Synchrotron radiation and prospects of its applications

Energy Technology Data Exchange (ETDEWEB)

Kulipanov, G; Skrinskii, A

1981-04-01

Current and prospective applications are described of synchrotron radiation resulting from the motion of high-energy electrons or positrons in a magnetic field and covering a wide spectral range from the infrared to X-ray. The advantages of the synchrotron radiation include a big source luminance, a small angular divergence, the possibility of calculating the absolute intensity and the spectral distribution of the radiation. Special storage rings are most suitable as a source. Synchrotron radiation is applied in X-ray microscopy, energy diffractometry, atomic and molecular spectroscopy, in the structural analysis of microcrystals, very rapid diffractometry of biological objects and crystals, and in Moessbauer spectroscopy. The prospective applications include uses in metrology, medicine, X-ray lithography, elemental analysis, molecular microsurgery, and in radiation technology.

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

Science.gov (United States)

2010-10-01

... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

Application of PKI in health care--needs, ambitions, prospects.

Science.gov (United States)

Suselj, Marjan; Marcun, Tomaz; Trcek, Denis; Kandus, Gorazd

2003-01-01

Through continual development and considerable investment over the past years, Slovenia has established an information infrastructure providing efficient data links between all the health care actors. This includes furnishing all the citizens and health workers with microprocessor cards--health insurance card and health professional card. These tools have significantly simplified different procedures in the health care and brought services closer to insured persons. The know-how and experiences gathered to day have given rise to vivid discussions of further development steps: introduction of new contents on the infrastructure in place and technological upgrading, in particular progressive incorporation of the PKI concept and thereby integration of card and network solutions to provide an efficient and secure communication environment. This paper outlines key perspectives of the future developments in this segment. With the volume of health care data communications through internet growing steeply, and with the paramount importance of patient--doctor trust and confidence, security tools and solutions in the health care are a critical need.

Prospects for HTS applications

International Nuclear Information System (INIS)

Gamble, B.B.; Snitchler, G.L.; Schwall, R.E.

1996-01-01

High temperature superconductor (HTS) wire is rapidly maturing into a working material being produced in ever larger quantities and being used in more significant demonstrations and prototypes. Conductor is now produced routinely in several hundred meter lengths with reproducible results. Current density has progressed to a level suitable for demonstration of many applications. Wire strength has improved and large prototypes fabricated or under consideration using HTS include Superconducting Magnetic Energy Storage (SMES), rotating electrical machines including synchronous ac and dc homopolar motors and drives, generators and condensers, underground transmission cables, utility distribution equipment such as transformers and current limiters, commercial processing applications such as magnetic separation, and specialty magnets such as high field inserts. In this paper the requirements, progress toward these requirements, and the prospects for the future are reviewed

Remission in Depressed Geriatric Primary Care Patients: A Report From the PROSPECT Study

Science.gov (United States)

Alexopoulos, George S.; Katz, Ira R.; Bruce, Martha L.; Heo, Moonseong; Have, Thomas Ten; Raue, Patrick; Bogner, Hillary R.; Schulberg, Herbert C.; Mulsant, Benoit H.; Reynolds, Charles F.

2009-01-01

Objective This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled. PMID:15800144

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

Science.gov (United States)

2013-08-19

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

The Application of an Army Prospective Payment Model Structured on the Standards Set Forth by the CHAMPUS Maximum Allowable Charges and the Center for Medicare and Medicaid Services: An Academic Approach

Science.gov (United States)

2005-04-29

To) 29-04-2005 Final Report July 2004 to July 2005 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER The appli’eation of an army prospective payment model structured...Z39.18 Prospective Payment Model 1 The Application of an Army Prospective Payment Model Structured on the Standards Set Forth by the CHAMPUS Maximum...Health Care Administration 20060315 090 Prospective Payment Model 2 Acknowledgments I would like to acknowledge my wife, Karen, who allowed me the

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

Science.gov (United States)

2012-08-31

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

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

Science.gov (United States)

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

2014-05-22

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

The impact of prospective pricing on the information system in the health care industry.

Science.gov (United States)

Matta, K F

1988-02-01

The move from a retrospective payment system (value added) to a prospective payment system (diagnostic related) has not only influenced the health care business but also changed their information systems' requirements. The change in requirements can be attributed both to an increase in data processing tasks and also to an increase in the need for information to more effectively manage the organization. A survey was administered to capture the response of health care institutions, in the area of information systems, to the prospective payment system. The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data. In addition, the role of the information system has changed from a cost accounting system to one intended to provide a competitive edge in a highly competitive marketing environment.

China's health care system reform: Progress and prospects.

Science.gov (United States)

Li, Ling; Fu, Hongqiao

2017-07-01

This paper discusses the progress and prospects of China's complex health care reform beginning in 2009. The Chinese government's undertaking of systemic reform has achieved laudable achievements, including the expansion of social health insurance, the reform of public hospitals, and the strengthening of primary care. An innovative policy tool in China, policy experimentation under hierarchy, played an important role in facilitating these achievements. However, China still faces gaps and challenges in creating a single payer system, restructuring the public hospitals, and establishing an integrated delivery system. Recently, China issued the 13th 5-year plan for medical reform, setting forth the goals, policy priorities, and strategies for health reform in the following 5 years. Moreover, the Chinese government announced the "Healthy China 2030" blueprint in October 2016, which has the goals of providing universal health security for all citizens by 2030. By examining these policy priorities against the existing gaps and challenges, we conclude that China's health care reform is heading in the right direction. To effectively implement these policies, we recommend that China should take advantage of policy experimentation to mobilize bottom-up initiatives and encourage innovations. Copyright © 2017 John Wiley & Sons, Ltd.

Using a multi-method, user centred, prospective hazard analysis to assess care quality and patient safety in a care pathway

Directory of Open Access Journals (Sweden)

Escoto Kamisha

2007-06-01

Full Text Available Abstract Background Care pathways can be complex, often involving multiple care providers and as such are recognised as containing multiple opportunities for error. Prospective hazard analysis methods may be useful for evaluating care provided across primary and secondary care pathway boundaries. These methods take into account the views of users (staff and patients when determining where potential hazards may lie. The aim of this study is to evaluate the feasibility of prospective hazard analysis methods when assessing quality and safety in care pathways that lie across primary and secondary care boundaries. Methods Development of a process map of the care pathway for patients entering into a Chronic Obstructive Pulmonary Disease (COPD supported discharge programme. Triangulation of information from: care process mapping, semi-structured interviews with COPD patients, semi-structured interviews with COPD staff, two round modified Delphi study and review of prioritised quality and safety challenges by health care staff. Results Interview themes emerged under the headings of quality of care and patient safety. Quality and safety concerns were mostly raised in relation to communication, for example, communication with other hospital teams. The three highest ranked safety concerns from the modified Delphi review were: difficulties in accessing hospital records, information transfer to primary care and failure to communicate medication changes to primary care. Conclusion This study has demonstrated the feasibility of using mixed methods to review the quality and safety of care in a care pathway. By using multiple research methods it was possible to get a clear picture of service quality variations and also to demonstrate which points in the care pathway had real potential for patient safety incidents or system failures to occur. By using these methods to analyse one condition specific care pathway it was possible to uncover a number of hospital

Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study

Science.gov (United States)

Mack, Jennifer W.; Cronin, Angel; Keating, Nancy L.; Taback, Nathan; Huskamp, Haiden A.; Malin, Jennifer L.; Earle, Craig C.; Weeks, Jane C.

2012-01-01

Purpose National guidelines recommend that discussions about end-of-life (EOL) care planning happen early for patients with incurable cancer. We do not know whether earlier EOL discussions lead to less aggressive care near death. We sought to evaluate the extent to which EOL discussion characteristics, such as timing, involved providers, and location, are associated with the aggressiveness of care received near death. Patients and Methods We studied 1,231 patients with stage IV lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system–based prospective cohort study, who died during the 15-month study period but survived at least 1 month. Our main outcome measure was the aggressiveness of EOL care received. Results Nearly half of patients received at least one marker of aggressive EOL care, including chemotherapy in the last 14 days of life (16%), intensive care unit care in the last 30 days of life (9%), and acute hospital-based care in the last 30 days of life (40%). Patients who had EOL discussions with their physicians before the last 30 days of life were less likely to receive aggressive measures at EOL, including chemotherapy (P = .003), acute care (P EOL discussions are prospectively associated with less aggressive care and greater use of hospice at EOL. PMID:23150700

42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

Science.gov (United States)

2010-10-01

... standardized amount— (i) Is adjusted for the applicable hospital inpatient prospective payment system DRG... applicable hospital inpatient prospective payment system DRG weighting factors; (ii) Is adjusted by the... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

Health care utilization in patients with gout: a prospective multicenter cohort study.

Science.gov (United States)

Singh, Jasvinder A; Bharat, Aseem; Khanna, Dinesh; Aquino-Beaton, Cleopatra; Persselin, Jay E; Duffy, Erin; Elashoff, David; Khanna, Puja P

2017-05-31

All published studies of health care utilization in gout have been cross-sectional to date, and most used a patient-reported diagnosis of gout. Our objective was to assess health care utilization and its predictors in patients with physician-confirmed gout in a prospective cohort study. In a multi-center prospective cohort study of U.S. veterans with rheumatologist-confirmed gout (N = 186; two centers), we assessed patient self-reported overall and gout-specific health care utilization with the Gout Assessment Questionnaire (GAQ) every 3-months for a 9-month period. Comparisons were made using the student's t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Mixed effects Poisson regression was used to assess potential correlates of gout-related health care utilization. Mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 32% were African-American, 6% did not graduate high school, mean serum urate was 8.3 and mean Deyo-Charlson score was 3.1. During the past year, mean gout-related visits were as follows: rheumatologist, 1.5; primary care physician, 2 visits; ≥1 inpatient visits, 7%; ≥1 ER visits, 26%; and urgent care/walk-in visit, 33%. In longitudinal analyses, African-American race and gout flares in the last 3 months were associated with significantly higher rate ratio of gout-related outpatient visits. African-American race and lack of college education were associated with significantly higher rate ratio for gout-related urgent visits and overnight stays. African-American race and recent gout flares were associated with higher outpatient utilization and African-American race and no college education with higher urgent or inpatient utilization. Future studies should examine whether modifiable predictors of utilization can be targeted to reduce healthcare utilization in patients with gout.

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

Directory of Open Access Journals (Sweden)

Bailey Kerry A

2010-08-01

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

Resource utilization in home health care: results of a prospective study.

Science.gov (United States)

Trisolini, M G; Thomas, C P; Cashman, S B; Payne, S M

1994-01-01

Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length--and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio-economic status; patient's clinical status; patient's support services; and visit-specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail.

The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

DEFF Research Database (Denmark)

Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef

2012-01-01

on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request......RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly....

Plant cell engineering: current research, application and future prospects

International Nuclear Information System (INIS)

Wang Xunqing; Liu Luxiang

2008-01-01

This paper reviewed the current status of basic research in plant cell engineering, highlighted the application of embryo culture, double haploid (DH) technology, protoplast culture and somatic hybridization, somaclonal variation, rapid propagation, and bio-products production of plant-origin, and t he prospects. (authors)

Applicability of the PROSPECT model for Norway spruce needles

NARCIS (Netherlands)

Malenovsky, Z.; Albrechtova, J.; Lhotakova, Z.; Zurita Milla, R.; Clevers, J.G.P.W.; Schaepman, M.E.; Cudlin, P.

2006-01-01

The potential applicability of the leaf radiative transfer model PROSPECT (version 3.01) was tested for Norway spruce (Picea abies (L.) Karst.) needles collected from stress resistant and resilient trees. Direct comparison of the measured and simulated leaf optical properties between 450¿1000 nm

32 CFR 728.13 - Application for care.

Science.gov (United States)

2010-07-01

... Duty § 728.13 Application for care. Possession of an ID card (a green colored DD 2 (with letter suffix... 32 National Defense 5 2010-07-01 2010-07-01 false Application for care. 728.13 Section 728.13 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE...

Prospective evaluation of an internet-linked handheld computer critical care knowledge access system.

Science.gov (United States)

Lapinsky, Stephen E; Wax, Randy; Showalter, Randy; Martinez-Motta, J Carlos; Hallett, David; Mehta, Sangeeta; Burry, Lisa; Stewart, Thomas E

2004-12-01

Critical care physicians may benefit from immediate access to medical reference material. We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit (ICU) to multiple community-based ICUs. Four community hospital ICUs with 17 physicians participated in this prospective interventional study. Following training in the use of an internet-linked, updateable handheld computer knowledge access system, the physicians used the handheld devices in their clinical environment for a 12-month intervention period. Feasibility of the system was evaluated by tracking use of the handheld computer and by conducting surveys and focus group discussions. Before and after the intervention period, participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed, as well as the speed and quality of their decision making. Participants generated admission orders during each scenario, which were scored by blinded evaluators. Ten physicians (59%) used the system regularly, predominantly for nonmedical applications (median 32.8/month, interquartile range [IQR] 28.3-126.8), with medical software accessed less often (median 9/month, IQR 3.7-13.7). Eight out of 13 physicians (62%) who completed the final scenarios chose to use the handheld computer for information access. The median time to access information on the handheld handheld computer was 19 s (IQR 15-40 s). This group exhibited a significant improvement in admission order score as compared with those who used other resources (P = 0.018). Benefits and barriers to use of this technology were identified. An updateable handheld computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making. However, during the study, acceptance of the system was variable. Improved training and new technology may overcome some of the barriers we

Neutron activation analysis of gold and prospectiveness of its application

International Nuclear Information System (INIS)

Tong Chunhan.

1988-01-01

NAA of gold is a method of high sensitivity and high percision, especially when epithermal neutron activation is applied. NAA is particularly emphasized in the process of gold reference standards preparation. In addition to the pure instrumental NAA, the NAA with pre-enrichment before sctivation is developed. This technque has been successfully used in assessment of micro and fine grained Au-Ag-phlymetal ores in Guixian, Guangxi. Through this example, prospectiveness of NAA application in Au-Ag-prospecting, fast assessment and trace element geochemistry investigation is seen

Health Care Psychology: Prospects for the Well-Being of Children.

Science.gov (United States)

Wright, Logan

1979-01-01

Health care psychology is distinguished from traditional child psychology in that it emphasizes clinical application and is concerned with primary mental health care. Diagnosis, classification, prediction, and treatment and control strategies in the field offer definite solutions to problems such as tracheotomy addiction, encopresis, psychogenic…

High-dose irradiated food: Current progress, applications, and prospects

Science.gov (United States)

Feliciano, Chitho P.

2018-03-01

Food irradiation as an established and mature technology has gained more attention in the food industry for ensuring food safety and quality. Primarily used for phytosanitary applications, its use has been expanded for developing various food products for varied purposes (e.g. ready-to-eat & ready-to-cook foods, hospital diets, etc.). This paper summarized and analyzed the recent progress and application of high-dose irradiation and discussed its prospects in the field of food product development, its safety and quality.

A prospective randomized clinical trial to evaluate methods of postoperative care of hypospadias.

Science.gov (United States)

McLorie, G; Joyner, B; Herz, D; McCallum, J; Bagli, D; Merguerian, P; Khoury, A

2001-05-01

Hypospadias repair is a common operation performed by pediatric urologists. Perhaps the greatest variable and source of controversy of postoperative care is the surgical dressing. We hypothesized that using no dressing would achieve surgically comparable results to those traditionally achieved by a postoperative dressing and it would also simplify postoperative parent delivered home care. Accordingly we designed a prospective randomized clinical trial to compare surgical outcome and postoperative care after hypospadias repair in boys with no dressing and those who received 1 of the 2 most common types of dressing. In a 12-month period 120 boys with an average age of 2.2 years underwent primary 1-stage hypospadias repair at a single center with 4 participating surgeons. Repair was performed in 60 boys with proximal and 60 with distal hypospadias on an outpatient basis. Ethics and Internal Review Board approval, and informed consent were obtained. Boys were then prospectively randomized to receive no dressing, an adhesive biomembrane dressing or a compressive wrap dressing. Comprehensive instructions on postoperative care were distributed to all families and a questionnaire was distributed to the parents at the initial followup. Surgical outcome was evaluated and questionnaire responses were analyzed. Fisher's exact test was done to test the significance of differences in surgical outcomes and questionnaire responses. A total of 117 boys completed the prospective randomized trial. Surgical staff withdrew 3 cases from randomized selection to place a dressing for postoperative hemostasis. We obtained 101 questionnaires for response analysis. The type or absence of the dressing did not correlate with the need for repeat procedures, urethrocutaneous fistula, or meatal stenosis or regression. Analysis revealed less narcotic use in the no dressing group and fewer telephone calls to the urology nurse, or on-call resident and/or fellow. These findings were statistically

Prospective study on quality of newborn care

Directory of Open Access Journals (Sweden)

N Khanam

2013-12-01

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

Short-Term Absenteeism and Health Care Utilization Due to Lower Extremity Injuries Among Novice Runners : A Prospective Cohort Study

NARCIS (Netherlands)

Smits, Dirk-Wouter; Huisstede, Bionka; Verhagen, Evert; van der Worp, Henk; Kluitenberg, Bas; van Middelkoop, Marienke; Hartgens, Fred; Backx, Frank

2016-01-01

Objective: To describe absenteeism and health care utilization (HCU) within 6 weeks after occurrence of running-related injuries (RRIs) among novice runners and to explore differences relating to injury and personal characteristics. Design: Prospective cohort study. Setting: Primary care.

16 CFR 680.28 - Effective date, compliance date, and prospective application.

Science.gov (United States)

2010-01-01

... REPORTING ACT AFFILIATE MARKETING § 680.28 Effective date, compliance date, and prospective application. (a... part shall not prohibit you from using eligibility information that you receive from an affiliate to...

Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care.

Science.gov (United States)

Golob, Joseph F; Fadlalla, Adam M A; Kan, Justin A; Patel, Nilam P; Yowler, Charles J; Claridge, Jeffrey A

2008-08-01

We developed a prototype electronic clinical information system called the Surgical Intensive Care-Infection Registry (SIC-IR) to prospectively study infectious complications and monitor quality of care improvement programs in the surgical and trauma intensive care unit. The objective of this study was to validate SIC-IR as a successful health information technology with an accurate clinical data repository. Using the DeLone and McLean Model of Information Systems Success as a framework, we evaluated SIC-IR in a 3-month prospective crossover study of physician use in one of our two surgical and trauma intensive care units (SIC-IR unit versus non SIC-IR unit). Three simultaneous research methodologies were used: a user survey study, a pair of time-motion studies, and an accuracy study of SIC-IR's clinical data repository. The SIC-IR user survey results were positive for system reliability, graphic user interface, efficiency, and overall benefit to patient care. There was a significant decrease in prerounding time of nearly 4 minutes per patient on the SIC-IR unit compared with the non SIC-IR unit. The SIC-IR documentation and data archiving was accurate 74% to 100% of the time depending on the data entry method used. This accuracy was significantly improved compared with normal hand-written documentation on the non SIC-IR unit. SIC-IR proved to be a useful application both at individual user and organizational levels and will serve as an accurate tool to conduct prospective research and monitor quality of care improvement programs.

Prospective Mathematics Teachers' Opinions about Mathematical Modeling Method and Applicability of This Method

Science.gov (United States)

Akgün, Levent

2015-01-01

The aim of this study is to identify prospective secondary mathematics teachers' opinions about the mathematical modeling method and the applicability of this method in high schools. The case study design, which is among the qualitative research methods, was used in the study. The study was conducted with six prospective secondary mathematics…

REDUCING SUICIDAL IDEATION AND DEPRESSION IN OLDER PRIMARY CARE PATIENTS: 24-MONTH OUTCOMES OF THE PROSPECT STUDY

Science.gov (United States)

Alexopoulos, George S.; Reynolds, Charles F.; Bruce, Martha L.; Katz, Ira R.; Raue, Patrick J.; Mulsant, Benoit H.; Oslin, David; Have, Thomas Ten

2010-01-01

Objective The PROSPECT Study evaluated the impact of a care management intervention on suicidal ideation and depression in older primary care patients. This is the first report of outcomes over a 2-year period. Method The subjects (N=599) were older (>=60 years) patients with major or minor depression selected after screening 9,072 randomly identified patients of 20 primary care practices randomly assigned to the PROSPECT intervention or usual care. The intervention consisted of services of 15 trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 24 months. Results Intervention patients had a higher likelihood to receive antidepressants and or psychotherapy (84.9–89% vs. 49–59%) and a 2.2 times greater decline in suicidal ideation than usual care patients over 24 months. Treatment response occurred earlier in intervention patients and continued to increase from the 18th to the 24th month, while there was no appreciable increase in usual care patients during the same period. Among patients with major depression, a greater number achieved remission in the intervention than the usual care group at 4 (26.6 vs. 15.2%), 8 (36% vs. 22.5%), and 24 (45.4% vs. 31.5%) months. Patients with minor depression had favorable outcomes regardless of treatment assignment. Conclusions Sustained collaborative care maintains high utilization of antidepressant treatment, reduces suicidal ideation, and improves the outcomes of major depression over two years. These observations suggest that sustained collaborative care increases depression-free days. PMID:19528195

Primary medical care and reductions in addiction severity: a prospective cohort study.

