICF Core Sets categories were not represented, including higher mental functions (Body Functions), civic life aspects (Activities and Participation), and support and attitudes of family (Environmental

Electromagnetically driven westward drift and inner-core superrotation in Earth’s core

Science.gov (United States)

Livermore, Philip W.; Hollerbach, Rainer; Jackson, Andrew

2013-01-01

A 3D numerical model of the earth’s core with a viscosity two orders of magnitude lower than the state of the art suggests a link between the observed westward drift of the magnetic field and superrotation of the inner core. In our model, the axial electromagnetic torque has a dominant influence only at the surface and in the deepest reaches of the core, where it respectively drives a broad westward flow rising to an axisymmetric equatorial jet and imparts an eastward-directed torque on the solid inner core. Subtle changes in the structure of the internal magnetic field may alter not just the magnitude but the direction of these torques. This not only suggests that the quasi-oscillatory nature of inner-core superrotation [Tkalčić H, Young M, Bodin T, Ngo S, Sambridge M (2013) The shuffling rotation of the earth’s inner core revealed by earthquake doublets. Nat Geosci 6:497–502.] may be driven by decadal changes in the magnetic field, but further that historical periods in which the field exhibited eastward drift were contemporaneous with a westward inner-core rotation. The model further indicates a strong internal shear layer on the tangent cylinder that may be a source of torsional waves inside the core. PMID:24043841

Complete Au@ZnO core-shell nanoparticles with enhanced plasmonic absorption enabling significantly improved photocatalysis

Science.gov (United States)

Sun, Yiqiang; Sun, Yugang; Zhang, Tao; Chen, Guozhu; Zhang, Fengshou; Liu, Dilong; Cai, Weiping; Li, Yue; Yang, Xianfeng; Li, Cuncheng

2016-05-01

Nanostructured ZnO exhibits high chemical stability and unique optical properties, representing a promising candidate among photocatalysts in the field of environmental remediation and solar energy conversion. However, ZnO only absorbs the UV light, which accounts for less than 5% of total solar irradiation, significantly limiting its applications. In this article, we report a facile and efficient approach to overcome the poor wettability between ZnO and Au by carefully modulating the surface charge density on Au nanoparticles (NPs), enabling rapid synthesis of Au@ZnO core-shell NPs at room temperature. The resulting Au@ZnO core-shell NPs exhibit a significantly enhanced plasmonic absorption in the visible range due to the Au NP cores. They also show a significantly improved photocatalytic performance in comparison with their single-component counterparts, i.e., the Au NPs and ZnO NPs. Moreover, the high catalytic activity of the as-synthesized Au@ZnO core-shell NPs can be maintained even after many cycles of photocatalytic reaction. Our results shed light on the fact that the Au@ZnO core-shell NPs represent a promising class of candidates for applications in plasmonics, surface-enhanced spectroscopy, light harvest devices, solar energy conversion, and degradation of organic pollutants.Nanostructured ZnO exhibits high chemical stability and unique optical properties, representing a promising candidate among photocatalysts in the field of environmental remediation and solar energy conversion. However, ZnO only absorbs the UV light, which accounts for less than 5% of total solar irradiation, significantly limiting its applications. In this article, we report a facile and efficient approach to overcome the poor wettability between ZnO and Au by carefully modulating the surface charge density on Au nanoparticles (NPs), enabling rapid synthesis of Au@ZnO core-shell NPs at room temperature. The resulting Au@ZnO core-shell NPs exhibit a significantly enhanced plasmonic

Looking after Lawns and Bedding. Youth Training Scheme. Core Exemplar Work Based Project.

Science.gov (United States)

Further Education Staff Coll., Blagdon (England).

This trainer's guide is intended to assist supervisors of work-based career training projects in teaching students about lawn care. The guide is one in a series of core curriculum modules that is intended for use in combination on- and off-the-job programs to familiarize youth with the skills, knowledge, and attitudes necessary for success in the…

Inner Core Rotation from Geomagnetic Westward Drift and a Stationary Spherical Vortex in Earth's Core

Science.gov (United States)

Voorhies, C. V.

1999-01-01

The idea that geomagnetic westward drift indicates convective leveling of the planetary momentum gradient within Earth's core is pursued in search of a differentially rotating mean state, upon which various oscillations and secular effects might be superimposed. The desired state conforms to roughly spherical boundary conditions, minimizes dissipative interference with convective cooling in the bulk of the core, yet may aide core cooling by depositing heat in the uppermost core and lower mantle. The variational calculus of stationary dissipation applied to a spherical vortex within the core yields an interesting differential rotation profile akin to spherical Couette flow bounded by thin Hartmann layers. Four boundary conditions are required. To concentrate shear induced dissipation near the core-mantle boundary, these are taken to be: (i) no-slip at the core-mantle interface; (ii) geomagnetically estimated bulk westward flow at the base of the core-mantle boundary layer; (iii) no-slip at the inner-outer core interface; and, to describe magnetic locking of the inner core to the deep outer core, (iv) hydrodynamically stress-free at the inner-outer core boundary. By boldly assuming the axial core angular momentum anomaly to be zero, the super-rotation of the inner core is calculated to be at most 1.5 degrees per year.

Epistemology and ontology in core ontologies: FOLaw and LRI-Core, two core ontologies for law

NARCIS (Netherlands)

Breukers, J.A.P.J.; Hoekstra, R.J.

2004-01-01

For more than a decade constructing ontologies for legal domains, we, at the Leibniz Center for Law, felt really the need to develop a core ontology for law that would enable us to re-use the common denominator of the various legal domains. In this paper we present two core ontologies for law. The

Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

Science.gov (United States)

Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

2016-05-01

Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements.

ProvenCare: Geisinger's Model for Care Transformation through Innovative Clinical Initiatives and Value Creation.

Science.gov (United States)

2009-04-01

Geisinger's system of care can be seen as a microcosm of the national delivery of healthcare, with implications for decision makers in other health plans. In this interview, Dr Ronald A. Paulus focuses on Geisinger's unique approach to patient care. In its core, this approach represents a system of quality and value initiatives based on 3 major programs-Proven Health Navigation (medical home); the ProvenCare model; and transitions of care. The goal of such an approach is to optimize disease management by using a rational reimbursement paradigm for appropriate interventions, providing innovative incentives, and engaging patients in their own care as part of any intervention. Dr Paulus explains the reasons why, unlike Geisinger, other stakeholders, including payers, providers, patients, and employers, have no intrinsic reasons to be concerned with quality and value initiatives. In addition, he says, an electronic infrastructure that could be modified as management paradigms evolve is a necessary tool to ensure the healthcare delivery system's ability to adapt to new clinical realities quickly to ensure the continuation of delivering best value for all stakeholders.

Investigation in uro-nephrology (2): renal cortical scintigraphy using {sup 99m}Tc-Dmsa in children; Enquete en uro-nephrologie (2): la scintigraphie renale au 99mTc-DMSA chez l'enfant

Energy Technology Data Exchange (ETDEWEB)

Archambaud, F. [Centre Hospitalier Universitaire de Bicetre, 94 - Le Kremlin-Bicetre (France); Olivier, P. [Centre Hospitalier Universitaire Nancy-Brabois, 54 - Vandoeuvre-les-Nancy (France); Guillet, J. [Centre Hospitalier Universitaire, 47 - Agen (France); Wioland, M. [Centre Hospitalier Universitaire Armand Trousseau, 75 - Paris (France); Bonnin, F. [Centre Hospitalier Universitaire Beaujon, 92 - Clichy (France)

2002-08-01

We present the results of a national investigation about the daily practice of renal cortical scintigraphy using {sup 99m}Tc-DMSA in children by comparison with the recommendations of the international consensus from the experts designated by the Scientific Committee of 'Radionuclides in Nephrology'. Questions were related to radiopharmaceutical image acquisition, processing and visualisation, relative renal function determination and indications of renal scan in urinary tract infection. National daily practice are similar to the one suggested by the international consensus about many aspects. However, a controversy exists between the experts in acquiring pinhole or tomographic images. Similarly to the international consensus, {sup 99m}Tc-DMSA renal scan is widely performed for detection of renal sequelae, while its indication in acute pyelonephritis remains to define. (authors)

Transformer core

NARCIS (Netherlands)

Mehendale, A.; Hagedoorn, Wouter; Lötters, Joost Conrad

2008-01-01

A transformer core includes a stack of a plurality of planar core plates of a magnetically permeable material, which plates each consist of a first and a second sub-part that together enclose at least one opening. The sub-parts can be fitted together via contact faces that are located on either side

Transformer core

NARCIS (Netherlands)

Mehendale, A.; Hagedoorn, Wouter; Lötters, Joost Conrad

2010-01-01

A transformer core includes a stack of a plurality of planar core plates of a magnetically permeable material, which plates each consist of a first and a second sub-part that together enclose at least one opening. The sub-parts can be fitted together via contact faces that are located on either side

[Core muscle chains activation during core exercises determined by EMG-a systematic review].