Science.gov (United States)

Saitz, Richard; Horton, Nicholas J; Larson, Mary Jo; Winter, Michael; Samet, Jeffrey H

2005-01-01

To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions. We studied a prospective cohort of adults enrolled in a randomized trial to improve linkage with primary medical care. Subjects at a residential detoxification unit with alcohol, heroin or cocaine as a substance of choice, and no primary medical care were enrolled. Receipt of primary medical care was assessed over 2 years. Outcomes included (1) alcohol severity, (2) drug severity and (3) any substance use. For the 391 subjects, receipt of primary care (> or = 2 visits) was associated with a lower odds of drug use or alcohol intoxication (adjusted odds ratio (AOR) 0.45, 95% confidence interval (CI) 0.29-0.69, 2 d.f. chi(2)P = 0.002). For 248 subjects with alcohol as a substance of choice, alcohol severity was lower in those who received primary care [predicted mean Addiction Severity Index (ASI) alcohol scores for those reporting > or = 2, 1 and 0 visits, respectively, 0.30, 0.26 and 0.34, P = 0.04]. For 300 subjects with heroin or cocaine as a substance of choice, drug severity was lower in those who received primary care (predicted mean ASI drug scores for those reporting > or = 2, 1 and 0 visits, respectively, 0.13, 0.15 and 0.16, P = 0.01). Receipt of primary medical care is associated with improved addiction severity. These results support efforts to link patients with addictions to primary medical care services.

Current state and prospects of the phytosynthesized colloidal gold nanoparticles and their applications in cancer theranostics.

Science.gov (United States)

Ovais, Muhammad; Raza, Abida; Naz, Shagufta; Islam, Nazar Ul; Khalil, Ali Talha; Ali, Shaukat; Khan, Muhammad Adeeb; Shinwari, Zabta Khan

2017-05-01

The design, development, and biomedical applications of phytochemical-based green synthesis of biocompatible colloidal gold nanoparticles (AuNPs) are becoming an emerging field due to several advantages (safer, eco-friendly, simple, fast, energy efficient, low-cost, and less toxic) over conventional chemical synthetic procedures. Biosynthesized colloidal gold nanoparticles are remarkably attractive in several biomedical applications including cancer theranostics due to small size, unusual physico-chemical properties, facile surface modification, high biocompatibility, and numerous other advantages. Of late, several researchers have investigated the biosynthesis and prospective applications (diagnostics, imaging, drug delivery, and cancer therapeutics) of AuNPs in health care and medicine. However, not a single review article is available in the literature that demonstrates the anti-cancer potential of biosynthesized colloidal AuNPs with detailed mechanistic study. In the present review article, we for the first time discuss the biointerface of colloidal AuNPs, plants, and cancer mainly (i) comprehensive mechanistic aspects of phytochemical-based synthesis of AuNPs; (ii) proposed anti-cancer mechanisms along with biomedical applications in diagnostics, imaging, and drug delivery; and (iii) key challenges for biogenic AuNPs as future cancer nanomedicine.

Prospect for application of umbilical cord blood to clinical treatment of radiation sickness

International Nuclear Information System (INIS)

Jia Tingzhen; Ke Xiaoyan

1998-01-01

Objective: To look forward to the prospect for application of umbilical cord blood to clinical treatment of radiation sickness by analyzing the results using umbilical cord blood in laboratory experiments and clinical research. Method: The data on umbilical cord blood published in literature are reviewed. Results: The umbilical blood is rich in hematopoietic stem/progenitor cells, low in immunological activity of lymphocytes, expanded significantly ex vivo under selected culture condition readily available and collected easily. Conclusion: With the above advantages, the prospect for application of umbilical cord blood is encouraging, particularly in the clinical treatment of radiation sickness

Effectiveness of telemedicine and distance learning applications for patients with chronic heart failure. A protocol for prospective parallel group non-randomised open label study

OpenAIRE

Vanagas, Giedrius; Umbrasienė, Jelena; Šlapikas, Rimvydas

2012-01-01

Introduction Chronic heart failure in Baltic Sea Region is responsible for more hospitalisations than all forms of cancer combined and is one of the leading causes of hospitalisations in elderly patients. Frequent hospitalisations, along with other direct and indirect costs, place financial burden on healthcare systems. We aim to test the hypothesis that telemedicine and distance learning applications is superior to the current standard of home care. Methods and analysis Prospective parallel ...

Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use

NARCIS (Netherlands)

Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

2000-01-01

Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

[Research Progress and Prospect of Applications of Finite Element Method in Lumbar Spine Biomechanics].

Science.gov (United States)

Zhang, Zhenjun; Li, Yang; Liao, Zhenhua; Liu, Weiqiang

2016-12-01

Based on the application of finite element analysis in spine biomechanics,the research progress of finite element method applied in lumbar spine mechanics is reviewed and the prospect is forecasted.The related works,including lumbar ontology modeling,clinical application research,and occupational injury and protection,are summarized.The main research areas of finite element method are as follows:new accurate modeling process,the optimized simulation method,diversified clinical effect evaluation,and the clinical application of artificial lumbar disc.According to the recent research progress,the application prospects of finite element method,such as automation and individuation of modeling process,evaluation and analysis of new operation methods and simulation of mechanical damage and dynamic response,are discussed.The purpose of this paper is to provide the theoretical reference and practical guidance for the clinical lumbar problems by reviewing the application of finite element method in the field of the lumbar spine biomechanics.

Blockchain distributed ledger technologies for biomedical and health care applications.

Science.gov (United States)

Kuo, Tsung-Ting; Kim, Hyeon-Eui; Ohno-Machado, Lucila

2017-11-01

To introduce blockchain technologies, including their benefits, pitfalls, and the latest applications, to the biomedical and health care domains. Biomedical and health care informatics researchers who would like to learn about blockchain technologies and their applications in the biomedical/health care domains. The covered topics include: (1) introduction to the famous Bitcoin crypto-currency and the underlying blockchain technology; (2) features of blockchain; (3) review of alternative blockchain technologies; (4) emerging nonfinancial distributed ledger technologies and applications; (5) benefits of blockchain for biomedical/health care applications when compared to traditional distributed databases; (6) overview of the latest biomedical/health care applications of blockchain technologies; and (7) discussion of the potential challenges and proposed solutions of adopting blockchain technologies in biomedical/health care domains. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

The application actualities and prospects of geophysical methods to uranium prospecting

International Nuclear Information System (INIS)

Liu Qingcheng

2010-01-01

Basic principles of geophysical methods to uranium prospect are briefly introduced, and the effects as well as problems in using those methods are analysed respectively. Combining with the increasing demand of uranium resources for Chinese nuclear power development and the higher requirements of geophysical techniques, the developing directions and the thoughts of geophysical techniques in uranium prospecting were proposed. A new pattern with producing, teaching and researching together is brought forward to develop advancing uranium prospecting key technologies and to break through technological bottlenecks depending on independent innovation. Integrated geophysical methods for prospecting uranium deposits are suggested. The method includes geophysical techniques as follows: gravity, magnetic, seismic, radioactive, remote sensing, and geochemical method in some proving grounds. Based on the experimental research, new uranium deposits prospecting models with efficient integrated geophysical methods can be established. (authors)

17 CFR 248.128 - Effective date, compliance date, and prospective application.

Science.gov (United States)

2010-04-01

... Affiliate Marketing § 248.128 Effective date, compliance date, and prospective application. (a) Effective date. This subpart is effective September 10, 2009. (b) Mandatory compliance date. Compliance with this... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Effective date, compliance...

Involving the patient: A prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care

NARCIS (Netherlands)

J.L. van den Brink (Jaap); P.W. Moorman (Peter); M.F. de Boer (Maarten); J.F.A. Pruyn (Jean); C.D.A. Verwoerd (Carel); J.H. van Bemmel (Jan)

2005-01-01

textabstractObjective: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. Design: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers

Prospects for regulated competition in the health care system: what can China learn from Russia's experience?

Science.gov (United States)

Xu, Weiwei; Sheiman, Igor; van de Ven, Wynand P M M; Zhang, Wei

2011-05-01

As China explores new directions to reform its health care system, regulated competition among both insurers and providers of care might be one potential model. The Russian Federation in 1993 implemented legislation intended to stimulate such regulated competition in the health care sector. The subsequent progress and lessons learned over these 17 years can shed light on and inform the future evolution of the Chinese system. In this paper, we list the necessary pre-conditions for reaping the benefits of regulated competition in the health care sector. We indicate to what extent these conditions are being fulfilled in the post-reform Russian and current Chinese health care systems. We draw lessons from the Russian experience for the Chinese health care system, which shares a similar economic and political background with the pre-reform Russian health care system in terms of the starting point of the reform, and analyse the prospects for regulated competition in China.

Effects of competition on the cost and quality of inpatient rehabilitation care under prospective payment.

Science.gov (United States)

Colla, Carrie Hoverman; Escarce, José J; Buntin, Melinda Beeuwkes; Sood, Neeraj

2010-12-01

To determine the effect of competition in postacute care (PAC) markets on resource intensity and outcomes of care in inpatient rehabilitation facilities (IRFs) after prospective payment was implemented. Medicare claims, Provider of Services file, Enrollment file, Area Resource file, Minimum Data Set. We created an exogenous measure of competition based on patient travel distances and used instrumental variables models to estimate the effect of competition on inpatient rehabilitation costs, length of stay, and death or institutionalization. A file was constructed linking data for Medicare patients discharged from acute care between 2002 and 2003 and admitted to an IRF with a diagnosis of hip fracture or stroke. Competition had different effects on treatment intensity and outcomes for hip fracture and stroke patients. In the treatment of hip fracture, competition increased costs and length of stay, while increasing rates of death or institutionalization. In the treatment of stroke, competition decreased costs and length of stay and produced inferior outcomes. The effects of competition in PAC markets may vary by condition. It is important to study the effects of competition by diagnostic condition and to study the effects across populations that vary in severity. Our finding that higher competition under prospective payment led to worse IRF outcomes raises concerns and calls for additional research. © Health Research and Educational Trust.

Advances on application of remote sensing technology to uranium prospecting in northwest of China

International Nuclear Information System (INIS)

Ye Fawang; Liu Dechang; Zhao Yingjun; Zhang Jielin; Fang Maolong

2012-01-01

Some advances on application of remote sensing technology to uranium prospecting in northwest of China since 21st century are presented in this paper. They included: (1) application of ETM multi-spectral remote sensing technology to identify the sandstone-type uranium ore-controlling structure in north of Ordos Basin and investigate the uranium metallogenetic geological conditions in Qiangtang Basin, Tibet, (2) application of ASTER multi-spectral and QuickBird high spatial resolution remote sensing technology to extract and analyze the oil-gas reduced alteration in Bashibulake uranium ore district, Xinjiang, (3) discovery of Salamubulake uranium metallogenetic belt in Keping, Xinjiang, using ASTER multi-spectral, QuickBird high spatial resolution, and CASI/SASI airborne hyper-spectral remote sensing comprehensively, and (4) application of CASI/SASI airborne hyper-spectral remote sensing technology to extract volcanicrock type uranium mineralization alteration in Baiyanghe area, Xinjiang. These application advances show the good application effects of remote sensing technology to uranium exploration in northwest of China, which provides important references for making further uranium prospecting using remote sensing technology. (authors)

Thermoelectric microgenerators. Current status and prospects of application

Directory of Open Access Journals (Sweden)

Strutynska L. T.

2008-08-01

Full Text Available Analysis of current status and prospects of using thermoelectric microgenerators, including organic-fueled ones, is performed. Developments of thermoelectric microgenerators presented in this review demonstrate that their increasingly wide use forms a separate, very important line of thermoelectricity – micropower generation with growing potential of practical applications for charging batteries, mobile phones, digital cameras and photocameras, power supply to small radio stations, other portable devices, including medical. The ways of increasing the efficiency of such devices and relevant lines of their wide use in practice are determined.

Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study.

Science.gov (United States)

Reeves, David; Hann, Mark; Rick, Jo; Rowe, Kelly; Small, Nicola; Burt, Jenni; Roland, Martin; Protheroe, Joanne; Blakeman, Tom; Richardson, Gerry; Kennedy, Anne; Bower, Peter

2014-09-01

In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits. To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care. A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning. Implementation of care plans and care planning in general practice was assessed using the 2009-2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling. The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time. The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning. © British Journal of General Practice 2014.

Mechanisms of plastein formation, and prospective food and nutraceutical applications of the peptide aggregates

Directory of Open Access Journals (Sweden)

Min Gong

2015-03-01

Full Text Available Plastein is a protease-induced peptide aggregate with prospective application in enhancing the nutritional quality of proteins and debittering protein hydrolysates. These properties are yet to be applied in product development possibly due to economic considerations (production cost vs. product yields. This paper reviews currently proposed mechanisms of plastein formation including condensation, transpeptidation and physical interaction of aggregating peptides. Emerging findings indicate that plastein possesses bioactivities, thereby expanding its prospective application. The role of proteases in inducing peptide interaction in plastein remains unclear. Understanding the protease function will facilitate the development of efficient proteases and scalable industrial processes for plastein production.

CAreDroid: Adaptation Framework for Android Context-Aware Applications.

Science.gov (United States)

Elmalaki, Salma; Wanner, Lucas; Srivastava, Mani

2015-09-01

Context-awareness is the ability of software systems to sense and adapt to their physical environment. Many contemporary mobile applications adapt to changing locations, connectivity states, available computational and energy resources, and proximity to other users and devices. Nevertheless, there is little systematic support for context-awareness in contemporary mobile operating systems. Because of this, application developers must build their own context-awareness adaptation engines, dealing directly with sensors and polluting application code with complex adaptation decisions. In this paper, we introduce CAreDroid, which is a framework that is designed to decouple the application logic from the complex adaptation decisions in Android context-aware applications. In this framework, developers are required- only-to focus on the application logic by providing a list of methods that are sensitive to certain contexts along with the permissible operating ranges under those contexts. At run time, CAreDroid monitors the context of the physical environment and intercepts calls to sensitive methods, activating only the blocks of code that best fit the current physical context. CAreDroid is implemented as part of the Android runtime system. By pushing context monitoring and adaptation into the runtime system, CAreDroid eases the development of context-aware applications and increases their efficiency. In particular, case study applications implemented using CAre-Droid are shown to have: (1) at least half lines of code fewer and (2) at least 10× more efficient in execution time compared to equivalent context-aware applications that use only standard Android APIs.

Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial application.

Science.gov (United States)

Jha, Ashish K; Laguette, Julia; Seger, Andrew; Bates, David W

2008-01-01

Computerized monitors can effectively detect and potentially prevent adverse drug events (ADEs). Most monitors have been developed in large academic hospitals and are not readily usable in other settings. We assessed the ability of a commercial program to identify and prevent ADEs in a community hospital. and Measurement We prospectively evaluated the commercial application in a community-based hospital. We examined the frequency and types of alerts produced, how often they were associated with ADEs and potential ADEs, and the potential financial impact of monitoring for ADEs. Among 2,407 patients screened, the application generated 516 high priority alerts. We were able to review 266 alerts at the time they were generated and among these, 30 (11.3%) were considered substantially important to warrant contacting the physician caring for the patient. These 30 alerts were associated with 4 ADEs and 11 potential ADEs. In all 15 cases, the responsible physician was unaware of the event, leading to a change in clinical care in 14 cases. Overall, 23% of high priority alerts were associated with an ADE (95% confidence interval [CI] 12% to 34%) and another 15% were associated with a potential ADE (95% CI 6% to 24%). Active surveillance used approximately 1.5 hours of pharmacist time daily. A commercially available, computer-based ADE detection tool was effective at identifying ADEs. When used as part of an active surveillance program, it can have an impact on preventing or ameliorating ADEs.

Childhood obesity in secondary care: national prospective audit of Australian pediatric practice.

Science.gov (United States)

Campbell, Michele; Bryson, Hannah E; Price, Anna M H; Wake, Melissa

2013-01-01

In many countries, pediatricians offer skilled secondary care for children with conditions more challenging than can readily be managed in the primary care sector, but the extent to which this sector engages with the detection and management of obesity remains largely unexplored. This study aimed to audit the prevalence, diagnosis, patient, and consultation characteristics of obesity in Australian pediatric practices. This was a national prospective patient audit in Australia. During the course of 2 weeks, members of the Australian Paediatric Research Network prospectively recorded consecutive outpatient consultations by using a brief standardized data collection form. Measures included height, weight, demographics, child and parent health ratings, diagnoses, referrals, investigations, and consultation characteristics. We compared the prevalence of pediatrician-diagnosed and measured obesity (body mass index ≥95th percentile) and top-ranked diagnoses, patient, and consultation characteristics in (a) obese and nonobese children, and (b) obese children with and without a diagnosis. A total of 198 pediatricians recorded 5466 consultations with 2-17 year olds, with body mass index z-scores calculated for 3436 (62.9%). Of the 12.6% obese children, only one-third received an "overweight/obese" diagnosis. Obese children diagnosed as overweight/obese were heavier, older, and in poorer health than those not diagnosed and incurred more Medicare (government-funded health system) cost and referrals. Obesity is infrequently clinically diagnosed by Australian pediatricians and measurement practices vary widely. Further research could focus on supporting and normalizing clinical obesity activities from which pediatricians and parents could see clear benefits. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Mobile Technology Applications in Cancer Palliative Care.

Science.gov (United States)

Freire de Castro Silva, Sandro Luís; Gonçalves, Antônio Augusto; Cheng, Cezar; Fernandes Martins, Carlos Henrique

2018-01-01

Mobile devices frequently used in other specialties can find great utility in palliative care. For healthcare professionals, the use of mobile technology not only can bring additional resources to the care, but it can actually radically change the cancer remote care practices. The Brazilian National Cancer Institute (INCA) has developed the largest cancer home care program in Latin America, which currently benefits more than 500 patients. The purpose of this paper is to show the development of an ICT environment of mobile applications developed to support the palliative cancer care program at INCA.

Research progress and application prospect of radiation-resistant prokaryotic microbe

International Nuclear Information System (INIS)

Wang Wei; Zhu Jing; Zhang Zhidong; Tang Qiyong; Chen Ming

2013-01-01

Radiation-resistant microbe is becoming the research hotspot because of its special life phenomenon and physiological mechanism. Radiation-resistant bacteria are one kind of the most studied radiation-resistant microbe. This article summarized some aspects of the research on radiation-resistant bacteria, including the radiation resistant bacteria resources, and discussed its potential application prospects in the environmental engineering, biotechnology, human health, military and space et al. (authors)

Medicare's prospective payment system for hospitals: new evidence on transitions among health care settings

OpenAIRE

Qian, Xufeng; Russell, Louise B.; Valiyeva, Elmira; Miller, Jane E.

2007-01-01

Previous studies of Medicare’s prospective payment system for hospitals (PPS), introduced in 1983, evaluated only its first few years, using data collected during the hospital stay to control for patients’ health. We examine transitions among health care settings over a full decade following implementation of PPS, using survival models and a national longitudinal survey with independent information on health. We find that the rate of discharge from hospitals to nursing homes continued to rise...

Artificial intelligence applications in the intensive care unit.

Science.gov (United States)

Hanson, C W; Marshall, B E

2001-02-01

To review the history and current applications of artificial intelligence in the intensive care unit. The MEDLINE database, bibliographies of selected articles, and current texts on the subject. The studies that were selected for review used artificial intelligence tools for a variety of intensive care applications, including direct patient care and retrospective database analysis. All literature relevant to the topic was reviewed. Although some of the earliest artificial intelligence (AI) applications were medically oriented, AI has not been widely accepted in medicine. Despite this, patient demographic, clinical, and billing data are increasingly available in an electronic format and therefore susceptible to analysis by intelligent software. Individual AI tools are specifically suited to different tasks, such as waveform analysis or device control. The intensive care environment is particularly suited to the implementation of AI tools because of the wealth of available data and the inherent opportunities for increased efficiency in inpatient care. A variety of new AI tools have become available in recent years that can function as intelligent assistants to clinicians, constantly monitoring electronic data streams for important trends, or adjusting the settings of bedside devices. The integration of these tools into the intensive care unit can be expected to reduce costs and improve patient outcomes.

[A new artificial intelligence tool for assessing symptoms in patients seeking emergency department care: the Mediktor application].

Science.gov (United States)

Moreno Barriga, Elvira; Pueyo Ferrer, Irene; Sánchez Sánchez, Miquel; Martín Baranera, Montserrat; Masip Utset, Josep

2017-01-01

To analyze agreement between diagnoses issued by the Mediktor application and those of an attending physician, and to evaluate the usefulness of this application in patients who seek emergency care. Prospective observational study in a tertiary care university hospital emergency department. Patients with medical problems and surgical conditions (surgery and injuries) who did not require immediate emergency care responded to the Mediktor questions on a portable computer tablet. The software analyzed the answers and provided a list of 10 possible preliminary diagnoses in order of likelihood. The patient and the attending physician were blinded to the list to so that the usual care process would not be altered. The level of agreement between the physician's diagnosis and the Mediktor diagnosis was analyzed. A total of 1015 patients were included; 622 cases were considered valid for study. Cases were excluded if the patients did not meet the inclusion criteria, they did not have a discharge diagnosis, they had a final diagnosis expressed as a symptom or their final diagnosis was not included in the Mediktor database. The physician's diagnosis (the gold standard) coincided with one of the 10 MEDIKTOR diagnoses in 91.3% of the cases, with one of the first 3 diagnoses in 75.4%, and with the first diagnosis in 42.9%. Sensitivity was over 92% and specificity over 91% in the majority of common diagnostic groups; the κ statistic ranged from 0.24 to 0.98. The Mediktor application is a reliable diagnostic aid for the most prevalent problems treated in a hospital emergency department. The general public finds it easy to use.