Science.gov (United States)

Rogan, Slavko; Riesen, Jan; Taeymans, Jan

2014-10-15

Good core muscles strength is essential for daily life and sports activities. However, the mechanism how core muscles may be effectively triggered by exercises is not yet precisely described in the literature. The aim of this systematic review was to evaluate the rate of activation as measured by electromyography of the ventral, lateral and dorsal core muscle chains during core (trunk) muscle exercises. A total of 16 studies were included. Exercises with a vertical starting position, such as the deadlift or squat activated significantly more core muscles than exercises in the horizontal initial position.

Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent.

Science.gov (United States)

Salmon, Margaret; Landes, Megan; Hunchak, Cheryl; Paluku, Justin; Malemo Kalisya, Luc; Salmon, Christian; Muller, Mundenga Mutendi; Wachira, Benjamin; Mangan, James; Chhaganlal, Kajal; Kalanzi, Joseph; Azazh, Aklilu; Berman, Sara; Zied, El-Sayed; Lamprecht, Hein

2017-02-01

Significant evidence identifies point-of-care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource-limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high-impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource-rich PoCUS curricula and delivery methods to resource-limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Factors in career choice among US nephrologists.

Science.gov (United States)

McMahon, Gearoid M; Thomas, Lynette; Tucker, J Kevin; Lin, Julie

2012-11-01

There is a projected shortage of kidney specialists, and retention of trainees in nephrology is important. Determining factors that result in choosing a nephrology career could inform future strategies to attract nephrology fellows. An anonymous, internet-based survey was sent to members of the American Society of Nephrology in June 2009. Respondents answered questions about demographics, training background, and career choices. Of the 3399 members, 913 (23%) returned the survey. Mean age was 51.1 ± 10.5 years, and 46.1% were academic nephrologists. In addition, 38.4% of respondents graduated between 2000 and 2009. Interest in nephrology began early in training, with the intellectual aspects of nephrology, early mentoring, and participation in nephrology electives named as the most common reasons in choosing nephrology. Academic nephrologists were more likely to have participated in research in medical school, have a master's degree or PhD, and successfully obtained research funding during training. Academic debt was higher among nonacademic nephrologists. Research opportunities and intellectual stimulation were the main factors for academic nephrologists when choosing their first postfellowship positions, whereas geographic location and work-life balance were foremost for nonacademic nephrologists. These findings highlight the importance of exposing medical students and residents to nephrology early in their careers through involvement in research, electives, and positive mentoring. Further work is needed to develop and implement effective strategies, including increasing early exposure to nephrology in preclinical and clinical years, as well as encouraging participation in research, in order to attract future nephrology trainees.

Risk reduction of core-melt accidents in advaned CAPRA burner cores

International Nuclear Information System (INIS)

Maschek, W.; Struwe, D.; Eigemann, M.

1997-01-01

As part of the CAPRA Program (Consommation Accrue de Plutonium dans les RApides) the feasibility of fast reactors is investigated to burn plutonium and also to destruct minor actinides. The design of CAPRA cores shows significant differences compared to conventional cores. Especially the high Pu-enrichment has an important influence on the core melt-down behavior and the associated recriticality risk. To cope with this risk, inherent design features and special measures/devices are investigated for their potential of early fuel discharge to reduce the criticality of the reactor core. An assessment of such measures/devices is given and experimental needs are formulated. 11 refs., 5 figs

Sports Cardiology: Core Curriculum for Providing Cardiovascular Care to Competitive Athletes and Highly Active People.

Science.gov (United States)

Baggish, Aaron L; Battle, Robert W; Beckerman, James G; Bove, Alfred A; Lampert, Rachel J; Levine, Benjamin D; Link, Mark S; Martinez, Matthew W; Molossi, Silvana M; Salerno, Jack; Wasfy, Meagan M; Weiner, Rory B; Emery, Michael S

2017-10-10

The last few decades have seen substantial growth in the populations of competitive athletes and highly active people (CAHAP). Although vigorous physical exercise is an effective way to reduce the risk of cardiovascular (CV) disease, CAHAP remain susceptible to inherited and acquired CV disease, and may be most at risk for adverse CV outcomes during intense physical activity. Traditionally, multidisciplinary teams comprising athletic trainers, physical therapists, primary care sports medicine physicians, and orthopedic surgeons have provided clinical care for CAHAP. However, there is increasing recognition that a care team including qualified CV specialists optimizes care delivery for CAHAP. In recognition of the increasing demand for CV specialists competent in the care of CAHAP, the American College of Cardiology has recently established a Sports and Exercise Council. An important primary objective of this council is to define the essential skills necessary to practice effective sports cardiology. Copyright © 2017. Published by Elsevier Inc.

The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

Directory of Open Access Journals (Sweden)

Stephan Brenner

Full Text Available A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs, a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC, the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example.We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi.Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks.The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining

The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

Science.gov (United States)

Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S

2015-01-01

A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program

Animal MRI Core

Data.gov (United States)

Federal Laboratory Consortium — The Animal Magnetic Resonance Imaging (MRI) Core develops and optimizes MRI methods for cardiovascular imaging of mice and rats. The Core provides imaging expertise,...

How unique is continuity of care? A review of continuity and related concepts.

Science.gov (United States)

Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M

2012-06-01

The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.

Error Analysis of High Frequency Core Loss Measurement for Low-Permeability Low-Loss Magnetic Cores

DEFF Research Database (Denmark)

Niroumand, Farideh Javidi; Nymand, Morten

2016-01-01

in magnetic cores is B-H loop measurement where two windings are placed on the core under test. However, this method is highly vulnerable to phase shift error, especially for low-permeability, low-loss cores. Due to soft saturation and very low core loss, low-permeability low-loss magnetic cores are favorable...... in many of the high-efficiency high power-density power converters. Magnetic powder cores, among the low-permeability low-loss cores, are very attractive since they possess lower magnetic losses in compared to gapped ferrites. This paper presents an analytical study of the phase shift error in the core...... loss measuring of low-permeability, low-loss magnetic cores. Furthermore, the susceptibility of this measurement approach has been analytically investigated under different excitations. It has been shown that this method, under square-wave excitation, is more accurate compared to sinusoidal excitation...

Development and pilot testing of a patient-participatory pressure ulcer prevention care bundle.

Science.gov (United States)

Gillespie, Brigid M; Chaboyer, Wendy; Sykes, Mark; O'Brien, Jennifer; Brandis, Susan

2014-01-01

This study developed and piloted a patient-centered pressure ulcer prevention care bundle for adult hospitalized patients to promote patient participation in prevention. The care bundle had 3 core messages: (1) keep moving, (2) care for your skin, and (3) ensure a good diet. A brief video, combined brochure/checklist, and poster were developed as training resources. Patient evaluation identified benefits of the care bundle; however, the combined checklist/brochure was rarely used.

The Faculty of Language Integrates the Two Core Systems of Number.

Science.gov (United States)

Hiraiwa, Ken

2017-01-01

Only humans possess the faculty of language that allows an infinite array of hierarchically structured expressions (Hauser et al., 2002; Berwick and Chomsky, 2015). Similarly, humans have a capacity for infinite natural numbers, while all other species seem to lack such a capacity (Gelman and Gallistel, 1978; Dehaene, 1997). Thus, the origin of this numerical capacity and its relation to language have been of much interdisciplinary interest in developmental and behavioral psychology, cognitive neuroscience, and linguistics (Dehaene, 1997; Hauser et al., 2002; Pica et al., 2004). Hauser et al. (2002) and Chomsky (2008) hypothesize that a recursive generative operation that is central to the computational system of language (called Merge ) can give rise to the successor function in a set-theoretic fashion, from which capacities for discretely infinite natural numbers may be derived. However, a careful look at two domains in language, grammatical number and numerals, reveals no trace of the successor function. Following behavioral and neuropsychological evidence that there are two core systems of number cognition innately available, a core system of representation of large, approximate numerical magnitudes and a core system of precise representation of distinct small numbers (Feigenson et al., 2004), I argue that grammatical number reflects the core system of precise representation of distinct small numbers alone. In contrast, numeral systems arise from integrating the pre-existing two core systems of number and the human language faculty. To the extent that my arguments are correct, linguistic representations of number, grammatical number, and numerals do not incorporate anything like the successor function.

MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip.

Science.gov (United States)

Nori, Madhavi; Marupaka, Sravan Kumar; Alluri, Swathi; Md, Naseeruddin; Irfan, Kazi Amir; Jampala, Venkateshwarlu; Apsingi, Sunil; Eachempati, Krishna Kiran

2015-12-01

Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. To study pre and post core decompression MRI changes in avascular necrosis of hip. This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.

The core domain as the force sensor of the yeast mechanosensitive TRP channel.

Science.gov (United States)

Su, Zhenwei; Anishkin, Andriy; Kung, Ching; Saimi, Yoshiro

2011-12-01

Stretch-activated conductances are commonly encountered in careful electric recordings. Those of known proteins (TRP, MscL, MscS, K(2p), Kv, etc.) all share a core, which houses the ion pathway and the gate, but no recognizable force-sensing domain. Like animal TRPs, the yeast TRPY1 is polymodal, activated by stretch force, Ca(2+), etc. To test whether its S5-S6 core senses the stretch force, we tried to uncouple it from the peripheral domains by strategic peptide insertions to block the covalent core-periphery interactions. Insertion of long unstructured peptides should distort, if not disrupt, protein structures that transmit force. Such insertions between S6 and the C-terminal tail largely removed Ca(2+) activation, showing their effectiveness. However, such insertions as well as those between S5 and the N-terminal region, which includes S1-S4, did not significantly alter mechanosensitivity. Even insertions at both locations flanking the S5-S6 core did not much alter mechanosensitivity. Tryptophan scanning mutations in S5 were also constructed to perturb possible noncovalent core-periphery contacts. The testable tryptophan mutations also have little or no effects on mechanosensitivity. Boltzmann fits of the wild-type force-response curves agree with a structural homology model for a stretch-induced core expansion of ~2 nm(2) upon opening. We hypothesize that membrane tension pulls on S5-S6, expanding the core and opening the TRPY1 gate. The core being the major force sensor offers the simplest, though not the only, explanation of why so many channels of disparate designs are mechanically sensitive. Compared with the bacterial MscL, TRPY1 is much less sensitive to force, befitting a polymodal channel that relies on multiple stimuli.

The core paradox.

Science.gov (United States)

Kennedy, G. C.; Higgins, G. H.

1973-01-01

Rebuttal of suggestions from various critics attempting to provide an escape from the seeming paradox originated by Higgins and Kennedy's (1971) proposed possibility that the liquid in the outer core was thermally stably stratified and that this stratification might prove a powerful inhibitor to circulation of the outer core fluid of the kind postulated for the generation of the earth's magnetic field. These suggestions are examined and shown to provide no reasonable escape from the core paradox.

s-core network decomposition: A generalization of k-core analysis to weighted networks

Science.gov (United States)

Eidsaa, Marius; Almaas, Eivind

2013-12-01

A broad range of systems spanning biology, technology, and social phenomena may be represented and analyzed as complex networks. Recent studies of such networks using k-core decomposition have uncovered groups of nodes that play important roles. Here, we present s-core analysis, a generalization of k-core (or k-shell) analysis to complex networks where the links have different strengths or weights. We demonstrate the s-core decomposition approach on two random networks (ER and configuration model with scale-free degree distribution) where the link weights are (i) random, (ii) correlated, and (iii) anticorrelated with the node degrees. Finally, we apply the s-core decomposition approach to the protein-interaction network of the yeast Saccharomyces cerevisiae in the context of two gene-expression experiments: oxidative stress in response to cumene hydroperoxide (CHP), and fermentation stress response (FSR). We find that the innermost s-cores are (i) different from innermost k-cores, (ii) different for the two stress conditions CHP and FSR, and (iii) enriched with proteins whose biological functions give insight into how yeast manages these specific stresses.

The AVRDC - The World Vegetable Center mungbean (Vigna radiata) core and mini core collections.

Science.gov (United States)

Schafleitner, Roland; Nair, Ramakrishnan Madhavan; Rathore, Abhishek; Wang, Yen-wei; Lin, Chen-yu; Chu, Shu-hui; Lin, Pin-yun; Chang, Jian-Cheng; Ebert, Andreas W

2015-04-29

Large ex situ germplasm collections generally harbor a wide range of crop diversity. AVRDC--The World Vegetable Center is holding in trust the world's second largest mungbean (Vigna radiata) germplasm collection with more than 6,700 accessions. Screening large collections for traits of interest is laborious and expensive. To enhance the access of breeders to the diversity of the crop, mungbean core and mini core collections have been established. The core collection of 1,481 entries has been built by random selection of 20% of the accessions after geographical stratification and subsequent cluster analysis of eight phenotypic descriptors in the whole collection. Summary statistics, especially the low differences of means, equal variance of the traits in both the whole and core collection and the visual inspection of quantile-quantile plots comparing the variation of phenotypic traits present in both collections indicated that the core collection well represented the pattern of diversity of the whole collection. The core collection was genotyped with 20 simple sequence repeat markers and a mini core set of 289 accessions was selected, which depicted the allele and genotype diversity of the core collection. The mungbean core and mini core collections plus their phenotypic and genotypic data are available for distribution to breeders. It is expected that these collections will enhance the access to biodiverse mungbean germplasm for breeding.

Team-Based Care: A Concept Analysis.