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Directory of Open Access Journals (Sweden)

Cinnamon S. Bloss

2016-01-01

Full Text Available Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large

A 15-Year Comparative Prospective Study of Surgical and Prosthetic Care and Aftercare of Overdenture Treatment in the Atrophied Mandible : Augmentation Versus Nonaugmentation

NARCIS (Netherlands)

Visser, Anita; Stellingsma, Cornelis; Raghoebar, Gerry M.; Meijer, Henny J. A.; Vissink, Arjan

2016-01-01

BackgroundDifferent treatment strategies for the atrophied mandible are described in literature. The need for long term care and aftercare for these strategies is sparsely described, however. PurposeTo prospectively assess the need for prosthetic and surgical care and aftercare of two implant

Posttraumatic stress in intensive care unit survivors - a prospective study

DEFF Research Database (Denmark)

Ratzer, Mette; Brink, Ole; Knudsen, Linda

2014-01-01

Aims: This study aimed to estimate the prevalence of severe Posttraumatic Stress Disorder (PTSD) symptoms and to identify factors associated with PTSD in survivors of intensive care unit (ICU) treatment following traumatic injury. Methods: Fifty-two patients who were admitted to an ICU through...... the emergency ward following traumatic injury were prospectively followed. Information on injury severity and ICU treatment were obtained through medical records. Demographic information and measures of acute stress symptoms, experienced social support, coping style, sense of coherence (SOC) and locus...... of control were assessed within one-month post-accident (T1). At the six months follow-up (T2), PTSD was assessed with the Harvard Trauma Questionnaire (HTQ). Results: In the six months follow-up, 10 respondents (19.2%) had HTQ total scores reaching a level suggestive of PTSD (N = 52), and 11 respondents (21...

76 FR 41178 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

Science.gov (United States)

2011-07-13

... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the...

Systems modeling and simulation applications for critical care medicine

Science.gov (United States)

2012-01-01

Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

Systems modeling and simulation applications for critical care medicine.

Science.gov (United States)

Dong, Yue; Chbat, Nicolas W; Gupta, Ashish; Hadzikadic, Mirsad; Gajic, Ognjen

2012-06-15

Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area.

Application potential of sequence stratigraphy to prospecting for sandstone-type uranium deposit in continental depositional basins

International Nuclear Information System (INIS)

Li Shengxiang; Chen Zhaobo; Chen Zuyi; Xiang Weidong; Cai Yuqi

2001-01-01

Sequence stratigraphy has been widely used in hydrocarbon exploration and development, and great achievements have been achieved. However, its application to the prospecting for sandstone-type uranium deposits is just beginning. The metallogenic characteristics of sandstone-type uranium deposits and those of oil and gas are compared, and the relationship between sandstone-type uranium metallogenesis and the system tracts of sequence stratigraphy is studied. The authors propose that highest and system tracts are the main targets for prospecting interlayer oxidation zone type sandstone uranium deposits, and the incised valleys of low stand system tracts are favourable places for phreatic oxidation zone type sandstone uranium deposits, and transgressive system tracts are generally unfavorable to the formation of in-situ leachable sandstone-type uranium deposits. Finally, the authors look ahead the application potential of sequence stratigraphy to the prospecting for sandstone-type uranium deposits in continental depositional basins

Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

OpenAIRE

Asmus-Szepesi, Kirsten; Flinterman, Linda; Koopmanschap, Marc; Nieboer, Anna; Bakker, Ton; Mackenbach, Johan; Steyerberg, Ewout

2015-01-01

textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual car...

A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications.

Science.gov (United States)

Richesson, Rachel L; Smerek, Michelle M; Blake Cameron, C

2016-01-01

The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use.

75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

Science.gov (United States)

2010-11-24

...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security

Flow cytometric applications of tumor biology: prospects and pitfalls

International Nuclear Information System (INIS)

Raju, M.R.; Johnson, T.S.; Tokita, N.; Gillette, E.L.

1979-01-01

A brief review of cytometry instrumentation and its potential applications in tumor biology is presented using our recent data. Age-distribution measurements of cells from spontaneous dog tumors and cultured cells after exposure to x rays, alpha particles, or adriamycin are shown. The data show that DNA fluorescence measurements have application in the study of cell kinetics after either radiation or drug treatment. Extensive and careful experimentation is needed to utilize the sophisticated developments in flow cytometry instrumentation

Flow cytometric applications to tumour biology: prospects and pitfalls

International Nuclear Information System (INIS)

Raju, M.R.; Johnson, T.S.; Tokita, N.; Gillette, E.L.

1980-01-01

A brief review of cytometry instrumentation and its potential applications in tumour biology is presented. DNA distribution measurements of cells from spontaneous dog tumours and cultured cells after exposure to X-rays, alpha particles or adriamycin are shown. The data show that DNA fluorescence measurements have application in the study of cell kinetics after either radiation or drug treatment. Extensive and careful experimentation is needed, however, to utilize the sophisticated developments in flow cytometry instrumentation. (author)

Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

NARCIS (Netherlands)

K.J.E. Asmus-Szepesi (Kirsten); L.E. Flinterman (Linda); M.A. Koopmanschap (Marc); A.P. Nieboer (Anna); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); E.W. Steyerberg (Ewout)

2015-01-01

textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled

Critical decisions for older people with advanced dementia: a prospective study in long-term institutions and district home care

NARCIS (Netherlands)

Toscani, F.; Steen, J.T. van der; Finetti, S.; Giunco, F.; Pettenati, F.; Villani, D.; Monti, M.; Gentile, S.; Charrier, L.; Giulio, P. Di

2015-01-01

OBJECTIVE: To describe and compare the decisions critical for survival or quality of life [critical decisions (CDs)] made for patients with advanced dementia in nursing homes (NHs) and home care (HC) services. DESIGN: Prospective cohort study with a follow-up of 6 months. SETTING: Lombardy Region

Prospects for the applications of computer in the field of domestic nuclear medicinal instrument

International Nuclear Information System (INIS)

Zhao Changhe

1993-01-01

The current situation and prospects about domestic nuclear medical instrument, as well as the comparisons of computer application in nuclear medical instruments with in other medical instruments from various points of view have all been described in the paper

Incidence of neuralgic amyotrophy (Parsonage Turner syndrome in a primary care setting--a prospective cohort study.

Directory of Open Access Journals (Sweden)

Nens van Alfen

Full Text Available Neuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting.In a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation.Of the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000.Our findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications.

78 FR 38810 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to...

Science.gov (United States)

2013-06-27

... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... 2900-0616.'' SUPPLEMENTARY INFORMATION: Title: Residential Care Home Program--Sponsor Application, VA... collection. Abstract: VA Form 10-2407 is an application used by a residential care facility or home that...

MEDICO-LABORATORY SERVICES IN OUTPATIENT CARE IN NORTHEASTERN BULGARIA – STATE AND PROSPECTS

Directory of Open Access Journals (Sweden)

Emilia P. Georgieva

2017-11-01

Full Text Available Aim: The aim of this article is to study the satisfaction of patients with laboratory services in outpatient care in Northeastern Bulgaria regarding access and quality of service. Study design: Prospective cohort study Material and methods: The survey was carried out on the territory of Northeastern Bulgaria and covered the districts of Varna, Dobrich and Shumen and thirty municipalities. The following methods were applied in the study: sociological method by applied direct anonymous questionnaire, documentary method and statistical methods for analysis and interpretation of the data in order to reveal the nature of the observed phenomena and their interrelations. Results: The research data show that 24,4% of the respondents live at a distance of more than ten kilometres from the nearest medico-diagnostic laboratory. The larger share of these patients are residents of small settlements in Northeastern Bulgaria. More than half (55% of the respondents are not satisfied with their provision of laboratory services, but the majority of patients claim that the location of the selected laboratory is accessible (69,4% and the quality of the laboratory service is high (83,7%. Conclusion: The main problems in outpatient care are related to the poor provision of medico-laboratory services and specialized outpatient care in the smaller settlements in Northeastern Bulgaria.

Telemedicine and rural health care applications

Directory of Open Access Journals (Sweden)

Smith Anthony

2005-01-01

Full Text Available Telemedicine has the potential to help facilitate the delivery of health services to rural areas. In the right circumstances, telemedicine may also be useful for the delivery of education and teaching programmes and the facilitation of administrative meetings. In this paper reference is made to a variety of telemedicine applications in Australia and other countries including telepaediatrics, home telehealth, critical care telemedicine for new born babies, telemedicine in developing countries, health screening via e-mail, and teleradiology. These applications represent some of the broad range of telemedicine applications possible. An overriding imperative is to focus on the clinical problem first with careful consideration given to the significant organisational changes which are associated with the introduction of a new service or alternative method of service delivery. For telemedicine to be effective it is also important that all sites involved are adequately resourced in terms of staff, equipment, telecommunications, technical support and training. In addition, there are a number of logistical factors which are important when considering the development of a telemedicine service including site selection, clinician empowerment, telemedicine management, technological requirements, user training, telemedicine evaluation, and information sharing through publication.

Prospect of radiation application in industry and agriculture

International Nuclear Information System (INIS)

Kume, Tamikazu

2007-01-01

The prospect of radiation application in industry and agriculture are described. In industry, the radiation-induced crosslinking of polymers and radiation-induced graft polymerization improved many chemical and physical properties and new functional materials were created using ion beams. In agriculture, the food irradiation improved the food hygiene and killed insect pest of fruits and vegetables. Furthermore, the sterile insect technique, mutation breeding of plants, positron imaging system for plant, sterilization of medical products, environmental conservation due to purification of flue gas and wastewater, and upgrading of natural polymer (polysaccharide etc.) have been performed. Radiation process is a clean one without use of chemical reagents. The electron beam radiation is expected to reduce the cost of radiation process compared with the gamma-ray radiation. (M.H.)

Prospect for the application of NHR in China

International Nuclear Information System (INIS)

Zhang Yajun; Zheng Wenxiang

2000-01-01

Space heating is a very important field in the non-electrical application of nuclear energy. The nuclear heating reactor has been developed by the Institute of Nuclear Energy Technology, Tsinghua University. A series of advanced features are adopted in the design for the NHR to achieve a higher standard of safety. Therefore any off-site emergency actions such as sheltering, evacuation, relocation and decontamination are not needed. The NHR can be used in district heating, seawater desalination, providing low-pressure steam for industrial process and as a heat source for agriculture and breed aquatics. The NHR R and D program, the present status and the prospect based on the analysis from the points of safety, economy and society will be discussed in this paper. (author)

78 FR 17777 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to...

Science.gov (United States)

2013-03-22

... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care Home Program--Sponsor Application, VA Form 2407. OMB Control Number: 2900-0616. Type of...

Police Spatial Big Data Location Code and Its Application Prospect

Directory of Open Access Journals (Sweden)

HU Xiaoguang

2016-12-01

Full Text Available The rich decision-making basis are provided for police work by police spatial big data. But some challenges are also brought by it, such as:large data integration complex, multi scale information related difficulties, the location identification is not unique. Thus, how to make the data better service to the police work reform and development is a problem need to be study. In this paper, we propose location identification method to solve the existing problems. Based on subdivision grid, we design the location encoding method of police spatial big data, and choose domicile location identification as a case. Finally, the prospect of its application is presented. So, a new idea is proposed to solve the problem existing in the police spatial data organization and application.

Evaluation of supportive care management outcomes in cancer chemotherapy: A prospective observational study in a tertiary care teaching hospital in South India

Directory of Open Access Journals (Sweden)

Reshma Susan Reji

2018-01-01

Full Text Available Aims: Evaluation of supportive care management of cancer patients experiencing drug-related problems (DRPs is a challenge because it might increase the cost due to additional therapy. The main objectives of this study were to estimate chemotherapy-associated drug-related hospital admissions in the department of medical oncology and to estimate the cost of managing chemotherapy-associated DRPs.Settings and Design: This study is a prospective observational study.Subjects and Methods: Patients with chemotherapy-related DRPs were prospectively identified from the patient's medical records. The contribution of DRPs and cost incurred due to each hospitalization was assessed.Statistical Analysis Used: Data were analyzed using SPSS® 20.0 version.Results: Out of 55 patients analyzed for DRPs, 25 (45.5% patients in the age group of 51–60 years experienced DRPs most frequently. Most commonly occurring DRP was adverse drug reactions 42 (76.4%, which were more frequent in females. DRPs were maximum with alkylating agents 15 (27.3% and the least with hormonal agents 1 (1.8%. The mean length of hospitalization was 9.6 ± 6.5 days. The total direct medical cost was Rs. 31,540 ± 42,476, of which medicine cost accounted for Rs. 16,550 ± 25,404, constituting a major share of the total medical costs.Conclusions: Pharmacists can provide better patient care by identifying and preventing DRPs and reducing drug-related morbidity and mortality.

Application status and prospect of X-ray lithography technology

International Nuclear Information System (INIS)

Xie Changqing; Chen Dapeng; Liu Ming; Ye Tianchun; Yi Futing

2004-01-01

Because of its many merits, such as high resolution, large depth of focus, large field size, high throughput, large process latitude, easy extendibility to 50 nm and below ground rule, and so on, the Proximity X-ray Lithography (PXL) is very attractive for the 100 nm and smaller ground rule integrated circuit manufacturing. In this paper, the international research and development status of PXL is briefly introduced firstly, and both its application status and prospect in nanoelectronics research, Monolithic Microwave Integrated Circuits (MMIC) production and silicon-based Ultra Large Scale Integrated Circuits (ULSIC) production are described, and the recent research progress in home PXL is also presented briefly. (authors)

Mobile health applications for HIV prevention and care in Africa.

Science.gov (United States)

Forrest, Jamie I; Wiens, Matthew; Kanters, Steve; Nsanzimana, Sabin; Lester, Richard T; Mills, Edward J

2015-11-01

More people have mobile phones in Africa than at any point in history. Mobile health (m-health), the use of mobile phones to support the delivery of health services, has expanded in recent years. Several models have been proposed for conceptualizing m-health in the fields of maternal-child health and chronic diseases. We conducted a literature review of m-health interventions for HIV prevention and care in African countries and present the findings in the context of a simplified framework. Our review identified applications of m-health for HIV prevention and care categorized by the following three themes: patient-care focused applications, such as health behavior change, health system-focused applications, such as reporting and data collection, and population health-focused applications, including HIV awareness and testing campaigns. The potential for m-health in Africa is numerous and should not be limited only to direct patient-care focused applications. Although the use of smart phone technology is on the rise in Africa, text messaging remains the primary mode of delivering m-health interventions. The rate at which mobile phone technologies are being adopted may outpace the rate of evaluation. Other methods of evaluation should be considered beyond only randomized-controlled trials.

A prospective study of factors associated with risk of turnover among care workers in group homes for elderly individuals with dementia.

Science.gov (United States)

Suzumura, Miwa; Fushiki, Yasuhiro; Kobayashi, Kota; Oura, Asae; Suzumura, Shigeo; Yamashita, Masafumi; Mori, Mitsuru

2013-01-01

A prospective study was conducted to assess factors associated with risk of turnover among care workers in group homes (GHs) for elderly individuals with dementia. In January, 2010, 51 out of 238 GHs in Sapporo City responded to our request for participation in a survey. During February and March of 2010, 438 out of 700 care workers (62.6%) in the GHs returned a completed questionnaire to us. They were followed up with until March of 2012, and 395 subjects (90.1%) responded to our survey, which was conducted twice. Over the course of 2 years, 91 subjects left their jobs. Cox's proportional hazards model was used for analysis, adjusting for gender and age. Less provision of social support by supervisors, colleagues, family or friends was significantly associated with increased risk of turnover. Financial aids for off-the-job training was marginally significantly associated with reduced risk of turnover. Longer duration of working for frail elderly care was significantly associated with decreased risk of turnover. Habitual smoking was significantly associated with increased risk of turnover. Social support in the workplace may be important to reduce the risk of turnover in care workers at GHs. Further prospective studies are required in other areas in Japan.

75 FR 15495 - Agency Information Collection (Application for Furnishing Long-Term Care Services to...

Science.gov (United States)

2010-03-29

... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care... application used by a residential care facility or home that wishes to provide residential home care to...

The Application of Gaming Theory in Health Care.

Science.gov (United States)

Elzein, Ashley; Drenkard, Karen; Deyo, Patricia; Swartwout, Ellen

2015-01-01

As the US health care system moves rapidly toward a population health management focus in communities and care settings, the chief nursing officer has an opportunity to lead innovation efforts for patient care. One innovative strategy for use to influence patient behavior change, ongoing clinical education, and prelicensure education is the application of gaming theory into learning strategies. With the ever-increasing emphasis the general public is placing on social media and online gaming, there has been a significant push by the health sector in recent years to harness this medium for use in health management, education, and behavior change. A number of organizations and insurers have dedicated significant resources to researching and developing games and apps to help patients manage diseases, track self-management activities, and motivate behavior change for healthy lifestyles. This article shares information about gaming theory and its application to health care including a review of the science behind the theory, the use of technology, and gaming education strategies for both patients and clinicians.

A prospective window into medical device-related pressure ulcers in intensive care.

Science.gov (United States)

Coyer, Fiona M; Stotts, Nancy A; Blackman, Virginia Schmied

2014-12-01

The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device-related pressure ulcers (PUs) in intensive care patients for up to 7 days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device-related ulcers were followed daily for up to 7 days. The outcome measures were device-related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device-related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device-related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7-day observation period. In conclusion, device-related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device-related ulcers, especially in patients with NG and ET tubes. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Effectiveness of Psychosocial Interventions in Complex Palliative Care Patients: A Quasi-Experimental, Prospective Multicenter Study.

Science.gov (United States)

Mateo-Ortega, Dolors; Gómez-Batiste, Xavier; Maté, Jorge; Beas, Elba; Ela, Sara; Lasmarias, Cristina; Limonero, Joaquín T

2018-03-13

To determine whether specific psychosocial interventions can ease discomfort in palliative care (PC) patients, particularly in those with high levels of pain or emotional distress. Changes in the psychological parameters of 8333 patients were assessed in a quasi-experimental, prospective, multicenter, single group pretest/post-test study. Psychosocial care was delivered by 29 psychosocial care teams (PSTs; 137 professionals). Pre- and post-intervention changes in these variables were assessed: mood, anxiety, and emotional distress. Patients were classified as complex, when presented with high levels of anxiety, mood, suffering (or perception of time as slow), and distress (or unease, or discomfort), or noncomplex. These groups were compared to assess changes in suffering-related parameters from baseline. Psychosocial interventions reduced patients' suffering. These interventions were more effective in complex patients. After successive psychosocial interventions, the level of suffering in complex patients decreased until close to parity with noncomplex patients, suggesting that patients with major complexity could benefit most from specific psychosocial treatment. These findings support the importance of assessing and treating patients' psychosocial needs.

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

Directory of Open Access Journals (Sweden)

Schäfer Ingmar

2009-08-01

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

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

Science.gov (United States)

Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

2015-04-25

Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study

Directory of Open Access Journals (Sweden)

Costantini Massimo

2002-03-01

Full Text Available Abstract Background Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range. Methods and measurements A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum – maximum at referral, patient characteristics, were recorded by staff, and later compared with actual survival. Results Minimum survival estimates ranged Conclusions Offering a prognosis range has higher levels of accuracy (about double than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range.

Prospect of nuclear application in food technology

Energy Technology Data Exchange (ETDEWEB)

Maha, M [National Atomic Energy Agency, Jakarta (Indonesia). Pasar Djumat Research Centre

1982-04-01

Irradiation changes the normal living process of cells and the structure of molecules. It is good for food preservation because it kills off many of the microorganisms in the product and makes the remainder more sensitive to antimicrobial factors prevailing after the radiation treatment. It offers more benefits than conventional preservation in that it increases storage stability and quality of foodstuffs with the minimum use of energy. Good storage quality gives way to wider distribution of food, alleviates the world's food shortage, and improves food supplies. Research proved that irradiation increased the quality of subtropical fruits, spices, fish, and meat. No refrigeration is needed to store meat, poultry and fish preserved by the combination of irradiation and mild heat treatment. Nuclear technology can also be applied to destroy harmful insects, to sterilize food, to inhibit the sprouting of root crops, and to control ripening in stored fruits and vegetables. Based on the above potentials of irradiation, the prospect of nuclear application in food technology is promising.

Physical capacity and risk for long-term sickness absence: a prospective cohort study among 8664 female health care workers.

Science.gov (United States)

Rasmussen, Charlotte Diana Nørregaard; Andersen, Lars Louis; Clausen, Thomas; Strøyer, Jesper; Jørgensen, Marie Birk; Holtermann, Andreas

2015-05-01

To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. Low physical capacity increases the risk of long-term sickness absence among female health care workers.

Application of lean thinking to health care: issues and observations

Science.gov (United States)

Joosten, Tom; Bongers, Inge; Janssen, Richard

2009-01-01

Background Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care. Development, theory and application of lean thinking to health care Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles. Discussion We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term. PMID:19696048

[Current status and clinical application prospect of Akabane's test].

Science.gov (United States)

Wang, Wenjie; Du, Yanjun

2016-06-12

The Akabane's test is one of the meridian diagnostic methods. Compared with the current meridian diagnostic methods, it has the advantages of convenience and efficiency, but it also has several disadvantages such as the accuracy is difficult to control, the outcome interpretation is limited, etc. In this paper, the influence factors of Akabane's test were analyzed one by one, especially proposed personal opinion on outcome interpretation, which could ascertain the location and nature of disease, leading to disease syndrome. With accurate syndrome, the treatment plan could be established. The application prospect of Akabane's test was initially explored, and it was proposed that wearable automation equipment could be one of the development directions.