Science.gov (United States)

Baik, Dawon

2017-10-01

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

Synthesis and Plasmonic Understanding of Core/Satellite and Core Shell Nanostructures

Science.gov (United States)

Ruan, Qifeng

Localized surface plasmon resonance, which stems from the collective oscillations of conduction-band electrons, endows Au nanocrystals with unique optical properties. Au nanocrystals possess extremely large scattering/absorption cross-sections and enhanced local electromagnetic field, both of which are synthetically tunable. Moreover, when Au nanocrystals are closely placed or hybridized with semiconductors, the coupling and interaction between the individual components bring about more fascinating phenomena and promising applications, including plasmon-enhanced spectroscopies, solar energy harvesting, and cancer therapy. The continuous development in the field of plasmonics calls for further advancements in the preparation of high-quality plasmonic nanocrystals, the facile construction of hybrid plasmonic nanostructures with desired functionalities, as well as deeper understanding and efficient utilization of the interaction between plasmonic nanocrystals and semiconductor components. In this thesis, I developed a seed-mediated growth method for producing size-controlled Au nanospheres with high monodispersity and assembled Au nanospheres of different sizes into core/satellite nanostructures for enhancing Raman signals. For investigating the interactions between Au nanocrystals and semiconductors, I first prepared (Au core) (TiO2 shell) nanostructures, and then studied their synthetically controlled plasmonic properties and light-harvesting applications. Au nanocrystals with spherical shapes are desirable in plasmon-coupled systems owing to their high geometrical symmetry, which facilitates the analysis of electrodynamic responses in a classical electromagnetic framework and the investigation of quantum tunneling and nonlocal effects. I prepared remarkably uniform Au nanospheres with diameters ranging from 20 nm to 220 nm using a simple seed-mediated growth method associated with mild oxidation. Core/satellite nanostructures were assembled out of differently sized

Accelerator driven sub-critical core

Science.gov (United States)

McIntyre, Peter M; Sattarov, Akhdiyor

2015-03-17

Systems and methods for operating an accelerator driven sub-critical core. In one embodiment, a fission power generator includes a sub-critical core and a plurality of proton beam generators. Each of the proton beam generators is configured to concurrently provide a proton beam into a different area of the sub-critical core. Each proton beam scatters neutrons within the sub-critical core. The plurality of proton beam generators provides aggregate power to the sub-critical core, via the proton beams, to scatter neutrons sufficient to initiate fission in the sub-critical core.

The core competencies of James Marion Sims, MD.

Science.gov (United States)

Straughn, J Michael; Gandy, Roy E; Rodning, Charles B

2012-07-01

The concept of core competencies in graduate medical education was introduced by the Accreditation Council for Graduate Medical Education of the American Medical Association to semiquantitatively assess the professional performance of students, residents, practitioners, and faculty. Many aspects of the career of J. Marion Sims, MD, are exemplary of those core competencies: MEDICAL KNOWLEDGE: Author of the first American textbook related to gynecology. MEDICAL CARE: Innovator of the Sims' Vaginal Speculum, Sims' Position, Sims' Test, and vesico-/rectovaginal fistulorrhaphy; advocated abdominal exploration for penetrating wounds; performed the first cholecystostomy. PROFESSIONALISM: Served as President of the New York Academy of Medicine, the American Medical Association, and the American Gynecologic Society. INTERPERSONAL RELATIONSHIPS/COMMUNICATION: Cared for the indigent, hearthless, indentured, disenfranchised; served as consulting surgeon to the Empress Eugénie (France), the Duchess of Hamilton (Scotland), the Empress of Austria, and other royalty of the aristocratic Houses of Europe; accorded the National Order of the Legion of Honor. PRACTICE-BASED LEARNING: Introduction of silver wire sutures; adoption of the principles of asepsis/antisepsis; adoption of the principles of general anesthesia. SYSTEMS-BASED PRACTICE: Established the Woman's Hospital, New York City, New York, the predecessor of the Memorial Sloan-Kettering Center for the Treatment of Cancer and Allied Diseases; organized the Anglo-American Ambulance Corps under the patronage of Napoleon III. What led him to a life of clinical and humanitarian service? First, he was determined to succeed. His formal medical/surgical education was perhaps the best available to North Americans during that era. Second, he was courageous in experimentation and innovation, applying new developments in operative technique, asepsis/antisepsis, and general anesthesia. Third, his curiosity was not burdened by rigid

In-core flow rate distribution measurement test of the JOYO irradiation core

International Nuclear Information System (INIS)

Suzuki, Toshihiro; Isozaki, Kazunori; Suzuki, Soju

1996-01-01

A flow rate distribution measurement test was carried out for the JOYO irradiation core (the MK-II core) after the 29th duty cycle operation. The main object of the test is to confirm the proper flow rate distribution at the final phase of the MK-II core. The each flow rate at the outlet of subassemblies was measured by the permanent magnetic flowmeter inserted avail of fuel exchange hole in the rotating plug. This is third test in the MK-II core, after 10 years absence from the final test (1985). Total of 550 subassemblies were exchanged and accumulated reactor operation time reached up to 38,000 hours from the previous test. As a conclusion, it confirmed that the flow rate distribution has been kept suitable in the final phase of the MK-II core. (author)

Models of the earth's core

International Nuclear Information System (INIS)

Stevenson, D.J.

1981-01-01

The combination of seismology, high pressure experiment and theory, geomagnetism, fluid dynamics, and current views of terrestrial planetary evolution lead to strong constraints on core models. The synthesis presented here is devoted to the defense of the following properties: (1) core formation was contemporaneous with earth accretion; (2) the outer, liquid core is predominately iron but cannot be purely iron; (3) the inner core-outer core boundary represents a thermodynamic equilibrium between a liquid alloys and a predominanately iron solid; (4) thermodynamic and transport properties of outer core can be estimated from liquid-state theories; and (5) the outer core is probably adiabatic and uniform in composition. None of these propositions are universally accepted by geophysicists. But, the intent of this paper is to present a coherent picture which explains most of the data with the fewest ad hoc assumptions. Areas in which future progress is both essential and likely are geo- and cosmochronology, seismological determinations of core structure, fluid dynamics of the core and mantle, and condensed matter physics

Time-dependent fracture probability of bilayer, lithium-disilicate-based glass-ceramic molar crowns as a function of core/veneer thickness ratio and load orientation

Science.gov (United States)

Anusavice, Kenneth J.; Jadaan, Osama M.; Esquivel–Upshaw, Josephine

2013-01-01

Recent reports on bilayer ceramic crown prostheses suggest that fractures of the veneering ceramic represent the most common reason for prosthesis failure. Objective The aims of this study were to test the hypotheses that: (1) an increase in core ceramic/veneer ceramic thickness ratio for a crown thickness of 1.6 mm reduces the time-dependent fracture probability (Pf) of bilayer crowns with a lithium-disilicate-based glass-ceramic core, and (2) oblique loading, within the central fossa, increases Pf for 1.6-mm-thick crowns compared with vertical loading. Materials and methods Time-dependent fracture probabilities were calculated for 1.6-mm-thick, veneered lithium-disilicate-based glass-ceramic molar crowns as a function of core/veneer thickness ratio and load orientation in the central fossa area. Time-dependent fracture probability analyses were computed by CARES/Life software and finite element analysis, using dynamic fatigue strength data for monolithic discs of a lithium-disilicate glass-ceramic core (Empress 2), and ceramic veneer (Empress 2 Veneer Ceramic). Results Predicted fracture probabilities (Pf) for centrally-loaded 1,6-mm-thick bilayer crowns over periods of 1, 5, and 10 years are 1.2%, 2.7%, and 3.5%, respectively, for a core/veneer thickness ratio of 1.0 (0.8 mm/0.8 mm), and 2.5%, 5.1%, and 7.0%, respectively, for a core/veneer thickness ratio of 0.33 (0.4 mm/1.2 mm). Conclusion CARES/Life results support the proposed crown design and load orientation hypotheses. Significance The application of dynamic fatigue data, finite element stress analysis, and CARES/Life analysis represent an optimal approach to optimize fixed dental prosthesis designs produced from dental ceramics and to predict time-dependent fracture probabilities of ceramic-based fixed dental prostheses that can minimize the risk for clinical failures. PMID:24060349

Time-dependent fracture probability of bilayer, lithium-disilicate-based, glass-ceramic, molar crowns as a function of core/veneer thickness ratio and load orientation.

Science.gov (United States)

Anusavice, Kenneth J; Jadaan, Osama M; Esquivel-Upshaw, Josephine F

2013-11-01

Recent reports on bilayer ceramic crown prostheses suggest that fractures of the veneering ceramic represent the most common reason for prosthesis failure. The aims of this study were to test the hypotheses that: (1) an increase in core ceramic/veneer ceramic thickness ratio for a crown thickness of 1.6mm reduces the time-dependent fracture probability (Pf) of bilayer crowns with a lithium-disilicate-based glass-ceramic core, and (2) oblique loading, within the central fossa, increases Pf for 1.6-mm-thick crowns compared with vertical loading. Time-dependent fracture probabilities were calculated for 1.6-mm-thick, veneered lithium-disilicate-based glass-ceramic molar crowns as a function of core/veneer thickness ratio and load orientation in the central fossa area. Time-dependent fracture probability analyses were computed by CARES/Life software and finite element analysis, using dynamic fatigue strength data for monolithic discs of a lithium-disilicate glass-ceramic core (Empress 2), and ceramic veneer (Empress 2 Veneer Ceramic). Predicted fracture probabilities (Pf) for centrally loaded 1.6-mm-thick bilayer crowns over periods of 1, 5, and 10 years are 1.2%, 2.7%, and 3.5%, respectively, for a core/veneer thickness ratio of 1.0 (0.8mm/0.8mm), and 2.5%, 5.1%, and 7.0%, respectively, for a core/veneer thickness ratio of 0.33 (0.4mm/1.2mm). CARES/Life results support the proposed crown design and load orientation hypotheses. The application of dynamic fatigue data, finite element stress analysis, and CARES/Life analysis represent an optimal approach to optimize fixed dental prosthesis designs produced from dental ceramics and to predict time-dependent fracture probabilities of ceramic-based fixed dental prostheses that can minimize the risk for clinical failures. Copyright © 2013 Academy of Dental Materials. All rights reserved.

Models of the earth's core

Science.gov (United States)

Stevenson, D. J.

1981-01-01

Combined inferences from seismology, high-pressure experiment and theory, geomagnetism, fluid dynamics, and current views of terrestrial planetary evolution lead to models of the earth's core with five basic properties. These are that core formation was contemporaneous with earth accretion; the core is not in chemical equilibrium with the mantle; the outer core is a fluid iron alloy containing significant quantities of lighter elements and is probably almost adiabatic and compositionally uniform; the more iron-rich inner solid core is a consequence of partial freezing of the outer core, and the energy release from this process sustains the earth's magnetic field; and the thermodynamic properties of the core are well constrained by the application of liquid-state theory to seismic and labroatory data.

Core and Complementary Chiropractic: Lowering Barriers to Patient Utilization of Services.

Science.gov (United States)

Triano, John J; McGregor, Marion

2016-12-01

The use of chiropractic services has stalled while interest in accessing manipulation services is rising. The purpose of this paper is to consider this dilemma in the context of the dynamics of professional socialization, surveys of public attitudes, and a potential strategic action. This is a reflection work grounded in the literature on professional socialization and the attitudes held regarding chiropractic in modern society, to include its members, and in original data on training programs. Data were interpreted on the background of the authors' cross-cultural experiences spanning patient care, research, education, and interprofessional collaboration. Recommendation on a strategic action to counter barriers in patient referrals was synthesized. Professional socialization is the process by which society enables professional privilege. Illustration of typical and divergent professional socialization models emerged that explain cognitive dissonance toward the profession. Questions of trust are commensurate with the experiences during patient encounters rather than with a common identity for the profession. Diversity among encounters perpetuates the uncertainty that affects referral sources. Commonality as an anchor for consistent professional identity and socialization through the content of core chiropractic, defined by training and practice, offers a means to offset uncertainty. Complementary chiropractic, analogous to complementary medicine, provides an outlet under professional socialization for the interests to explore additional methods of care. The practice workplace is an effective lever for altering barriers to the use of services. Clarifying rhetoric through conceptualization of core and complementary practices simplifies the socialization dynamic. Further, it takes advantage of accepted cultural semantics in meaningful analogy while continuing to empower practical diversity in care delivery in response to evolving scientific evidence.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

Science.gov (United States)

Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

Study of the mechanism of clamping and detachment of a core sample by core lever lifters

Energy Technology Data Exchange (ETDEWEB)

Barabashkin, I I; Mizyakin, V M; Nikitin, S V

1981-01-01

Geometric dimensions of the basic elements of a core lifter should be determined depending on the clamping conditions. The changes should be determined depending on the conditions of the core sample diameter, critical angle between the lever and the core samples in the necessary depth of submersion of the contact edge of the lever into its surface. The core lifter KTsRZ-80 with eccentric core reception makes it possible to arrange more efficiently the core removing elements on the edge of the band. The use of the core lifters with eccentric plan of arrangement of the levers and their optimal length increases the removal of the core sample.

Dignity-conserving care actions in palliative care: an integrative review of Swedish research.

Science.gov (United States)

Harstäde, Carina Werkander; Blomberg, Karin; Benzein, Eva; Östlund, Ulrika

2018-03-01

Previous research has proposed that persons in need of palliative care often have a loss of functions and roles that affects social and existential self-image. Moreover, these individuals also commonly suffer from complex multisymptoms. This, together with the situation of facing an impending death, can lead to a loss of dignity. Therefore, supporting these persons' dignity is a crucial challenge for professional nurses. The 'Dignity Care Intervention' addresses the multidimensionality of dignity by identifying patients' dignity-related concerns and suggests care actions to address them. At the present, the Dignity Care Intervention is adapted for implementation in Swedish care settings. Because expressions of dignity are influenced by culture, and an overview of care actions in a Swedish context is lacking, this integrative review aimed to find suggestions from Swedish research literature on what kind of care actions can preserve dignity. An integrative literature review was conducted using the databases SwePub and SweMed+. Articles published from 2006 to 2015 and theses published from 2000 to 2015 were searched for using the terms 'dignity' and 'palliative care'. Result sections of articles and theses were reviewed for dignity-conserving care actions synthesised by thematic analysis and categorised under themes and subthemes in Chochinov's model of dignity. Fifteen articles and 18 theses were included together providing suggestions of care actions in all themes and subthemes in the dignity model. Suggested care actions included listening, communication, information, symptom control, facilitating daily living and including patients in decision-making. Additionally, nurses' perceptiveness towards the patients was a core approach. The review offers culturally relevant suggestions on how to address specific dignity-related concerns. The adapted Dignity Care Intervention will be a way for Swedish nurses to provide person-centred palliative care that will conserve

Inflation targeting and core inflation

OpenAIRE

Julie Smith

2005-01-01

This paper examines the interaction of core inflation and inflation targeting as a monetary policy regime. Interest in core inflation has grown because of inflation targeting. Core inflation is defined in numerous ways giving rise to many potential measures; this paper defines core inflation as the best forecaster of inflation. A cross-country study finds before the start of inflation targeting, but not after, core inflation differs between non-inflation targeters and inflation targeters. Thr...

Development of new core competencies for Taiwanese Emergency Medical Technicians

Directory of Open Access Journals (Sweden)

Chang YT

2018-03-01

Full Text Available Yu-Tung Chang,1,2 Kuang-Chau Tsai,2 Brett Williams1,3 1Department of Community Emergency Health and Paramedic Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia; 2Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 3Division of Paramedicine, University of Tasmania, Hobart, TAS, Australia Objectives: Core competencies are considered the foundation for establishing Emergency Medical Technician (EMT and paramedic curricula, and for ensuring performance standards in the delivery of prehospital care. This study surveyed EMT instructors and medical directors to identify the most desirable core competencies for all levels of EMTs in Taiwan. Methods: A principal components analysis with Varimax rotation was conducted. An online questionnaire was distributed to obtain perspectives of EMT instructors and medical directors on the most desirable core competencies for EMTs. The target population was EMT training-course instructors and medical directors of fire departments in Taiwan. The questionnaire comprised 61 competency items, and multiple-choice and open-ended questions were used to obtain respondents’ perspectives of the Taiwanese EMT training and education system. Results: The results identified three factors at EMT-1 and EMT-2 levels and five factors at the EMT-Paramedic level. The factors for EMT-1 and EMT-2 were similar, and those for EMT-Paramedics identified further comprehensive competence perspectives. The key factors that appear to influence the development of the Taiwanese Emergency Medical Services (EMS education system are the attitude of authorities, the licensure system, and legislation. Conclusion: The findings present new core competencies for the Taiwanese EMT system and provide capacity to redesign curricula and reconsider roles for EMT-1 and EMT-2 technicians. At the EMT-Paramedic level, the findings demonstrate the importance of

Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis.