75 FR 2595 - Proposed Information Collection (Application for Furnishing Long-Term Care Services to...

Science.gov (United States)

2010-01-15

... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... comments for information needed to determine non-Federal nursing home or residential care home... information technology. Titles: a. Application for Furnishing Long-Term Care Services to Beneficiaries of...

Enhancing prospective chemistry teachers cognitive structures in the topics of bonding and hybridization by internet-assisted chemistry applications

Directory of Open Access Journals (Sweden)

Özge Özyalçın Oskay, Sinem Dinçol

2011-08-01

Full Text Available The purpose of this study is to determine the effects of internet-assisted chemistry applications on prospective chemistry teachers’ cognitive structures in the topics of bonding and hybridization. The sample of the study consisted of 36 prospective chemistry teachers attending Hacettepe University, Faculty of Education, the Department of Chemistry Education in 2010-2011 academic year and taking Basic Chemistry I lesson. In the study, students were separated into experimental and control groups according to their pre-cognitive structures. Students were requested to answer two open ended questions. Answers by each student were gathered and evaluated by flow map method. “Bonding and hybridization” topics were taught to control group with traditional teaching method and to experimental group besides traditional method internet-assisted applications were conducted. The same open-ended questions were given to both groups and their cognitive structures were examined once more. The differences between control and experimental groups’ cognitive structures were examined. A significant difference was identified in favour of experimental group (p<0, 05. The mean score of the Experimental group was X=19.94, and the mean score of the Control group was X=13.88. In addition, subsequent to internet assisted chemistry applications differences in terms of concepts and descriptions in prospective chemistry teachers’ in experimental and control group cognitive structure have been determined. When post flow maps of prospective chemistry teachers in experimental group, on whom internet assisted chemistry applications were made, are formed, it has been determined that there are more statements about hybridization, hybridization types, molecule geometry and bond angles compared to control grou

Applications and Prospects of Modularization Technology in HTR Project Starting from Primary Loop Cavity Construction

International Nuclear Information System (INIS)

Yang Guokang; Chen Jing; Huang Wen; Lin Lizhi; Sun Yunlun; Chen Yan; Mao Jiaxin; Wang Yougang; Wang Jinwen; Lin Mingfeng; Yang Mingshan

2014-01-01

Primary loop cavity is one of the key areas and major difficulties in HTR-PM project construction. In order to shorten the construction schedule and improve the construction quality, researches on modular design and construction of primary loop cavity has been carried out and the results have been applied in HTR-PM project construction, and got significant application benefit. This paper summarizes the modularization technology application research and project implementation results of primary loop cavity, and analyzes the application and prospects of modularization technology in the HTR project construction. (author)

Contribution of the education of the prospective fathers to the success of maternal health care programme.

OpenAIRE

Bhalerao V; Galwankar M; Kowli S; Kumar R; Chaturvedi R

1984-01-01

The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need fo...

Current state and prospects of industrial application of electron beam irradiation

International Nuclear Information System (INIS)

Washio, Masakazu

2000-01-01

This paper reviewed the low energy, medium energy, and high energy accelerators used for the industrial application of electron beams. Next, it described the absorption of electron beam energy, distribution of the absorbed dose of electron beams in a substance, and the basis of electron beam reaction. Furthermore, as the industrial application examples of electron beams, it briefly described about the reforming and curing of polymers, irradiation effect of inorganic material (characteristic control of semiconductors), and sterilization. Regarding curing, as examples using mainly low energy electron beams (300 keV or below), this paper briefly explained the manufacture of thermosensitive recording materials, electron beam cured silicone for release papers, tunnel metal interior finishing board, high gloss - high smooth paper. Finally, it looked at latest trends and prospects of electron beam generators. (A.O.)

Prospective cohort study on noise levels in a pediatric cardiac intensive care unit.

Science.gov (United States)

Garcia Guerra, Gonzalo; Joffe, Ari R; Sheppard, Cathy; Pugh, Jodie; Moez, Elham Khodayari; Dinu, Irina A; Jou, Hsing; Hartling, Lisa; Vohra, Sunita

2018-04-01

To describe noise levels in a pediatric cardiac intensive care unit, and to determine the relationship between sound levels and patient sedation requirements. Prospective observational study at a pediatric cardiac intensive care unit (PCICU). Sound levels were measured continuously in slow A weighted decibels dB(A) with a sound level meter SoundEarPro® during a 4-week period. Sedation requirement was assessed using the number of intermittent (PRNs) doses given per hour. Analysis was conducted with autoregressive moving average models and the Granger test for causality. 39 children were included in the study. The average (SD) sound level in the open area was 59.4 (2.5) dB(A) with a statistically significant but clinically unimportant difference between day/night hours (60.1 vs. 58.6; p-value noise levels were > 90 dB. There was a significant association between average (p-value = 0.030) and peak sound levels (p-value = 0.006), and number of sedation PRNs. Sound levels were above the recommended values with no differences between day/night or open area/single room. High sound levels were significantly associated with sedation requirements. Copyright © 2017 Elsevier Inc. All rights reserved.

Musculoskeletal health and work ability in physically demanding occupations: study protocol for a prospective field study on construction and health care workers.

Science.gov (United States)

Lunde, Lars-Kristian; Koch, Markus; Knardahl, Stein; Wærsted, Morten; Mathiassen, Svend Erik; Forsman, Mikael; Holtermann, Andreas; Veiersted, Kaj Bo

2014-10-16

Musculoskeletal disorders have a profound impact on individual health, sickness absence and early retirement, particularly in physically demanding occupations. Demographics are changing in the developed countries, towards increasing proportions of senior workers. These senior workers may have particular difficulties coping with physically demanding occupations while maintaining good health. Previous studies investigating the relationship between physical work demands and musculoskeletal disorders are mainly based on self-reported exposures and lack a prospective design. The aim of this paper is to describe the background and methods and discuss challenges for a field study examining physical demands in construction and health care work and their prospective associations with musculoskeletal disorders, work ability and sickness absence. This protocol describes a prospective cohort study on 1200 construction and health care workers. Participants will answer a baseline questionnaire concerning musculoskeletal complaints, general health, psychosocial and organizational factors at work, work demands, work ability and physical activity during leisure. A shorter questionnaire will be answered every 6th months for a total of two years, together with continuous sickness absence monitoring during this period. Analysis will prospectively consider associations between self-reported physical demands and musculoskeletal disorders, work ability and sickness absence. To obtain objective data on physical exposures, technical measurements will be collected from two subgroups of N = 300 (Group A) and N = 160 (Group B) during work and leisure. Both group A and B will be given a physical health examination, be tested for physical capacity and physical activity will be measured for four days. Additionally, muscle activity, ground reaction force, body positions and physical activity will be examined during one workday for Group B. Analysis of associations between objectively measured

Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study.

Science.gov (United States)

Dhiliwal, Sunil R; Muckaden, Maryann

2015-01-01

Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.

Effect of prospective reimbursement on nursing home costs.

OpenAIRE

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-01-01

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and ...

Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

Science.gov (United States)

Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

2015-11-01

Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources. ©2015 The British Editorial Society of Bone & Joint Surgery.

Preoperative fasting in the day care patient population at a tertiary care, teaching institute: A prospective, cross-sectional study

Directory of Open Access Journals (Sweden)

Merlin Shalini Ruth

2018-01-01

Full Text Available Context: Patients are fasting for inappropriately long duration preoperatively despite the American Society of Anesthesiologists (ASA recommendations for liberal fasting guidelines. There is paucity of data on preoperative fasting duration in the day care patient population from India; hence, we studied the preoperative fasting status in the day care patient population. Aims: This study aims to study the preoperative fasting duration for solids and clear fluids and to compare the fasting times in the patients posted for the morning slot and the afternoon slot. Settings and Design: This was a prospective, observational, cross-sectional study at a tertiary care, teaching institute. Subjects and Methods: All Consenting adults, ASA grade 1 or 2, of either gender, presenting for day care surgery were included in the study. Data collected included the demographic profile, duration of fasting for solids, and clear fluids. The patients rated their hunger and thirst on a ten point numeric rating scale. We compared the fasting durations for solids and clear fluids in the patients presenting for the morning slot and afternoon slot for surgery. Statistical Analysis Used: T-test was used for analysis of continuous data with normal distribution and Mann–Whitney U-test for data with nonnormal distribution. Chi-square test was performed for categorical variables. Differences were considered significant at P < 0.05. Results: The mean duration of preoperative fasting for solids was 12.58 ± 2.70 h and for clear fluids was 9.02 ± 3.73 h. The mean fasting duration for solids in the patients presenting for the afternoon slot was significantly longer (P < 0.0001 than those presenting for the morning slot. The mean preoperative fasting duration for clear fluids was comparable among these patient groups (P = 0.0741. Conclusions: Patients are following inappropriately prolonged fasting routines, and there is a need to enforce liberal preoperative fasting guidelines

Use of health care services and pharmaceutical agents in coeliac disease: a prospective nationwide study

Directory of Open Access Journals (Sweden)

Ukkola Anniina

2012-09-01

Full Text Available Abstract Background Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet. Methods A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed. Results Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month and painkillers (6.8-5.5 pills/month and the number of antibiotic courses (0.6-0.5 prescriptions/year was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment. Conclusions Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease. Trial registration ClinicalTrials.gov NCT01145287

Use of health care services and pharmaceutical agents in coeliac disease: a prospective nationwide study.

Science.gov (United States)

Ukkola, Anniina; Kurppa, Kalle; Collin, Pekka; Huhtala, Heini; Forma, Leena; Kekkonen, Leila; Mäki, Markku; Kaukinen, Katri

2012-09-27

Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet. A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed. Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month) and painkillers (6.8-5.5 pills/month) and the number of antibiotic courses (0.6-0.5 prescriptions/year) was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment. Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease. ClinicalTrials.gov NCT01145287.

Volunteering is prospectively associated with health care use among older adults.

Science.gov (United States)

Kim, Eric S; Konrath, Sara H

2016-01-01

Although observational and experimental studies have shown that volunteering is linked with better mental health, physical health, and health behaviors, no studies have examined whether volunteering is associated with patterns of health care use. The purpose of this study was to prospectively examine whether volunteering was associated with a greater use of preventive health care services, but fewer doctor visits and nights spent in the hospital. Participants (n = 7168) were drawn from the 2006 wave of the Health and Retirement Study, a nationally representative panel study of American adults over the age of 51, and tracked for one wave (2 years). Logistic regression and generalized linear models were used for analyses. In analyses that adjusted for sociodemographic factors and baseline health, volunteers were 30% more likely to receive flu shots (OR = 1.30, 95% CI = 1.16-1.47), 47% more likely to receive cholesterol tests (OR = 1.47, 95% CI = 1.24-1.74); female volunteers were 53% more likely to receive mammograms/x-rays (OR = 1.53, 95% CI = 1.28-1.83) and 21% more likely to receive Pap smears (OR = 1.21, 95% CI = 1.03-1.41); male volunteers were 59% more likely to receive prostate exams (OR = 1.59, 95% CI = 1.29-1.95). In a model that adjusted for sociodemographic factors, volunteers spent 38% fewer nights in the hospital (RR = 0.62, 95% CI = 0.52-0.76), however volunteering was not associated with frequency of doctor visits (RR = 0.94, 95% CI = 0.87-1.02). The association between volunteering and number of nights spent in the hospital was minimally affected after adjusting for potential confounding (baseline health) and explanatory variables (health behaviors, social integration, stress, positive psychological factors, personality). This is the first known study to examine the association between volunteering and health care use. If future studies replicate these findings, the results may be used to inform the development of new

Prospects and strategy for large scale utility applications of photovoltaic power systems

International Nuclear Information System (INIS)

Vigotti, R.; Lysen, E.; Cole, A.

1996-01-01

The status and prospects of photovoltaic (PV) power systems are reviewed. The market diffusion strategy for the application of PV systems by utilities is described, and the mission, objectives and thoughts of the collaboration programme launched among 18 industrialized countries under the framework of the International Energy Agency are highly with particular reference to technology transfer to developing countries. Future sales of PV systems are expected to grow in the short and medium term mainly in the sector of isolated systems. (R.P.)

Future prospects in dermatologic applications of lasers, nanotechnology, and other new technologies.

Science.gov (United States)

Boixeda, P; Feltes, F; Santiago, J L; Paoli, J

2015-04-01

We review novel technologies with diagnostic and therapeutic applications in dermatology. Among the diagnostic techniques that promise to become part of dermatologic practice in the future are optical coherence tomography, multiphoton laser scanning microscopy, Raman spectroscopy, thermography, and 7-T magnetic resonance imaging. Advances in therapy include novel light-based treatments, such as those applying lasers to new targets and in new wavelengths. Devices for home therapy are also appearing. We comment on the therapeutic uses of plasma, ultrasound, radiofrequency energy, total reflection amplification of spontaneous emission of radiation, light stimulation, and transepidermal drug delivery. Finally, we mention some basic developments in nanotechnology with prospects for future application in dermatology. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

Enhancing prospective chemistry teachers cognitive structures in the topics of bonding and hybridization by internet-assisted chemistry applications

OpenAIRE

Özge Özyalçın Oskay, Sinem Dinçol

2011-01-01

The purpose of this study is to determine the effects of internet-assisted chemistry applications on prospective chemistry teachers’ cognitive structures in the topics of bonding and hybridization. The sample of the study consisted of 36 prospective chemistry teachers attending Hacettepe University, Faculty of Education, the Department of Chemistry Education in 2010-2011 academic year and taking Basic Chemistry I lesson. In the study, students were separated into experimental and control gr...

Antimicrobial usage in an intensive care unit: a prospective analysis.

LENUS (Irish Health Repository)

Conrick-Martin, I

2012-01-31

Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.

Nursing application of Bobath principles in stroke care.

Science.gov (United States)

Passarella, P M; Lewis, N

1987-04-01

The nursing approach in the care of stroke patients has a direct impact on functional outcome. Nursing application of Bobath principles in stroke care offers a nursing focus on involvement of the affected side; facilitation of normal tone, posture, and movement; and development of more normal function. A research study evaluating the functional gains of stroke patients demonstrated a significant level of functional improvement in those treated with Bobath principles over stroke patients treated with the traditional nursing approach. Practical methods for applying Bobath principles in patient care activities are described. These therapeutic methods provide nurses with the means to maximize stroke patients' potential and further influence their functional recovery.

Mobile Health Applications for Pediatric Care: Review and Comparison.

Science.gov (United States)

Morse, Samantha Sangie; Murugiah, Muthu Kumar; Soh, Yee Chang; Wong, Tin Wui; Ming, Long Chiau

2018-05-01

Despite the surge in mobile health (mHealth) applications (apps) about pediatric care in commercial app stores, to our knowledge, reviews of the quality of such apps are lacking. Consequently, it is a great challenge for health care professionals (HCPs) to identify appropriate and reliable mHealth apps for delivering health care services. Thus, we performed a structured review of the extant literature about mHealth apps in pediatric care and quality assessment of selected apps found in commercial app stores. A review and comparison of mHealth apps in pediatric care found in Google's Play Store (Android system) and Apple's App Store (iOS system) were performed. For the structured review of the available literature, Google Scholar, PubMed, IEEE Xplore Digital Library, and Science Direct online databases were used for the literature search. The assessment criteria used for comparison included requirement for Internet connection, size of application, information on disease, diagnostic tools, medical calculator, information on disease treatments, dosage recommendations, and drug interaction checker. Fifty mHealth apps for general pediatric care and 8 mHealth apps for specific pediatric diseases were discussed in the literature. Of the 90 mHealth apps we reviewed, 27 that fulfilled the study criteria were selected for quality assessment. Medscape, Skyscape, and iGuideline scored the highest (score=7), while PediaBP scored the lowest (score=3). Medscape, Skyscape, and iGuideline are the most comprehensive mHealth apps for HCPs as quick references for pediatric care. More studies about mHealth apps in pediatric care are warranted to ensure the quality and reliability of mHealth apps.

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

Science.gov (United States)

2016-08-22

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

NASA/CARES dual-use ceramic technology spinoff applications

Science.gov (United States)

Powers, Lynn M.; Janosik, Lesley A.; Gyekenyesi, John P.; Nemeth, Noel N.

1994-01-01

NASA has developed software that enables American industry to establish the reliability and life of ceramic structures in a wide variety of 21st Century applications. Designing ceramic components to survive at higher temperatures than the capability of most metals and in severe loading environments involves the disciplines of statistics and fracture mechanics. Successful application of advanced ceramics material properties and the use of a probabilistic brittle material design methodology. The NASA program, known as CARES (Ceramics Analysis and Reliability Evaluation of Structures), is a comprehensive general purpose design tool that predicts the probability of failure of a ceramic component as a function of its time in service. The latest version of this software, CARESALIFE, is coupled to several commercially available finite element analysis programs (ANSYS, MSC/NASTRAN, ABAQUS, COSMOS/N4, MARC), resulting in an advanced integrated design tool which is adapted to the computing environment of the user. The NASA-developed CARES software has been successfully used by industrial, government, and academic organizations to design and optimize ceramic components for many demanding applications. Industrial sectors impacted by this program include aerospace, automotive, electronic, medical, and energy applications. Dual-use applications include engine components, graphite and ceramic high temperature valves, TV picture tubes, ceramic bearings, electronic chips, glass building panels, infrared windows, radiant heater tubes, heat exchangers, and artificial hips, knee caps, and teeth.

Usage Patterns of a Mobile Palliative Care Application.

Science.gov (United States)

Zhang, Haipeng; Liu, David; Marks, Sean; Rickerson, Elizabeth M; Wright, Adam; Gordon, William J; Landman, Adam

2018-06-01

Fast Facts Mobile (FFM) was created to be a convenient way for clinicians to access the Fast Facts and Concepts database of palliative care articles on a smartphone or tablet device. We analyzed usage patterns of FFM through an integrated analytics platform on the mobile versions of the FFM application. The primary objective of this study was to evaluate the usage data from FFM as a way to better understand user behavior for FFM as a palliative care educational tool. This is an exploratory, retrospective analysis of de-identified analytics data collected through the iOS and Android versions of FFM captured from November 2015 to November 2016. FFM App download statistics from November 1, 2015, to November 1, 2016, were accessed from the Apple and Google development websites. Further FFM session data were obtained from the analytics platform built into FFM. FFM was downloaded 9409 times over the year with 201,383 articles accessed. The most searched-for terms in FFM include the following: nausea, methadone, and delirium. We compared frequent users of FFM to infrequent users of FFM and found that 13% of all users comprise 66% of all activity in the application. Demand for useful and scalable tools for both primary palliative care and specialty palliative care will likely continue to grow. Understanding the usage patterns for FFM has the potential to inform the development of future versions of Fast Facts. Further studies of mobile palliative care educational tools will be needed to further define the impact of these educational tools.

Business model framework applications in health care: A systematic review.

Science.gov (United States)

Fredriksson, Jens Jacob; Mazzocato, Pamela; Muhammed, Rafiq; Savage, Carl

2017-11-01

It has proven to be a challenge for health care organizations to achieve the Triple Aim. In the business literature, business model frameworks have been used to understand how organizations are aligned to achieve their goals. We conducted a systematic literature review with an explanatory synthesis approach to understand how business model frameworks have been applied in health care. We found a large increase in applications of business model frameworks during the last decade. E-health was the most common context of application. We identified six applications of business model frameworks: business model description, financial assessment, classification based on pre-defined typologies, business model analysis, development, and evaluation. Our synthesis suggests that the choice of business model framework and constituent elements should be informed by the intent and context of application. We see a need for harmonization in the choice of elements in order to increase generalizability, simplify application, and help organizations realize the Triple Aim.

Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression

Science.gov (United States)

Campbell, Duncan G.; Bonner, Laura M.; Bolkan, Cory R.; Lanto, Andrew B.; Zivin, Kara; Waltz, Thomas J.; Klap, Ruth; Rubenstein, Lisa V.; Chaney, Edmund F.

2016-01-01

Background Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. Purpose To test whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. Methods We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Results Relative to low stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. Conclusions High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement. PMID:26935310

The prospect of nuclear application in food technology

International Nuclear Information System (INIS)

Maha, Munsiah

1982-01-01

Irradiation changes the normal living process of cells and the structure of molecules. It is good for food preservation because it kills off many of the microorganisms in the product and makes the remainder more sensitive to antimicrobial factors prevailing after the radiation treatment. It offers more benefits than conventional preservation in that it increases storage stability and quality of foodstuffs with the minimum use of energy. Good storage quality gives way to wider distribution of food, alleviates the world's food shortage, and improves food supplies. Research proved that irradiation increased the quality of subtropical fruits, spices, fish, and meat. No refrigeration is needed to store meat, poultry and fish preserved by the combination of irradiation and mild heat treatment. Nuclear technology can also be applied to destroy harmful insects, to sterilize food, to inhibit the sprouting of root crops, and to control ripening in stored fruits and vegetables. Based on the above potentials of irradiation, the prospect of nuclear application in food technology is promising. (RUW)

Chronic Kidney Disease in Primary Care: Outcomes after Five Years in a Prospective Cohort Study.