Directory of Open Access Journals (Sweden)

Seon Ha Baek

Full Text Available The proportion of elderly patients beginning to undergo dialysis is increasing globally. Whether early referral (ER of elderly patients is associated with favorable outcomes remains under debate. We investigated the influence of referral timing on the mortality of elderly patients.We retrospectively assessed mortality in 820 patients aged ≥70 years with end-stage renal disease (ESRD who initiated hemodialysis at a tertiary university hospital between 2000 and 2010. Mortality data was obtained from the time of dialysis initiation until December 2010. We assigned patients to one of two groups according to the time of their first encounters with nephrologists: ER (≥ 3 months and late referral (LR; < 3 months.During a mean follow-up period of 25.1 months, the ER group showed a 24% reduced risk of long-term mortality relative to the LR group (HR = 0.760, P = 0.009. Rate of reduction in 90-day mortality for ER patients was 58% (HR = 0.422, P=0.012. However, the statistical significance of the difference in mortality rates between ER and LR group was not observed across age groups after 90 days. Old age, LR, central venous catheter, high white blood cell count and corrected Ca level, and lower levels of albumin, creatinine, hemoglobin, and sodium were significantly associated with increased risk of mortality.Timely referral was also associated with reduced mortality in elderly ESRD patients who initiated hemodialysis. In particular, the initial 90-day mortality reduction in ER patients contributed to mortality differences during the follow-up period.

Collapsing stellar cores and supernovae

Energy Technology Data Exchange (ETDEWEB)

Epstein, R J [Nordisk Inst. for Teoretisk Atomfysik, Copenhagen (Denmark); Noorgaard, H [Nordisk Inst. for Teoretisk Atomfysik, Copenhagen (Denmark); Chicago Univ., IL (USA). Enrico Fermi Inst.); Bond, J R [Niels Bohr Institutet, Copenhagen (Denmark); California Inst. of Tech., Pasadena (USA). W.K. Kellogg Radiation Lab.)

1979-05-01

The evolution of a stellar core is studied during its final quasi-hydrostatic contraction. The core structure and the (poorly known) properties of neutron rich matter are parametrized to include most plausible cases. It is found that the density-temperature trajectory of the material in the central part of the core (the core-center) is insensitive to nearly all reasonable parameter variations. The central density at the onset of the dynamic phase of the collapse (when the core-center begins to fall away from the rest of the star) and the fraction of the emitted neutrinos which are trapped in the collapsing core-center depend quite sensitively on the properties of neutron rich matter. We estimate that the amount of energy Ecm which is imparted to the core-mantle by the neutrinos which escape from the imploded core-center can span a large range of values. For plausible choices of nuclear and model parameters Ecm can be large enough to yield a supernova event.

R and D on thermal hydraulics of core and core-bottom structure

International Nuclear Information System (INIS)

Inagaki, Yoshiyuki; Hino, Ryutaro; Kunitomi, Kazuhiko; Takase, Kazuyuki; Ioka, Ikuo; Maruyama, So

2004-01-01

Thermal hydraulic tests on the core and core-bottom structure of the high-temperature engineering test reactor (HTTR) were carried out with the helium engineering demonstration loop (HENDEL) under simulated reactor operating conditions. The HENDEL was composed of helium gas circulation loops, mother sections (M 1 and M 2 ) and adaptor section (A), and two test sections, i.e. the fuel stack test section (T 1 ) and in-core structure test section (T 2 ). In the T 1 test section simulating a fuel stack of the core, thermal and hydraulic performances of helium gas flowing through a fuel block were investigated for thermal design of the HTTR core. In the T 2 test section simulating the core-bottom structure, demonstration tests were performed to verify the structural integrity of graphite and metal components, seal performance against helium gas leakage among the graphite permanent blocks and thermal mixing performance of helium gas. The above test results in the T 1 and T 2 test sections were applied to the detailed design and licensing works of the HTTR and the HENDEL-loop was dismantled in 1999

78 FR 56174 - In-Core Thermocouples at Different Elevations and Radial Positions in Reactor Core

Science.gov (United States)

2013-09-12

... 52 [Docket No. PRM-50-105; NRC-2012-0056] In-Core Thermocouples at Different Elevations and Radial Positions in Reactor Core AGENCY: Nuclear Regulatory Commission. ACTION: Petition for rulemaking; denial...-core thermocouples at different elevations and radial positions throughout the reactor core to enable...

IGCSE core mathematics

CERN Document Server

Wall, Terry

2013-01-01

Give your core level students the support and framework they require to get their best grades with this book dedicated to the core level content of the revised syllabus and written specifically to ensure a more appropriate pace. This title has been written for Core content of the revised Cambridge IGCSE Mathematics (0580) syllabus for first teaching from 2013. ? Gives students the practice they require to deepen their understanding through plenty of practice questions. ? Consolidates learning with unique digital resources on the CD, included free with every book. We are working with Cambridge

Fast neutrino flavor conversions near the supernova core with realistic flavor-dependent angular distributions

Energy Technology Data Exchange (ETDEWEB)

Dasgupta, Basudeb; Sen, Manibrata [Tata Institute of Fundamental Research, Homi Bhabha Road, Mumbai, 400005 (India); Mirizzi, Alessandro, E-mail: bdasgupta@theory.tifr.res.in, E-mail: alessandro.mirizzi@ba.infn.it, E-mail: manibrata.sen@gmail.com [Dipartimento Interateneo di Fisica ' Michelangelo Merlin' , Via Amendola 173, 70126 Bari (Italy)

2017-02-01

It has been recently pointed out that neutrino fluxes from a supernova can show substantial flavor conversions almost immediately above the core. Using linear stability analyses and numerical solutions of the fully nonlinear equations of motion, we perform a detailed study of these fast conversions , focussing on the region just above the supernova core. We carefully specify the instabilities for evolution in space or time, and find that neutrinos travelling towards the core make fast conversions more generic, i.e., possible for a wider range of flux ratios and angular asymmetries that produce a crossing between the zenith-angle spectra of ν {sub e} and ν-bar {sub e} . Using fluxes and angular distributions predicted by supernova simulations, we find that fast conversions can occur within tens of nanoseconds, only a few meters away from the putative neutrinospheres. If these fast flavor conversions indeed take place, they would have important implications for the supernova explosion mechanism and nucleosynthesis.

Replaceable LMFBR core components

International Nuclear Information System (INIS)

Evans, E.A.; Cunningham, G.W.

1976-01-01

Much progress has been made in understanding material and component performance in the high temperature, fast neutron environment of the LMFBR. Current data have provided strong assurance that the initial core component lifetime objectives of FFTF and CRBR can be met. At the same time, this knowledge translates directly into the need for improved core designs that utilize improved materials and advanced fuels required to meet objectives of low doubling times and extended core component lifetimes. An industrial base for the manufacture of quality core components has been developed in the US, and all procurements for the first two core equivalents for FFTF will be completed this year. However, the problem of fabricating recycled plutonium while dramatically reducing fabrication costs, minimizing personnel exposure, and protecting public health and safety must be addressed

Evolutionary Nephrology.