Directory of Open Access Journals (Sweden)

Adam Shardlow

2016-09-01

Full Text Available Chronic kidney disease (CKD is commonly managed in primary care, but most guidelines have a secondary care perspective emphasizing the risk of end-stage kidney disease (ESKD and need for renal replacement therapy. In this prospective cohort study, we sought to study in detail the natural history of CKD in primary care to better inform the appropriate emphasis for future guidance.In this study, 1,741 people with CKD stage 3 were individually recruited from 32 primary care practices in Derbyshire, United Kingdom. Study visits were undertaken at baseline, year 1, and year 5. Binomial logistic regression and Cox proportional hazards models were used to model progression, CKD remission, and all-cause mortality. We used Kidney Disease: Improving Global Outcomes (KDIGO criteria to define CKD progression and defined CKD remission as the absence of diagnostic criteria (estimated glomerular filtration rate [eGFR] >60 ml/min/1.73 m2 and urine albumin-to-creatinine ratio [uACR] <3 mg/mmol at any study visit. Participants were predominantly elderly (mean ± standard deviation (SD age 72.9 ± 9.0 y, with relatively mild reduction in GFR (mean ± SD eGFR 53.5 ± 11.8 mL/min/1,73 m2 and a low prevalence of albuminuria (16.9%. After 5 y, 247 participants (14.2% had died, most of cardiovascular causes. Only 4 (0.2% developed ESKD, but 308 (17.7% evidenced CKD progression by KDIGO criteria. Stable CKD was observed in 593 participants (34.1%, and 336 (19.3% met the criteria for remission. Remission at baseline and year 1 was associated with a high likelihood of remission at year 5 (odds ratio [OR] = 23.6, 95% CI 16.5-33.9 relative to participants with no remission at baseline and year 1 study visits. Multivariable analyses confirmed eGFR and albuminuria as key risk factors for predicting adverse as well as positive outcomes. Limitations of this study include reliance on GFR estimated using the Modification of Diet in Renal Disease study (MDRD equation for

Graphene Field Effect Transistors for Biomedical Applications: Current Status and Future Prospects.

Science.gov (United States)

Forsyth, Rhiannan; Devadoss, Anitha; Guy, Owen J

2017-07-26

Since the discovery of the two-dimensional (2D) carbon material, graphene, just over a decade ago, the development of graphene-based field effect transistors (G-FETs) has become a widely researched area, particularly for use in point-of-care biomedical applications. G-FETs are particularly attractive as next generation bioelectronics due to their mass-scalability and low cost of the technology's manufacture. Furthermore, G-FETs offer the potential to complete label-free, rapid, and highly sensitive analysis coupled with a high sample throughput. These properties, coupled with the potential for integration into portable instrumentation, contribute to G-FETs' suitability for point-of-care diagnostics. This review focuses on elucidating the recent developments in the field of G-FET sensors that act on a bioaffinity basis, whereby a binding event between a bioreceptor and the target analyte is transduced into an electrical signal at the G-FET surface. Recognizing and quantifying these target analytes accurately and reliably is essential in diagnosing many diseases, therefore it is vital to design the G-FET with care. Taking into account some limitations of the sensor platform, such as Debye-Hükel screening and device surface area, is fundamental in developing improved bioelectronics for applications in the clinical setting. This review highlights some efforts undertaken in facing these limitations in order to bring G-FET development for biomedical applications forward.

Graphene Field Effect Transistors for Biomedical Applications: Current Status and Future Prospects

Directory of Open Access Journals (Sweden)

Rhiannan Forsyth

2017-07-01

Full Text Available Since the discovery of the two-dimensional (2D carbon material, graphene, just over a decade ago, the development of graphene-based field effect transistors (G-FETs has become a widely researched area, particularly for use in point-of-care biomedical applications. G-FETs are particularly attractive as next generation bioelectronics due to their mass-scalability and low cost of the technology’s manufacture. Furthermore, G-FETs offer the potential to complete label-free, rapid, and highly sensitive analysis coupled with a high sample throughput. These properties, coupled with the potential for integration into portable instrumentation, contribute to G-FETs’ suitability for point-of-care diagnostics. This review focuses on elucidating the recent developments in the field of G-FET sensors that act on a bioaffinity basis, whereby a binding event between a bioreceptor and the target analyte is transduced into an electrical signal at the G-FET surface. Recognizing and quantifying these target analytes accurately and reliably is essential in diagnosing many diseases, therefore it is vital to design the G-FET with care. Taking into account some limitations of the sensor platform, such as Debye–Hükel screening and device surface area, is fundamental in developing improved bioelectronics for applications in the clinical setting. This review highlights some efforts undertaken in facing these limitations in order to bring G-FET development for biomedical applications forward.

Prospects of HTGR process heat application and role of HTTR

International Nuclear Information System (INIS)

Shiozawa, S.; Miyamoto, Y.

2000-01-01

At Japan Atomic Energy Research Institute, an effort on development of process heat application with high temperature gas cooled reactor (HTGR) has been continued for providing a future clean alternative to the burning of fossil energy for the production of industrial process heat. The project is named 'HTTR Heat Utilization Project', which includes a demonstration of hydrogen production using the first Japanese HTGR of High Temperature Engineering Test Reactor (HTTR). In the meantime, some countries, such as China, Indonesia, Russia and South Africa are trying to explore the HTGR process heat application for industrial use. One of the key issues for this application is economy. It has been recognized for a long time and still now that the HTGR heat application system is not economically competitive to the current fossil ones, because of the high cost of the HTGR itself. However, the recent movement on the HTGR development, as represented by South Africa Pebble Beds Modular Reactor (SA-PBMR) Project, has revealed that the HTGRs are well economically competitive in electricity production to fossil fuel energy supply under a certain condition. This suggests that the HTGR process heat application will also possibly get economical in the near future. In the present paper, following a brief introduction describing the necessity of the HTGRs for the future process heat application, Japanese activities and prospect of the development on the process heat application with the HTGRs are described in relation with the HTTR Project. In conclusion, the process heat application system with HTGRs is thought technically and economically to be one of the most promising applications to solve the global environmental issues and energy shortage which may happen in the future. However, the commercialization for the hydrogen production system from water, which is the final goal of the HTGR process heat application, must await the technology development to be completed in 2030's at the

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR)

Science.gov (United States)

2017-08-14

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

Health Care Delivery.

Science.gov (United States)

Starfield, Barbara

1987-01-01

The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

Adverse Consequences of School Mobility for Children in Foster Care: A Prospective Longitudinal Study

Science.gov (United States)

Pears, Katherine C.; Kim, Hyoun K.; Buchanan, Rohanna; Fisher, Philip A.

2015-01-01

Few prospective studies have examined school mobility in children in foster care. This study described the school moves of 86 such children and 55 community comparison children (primarily Caucasian), living in a medium-sized metropolitan area in the Pacific Northwest who were approximately 3-6-years-old at the study start. Additionally, the effects of moves from kindergarten through Grade 2 on academic and social emotional competence in Grades 3 through 5 were examined. A greater number of early school moves was associated with poorer later social emotional competence and partially mediated the effects of maltreatment and out-of-home placement on social emotional competence. This was only the case for children with poorer early learning skills in kindergarten. Implications for preventive intervention are discussed. PMID:25906815

Vacancy-impurity centers in diamond: prospects for synthesis and applications

Science.gov (United States)

Ekimov, E. A.; Kondrin, M. V.

2017-06-01

The bright luminescence of impurity-vacancy complexes, combined with high chemical and radiation resistance, makes diamond an attractive platform for the production of single-photon emitters and luminescent biomarkers for applications in nanoelectronics and medicine. Two representatives of this kind of defects in diamond, silicon-vacancy (SiV) and germanium-vacancy (GeV) centers, are discussed in this review; their similarities and differences are demonstrated in terms of the more thoroughly studied nitrogen-vacancy (NV) complexes. The recent discovery of GeV luminescent centers opens a unique opportunity for the controlled synthesis of single-photon emitters in nanodiamonds. We demonstrate prospects for the high-pressure high-temperature (HPHT) technique to create single-photon emitters, not only as an auxiliary to chemical vapor deposition (CVD) and ion-implantation methods but also as a primary synthesis tool for producing color centers in nanodiamonds. Besides practical applications, comparative studies of these two complexes, which belong to the same structural class of defects, have a fundamental importance for deeper understanding of shelving levels, the electronic structure, and optical properties of these centers. In conclusion, we discuss several open problems regarding the structure, charge state, and practical application of these centers, which still require a solution.

Supporting parents in taking care of their infants admitted to a neonatal intensive care unit: a prospective cohort pilot study.

Science.gov (United States)

De Bernardo, Giuseppe; Svelto, Maria; Giordano, Maurizio; Sordino, Desiree; Riccitelli, Marina

2017-04-17

Family-Centred Care (FCC) is recognized as an important component of all paediatric care, including neonatal care, although practical clinical guidelines to support this care model are still needed in Italy. The characteristics and services for families in Italian NICUs show a lack of organization and participation. The first aim was to compare satisfaction and stress levels in two groups of parents: an FCC group and a non-FCC group (NFCC). The second aim was to evaluate body weight gain in the newborns enrolled. This non-randomized, prospective cohort pilot study was conducted in a single level III NICU at a hospital in Naples, Italy. A cohort of newborns in the NICU, with their parents were enrolled between March 2014 and April 2015 and they were divided into two groups: the FCC group (enrolled between October 2014 and April 2015) remained in the NICU for 8 h a day with FCC model; the NFCC group (enrolled between March 2014 and September 2014) was granted access to the NICU for only 1 hour per day. At discharge, both parent groups completed the Parental Stressor Scale (PSS)-NICU and a questionnaire to assess their satisfaction. In addition, we compared scores from the mothers and fathers within and between groups and the body weights of the newborns in the two groups at 60 days. Parents participating in the FCC group were more satisfied and less stressed than those in the NFCC group. Infants in the FCC group also showed increased body weight after 60 days of hospital stay. Despite our small population, we confirm that routine adoption of a procedure designed to apply a FCC model can contribute to improving satisfaction and distress among preterm infants' parents. Future multi-centre, randomized, controlled trials are needed to confirm these findings.

Health values and prospect theory.

Science.gov (United States)

Treadwell, J R; Lenert, L A

1999-01-01

Health values are important components of medical decisions. Experimental data suggest that people value health in complex and dynamic ways. Prospect theory is a descriptive theory of choice that may accurately characterize how people assign values to health states. The authors first provide background on prospect theory and how it can be applied to health values. Next, they review the relevant health research and find mixed support for prospect theory. Last, they discuss implications of prospect theory for cost-effectiveness analysis. The application of prospect theory to health deserves further research because it may help clarify the link between health and values.

Pediatric Patients Receiving Specialized Palliative Home Care According to German Law: A Prospective Multicenter Cohort Study

Directory of Open Access Journals (Sweden)

Silke Nolte-Buchholtz

2018-05-01

Full Text Available In Germany, every child with a life-limiting condition suffering from symptoms that cannot sufficiently be controlled is eligible by law for specialized pediatric palliative home care (SPPHC. It is the aim of this study to describe the demographic and clinical characteristics of children referred to SPPHC and to compare patients with cancer and non-cancer conditions. The prospective multicenter study includes data on 75 children (median age 7.7 years, 50.7% male. The majority had non-cancer conditions (72%. The most common symptoms were cognitive impairment, somatic pain, impairment in communication or swallowing difficulties. Swallowing difficulties, seizures, and spasticity occurred significantly more often in non-cancer patients (p < 0.01. Cancer patients received antiemetics significantly more often (permanent and on demand than non-cancer patients (p < 0.01. Significantly more non-cancer patients had some type of feeding tube (57.3% or received oxygen (33.3% (p < 0.01. Central venous catheters had been fitted in 20% of the patients, mostly in cancer patients (p < 0.001. Tracheostomy tubes (9.3% or ventilation (14.7% were only used in non-cancer patients. In conclusion, patients referred to SPPHC are a diverse cohort with complex conditions including a large range of neurologically originating symptoms. The care of pediatric palliative care patients with cancer is different to the care of non-cancer patients.

Smarter palliative care for cancer: Use of smartphone applications

Directory of Open Access Journals (Sweden)

Nisha Rani Jamwal

2016-01-01

Full Text Available Smartphones are technologically advanced mobile phone devices which use software similar to computer-based devices as a user-friendly interface. This review article is aimed to inform the palliative care professionals, cancer patients and their caregivers about the role of smartphone applications (apps in the delivery of palliative care services, through a brief review of existing literature on the development, feasibility, analysis, and effectiveness of such apps. There is a dearth need for sincere palliative care clinicians to work together with software professionals to develop the suitable smartphone apps in accordance with the family/caregivers' necessities and patients' biopsychosocial characteristics that influence the technology driven evidence informed palliative cancer care.

42 CFR 412.525 - Adjustments to the Federal prospective payment.

Science.gov (United States)

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.525 Adjustments to the Federal prospective payment. (a... its estimated costs for a patient exceed the adjusted LTC-MS-DRG payment plus a fixed-loss amount. For...

Issues Concerning The Development Of A Mobile Platform For Health Care Applications

Science.gov (United States)

Korba, Larry W.; Liscano, Ramiro; Green, David; Durie, Nelson

1989-03-01

There are a number of problems that must yet be overcome before robotic technology can be applied in a hospital or a home care setting. The four basic problems are: cost, safety, finding appropriate applications and developing application specific solutions. Advanced robotics technology is now costly because of the complexity associated with autonomous systems. In any application, it is most important that the safety of the individuals using or exposed to the vehicle is ensured. Often in the health care field, innovative and useful new devices require an inordinate amount of time before they are accepted. The technical and ergonomic problems associated with any application must be solved so that cost containment, safety, ease of use, and quality of life are ensured. This paper discusses these issues in relation to our own development of an autonomous vehicle for health care applications. In this advancement, a commercially available platform is being equipped with an on-board, multiprocessor computer system and a variety of sensor systems. In order to develop pertinent solutions to the technical problems, there must be a framework wherein there is a focus upon the practical issues associated with the end application.

Geochemical methodology for gold prospect ion in Uruguay

International Nuclear Information System (INIS)

Spangenber, J.

1987-01-01

This work is about the history of gold prospection in Uruguay. In this study there are considered the geochemical aspects, the gold performance, the applicability to mining prospection and the gold prospection aluvionar

Control and synchronization of chaos in nonlinear systems and prospects for application. Pt.1

International Nuclear Information System (INIS)

Fang Jinqing

1996-01-01

Main progress in one challenging subject of nonlinear science--control and synchronization of chaos in nonlinear systems are reviewed systematically, including recent advance in controlling and synchronizing hyperchaos. Current methods and principles of schemes of chaos control and synchronization are classified and summarized in detail. Potential prospects for application are commented both in theory and experiment. The whole review is divided into two parts. In the first one, subject on the mechanism and method of chaos control are analyzed and discussed extensively. In the second one, the synchronization of non-chaos, chaos, hyperchaos and their control and application are described. Main trends for development of the subject is mentioned. (101 refs.)

Big Data Application in Biomedical Research and Health Care: A Literature Review.

Science.gov (United States)

Luo, Jake; Wu, Min; Gopukumar, Deepika; Zhao, Yiqing

2016-01-01

Big data technologies are increasingly used for biomedical and health-care informatics research. Large amounts of biological and clinical data have been generated and collected at an unprecedented speed and scale. For example, the new generation of sequencing technologies enables the processing of billions of DNA sequence data per day, and the application of electronic health records (EHRs) is documenting large amounts of patient data. The cost of acquiring and analyzing biomedical data is expected to decrease dramatically with the help of technology upgrades, such as the emergence of new sequencing machines, the development of novel hardware and software for parallel computing, and the extensive expansion of EHRs. Big data applications present new opportunities to discover new knowledge and create novel methods to improve the quality of health care. The application of big data in health care is a fast-growing field, with many new discoveries and methodologies published in the last five years. In this paper, we review and discuss big data application in four major biomedical subdisciplines: (1) bioinformatics, (2) clinical informatics, (3) imaging informatics, and (4) public health informatics. Specifically, in bioinformatics, high-throughput experiments facilitate the research of new genome-wide association studies of diseases, and with clinical informatics, the clinical field benefits from the vast amount of collected patient data for making intelligent decisions. Imaging informatics is now more rapidly integrated with cloud platforms to share medical image data and workflows, and public health informatics leverages big data techniques for predicting and monitoring infectious disease outbreaks, such as Ebola. In this paper, we review the recent progress and breakthroughs of big data applications in these health-care domains and summarize the challenges, gaps, and opportunities to improve and advance big data applications in health care.

Associations between the organisation of stroke services, process of care, and mortality in England: prospective cohort study.

Science.gov (United States)

Bray, Benjamin D; Ayis, Salma; Campbell, James; Hoffman, Alex; Roughton, Michael; Tyrrell, Pippa J; Wolfe, Charles D A; Rudd, Anthony G

2013-05-10

To estimate the relations between the organisation of stroke services, process measures of care quality, and 30 day mortality in patients admitted with acute ischaemic stroke. Prospective cohort study. Hospitals (n=106) admitting patients with acute stroke in England and participating in the Stroke Improvement National Audit Programme and 2010 Sentinel Stroke Audit. 36,197 adults admitted with acute ischaemic stroke to a participating hospital from 1 April 2010 to 30 November 2011. Associations between process of care (the assessments, interventions, and treatments that patients receive) and 30 day all cause mortality, adjusting for patient level characteristics. Process of care was measured using six individual measures of stroke care and summarised into an overall quality score. Of 36,197 patients admitted with acute ischaemic stroke, 25,904 (71.6%) were eligible to receive all six care processes. Patients admitted to stroke services with high organisational scores were more likely to receive most (5 or 6) of the six care processes. Three of the individual processes were associated with reduced mortality, including two care bundles: review by a stroke consultant within 24 hours of admission (adjusted odds ratio 0.86, 95%confidence interval 0.78 to 0.96), nutrition screening and formal swallow assessment within 72 hours (0.83, 0.72 to 0.96), and antiplatelet therapy and adequate fluid and nutrition for first the 72 hours (0.55, 0.49 to 0.61). Receipt of five or six care processes was associated with lower mortality compared with receipt of 0-4 in both multilevel (0.74, 0.66 to 0.83) and instrumental variable analyses (0.62, 0.46 to 0.83). Patients admitted to stroke services with higher levels of organisation are more likely to receive high quality care as measured by audited process measures of acute stroke care. Those patients receiving high quality care have a reduced risk of death in the 30 days after stroke, adjusting for patient characteristics and

Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before-after study.

Science.gov (United States)

Hess, Sascha; Sidler, Patrick; Chmiel, Corinne; Bögli, Karin; Senn, Oliver; Eichler, Klaus

2015-10-01

The increasing number of patients requiring emergency care is a challenge and leads to decreased satisfaction of health professionals at emergency departments (EDs). Thus, a Swiss hospital implemented a hospital-associated primary care centre at the ED. The study aim was to investigate changes in job satisfaction of ED staff before and after the implementation of this new service model and to measure hospital GPs' (HGPs) satisfaction at the hospital-associated primary care centre. This study was embedded in a large prospective before-after study over two years. We examined changes in job satisfaction with a questionnaire followed by selected interviews approaching all of the involved 25 ED staff members and 38 HGPs. The new emergency care model increased job satisfaction of ED staff and HGPs in all measured dimensions. The overall job satisfaction of ED employees improved from 76.5 to 83.9 points (visual analogue scale 0-100; difference 7.4 points [95% CI: 1.3 to 13.5, p = 0.02]). 86% of 29 HGPs preferred to provide their out-of-hours service at the new hospital-associated primary care centre. The hospital-associated primary care centre is a promising option to improve job satisfaction of different health professionals in emergency care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of prospective reimbursement on nursing home costs.

Science.gov (United States)

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-04-01

This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

Prospect theory: An application to European option pricing

OpenAIRE

Martina Nardon; Paolo Pianca

2012-01-01

Empirical studies on quoted options highlight deviations from the theoretical model of Black and Scholes; this is due to different causes, such as assumptions regarding the price dynamics, markets frictions and investors' attitude toward risk. In this contribution, we focus on this latter issue and study how to value European options within the continuous cumulative prospect theory. According to prospect theory, individuals do not always take their decisions consistently with the maximization...

Prospects of High Temperature Superconductors for fusion magnets and power applications

International Nuclear Information System (INIS)

Fietz, Walter H.; Barth, Christian; Drotziger, Sandra; Goldacker, Wilfried; Heller, Reinhard; Schlachter, Sonja I.; Weiss, Klaus-Peter

2013-01-01

Highlights: • An overview of HTS application in fusion is given. • BSCCO application for current leads is discussed. • Several approaches to come to a high current HTS cable are shown. • Open issues and benefits of REBCO high current HTS cables are discussed. -- Abstract: During the last few years, progress in the field of second-generation High Temperature Superconductors (HTS) was breathtaking. Industry has taken up production of long length coated REBCO conductors with reduced angular dependency on external magnetic field and excellent critical current density jc. Consequently these REBCO tapes are used more and more in power application. For fusion magnets, high current conductors in the kA range are needed to limit the voltage during fast discharge. Several designs for high current cables using High Temperature Superconductors have been proposed. With the REBCO tape performance at hand, the prospects of fusion magnets based on such high current cables are promising. An operation at 4.5 K offers a comfortable temperature margin, more mechanical stability and the possibility to reach even higher fields compared to existing solutions with Nb 3 Sn which could be interesting with respect to DEMO. After a brief overview of HTS use in power application the paper will give an overview of possible use of HTS material for fusion application. Present high current HTS cable designs are reviewed and the potential using such concepts for future fusion magnets is discussed

Prospect Theory and Coercive Bargaining

Science.gov (United States)

Butler, Christopher K.