Science.gov (United States)

Chevalier, Robert L

2017-05-01

Progressive kidney disease follows nephron loss, hyperfiltration, and incomplete repair, a process described as "maladaptive." In the past 20 years, a new discipline has emerged that expands research horizons: evolutionary medicine. In contrast to physiologic (homeostatic) adaptation, evolutionary adaptation is the result of reproductive success that reflects natural selection. Evolutionary explanations for physiologically maladaptive responses can emerge from mismatch of the phenotype with environment or evolutionary tradeoffs. Evolutionary adaptation to a terrestrial environment resulted in a vulnerable energy-consuming renal tubule and a hypoxic, hyperosmolar microenvironment. Natural selection favors successful energy investment strategy: energy is allocated to maintenance of nephron integrity through reproductive years, but this declines with increasing senescence after ~40 years of age. Risk factors for chronic kidney disease include restricted fetal growth or preterm birth (life history tradeoff resulting in fewer nephrons), evolutionary selection for APOL1 mutations (that provide resistance to trypanosome infection, a tradeoff), and modern life experience (Western diet mismatch leading to diabetes and hypertension). Current advances in genomics, epigenetics, and developmental biology have revealed proximate causes of kidney disease, but attempts to slow kidney disease remain elusive. Evolutionary medicine provides a complementary approach by addressing ultimate causes of kidney disease. Marked variation in nephron number at birth, nephron heterogeneity, and changing susceptibility to kidney injury throughout life history are the result of evolutionary processes. Combined application of molecular genetics, evolutionary developmental biology (evo-devo), developmental programming and life history theory may yield new strategies for prevention and treatment of chronic kidney disease.

Evolutionary Nephrology

Directory of Open Access Journals (Sweden)

Robert L. Chevalier

2017-05-01

Full Text Available Progressive kidney disease follows nephron loss, hyperfiltration, and incomplete repair, a process described as “maladaptive.” In the past 20 years, a new discipline has emerged that expands research horizons: evolutionary medicine. In contrast to physiologic (homeostatic adaptation, evolutionary adaptation is the result of reproductive success that reflects natural selection. Evolutionary explanations for physiologically maladaptive responses can emerge from mismatch of the phenotype with environment or from evolutionary tradeoffs. Evolutionary adaptation to a terrestrial environment resulted in a vulnerable energy-consuming renal tubule and a hypoxic, hyperosmolar microenvironment. Natural selection favors successful energy investment strategy: energy is allocated to maintenance of nephron integrity through reproductive years, but this declines with increasing senescence after ∼40 years of age. Risk factors for chronic kidney disease include restricted fetal growth or preterm birth (life history tradeoff resulting in fewer nephrons, evolutionary selection for APOL1 mutations (which provide resistance to trypanosome infection, a tradeoff, and modern life experience (Western diet mismatch leading to diabetes and hypertension. Current advances in genomics, epigenetics, and developmental biology have revealed proximate causes of kidney disease, but attempts to slow kidney disease remain elusive. Evolutionary medicine provides a complementary approach by addressing ultimate causes of kidney disease. Marked variation in nephron number at birth, nephron heterogeneity, and changing susceptibility to kidney injury throughout the life history are the result of evolutionary processes. Combined application of molecular genetics, evolutionary developmental biology (evo-devo, developmental programming, and life history theory may yield new strategies for prevention and treatment of chronic kidney disease.

Developing and Implementing a Pediatric Emergency Care Curriculum for Providers at District Level Hospitals in Sub-Saharan Africa: A Case Study in Kenya

Directory of Open Access Journals (Sweden)

Colleen Diane Fant

2017-12-01

Full Text Available IntroductionEmergency medicine is a relatively new field in sub-Saharan Africa and dedicated training in pediatric emergency care is limited. While guidelines from the African Federation of Emergency Medicine (AFEM regarding emergency training exist, a core curriculum in pediatric emergency care has not yet been established for providers at the district hospital level.MethodsThe objective of the project was to develop a curriculum for providers with limited training in pediatric emergencies, and contain didactic and simulation components with emphasis on treatment and resuscitation using available resources. A core curriculum for pediatric emergency care was developed using a validated model of medical education curriculum development and through review of existing guidelines and literature. Based on literature review, as well as a review of existent guidelines in pediatric and emergency care, 10 core topics were chosen and agreed upon by experts in the field, including pediatric and emergency care providers in Kenya and the United States. These topics were confirmed to be consistent with the principles of emergency care endorsed by AFEM as well as complimentary to existing Kenyan medical school syllabi. A curriculum based on these 10 core topics was created and subsequently piloted with a group of medical residents and clinical officers at a community hospital in western Kenya.ResultsThe 10 core pediatric topics prioritized were airway management, respiratory distress, thoracic and abdominal trauma, head trauma and cervical spine management, sepsis and shock, endocrine emergencies, altered mental status/toxicology, orthopedic emergencies, burn and wound management, and pediatric advanced life support. The topics were incorporated into a curriculum comprised of ten 1.5-h combined didactic plus low-fidelity simulation modules. Feedback from trainers and participating providers gave high ratings to the ease of information delivery, relevance, and

Pennsylvania State Core Competencies for Education on Opioids and Addiction.

Science.gov (United States)

Ashburn, Michael A; Levine, Rachel L

2017-10-01

The objective of this project was to develop core competencies for education on opioids and addiction to be used in all Pennsylvania medical schools. The Pennsylvania Physician General created a task force that was responsible for the creation of the core competencies. A literature review was completed, and a survey of graduating medical students was conducted. The task force then developed, reviewed, and approved the core competencies. The competencies were grouped into nine domains: understanding core aspects of addiction; patient screening for substance use disorder; proper referral for specialty evaluation and treatment of substance use disorder; proper patient assessment when treating pain; proper use of multimodal treatment options when treating acute pain; proper use of opioids for the treatment of acute pain (after consideration of alternatives); the role of opioids in the treatment of chronic noncancer pain; patient risk assessment related to the use of opioids to treat chronic noncancer pain, including the assessment for substance use disorder or increased risk for aberrant drug-related behavior; and the process for patient education, initiation of treatment, careful patient monitoring, and discontinuation of therapy when using opioids to treat chronic noncancer pain. Specific competencies were developed for each domain. These competencies will be incorporated into the educational process at all Pennsylvania medical schools. It is hoped that these curriculum changes will improve student knowledge and attitudes in these areas, thus improving patient outcomes. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Dual-core Itanium Processor

CERN Multimedia

2006-01-01

Intel’s first dual-core Itanium processor, code-named "Montecito" is a major release of Intel's Itanium 2 Processor Family, which implements the Intel Itanium architecture on a dual-core processor with two cores per die (integrated circuit). Itanium 2 is much more powerful than its predecessor. It has lower power consumption and thermal dissipation.

Core TuLiP

NARCIS (Netherlands)

Czenko, M.R.; Etalle, Sandro

2007-01-01

We propose CoreTuLiP - the core of a trust management language based on Logic Programming. CoreTuLiP is based on a subset of moded logic programming, but enjoys the features of TM languages such as RT; in particular clauses are issued by different authorities and stored in a distributed manner. We

The family experience of care in chronic situation

Directory of Open Access Journals (Sweden)

Roseney Bellato

2016-06-01

Full Text Available An essay that aims to reflect on the family experience of care in chronic situation, increasing the understanding of the family as the primary caregiver. It is based on comprehensive approach in studies conducted in three matrix searches from family care experiences. We have taken three axes to organize our reflections: a conformation of family care in chronic situation, highlighting the multiple costs incurred to the family, which can exhaust the potential of care and establish or increase its vulnerability if it is not backed by networks support and sustenance; b family rearrangements for the care, giving visibility to care cores in which many loved family members share the care, dynamic, plural and changeable way; c self care modeling family care, pointing to the range of possibilities of the person taking care of diseased conditions supported by people close to them. We learn that the family takes care of itself in everyday life and in the illness experience, creating networks that can provide you support and sustenance. Thus, professionals in health practices should shape up in a longitudinal and very personal way, by reference to the family care, supporting him in what is his own.

Providing high-quality care in primary care settings: how to make trade-offs.

Science.gov (United States)

Beaulieu, Marie-Dominique; Geneau, Robert; Del Grande, Claudio; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

2014-05-01

To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. Copyright© the College of Family Physicians of Canada.

Core discrete event simulation model for the evaluation of health care technologies in major depressive disorder.

Science.gov (United States)

Vataire, Anne-Lise; Aballéa, Samuel; Antonanzas, Fernando; Roijen, Leona Hakkaart-van; Lam, Raymond W; McCrone, Paul; Persson, Ulf; Toumi, Mondher

2014-03-01

A review of existing economic models in major depressive disorder (MDD) highlighted the need for models with longer time horizons that also account for heterogeneity in treatment pathways between patients. A core discrete event simulation model was developed to estimate health and cost outcomes associated with alternative treatment strategies. This model simulated short- and long-term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined on the basis of fictitious antidepressants with three levels of efficacy, tolerability, and price (low, medium, and high) from first line to third line. The model was populated with input data from the literature for the UK setting. Model outputs include time in different health states, quality-adjusted life-years (QALYs), and costs from National Health Service and societal perspectives. The codes are open source. Predicted costs and QALYs from this model are within the range of results from previous economic evaluations. The largest cost components from the payer perspective were physician visits and hospitalizations. Key parameters driving the predicted costs and QALYs were utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between two strategies with different effectiveness increased approximately twofold when the time horizon increased from 1 to 5 years. The discrete event simulation model can provide a more comprehensive evaluation of different therapeutic options in MDD, compared with existing Markov models, and can be used to compare a wide range of health care technologies in various groups of patients with MDD. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Beyond the Core: Peer Observation Brings Common Core to Vocational and Electives Classes

Science.gov (United States)

Thurber Rasmussen, Harriette

2014-01-01

This article describes how a Washington State School District increased professional learning around the Common Core State Standards. The challenge was how to establish a way for career and technical education and electives teachers to learn and apply Common Core in their classes. Weaving Common Core literacy standards into vocational and…

FBR type reactor core

International Nuclear Information System (INIS)

Tamiya, Tadashi; Kawashima, Katsuyuki; Fujimura, Koji; Murakami, Tomoko.

1995-01-01

Neutron reflectors are disposed at the periphery of a reactor core fuel region and a blanket region, and a neutron shielding region is disposed at the periphery of them. The neutron reflector has a hollow duct structure having a sealed upper portion, a lower portion opened to cooling water, in which a gas and coolants separately sealed in the inside thereof. A driving pressure of a primary recycling pump is lowered upon reduction of coolant flow rate, then the liquid level of coolants in the neutron reflector is lowered due to imbalance between the driving pressure and a gas pressure, so that coolants having an effect as a reflector are eliminated from the outer circumference of the reactor core. Therefore, the amount of neutrons leaking from the reactor core is increased, and negative reactivity is charged to the reactor core. The negative reactivity of the neutron reflector is made greater than a power compensation reactivity. Since this enables reactor scram by using an inherent performance of the reactor core, the reactor core safety of an LMFBR-type reactor can be improved. (I.N.)

Quality of Care for Lung Cancer in Taiwan: A Pattern of Care Based on Core Measures in the Taiwan Cancer Database Registry

Directory of Open Access Journals (Sweden)

Chun-Ru Chien

2008-08-01

Conclusion: It is very likely that significant variation in QOC for lung cancer in Taiwan exists among different types but not locations of hospitals, at least in the diagnostic domain. The introduction of internal benchmarking (TCDB and core measures was associated with some changes, at least in some diagnostic domains, which may lead to improvement in QOC for lung cancer in Taiwan.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Reactor core

International Nuclear Information System (INIS)

Matsuura, Tetsuaki; Nomura, Teiji; Tokunaga, Kensuke; Okuda, Shin-ichi

1990-01-01

Fuel assemblies in the portions where the gradient of fast neutron fluxes between two opposing faces of a channel box is great are kept loaded at the outermost peripheral position of the reactor core also in the second operation cycle in the order to prevent interference between a control rod and the channel box due to bending deformation of the channel box. Further, the fuel assemblies in the second row from the outer most periphery in the first operation cycle are also kept loaded at the second row in the second operation cycle. Since the gradient of the fast neutrons in the reactor core is especially great at the outer circumference of the reactor core, the channel box at the outer circumference is bent such that the surface facing to the center of the reactor core is convexed and the channel box in the second row is also bent to the identical direction, the insertion of the control rod is not interfered. Further, if the positions for the fuels at the outermost periphery and the fuels in the second row are not altered in the second operation cycle, the gaps are not reduced to prevent the interference between the control rod and the channel box. (N.H.)

Emergency Nurses' Perspectives: Factors Affecting Caring.

Science.gov (United States)

Enns, Carol L; Sawatzky, Jo-Ann V

2016-05-01

Caring is a universal phenomenon. However, as a result of higher patient acuity and staff shortages within the chaotic ED environment, caring behaviors may be in peril. The purpose of this study was to gain insight into the meaning of caring from the perspective of emergency nurses. Exploring nurses' perspectives of caring is central to improving staffing and retention issues in this unique work environment. As part of a larger study, a subsample of emergency nurses who work in public hospitals in Manitoba, Canada (n = 17) were interviewed. A qualitative descriptive design was used to gain insight into the caring perspectives of nurses by asking them, "What does caring meaning to you?" and "What affects caring in your practice in the emergency department?" Emerging themes were extracted through analysis of audio tapes and transcripts. Advocacy and holistic care emerged as major themes in the meaning of caring for emergency nurses. Caring was affected by a number of factors, including workload, lack of time, staffing issues, shift work, and lack of self-care. However, lack of management support was the most consistent hindrance to caring identified by study participants. Caring continues to be a unifying concept in nursing; however, influencing factors continue to undermine caring for emergency nurses. Caring is not subsidiary to nursing; it is the central core of nursing. Therefore, fostering a caring working environment is essential for nurses to practice holistic nursing care. It is also imperative to job satisfaction and the retention of emergency nurses. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery.

Science.gov (United States)

Trosman, Julia R; Carlos, Ruth C; Simon, Melissa A; Madden, Debra L; Gradishar, William J; Benson, Al B; Rapkin, Bruce D; Weiss, Elisa S; Gareen, Ilana F; Wagner, Lynne I; Khan, Seema A; Bunce, Mikele M; Small, Art; Weldon, Christine B

2016-11-01

Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient's care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient's care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

The Quality of Clinical Maternal and Neonatal Healthcare – A Strategy for Identifying ‘Routine Care Signal Functions’

Science.gov (United States)

Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S.

2015-01-01

Background A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. Methods We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Results Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. Conclusion The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes

Curricular Guidelines for Dental Hygiene Care for the Handicapped.

Science.gov (United States)

Journal of Dental Education, 1984

1984-01-01

The American Association of Dental Schools' guidelines for dental hygiene curriculum cover the scope and definitions of care for the handicapped, interrelationships between disciplines and courses, a curriculum overview, primary educational goals, prerequisites, a core content outline, specific behavioral objectives, sequencing, faculty, and…

A Testbed For Validating the LHC Controls System Core Before Deployment

CERN Document Server

Nguyen Xuan, J

2011-01-01

Since the start-up of the LHC, it is crucial to carefully test core controls components before deploying them operationally. The Testbed of the CERN accelerator controls group was developed for this purpose. It contains different hardware (PPC, i386) running various operating systems (Linux and LynxOS) and core software components running on front-ends, communication middleware and client libraries. The Testbed first executes integration tests to verify that the components delivered by individual teams interoperate, and then system tests, which verify high-level, end-user functionality. It also verifies that different versions of components are compatible, which is vital, because not all parts of the operational LHC control system can be upgraded simultaneously. In addition, the Testbed can be used for performance and stress tests. Internally, the Testbed is driven by Atlassian Bamboo, a Continuous Integration server, which builds and deploys automatically new software versions into the Test...

Core concepts for ''zero-sodium-void-worth core'' in metal fuelled fast reactor

International Nuclear Information System (INIS)

Chang, Y.I.; Hill, R.N.; Fujita, E.K.; Wade, D.C.; Kumaoka, Y.; Suzuki, M.; Kawashima, M.; Nakagawa, H.