2007-01-01

Despite many applications of prospect theory's concepts to explain political and strategic phenomena, formal analyses of strategic problems using prospect theory are rare. Using Fearon's model of bargaining, Tversky and Kahneman's value function, and an existing probability weighting function, I construct a model that demonstrates the differences…

Introducing the Index of Care: A web-based application supporting archaeological research into health-related care.

Science.gov (United States)

Tilley, Lorna; Cameron, Tony

2014-09-01

The Index of Care is a web-based application designed to support the recently proposed four-stage 'bioarchaeology of care' methodology for identifying and interpreting health-related care provision in prehistory. The Index offers a framework for guiding researchers in 'thinking through' the steps of a bioarchaeology of care analysis; it continuously prompts consideration of biological and archaeological evidence relevant to care provision; it operationalises key concepts such as 'disability' and 'care'; and it encourages transparency in the reasoning underlying conclusions, facilitating review. This paper describes the aims, structure and content of the Index, and provides an example of its use. The Index of Care is freely available on-line; it is currently in active development, and feedback is sought to improve its utility and usability. This is the first time in bioarchaeology that an instrument for examining behaviour as complex as caregiving has been proposed. Copyright © 2014 Elsevier Inc. All rights reserved.

Designing robots for care: care centered value-sensitive design.

Science.gov (United States)

van Wynsberghe, Aimee

2013-06-01

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

Mobile-Based Medical Health Application - Medi-Chat App

Directory of Open Access Journals (Sweden)

Mustapha Adamu Mohammed

2017-05-01

Full Text Available The aftermath of the development and implementation of the Android operating system and its associated Application Programming InterfacesAPI by Google culminated in the development more mobile device-enabled applications designed for our day-to-day businesses and personal use however in recent times we are experiencing a massive revolution in the use of mobile technology in the health sectors of our economy and this revolution is termed as Mobile Health Technology MHT.This new technological breakthrough has enabled the development of powerful android applications that enabled people tract and monitor the treat of heart and kidney related diseases as well as the monitoring and evaluation certain drug prescriptions. It has also changed the way we communicate with our specialist doctors from phone text to mobile-based communication. All these interventions provided by MHT have drastically increased the efficient and effective provision of health care delivery on one side and providing a common platform for prospective patients to easily interact with health professionals for medical advice and subsequent treatment of their diseases. Moreover In Ghana It would provide a much efficient and cost effective way of improving health-care methodologies in this 21st century which is characterized by information and communication technology. In this paper the main goal is to develop a mobile health application that provides common platform prospective patients and specialist doctors give free consultation and health tips on health related conditions thereby reducing the difficulty and challenges uncounted in accessing free medical health care at the already overburdened hospitals polyclinics and health centers in Ghana.

The application of geophysical methods to archaeological prospection

Energy Technology Data Exchange (ETDEWEB)

Linford, Neil [Geophysics Team, English Heritage, Fort Cumberland, Eastney, Portsmouth PO4 9LD (United Kingdom)

2006-07-15

The aim of this review is to combine the almost universal fascination we share for our past with the comparatively recent, in archaeological terms, application of geophysical prospection methods. For their success, each of these methods relies upon a physical contrast to exist between the buried archaeological feature and the properties of the surrounding subsoil. Understanding the archaeological origin of such physical contrasts, in terms of density, thermal conductivity, electrical resistance, magnetic or dielectric properties, remains fundamental to an appreciation of the discipline. This review provides a broad introduction to the subject area acknowledging the historical development of the discipline and discusses each of the major techniques in turn: earth resistance, magnetic and electromagnetic methods (including ground penetrating radar), together with an appreciation of more esoteric approaches, such as the use of micro-gravity survey to detect buried chambers and voids. The physical principles and field instrumentation involved for the acquisition of data with each method are considered and fully illustrated with case histories of results from the English Heritage archives.

The application of geophysical methods to archaeological prospection

International Nuclear Information System (INIS)

Linford, Neil

2006-01-01

The aim of this review is to combine the almost universal fascination we share for our past with the comparatively recent, in archaeological terms, application of geophysical prospection methods. For their success, each of these methods relies upon a physical contrast to exist between the buried archaeological feature and the properties of the surrounding subsoil. Understanding the archaeological origin of such physical contrasts, in terms of density, thermal conductivity, electrical resistance, magnetic or dielectric properties, remains fundamental to an appreciation of the discipline. This review provides a broad introduction to the subject area acknowledging the historical development of the discipline and discusses each of the major techniques in turn: earth resistance, magnetic and electromagnetic methods (including ground penetrating radar), together with an appreciation of more esoteric approaches, such as the use of micro-gravity survey to detect buried chambers and voids. The physical principles and field instrumentation involved for the acquisition of data with each method are considered and fully illustrated with case histories of results from the English Heritage archives

Anaphylaxis in an emergency care setting

DEFF Research Database (Denmark)

Ruiz Oropeza, Athamaica; Lassen, Annmarie; Halken, Susanne

2017-01-01

BACKGROUND: Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). METHODS: Prospect......BACKGROUND: Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). METHODS......: Prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). To identify anaphylaxis cases, records from all patients with clinical suspicion on anaphylaxis or a related diagnosis according to the International Classification of Diseases 10 and from patients treated...... at the emergency care setting or at prehospital level with adrenaline, antihistamines or glucocorticoids were reviewed daily. The identified cases were referred to the Allergy Center, where a standardized interview regarding the anaphylactic reaction was conducted. International guidelines were applied...

Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients.

Science.gov (United States)

Detering, Karen Margaret; Carter, Rachel Zoe; Sellars, Marcus William; Lewis, Virginia; Sutton, Elizabeth Anne

2017-12-01

Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client's case manager (CM) ('Facilitator') and ACP conducted by an external ACP service ('Referral') over a 6-month period. This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week. CMs were recruited via their organisations, sequentially allocated to a group and received education based on the group allocation. They were expected to initiate ACP with all clients and to facilitate ACP or refer for ACP. Outcomes were quantity of new ACP conversations and quantity and quality of new advance care directives (ACDs). 30 CMs (16 Facilitator, 14 Referral) completed the study; all 784 client's files (427 Facilitator, 357 Referral) were audited. ACP was initiated with 508 (65%) clients (293 Facilitator, 215 Referral; p<0.05); 89 (18%) of these (53 Facilitator, 36 Referral) and 41 (46%) (13 Facilitator, 28 Referral; p<0.005) completed ACDs. Most ACDs (71%) were of poor quality/not valid. A further 167 clients (facilitator 124; referral 43; p<0.005) reported ACP was in progress at study completion. While there were some differences, overall, models achieved similar outcomes. ACP was initiated with 65% of clients. However, fewer clients completed ACP, there was low numbers of ACDs and document quality was generally poor. The findings raise questions for future implementation and research into community ACP provision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mathematical geology studies of deposit prospect types

International Nuclear Information System (INIS)

Liu Guangping

1998-08-01

Exact certainty prospect type of uranium deposit, not only can assure the quality of deposit prospects, but also increase economic benefits. Based on the standard of geological prospect of uranium deposit, the author introduces a method of Fuzzy Synthetical Comment for dividing prospect type of uranium deposit. The practical applications demonstrate that the regression accuracy, discriminated by Zadeh operator, of 15 known deposits is 100%

Explanatory factors for first and second-generation non-western women's inadequate prenatal care utilisation: a prospective cohort study.

Science.gov (United States)

Boerleider, Agatha W; Manniën, Judith; van Stenus, Cherelle M V; Wiegers, Therese A; Feijen-de Jong, Esther I; Spelten, Evelien R; Devillé, Walter L J M

2015-04-21

Little research into non-western women's prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women's prenatal care utilisation and its explanatory factors according to generational status. Data from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women's prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios. The unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation. Irrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤ 19 or ≥ 36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance.

Methicillin-resistant Staphylococcus aureus in palliative care: A prospective study of Methicillin-resistant Staphylococcus aureus prevalence in a hospital-based palliative care unit.

Science.gov (United States)

Schmalz, Oliver; Strapatsas, Tobias; Alefelder, Christof; Grebe, Scott Oliver

2016-07-01

Methicillin-resistant Staphylococcus aureus is a common organism in hospitals worldwide and is associated with morbidity and mortality. However, little is known about the prevalence in palliative care patients. Furthermore, there is no standardized screening protocol or treatment for patients for whom therapy concentrates on symptom control. Examining the prevalence of methicillin-resistant Staphylococcus aureus in palliative care patients as well as the level of morbidity and mortality. We performed a prospective study where methicillin-resistant Staphylococcus aureus screening was undertaken in 296 consecutive patients within 48 h after admission to our palliative care unit. Medical history was taken, clinical examination was performed, and the Karnofsky Performance Scale and Palliative Prognostic Score were determined. Prevalence of Methicillin-resistant Staphylococcus aureus was compared to data of general hospital patients. In total, 281 patients were included in the study having a mean age of 69.7 years (standard deviation = 12.9 years) and an average Karnofsky Performance Scale between 30% and 40%. The mean length of stay was 9.7 days (standard deviation = 7.6 days). A total of 24 patients were methicillin-resistant Staphylococcus aureus positive on the first swab. Median number of swabs was 2. All patients with a negative methicillin-resistant Staphylococcus aureus swab upon admission remained Methicillin-resistant Staphylococcus aureus negative in all subsequent swabs. Our study suggests that the prevalence of Methicillin-resistant Staphylococcus aureus among patients in an in-hospital palliative care unit is much higher than in other patient populations. © The Author(s) 2016.

Nanocellulose as a sustainable biomass material: structure, properties, present status and future prospects in biomedical applications.

Science.gov (United States)

Xue, Yan; Mou, Zihao; Xiao, Huining

2017-10-12

Nanocellulose, extracted from the most abundant biomass material cellulose, has proved to be an environmentally friendly material with excellent mechanical performance owing to its unique nano-scaled structure, and has been used in a variety of applications as engineering and functional materials. The great biocompatibility and biodegradability, in particular, render nanocellulose promising in biomedical applications. In this review, the structure, treatment technology and properties of three different nanocellulose categories, i.e., nanofibrillated cellulose (NFC), nanocrystalline cellulose (NCC) and bacterial nanocellulose (BNC), are introduced and compared. The cytotoxicity, biocompatibility and frontier applications in biomedicine of the three nanocellulose categories were the focus and are detailed in each section. Future prospects concerning the cytotoxicity, applications and industrial production of nanocellulose are also discussed in the last section.

Prospective study of symptom control in 133 cases of palliative care inpatients in Shatin Hospital.

Science.gov (United States)

Lo, R S; Ding, A; Chung, T K; Woo, J

1999-07-01

We report a prospective study assessing the prevalence and severity of physical and nonphysical symptoms, and the benefits from treatment and intervention, in advanced cancer patients presenting to a local palliative care unit in Hong Kong. Patients were assessed by a modified version of the support team assessment schedule (STAS). The study highlighted some symptoms which needed better control, and also reinforced the team morale by demonstrating aspects where there was definite improvement. In general, the STAS was found to be practicable and acceptable by our patients and staff. The most important benefit gained from the study was the successful dissemination of the concept of audit and quality assurance throughout the unit, which is essential for continuous improvement in the future.

[Characteristics of heavy metals enrichment in algae ano its application prospects].

Science.gov (United States)

Lu, Kaixing; Tang, Jian-jun; Jiang, De'an

2006-01-01

Using algae to bio-remedy heavy metals-contaminated waters has become an available and practical approach for environmental restoration. Because of its special cell wall structure, high capacity of heavy metal-enrichment, and easy to desorption, algae has been considered as an ideal biological adsorbent. This paper briefly introduced the structural and metabolic characteristics adapted for heavy metals enrichment of algae, including functional groups on cell wall, extracellular products, and intracellular heavy metals-chelating proteins, discussed the enrichment capability of living, dead and immobilized algae as well as the simple and convenient ways for desorption, and analyzed the advantages and disadvantages of using algae for bioremediation of polluted water, and its application prospects.

Impact of aminoglycoside cycling in six tertiary intensive care units: prospective longitudinal interventional study.

Science.gov (United States)

Francetić, Igor; Kalenić, Smilja; Huić, Mirjana; Mercep, Iveta; Makar-Ausperger, Ksenija; Likić, Robert; Erdeljić, Viktorija; Tripković, Vesna; Simić, Petra

2008-04-01

To determine the effect of aminoglycoside cycling in six tertiary intensive care units (ICU) on the rates of sepsis, aminoglycoside resistance patterns, antibiotic consumption, and costs. This was a prospective longitudinal interventional study that measured the effect of change from first-line gentamicin usage (February 2002-February 2003) to amikacin usage (February 2003-February 2004) on the aminoglycoside resistance patterns, number of patients with gram-negative bacteremia, consumption of antibiotics, and the cost of antimicrobial drugs in 6 tertiary care ICUs in Zagreb, Croatia. The change from first-line gentamicin to amikacin usage led to a decrease in the overall gentamicin resistance of gram-negative bacteria (GNB) from 42% to 26% (PAcinetobacter baumanni (P=0.014). Sepsis rate in ICUs was reduced from 3.6% to 2.2% (P<0.001; chi(2) test), with a decline in the number of nosocomial bloodstream infections from 55/100 patient-days to 26/100 patient-days (P=0.001, chi(2) test). Furthermore, amikacin use led to a 16% decrease in the overall antibiotic consumption and 0.1 euro/patient/d cost reduction. Exclusive use of amikacin significantly reduced the resistance of GNB isolates to gentamicin and netilmicin, the number of GNB nosocomial bacteremias, and the cost of total antibiotic usage in ICUs.

Applications of prospecting geochemical techniques to the search for and to the study of uranium deposits in metropolitan France; Applications des techniques geochimiques de prospection a la recherche et a l'etude des gites uraniferes en France metropolitaine

Energy Technology Data Exchange (ETDEWEB)

Grimbert, Arnold

1957-07-01

After having recalled facts which leaded the CEA to use new geochemical techniques for the prospecting of uranium deposits through sampling and analysis of soils and waters, the author describes the organisation and methods implemented for this prospecting activity: team composition for sampling and analysis, role of each engineer and technician in the prospecting stages (preliminary study, routine prospecting, result interpretation), sampling and analysis processes. He also reports campaigns of geochemical prospecting: study of the La Chapelle Largeau deposit (objectives, geological context, preliminary study, routine prospecting, study of geochemical anomalies), tactical research on Verneix indices (study of radioactivity anomaly discovered by radio-prospecting), strategical searches in a non prospected area in the South of Avallon. The author discusses the issues of efficiency and cost price of this geochemical prospecting technique in soils and in waters. Appendices present the equipment and operation modality for soil sampling, and for soil sample preparation, and principles, equipment and products for soil analysis and for water analysis [French] A la suite des resultats satisfaisants obtenus dans la recherche de methodes de dosage adaptees au cas de l'uranium, la Direction des Recherches Minieres du Commissariat a l'Energie atomique a decide, en decembre 1954, d'utiliser, conjointement avec les methodes classiques de prospection, les techniques geochimiques pour la recherche et l'etude des gites uraniferes. Ces applications pratiques ont ete confiees a une Section de Geochimie dont l'organisation, les moyens en personnel et en materiel, ainsi que les methodes de travail, font l'objet d'un expose detaille. Quelques exemples de prospection, en France metropolitaine, montrent la nature des problemes poses (etude d'un gisement connu, recherche tactique sur des indices, recherche strategique dans une region non prospectee), les methodes utilisees pour les

Osmotic actuation for microfluidic components in point-of-care applications

KAUST Repository

Chen, Yu-Chih

2013-01-01

We present a novel design of micropumps and valves driven by osmotic force for point-of-care applications. Although there have been significant progresses in microfluidic components and control devices such as fluidic diodes, switches, resonators and digital-to-analog converters, the ultimate power source still depends on bulky off-chip components, which are expensive and cannot be easily miniaturized. For point-of-care applications, it is critical to integrate all the components in a compact size at low cost. In this work, we report two key active components actuated by osmotic mechanism for total integrated microfluidic system. For the proof of concept, we have demonstrated valve actuation, which can maintain stable ON/OFF switching operations under 125 kPa back pressure. We have also implemented an osmotic pump, which can pump a high flow rate over 30 μL/min for longer than 30 minutes. The experimental data demonstrates the possibility and potential of applying osmotic actuation in point-of-care disposable microfluidics. © 2013 IEEE.

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness.

Science.gov (United States)

Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja

2018-03-16

The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources

Current health and preferences for life-prolonging treatments: an application of prospect theory to end-of-life decision making.

Science.gov (United States)

Winter, Laraine; Parker, Barbara

2007-10-01

As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects-life (usually in poor health) and death-we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed.

Inclusion and Functionalization of Polymers with Cyclodextrins: Current Applications and Future Prospects

Directory of Open Access Journals (Sweden)

Christian Folch-Cano

2014-09-01

Full Text Available The numerous hydroxyl groups available in cyclodextrins are active sites that can form different types of linkages. They can be crosslinked with one another, or they can be derivatized to produce monomers that can form linear or branched networks. Moreover, they can form inclusion complexes with polymers and different substrates, modifying their physicochemical properties. This review shows the different applications using polymers with cyclodextrins, either by forming inclusion complexes, ternary complexes, networks, or molecularly imprinted polymers (MIPs. On one hand, the use of cyclodextrins enhances the properties of each polymer, and on the other the use of polymers decreases the amount of cyclodextrins required in different formulations. Both cyclodextrins and polymers contribute synergistically in several applications such as pharmacological, nutritional, environmental, and other industrial fields. The use of polymers based on cyclodextrins is a low cost easy to use potential tool with great future prospects.

Application effect of TEM sounding survey on prospecting and target area selection of sandstone-type uranium deposits

International Nuclear Information System (INIS)

He Jianguo; Liang Shanming; Zhao Cuiping

2006-01-01

Based on the results of transient electromagnetic (TEM) sounding survey during recent years regional geological reconnaissance with drilling (1:250000), the application effect of TEM sounding survey during regional reconnaissance is summarized in this paper. It is suggested that the data of TEM sounding are useful in judging hydrodynamic conditions of groundwater and determining favorable areas for uranium ore-formation; TEM sounding in large areas may be proper for prospecting in gobi-desert areas and be beneficial for regional reconnaissance and target area selection, and may reduce the target area and provide basis for further drilling program. It is of popularized significance in the prospecting for sandstone-type uranium deposits. (authors)

Ability to Assent in Pediatric Critical Care Research: A Prospective Environmental Scan of Two Canadian PICUs.

Science.gov (United States)

O'Hearn, Katharine J; Martin, Dori-Ann; Dagenais, Maryse; Menon, Kusum

2018-06-13

To determine the number of patients considered not appropriate to approach for assent within the first 24 hours of PICU admission. Exploratory prospective 1-month environmental scan. Two tertiary Canadian PICUs. Ninety patients age newborn to 17 years old admitted to the PICU during September 2016 (Site 1) or May 2017 (Site 2). None. At PICU admission, 81% of patients were deemed not appropriate to approach for assent most commonly due to age, influence of psychotropic medications, and/or mechanical ventilation. At PICU discharge, 74% of patients were considered not appropriate to approach, most commonly due to age and/or developmental delay. There was moderate to good agreement between the research team and care team assessments of appropriateness for assent. Only 8% of patients considered not approachable at admission become appropriate to approach for assent by PICU discharge. Very few patients were considered approachable for assent during the first 24 hours of PICU admission. Those who were considered appropriate to approach were less ill, spent less time in PICU, and were unlikely to be considered for enrollment in pediatric critical care research.

Application of solar chargers to prospection instruments; Application des chargeurs solaires aux appareils de prospection

Energy Technology Data Exchange (ETDEWEB)

Caille, G [Commissariat a l' Energie Atomique, Saclay (France).Centre d' Etudes Nucleaires

1960-07-01

The use of conventional batteries has certain disadvantages, and for this reason high-voltage batteries have been gradually replaced in all prospection instruments by transistor supply systems, using less cumbersome sources of energy. All the same low voltages are still necessary, and in hot or damp countries the use of these batteries leads to consumptions out of all proportion to the services rendered. This is why the use of solar energy possesses real advantages. After a brief review of the basic ideas on semiconductors, this article describes a selenium solar battery which was developed by the Westinghouse brakes and signals society. (author) [French] L'utilisation de piles classiques presente certains inconvenients. C'est pourquoi, dans tous les appareils de prospection, les piles fournissant des tensions elevees ont ete remplacees au fur et a mesure par des alimentations a base de transistors, utilisant des sources d'energie moins encombrantes. Toutefois, il faut tout de meme avoir des tensions faibles et l'utilisation de ces piles entraine dans les pays chauds ou humides une consommation disproportionnee par rapport aux services rendus. C'est pourquoi l'emploi de l'energie solaire presente de reels avantages. Cet expose decrit, apres un rappel de notion de base sur les semi-conducteurs, une batterie solaire a base de selenium qui a ete realisee par la Societe des freins et signaux Westinghouse. (auteur)

Integrated prospecting model in Jinguanchong uranium deposit

International Nuclear Information System (INIS)

Xie Yongjian

2006-01-01

Jinguanchong uranium deposit is large in scale, which brings difficulties to prospecting and researches. Based on conditions of mineral-formation, geophysics and geochemistry, this paper summarizes a few geophysical and geochemical prospecting methods applied to this deposit. The principles, characteristics, application condition and exploration phases of these prospecting methods are discussed and some prospecting examples are also given in the prospecting for Jinguanchong uranium deposit. Based on summarizing the practice and effects of different methods such as gamma and electromagnetic method, soil emanation prospecting, track etch technique and polonium method used in uranium prospecting, the author finally puts forward a primary uranium prospecting model for the further prospecting in Jinguanchong uranium deposit through combining the author's experience with practice. (authors)

Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls.

Science.gov (United States)

Stauffer, Brett D; Fullerton, Cliff; Fleming, Neil; Ogola, Gerald; Herrin, Jeph; Stafford, Pamala Martin; Ballard, David J

2011-07-25

Randomized controlled trials have demonstrated the efficacy of nurse-led transitional care programs to reduce readmission rates for patients with heart failure; the effectiveness of these programs in real-world health care systems is less well understood. We performed a prospective study with concurrent controls to test an advanced practice nurse-led transitional care program for patients with heart failure who were 65 years or older and were discharged from Baylor Medical Center Garland (BMCG) from August 24, 2009, through April 30, 2010. We compared the effect of the program on 30-day (from discharge) all-cause readmission rate, length of stay, and 60-day (from admission) direct cost for BMCG with that of other hospitals within the Baylor Health Care System. We also performed a budget impact analysis using costs and reimbursement experience from the intervention. The intervention significantly reduced adjusted 30-day readmission rates to BMCG by 48% during the postintervention period, which was better than the secular reductions seen at all other facilities in the system. The intervention had little effect on length of stay or total 60-day direct costs for BMCG. Under the current payment system, the intervention reduced the hospital financial contribution margin on average $227 for each Medicare patient with heart failure. Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure. This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals.

The computer tomography application of LUNG CARE to detect pulmonary nodules

International Nuclear Information System (INIS)

Minnoso Arabi, Yaysel; Ugarte Moreno, Dayana; Jordan Gonzalez, Jose

2011-01-01

The pulmonary nodule multiple or unique is frequently a casual finding and it is one of lung's cancer presentation. It's known that cancer is one of the first causes of death in our country and pulmonary tumor has become in a major sanitary problem. Methods. A descriptive prospective was carried out to detect pulmonary nodules in Medical Surgical Research Center. Patients were seen in General Medicine Consultation, in the period of time between January and December 2009. An inquiry was applied to every patients and a computer tomography scan with LUNG CARE program was performed to them. LUNG CARE program is used to early diagnosis and study of pulmonary nodule (mass). The data were analyzed with statistic packet SPSS version 13.0, for Windows. The data were summarized by means of stockings, deviations standard and percent, according to the variable type. For the comparison of the detection of nodules according to technical imagenology the test Chi -square was used at a level of significance of 0,05

Recent advances in bioprinting techniques: approaches, applications and future prospects.

Science.gov (United States)

Li, Jipeng; Chen, Mingjiao; Fan, Xianqun; Zhou, Huifang

2016-09-20

Bioprinting technology shows potential in tissue engineering for the fabrication of scaffolds, cells, tissues and organs reproducibly and with high accuracy. Bioprinting technologies are mainly divided into three categories, inkjet-based bioprinting, pressure-assisted bioprinting and laser-assisted bioprinting, based on their underlying printing principles. These various printing technologies have their advantages and limitations. Bioprinting utilizes biomaterials, cells or cell factors as a "bioink" to fabricate prospective tissue structures. Biomaterial parameters such as biocompatibility, cell viability and the cellular microenvironment strongly influence the printed product. Various printing technologies have been investigated, and great progress has been made in printing various types of tissue, including vasculature, heart, bone, cartilage, skin and liver. This review introduces basic principles and key aspects of some frequently used printing technologies. We focus on recent advances in three-dimensional printing applications, current challenges and future directions.

Medical care and organisation at the 2012 Roskilde Music Festival: a prospective observational study.

Science.gov (United States)

Stagelund, S; Jans, Ø; Nielsen, K; Jans, H; Wildgaard, K

2014-10-01

Music festivals, with a mix of music, alcohol and camping at the festival site combined with low hygiene, have become an integral part of society and attracts large numbers of guests. Our study was performed in order to increase the very limited knowledge on health-care issues and organisation of major music festivals. Pre-defined illness and injury categories were constructed based on categories previously reported from music festivals. We prospectively recorded patient presentations to the Medical Health Care Organisation (MHCO) at the 2012 Roskilde Festival. During 10 days, more than 130,000 guests and volunteers attended the 2012 Roskilde Festival. Ten thousand six hundred thirty patient presentations were registered between the 30th of June and 9th of July 2012 by the MHCO. The majority of patient presentations, 6919, could be handled by first-aid volunteers with different levels of training. The remaining 3473 patient presentations were assessed to require further health-care competencies or additional resources such as prescriptions, medication or suturing. Two hundred thirty-eight patient presentations were triaged to a designated observation area. Two hundred sixty patients were referred to a local hospital, a general practitioner or a dentist. The overall patient presentation rate was 72/1000 attendees, and the transport-to-hospital rate was 1.8/1000 attendees. Our study demonstrates that illnesses and injuries are frequent, although mostly minor, in this normally low-risk population consisting of primarily young and healthy guests. However, comparison with other recent events was difficult as only limited data have been published from other music festivals. Future festivals should publish similar data. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The impact of mentor mother programs on PMTCT service uptake and retention-in-care at primary health care facilities in Nigeria: a prospective cohort study (MoMent Nigeria).

Science.gov (United States)

Sam-Agudu, Nadia A; Cornelius, Llewellyn J; Okundaye, Joshua N; Adeyemi, Olusegun A; Isah, Haroun O; Wiwa, Owens M; Adejuyigbe, Ebun; Galadanci, Hadiza; Afe, Abayomi J; Jolaoso, Ibidun; Bassey, Emem; Charurat, Manhattan E

2014-11-01

Nigeria is a key target country in the global effort toward elimination of mother-to-child transmission of HIV. Low coverage of prevention of mother-to-child transmission (PMTCT) interventions, adherence, and retention-in-care rates in HIV-positive pregnant women are contributing factors to high mother-to-child transmission of HIV (MTCT) rates. In Nigeria, rural areas, served largely by primary health care facilities, have particularly poor indicators of PMTCT coverage. Mentor Mothers are HIV-positive women who serve as peer counselors for PMTCT clients, provide guidance, and support in keeping appointments and promoting antiretroviral adherence and retention-in-care. The Mother Mentor (MoMent) study aims to investigate the impact of structured Mentor Mother programs on PMTCT outcomes in rural Nigeria. A prospective cohort study will compare rates of retention-in-care among PMTCT clients who are supported by formally-trained supervised Mentor Mothers versus clients who receive standard-of-care, informal peer support. Study sites are 20 primary health care centers (10 intervention, 10 control) in rural North-Central Nigeria. The study population is HIV-positive mothers and exposed infant pairs (MIPs) (N = 480; 240 MIPs per study arm). Primary outcome measures are the proportion of exposed infants receiving early HIV testing by age 2 months, and the proportion of MIPs retained in care at 6 months postpartum. Secondary outcome measures examine antiretroviral adherence, 12-month postpartum MIP retention, and MTCT rates. This article presents details of the study design, the structured Mentor Mother programs, and how their impact on PMTCT outcomes will be assessed.

The care of constipated children in primary care in different countries

NARCIS (Netherlands)

Burgers, Rosa; Bonanno, Elvira; Madarena, Elisa; Graziano, Francesca; Pensabene, Licia; Gardner, William; Mousa, Hayat; Benninga, Marc A.; Di Lorenzo, Carlo

2012-01-01

Aim: To investigate and compare the approach to childhood constipation by primary care physicians (PCP) in three Western countries to give insight into adherence to current guidelines and in actual care. Methods: Prospective study utilizing a two-page survey regarding the approach to children

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

Science.gov (United States)

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.

Technical development of seismic imaging prospecting

International Nuclear Information System (INIS)

Xu Guilai

2006-01-01

Geophysical methods and apparatus for shallow engineering geophysical prospecting and mining related in-roadway geophysical prospecting are important research fields which has been studied for long time, unfortunately, little significant advancement has been made compared with the demand of engineering geology. The seismic imaging method and its corresponding equipment are viewed as the most hopeful choice for 0-50 m depth and are studied in this research systematically. The recording equipment CSA is made and the related in-situ data processing software is also developed. Field application experiment for shallow seismic prospecting has been finished, the results show that the CSA seismic imaging and its application technology are effective and practical for the engineering geophysical prospecting of 0-50 m depth, and can meet the demand of engineering geology investigation. Hence, the geophysical method and equipment, which can meet the demand for 0-50 m depth engineering geology investigation have been formed through this research. (authors)

An Application of Business Process Management to Health Care Facilities.

Science.gov (United States)

Hassan, Mohsen M D

The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

Telehealth, Mobile Applications, and Wearable Devices are Expanding Cancer Care Beyond Walls.

Science.gov (United States)

Cannon, Carol

2018-05-01

To review telehealth solutions, mobile applications, and wearable devices that are currently impacting patients, caregivers, and providers who work in the oncology setting. A literature search was conducted using the terms (Telehealth, Mobile Health, mHealth, Wearable Devices) + (Oncology, Cancer Care). There are many current applications of telehealth and mobile health in the oncology setting. Nurses who care for patients with cancer should be aware of the pervasiveness and impact of telehealth and mobile health to this unique population. Copyright © 2018 Elsevier Inc. All rights reserved.

Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors.

Science.gov (United States)

Lubberding, Sanne; van Uden-Kraan, Cornelia F; Te Velde, Elisabeth A; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M

2015-05-01

To gain insight into cancer survivors' needs towards an eHealth application monitoring quality of life and targeting personalised access to supportive care. Supportive care in cancer addresses survivors' concerns and needs. However, many survivors are not taking advantage of supportive care provided. To enable cancer survivors to benefit, survivors' needs must be identified timely and effectively. An eHealth application could be a solution to meet patients' individual supportive care needs. A qualitative approach. Thirty cancer survivors (15 head and neck and 15 breast cancer survivors) participated. The majority were female (n = 20·67%). The mean age was 60 (SD 8·8) years. Mean time interval since treatment was 13·5 months (SD 10·5). All interviews were audio-recorded and transcribed verbatim. During the interviews, participants were asked about their unmet needs during follow-up care and a potential eHealth application. Data were analyzed independently by two coders and coded into key issues and themes. Cancer survivors commented that they felt unprepared for the post-treatment period and that their symptoms often remained unknown to care providers. Survivors also mentioned a suboptimal referral pattern to supportive care services. Mentioned advantages of an eHealth application were as follows: insight into the course of symptoms by monitoring, availability of information among follow-up appointments, receiving personalised advice and tailored supportive care. Cancer survivors identified several unmet needs during follow-up care. Most survivors were positive towards the proposed eHealth application and expressed that it could be a valuable addition to follow-up cancer care. Study results provide care providers with insight into barriers that impede survivors from obtaining optimal supportive care. This study also provides insight into the characteristics needed to design, build and implement an eHealth application targeting personalised access to supportive

[Service quality in health care: the application of the results of marketing research].

Science.gov (United States)

Verheggen, F W; Harteloh, P P

1993-01-01

This paper deals with quality assurance in health care and its relation to quality assurance in trade and industry. We present the service quality model--a model of quality from marketing research--and discuss how it can be applied to health care. Traditional quality assurance appears to have serious flaws. It lacks a general theory of the sources of hazards in the complex process of patient care and tends to stagnate, for no real improvement takes place. Departing from this criticism, modern quality assurance in health care is marked by: defining quality in a preferential sense as "fitness for use"; the use of theories and models of trade and industry (process-control); an emphasis on analyzing the process, instead of merely inspecting it; use of the Deming problem solving technique (plan, do, check, act); improvement of the process of care by altering perceptions of parties involved. We present an experience of application and utilization of this method in the University Hospital Maastricht, The Netherlands. The successful application of this model requires a favorable corporate culture and motivation of the health care workers. This model provides a useful framework to uplift the traditional approach to quality assurance in health care.

[Prospective evaluation on ventilator-associated events: a cohort study from eight intensive care units].

Science.gov (United States)

Chen, W S; Liu, J; Liu, H; Song, Y Y; Chen, H Y; Wang, R; Zhang, Y P; Jiang, W; Li, H F; Li, S Q; Zhang, S M; Liu, B; Zhang, X; Zhang, W H

2016-08-10

The aim of this study was to prospectively investigate the incidence of ventilator associated events (VAEs) in intensive care units (ICUs) among adult patients, and to evaluate the correlation between VAEs and ventilator associated pneumonia (VAP). A prospective 3-month cohort study (January 2015 to March 2015) was carried out. VAEs were divided into three groups: with ventilator-associated condition (VAC), with infection related ventilator-associated complication (IVAC) and with possible VAP (PVAP). Sensitivity and specificity of VAEs were evaluated and compared to the traditional VAP. Kappa test was applied to judge the consistency of VAC and VAP. During Jan. 2015 and Mar. 2015, 1 014 patients were admitted to 8 ICUs, with 7 977 patients per day. In total, 197 patients used the mechanical ventilation installation, with, a total number of 3 152 ventilator-days. Finally, 1 214 ventilation days in the VAC group and 1 938 ventilation days in the non-VAC group) that were available for final analysis. 46 VAC cases were identified including 22 classified as IVAC (14.59 and 6.98 per 1 000 ventilation days, respectively). Length of ICU stay and duration on mechanical ventilation for VAC patients were both significantly longer than those for non-VAC patients (PVAC criteria for the detection of VAP were 36.92% and 83.33%, respectively. The VAEs surveillance paradigms could be applied to monitor patients on the use of mechanical ventilation installation. However, sensitivity and specificity of VAC were under pool for the diagnosis of VAP. However, automatically surveillance programs was relied on the improvement of auto-information systems.

A calculus of unnecessary echoes: application of management principles to health care.

Science.gov (United States)

Waldman, J D; McCullough, G

2002-01-01

We studied the clinical utility of echocardiography in children and applied principles of business management to draw conclusions that are applicable to health care in general. A significant number (13% in this series) of expensive medical diagnostic tests could be avoided without harm to patients. Cost reduction in medicine is possible in many situations without compromising quality of care. Care pathways (i.e., practice guidelines or clinical algorithms) provide one useful modality. However, for the safety of patients, all cost reduction methods must start with practicing physicians (or involve them at conceptualization) and an escape clause must be available to the treating physician for the atypical patient. The analytic approach used--concurrent assessment of percentage cost, charge, and payor--is applicable to all components of the health care value chain. The use of "percentage of charges" as an indicator of collection effectiveness is unrealistic and should be changed to "percentage potential reimbursement" because health care is effectively a fixed-reimbursement industry rather than a system subject to standard microeconomic (supply and demand) forces. The current reimbursement structure provides conflicting incentives both to health care institutions and to providers, creating an insurmountable barrier to any effective incentive system. Colloquy between practicing physicians and experts in operations management will stimulate cost reduction and can optimize the delivery of health care.

Organizing integrated care in a university hospital: application of a conceptual framework.

Science.gov (United States)

Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

2014-04-01

As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

Science.gov (United States)

2010-10-01

... standardized amount— (i) Is adjusted for the applicable hospital inpatient prospective payment system DRG... applicable hospital inpatient prospective payment system DRG weighting factors; (ii) Is adjusted by the... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR...

Developing and pilot testing M-health care application for pregnant and toddlers based on user experience

Science.gov (United States)

Lestantri, I. D.; Putrima; Sabiq, A.; Suherlan, E.

2018-03-01

Indonesia is the country number 4 as the largest smartphone user. In addition to functioning as a social media, the use of smartphones for other purposes has begun to develop in order to facilitate the work. Similarly in the field of maternal and child health. Most of the public, pregnant mothers and checking the development of children under five, were conducted to the Public Health Center. As a service center, Public Health Center need to improve its services. Among other things, it needs to be supported with technology. The high number of queues, the length of queue time and the traffic jam, prompted the need for the development of health applications, based on mobile. The role of the user is crucial to the successful implementation of a technology. This study aims to measure whether the application of M-Health Care application, as a prototype of the application developed to meet the needs of users. M-Health Care Application was developed with a prototyping approach. While for the measurement of M-Health Care Application done by using approach of USE Questionnaire. From result of data processing got result, usability measurement value equal to 88,3%. This indicates the M-Health Care application prototype is considered satisfactory for the user.The results of this measurement can be used as a reference for the next M-Health Care application development model based on user experience.

DIABETES, DEPRESSION, AND DEATH: A RANDOMIZED CONTROLLED TRIAL OF A DEPRESSION TREATMENT PROGRAM FOR OLDER ADULTS BASED IN PRIMARY CARE (PROSPECT)

Science.gov (United States)

Bogner, Hillary R; Morales, Knashawn H; Post, Edward P; Bruce, Martha L

2009-01-01

OBJECTIVE Our a priori hypothesis was that depressed patients with diabetes in practices implementing a depression management program would have a decreased risk of mortality compared to depressed patients with diabetes in usual care practices. RESEARCH DESIGN AND METHODS Multi-site practice-randomized controlled trial PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) with patient recruitment from 5/99-8/01 and supplemented with a search of the National Death Index. Twenty primary care practices participated from New York City, Philadelphia, and Pittsburgh. In all, 584 participants who were identified though a two-stage, age-stratified (60-74; 75+) depression screening of randomly sampled patients and were classified as depressed with complete information on diabetes status are included in these analyses. Of all the 584 participants, 123 (21.2%) reported a history of diabetes. A depression care manager worked with primary care physicians to provide algorithm-based care. Vital status was assessed at 5 years. RESULTS After a median follow-up of 52.0 months, 110 depressed patients had died. Depressed patients with diabetes in the Intervention Condition were less likely to have died during the 5-year follow-up interval than were depressed persons with diabetes in Usual Care after accounting for baseline differences among patients (adjusted hazard ratio 0.49, 95% CI [0.24, 0.98]). CONCLUSIONS Older depressed primary care patients with diabetes in practices implementing depression care management were less likely to die over the course of a 5-year interval than were depressed patients with diabetes in usual care practices. PMID:17717284

Semantic Technology Application for Collective Knowledge and Information Management: Prospective Consumer Needs Identification

Directory of Open Access Journals (Sweden)

Ilma Pranciulytė-Bagdziunienė

2013-01-01

Full Text Available Increasing the global flow of information forms qualitatively new complex information processing and filing requirements. The flow of information, data and knowledge manages the various activities of the original search for technological solutions. Very abundant and rapidly growing technology solutions groups are based on semantic technologies. Therefore, this article aims to provide user access needs for producing perspective survey methodology and the empirical study is based on the prospective development of innovative product lines. This article is formed based on the recommendations of the semantics of the applicability of technology development to business end users, public administration, organization of information flows the value of the generation of knowledge—based on environment and development issues. At a practical level, based on empirical evidence substantiates the semantics it is based on technology solutions for organizations in the integration of business processes, which can become the modern aspect of the success factors of the value of domestic and global market and facilitate the diffusion of innovation. The field of qualitative research has revealed the final consumer habits and problems of information search, organization, grouping aspects. Secondly, the study determined the idea of the necessity of technology in business processes, innovation generation and diffusion of knowledge issues aspects. Third, the authors submit proposals based on the semantics of the applicability of technology development opportunities in the business. Finally—users, public administrations and their mutual interaction activities. ST applicability of these segments may occur based on ST integration of IT systems in organizations, the general structure of existing products or used as a service by buying them from outside suppliers. It is important to emphasize that the ST innovative methods to ensure successful use of advanced, modern

Kartini Research Reactor prospective studies for neutron scattering application

International Nuclear Information System (INIS)

Widarto

1999-01-01

The Kartini Research Reactor (KRR) is located in Yogyakarta Nuclear Research Center, Yogyakarta - Indonesia. The reactor is operated for 100 kW thermal power used for research, experiments and training of nuclear technology. There are 4 beam ports and 1 column thermal are available at the reactor. Those beam ports have thermal neutron flux around 10 7 n/cm 2 s each other and used for sub critical assembly, neutron radiography studies and Neutron Activation Analysis (NAA). Design of neutron collimator has been done for piercing radial beam port and the calculation result of collimated neutron flux is around 10 9 n/cm 2 s. This paper describes experiment facilities and parameters of the Kartini research reactor, and further more the prospective studies for neutron scattering application. The purpose of this paper is to optimize in utilization of the beam ports facilities and enhance the manpower specialty. The special characteristic of the beam ports and preliminary studies, pre activities regarding with neutron scattering studies for KKR is presented. (author)

Prospects and strategy for large scale utility applications of photovoltaic power systems

International Nuclear Information System (INIS)

Cole, A.; Vigotti, R.; Lysen, E.

1995-01-01

The paper reviews the status and prospects of photovoltaic power systems and the R and D trends (silicon performances, thin films, balance of systems components), and describes the market diffusion strategy for the application of PV systems: at the short and medium term level, isolated systems for rural electricity supply in IEA member countries and decentralized energy supply (remote users and village power) in developing countries; at the medium and long term level, decentralized building integration in urban and rural areas, power stations for peak power and local grid support. The objectives of the IEA collaboration programme launched among 18 industrialized countries are summarized, with particular reference to technology transfer to developing countries. 4 figs

Enabling Compassionate Health Care: Perils, Prospects and Perspectives

Directory of Open Access Journals (Sweden)

Russell Mannion

2014-04-01

Full Text Available There is an emerging consensus that caring and compassion are under threat in the frenetic environment of modern healthcare. Enabling and sustaining compassionate care requires not only a focus on the needs of the patient, but also on those of the care giver. As such, threats and exhortations to health professionals are likely to have limited and perverse effects and it is to the organisational and system arrangements which support staff that attention should shift. Any approach to supporting compassionate care may work for some services, for some patients and staff, some of the time. No single approach is likely to be a panacea. Unravelling the contexts within which different approaches are effectual will allow for more selective development of support systems and interventions.

Leflunomide in active rheumatoid arthritis: A prospective study in daily practice

NARCIS (Netherlands)

Van Roon, E.N.; Jansen, T.L.Th.A.; Mourad, L.; Houtman, P.M.; Bruyn, G.A.W.; Griep, E.N.; Wilffert, B.; Tobi, H.; Brouwers, J.R.B.J.

2004-01-01

Aims: We prospectively studied the efficacy, incidence of adverse drug reactions and withdrawal from leflunomide in an outpatient population with rheumatoid arthritis in a setting of care-as-usual. Methods: In this prospective case series study, a standard dataset was collected from outpatient

How much does care in palliative care wards cost in Poland?

Science.gov (United States)

Ciałkowska-Rysz, Aleksandra D; Pokropska, Wieslawa; Łuczak, Jacek; Kaptacz, Anna; Stachowiak, Andrzej; Hurich, Krystyna; Koszela, Monika

2016-04-01

The main task of palliative care units is to provide a dignified life for people with advanced progressive chronic disease through appropriate symptom management, communication between medical specialists and the patient and his family, as well as the coordination of care. Many palliative care units struggle with low incomes from the National Health Fund (NHF), which causes serious economic problems. The aim of the study was to estimate of direct and administrative costs of care and the actual cost per patient per day in selected palliative care units and comparison of the results to the valuation of the NHF. The study of the costs of hospitalization of 175 patients was conducted prospectively in five palliative care units (PCUs). The costs directly associated with care were recorded on the specially prepared forms in each unit and also personnel and administrative costs provided by the accounting departments. The total costs of analyzed units amounted to 209 002 EUR (898 712 PLN), while the payment for palliative care services from the NHF amounted to 126 010 EUR (541 844 PLN), which accounted for only 60% of the costs incurred by the units. The average cost per person per day of hospitalization, calculated according to the actual duration of hospitalization in the unit, was 83 EUR (357 PLN), and the average payment from the NHF was 52.8 EUR (227 PLN). Underpayment per person per day was approximately 29.2 EUR (125 PLN). The study showed a significant difference between the actual cost of palliative care units and the level of refund from the NHF. Based on the analysis of costs, the application has been submitted to the NHF to change the reimbursement amount of palliative care services in 2013.

A clinician's artificial organ? Instant messaging applications in medical care.

Science.gov (United States)

Tazegul, Gokhan; Bozoglan, Humeyra; Ogut, Tahir S; Balcı, Mustafa K

2017-09-15

After the development of the first phone at the end of 19th century, communication technologies took a great leap forward in the 20th century. With the birth of the "smartphone" in the 21st century, communication technologies exponentially evolved and became an important part of our daily routine. Effective communications between clinicians is critical in medical care and miscommunications are a source of errors. Although telecommunication technologies have proliferated dramatically in the last decade, there is scarce evidence-based information on the use of this technology in medical care. For the purposes of medical communication, we can now consult each other about patients individually and within a group via instant messaging applications by using text messages, photos, audio messages and even videos. In this review, we examine the uses and drawbacks of instant messaging applications in medical communications.

Leflunomide in active rheumatoid arthritis : a prospective study in daily practice

NARCIS (Netherlands)

Van Roon, EN; Jansen, TLTA; Mourad, L; Houtman, PM; Bruyn, GAW; Griep, EN; Wilffert, B; Tobi, H; Brouwers, JRBJ

Aims We prospectively studied the efficacy, incidence of adverse drug reactions and withdrawal from leflunomide in an outpatient population with rheumatoid arthritis in a setting of care-as-usual. Methods In this prospective case series study, from outpatient medical records a standard dataset was

Organizing integrated care in a university hospital: application of a conceptual framework

Directory of Open Access Journals (Sweden)

Runo Axelsson

2014-06-01

Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals.Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews.Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location.Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

Organizing integrated care in a university hospital: application of a conceptual framework

Directory of Open Access Journals (Sweden)

Runo Axelsson

2014-06-01

Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

Organizing integrated care in a university hospital: application of a conceptual framework

Science.gov (United States)

Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

2014-01-01

Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care. PMID:24966806

Contribution of the education of the prospective fathers to the success of maternal health care programme.

Directory of Open Access Journals (Sweden)

Bhalerao V

1984-01-01

Full Text Available The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need for their husbands coming and meeting the doctor at the Center. The outcome of the maternal health care program for the 270 women whose husbands were invited and came (Group 1 was compared with the outcome of the same program, under the same roof, for 405 women whose husbands could not be invited (Group 2. The husbands who attended the center were educated individually and in groups about their role in nutrition and health of their wives during pregnancy and their responsibility in subsequent child rearing. The physiology of pregnancy, complications of pregnancy, and the possible ways and means of preventing the complications were explained in detail. The husbands were also told to encourage their wives to attend the antenatal clinic of the center as often as possible. There was no difference in the socioeconomic, educational, cultural, and religious background of the 2 groups of women who were similar in parity distribution. The main difference between the 2 groups was a significantly lower perinatal mortality in Group 1. Only 60 of the 405 Group 2 women were considered eligible for postpartum sterilization (para 3 and higher. In contrast, 41 of the 270 Group 1 women were considered eligible for postpartum sterilization and 110 women accepted. The excess of those who accepted over those who were eligible came form the lower paras. This effort confirms that the involvement of prospective fathers is possible and pays good dividends even in an uneducated and low

Contribution of the education of the prospective fathers to the success of maternal health care programme.

Science.gov (United States)

Bhalerao, V R; Galwankar, M; Kowli, S S; Kumar, R; Chaturvedi, R M

1984-01-01

The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need for their husbands coming and meeting the doctor at the Center. The outcome of the maternal health care program for the 270 women whose husbands were invited and came (Group 1) was compared with the outcome of the same program, under the same roof, for 405 women whose husbands could not be invited (Group 2). The husbands who attended the center were educated individually and in groups about their role in nutrition and health of their wives during pregnancy and their responsibility in subsequent child rearing. The physiology of pregnancy, complications of pregnancy, and the possible ways and means of preventing the complications were explained in detail. The husbands were also told to encourage their wives to attend the antenatal clinic of the center as often as possible. There was no difference in the socioeconomic, educational, cultural, and religious background of the 2 groups of women who were similar in parity distribution. The main difference between the 2 groups was a significantly lower perinatal mortality in Group 1. Only 60 of the 405 Group 2 women were considered eligible for postpartum sterilization (para 3 and higher). In contrast, 41 of the 270 Group 1 women were considered eligible for postpartum sterilization and 110 women accepted. The excess of those who accepted over those who were eligible came form the lower paras. This effort confirms that the involvement of prospective fathers is possible and pays good dividends even in an uneducated and low socioeconomic

Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study

Science.gov (United States)

Nathan, Lisa M.; Shi, Quihu; Plewniak, Kari; Zhang, Charles; Nsabimana, Damien; Sklar, Marc; Mutimura, Eugene; Merkatz, Irwin R.; Einstein, Mark H.; Anastos, Kathryn

2015-01-01

To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB. PMID:25652061

76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

Science.gov (United States)

2011-05-20

... Affordable Care Act, to test innovative payment and service delivery models that reduce spending under.... This Model will test the effectiveness of a combination of the following: Payment arrangements that...] Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications AGENCY: Centers for...

Functional analysis of concealment: a novel application of prospect and refuge theory.

Science.gov (United States)

Singh, Punya; Ellard, Colin G

2012-09-01

According to prospect-refuge theory, humans prefer environments that afford protection from threat (refuge), but also provide large fields of view (prospect). Prospect-refuge theory in the past has traditionally only been applied to humans, but many of the same contingencies governing spatial preference ought to also hold true in animals. The focus of this study was to examine if this phenomena also occurs in animals. Gerbils were placed in an arena containing three dome shaped refuges that varied in prospect-refuge levels. A simulated predator was released during the trial to examine how contextual factors may influence the degree of prospect and refuge preferred. The results indicate a preference for the enclosed refuge at stimulus onset even though this was not reflective of what happened prior to predator release. The results suggest spatial preferences in animals are influenced by prospect-refuge considerations in certain contexts. Copyright © 2012 Elsevier B.V. All rights reserved.

Telemedicine and biomedical care in Africa: Prospects and challenges

African Journals Online (AJOL)

2016-01-28

Jan 28, 2016 ... medical education in the absence or limited healthcare ... to medical services is inadequate, holds promise in expanding ... Prospects and challenges of telemedicine in Africa. 2 ... experts' opinions and sharing of knowledge between doctors. .... patients now depend on their pastors or spiritual leaders in.

Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol.

Science.gov (United States)

Teo, Irene; Singh, Ratna; Malhotra, Chetna; Ozdemir, Semra; Dent, Rebecca A; Kumarakulasinghe, Nesaretnam Barr; Yeo, Wee Lee; Cheung, Yin Bun; Malhotra, Rahul; Kanesvaran, Ravindran; Yee, Alethea Chung Pheng; Chan, Noreen; Wu, Huei Yaw; Chin, Soh Mun; Allyn, Hum Yin Mei; Yang, Grace Meijuan; Neo, Patricia Soek Hui; Nadkarni, Nivedita V; Harding, Richard; Finkelstein, Eric A

2018-04-23

aims to identify opportunities to meet the growing need for high quality care for Singapore's aging population. Results will also be of interest to policy makers and researchers beyond Singapore who are interested to understand and improve the end-of-life experience of cancer patients. NCT02850640 (Prospectively registered on June 9, 2016).

[Alcohol versus bath and natural drying for term newborns' umbilical cord care: a prospective randomized clinical trial].

Science.gov (United States)

Covas, María del Carmen; Alda, Ernesto; Medina, María Sol; Ventura, Silvia; Pezutti, Ornella; Paris de Baeza, Ana; Sillero, Josefna; Esandi, María Eugenia

2011-08-01

Umbilical cord (UC) care is a cause of concern for parents right from birth until its separation. Standard practice in Argentina includes frequent cleansing of the UC with alcohol and body bath only two days after its separation. The effect of different methods of UC care on its separation time and on colonization with microorganisms has been insufficiently explored. Main: To compare the effect on time of UC separation when using body bath with neutral soap followed by natural drying of the UC vs. standard care. Secondary: a) colonization rates during hospitalization; b) incidence of skin infection and conjunctivitis and c) parental comfort with both types of care. Normal term newborns (≥37 weeks), born at the HPS, and whose parents provided informed consent. Open prospective controlled clinical trial, with random allocation to two groups: study group -natural drying of the UC and body bath with neutral soap- and control group -UC hygiene with alcohol 70% at each diaper change until its separation and bath two days later-. UC separation time; UC colonization during hospital stay and skin and conjunctive infections in the first 30 days of life were monitored. Analysis was by intention-to-treat. 362 newborns were included, 181 in each group. The groups were well balanced in baseline characteristics. Being in the study group was associated with a shorter time to UC separation (median [interquartile range]= 6.00 [3] vs. 7.00 [4] days; p natural drying of the UC reduced the time to cord separation. This practice increased the colonization rate, but the risk of skin and conjunctive infections was apparently not modified by it. However, the study has insufficient power for secondary outcomes. Health care providers should continue to develop evidence to support or eliminate historical practices.

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Science.gov (United States)

2010-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

A centrifugal microfluidic platform for point-of-care diagnostic applications

Directory of Open Access Journals (Sweden)

Suzanne Hugo

2014-02-01

Full Text Available Microfluidic systems enable precise control over tiny volumes of fluid in a compact and low-cost form, thus providing the ideal platform on which to develop point-of-care diagnostic solutions. Centrifugal microfluidic systems, also referred to as lab-on-a-disc or lab-on-a-CD systems, provide a particularly attractive solution for the implementation of microfluidic point-of-care diagnostic solutions as a result of their simple and compact instrumentation, as well as their functional diversity. Here we detail the implementation of a centrifugal microfluidic platform the first of its kind in South Africa as a foundation for the development of point-of-care diagnostic applications for which both the need and impact is great. The centrifugal microfluidic platform consists of three main components: a microfluidic disc device similar in size and shape to a CD, a system for controlling fluid flow on the device, and a system for recording the results obtained. These components have been successfully implemented and tested. Preliminary test results show that microfluidic functions such as pumping and valving of fluids can be successfully achieved, as well as the generation of monodisperse microfluidic droplets, providing a complete centrifugal microfluidic platform and the building blocks on which to develop a variety of applications, including point-of-care diagnostics. The lab-on-a-disc platform has the potential to provide new diagnostic solutions at the point-of-need in health- and industry-related areas. This paves the way for providing resource limited areas with services such as improved, decentralised health-care access or water-quality monitoring, and reduced diagnosis times at a low cost.

Pilot implementation and user preferences of a Bariatric After-care application.

Science.gov (United States)

Zhang, Melvyn W B; Ho, Roger C M; Hawa, Raed; Sockalingam, Sanjeev

2015-01-01

The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Patients who have undergone Bariatric surgery tend to need chronic long-term follow-up with a multi-disciplinary team. In the past decade, there has been massive advancement and development in Internet, Web-based and Smartphone technologies. However, there seemed to be a pacuity of applications in this area that enables post-bariatric patients to self-manage their own condition. In addition, past research have highlighted the limited evidence based with regards to currently available bariatric applications, mainly due to the lack of medical professionals involvement. Our current research objective is to illustrate the development of a Bariatric After-care smartphone application and to highlight user preferences with regards to the features integrated within the application. The Bariatric Aftercare application was developed between the months of March 2014 to April 2014. Making use of low-cost online web-based application developmental technologies, the authors embarked on the development of the web-based application. Patients who attended their routine follow-up appointments are given the links to the web-based application. They were also recruited to participate in an online user evaluation survey to identify their preferences with regards to the features integrated. Since the inception of the web-based application to date, there has been a cumulative total of 385 unique assess to the online web-based application. There is a slight change in the confidence levels of the participants with regards to using the application to help them self-manage their own condition. The majority of the users have indicated that they preferred the information pertaining to what happens during each consult with members of the multidisciplinary team and also greatly valued

Wikis and Collaborative Writing Applications in Health Care: A Scoping Review Protocol

Science.gov (United States)

van de Belt, Tom H; Grajales III, Francisco J; Eysenbach, Gunther; Aubin, Karine; Gold, Irving; Gagnon, Marie-Pierre; Kuziemsky, Craig E; Turgeon, Alexis F; Poitras, Julien; Faber, Marjan J; Kremer, Jan A.M; Heldoorn, Marcel; Bilodeau, Andrea; Légaré, France

2012-01-01

The rapid rise in the use of collaborative writing applications (eg, wikis, Google Documents, and Google Knol) has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. While researchers have conducted systematic reviews on a range of software-based information and communication technologies as well as other social media (eg, virtual communities of practice, virtual peer-to-peer communities, and electronic support groups), none have reviewed collaborative writing applications in the medical sector. The overarching goal of this project is to explore the depth and breadth of evidence for the use of collaborative writing applications in health care. Thus, the purposes of this scoping review will be to (1) map the literature on collaborative writing applications; (2) compare the applications’ features; (3) describe the evidence of each application’s positive and negative effects as a KT intervention in health care; (4) inventory and describe the barriers and facilitators that affect the applications’ use; and (5) produce an action plan and a research agenda. A six-stage framework for scoping reviews will be used: (1) identifying the research question; (2) identifying relevant studies within the selected databases (using the EPPI-Reviewer software to classify the studies); (3) selecting studies (an iterative process in which two reviewers search the literature, refine the search strategy, and review articles for inclusion); (4) charting the data (using EPPI-Reviewer’s data-charting form); (5) collating, summarizing, and reporting the results (performing a descriptive, numerical, and interpretive synthesis); and (6) consulting knowledge users during three planned meetings. Since this scoping review concerns the use of collaborative writing applications as KT interventions in health care, we will use the Knowledge to Action

A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit.

Science.gov (United States)

Talento, Alida Fe; Dunne, Katie; Joyce, Eimear Ann; Palmer, Michael; Johnson, Elizabeth; White, P Lewis; Springer, Jan; Loeffler, Juergen; Ryan, Thomas; Collins, Daniel; Rogers, Thomas R

2017-08-01

The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU). A prospective observational study in patients receiving critical care for ≥7days was performed. Serum samples were tested for the presence of: (1-3) - β-d-glucan (BDG), galactomannan (GM), and Aspergillus fumigatus DNA. GM antigen detection was also performed on bronchoalveolar lavage (BAL) samples. The patients were classified using published definitions for IFD and a diagnostic algorithm for invasive pulmonary aspergillosis. Performance parameters of the assays were determined. In patients with proven and probable IFD, the sensitivity, specificity, PPV and NPV of a single positive BDG were 63%, 83%, 65% and 83% respectively. Specificity increased to 86% with 2 consecutive positive results. The mean BDG value of patients with proven and probable IFD was significantly higher compared to those with fungal colonization and no IFD (p value<0.0001). New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical application prospect of umbilical cord-derived mesenchymal stem cells on clearance of advanced glycation end products through autophagy on diabetic wound.

Science.gov (United States)

Han, Yanfu; Sun, Tianjun; Tao, Ran; Han, Yanqing; Liu, Jing

2017-03-24

Nowadays, wound healing delay due to diabetes is considered to be closely related to the accumulation of advanced glycation end products (AGEs). Although mesenchymal stem cells (MSCs) exhibit positive effects on diabetic wound healing, related mechanisms are still not fully elucidated. It has been reported that MSCs can improve the activity of autophagy in injured tissues, thereby playing an important role in wound healing. The autophagy induced by MSCs may be beneficial to diabetic wound healing via removing AGEs, which provide new ideas for clinical treatment of diabetic wounds with the potential of broad application prospects. In this study, the current research situation and application prospect of umbilical cord-derived MSCs on the clearance of AGEs in diabetic wound were reviewed.

Point-of-care testing: applications of 3D printing.

Science.gov (United States)

Chan, Ho Nam; Tan, Ming Jun Andrew; Wu, Hongkai

2017-08-08

Point-of-care testing (POCT) devices fulfil a critical need in the modern healthcare ecosystem, enabling the decentralized delivery of imperative clinical strategies in both developed and developing worlds. To achieve diagnostic utility and clinical impact, POCT technologies are immensely dependent on effective translation from academic laboratories out to real-world deployment. However, the current research and development pipeline is highly bottlenecked owing to multiple restraints in material, cost, and complexity of conventionally available fabrication techniques. Recently, 3D printing technology has emerged as a revolutionary, industry-compatible method enabling cost-effective, facile, and rapid manufacturing of objects. This has allowed iterative design-build-test cycles of various things, from microfluidic chips to smartphone interfaces, that are geared towards point-of-care applications. In this review, we focus on highlighting recent works that exploit 3D printing in developing POCT devices, underscoring its utility in all analytical steps. Moreover, we also discuss key advantages of adopting 3D printing in the device development pipeline and identify promising opportunities in 3D printing technology that can benefit global health applications.

Medication incidents in primary care medicine: a prospective study in the Swiss Sentinel Surveillance Network (Sentinella).

Science.gov (United States)

Gnädinger, Markus; Conen, Dieter; Herzig, Lilli; Puhan, Milo A; Staehelin, Alfred; Zoller, Marco; Ceschi, Alessandro

2017-07-26

To describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. Prospective surveillance study. Swiss primary healthcare, Swiss Sentinel Surveillance Network. Patients with drug treatment who experienced any erroneous event related to the medication process and interfering with normal treatment course, as judged by their physician. The 180 physicians in the study were general practitioners or paediatricians participating in the Swiss Federal Sentinel reporting system in 2015. Primary: medication incidents; secondary: potential risk factors like age, gender, polymedication, morbidity, care-dependency, previous hospitalisation. The mean rates of detected medication incidents were 2.07 per general practitioner per year (46.5 per 1 00 000 contacts) and 0.15 per paediatrician per year (2.8 per 1 00 000 contacts), respectively. The following factors were associated with medication incidents (OR, 95% CI): higher age 1.004 per year (1.001; 1.006), care by community nurse 1.458 (1.025; 2.073) and care by an institution 1.802 (1.399; 2.323), chronic conditions 1.052 (1.029; 1.075) per condition, medications 1.052 (1.030; 1.074) per medication, as well as Thurgau Morbidity Index for stage 4: 1.292 (1.004; 1.662), stage 5: 1.420 (1.078; 1.868) and stage 6: 1.680 (1.178; 2.396), respectively. Most cases were linked to an incorrect dosage for a given patient, while prescription of an erroneous medication was the second most common error. Medication incidents are common in adult primary care, whereas they rarely occur in paediatrics. Older and multimorbid patients are at a particularly high risk for medication incidents. Reasons for medication incidents are diverse but often seem to be linked to communication problems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

Utility of the theories of reasoned action and planned behavior for predicting physician behavior: a prospective analysis.

Science.gov (United States)

Millstein, S G

1996-09-01

The utility of the theory of reasoned action (TRA) and the theory of planned behavior (TPB) for prospectively predicting physicians' delivery of preventive services was compared. Primary care physicians (N = 765) completed 2 mail surveys at periods 6 months apart. The addition of perceived behavioral control to the TRA model significantly increased the variance accounted for in behavioral intention and subsequent behavior (p behavioral control had direct effects on behavior and interacted with social norms and behavioral intentions. Applications of models such as the TRA or TPB have focused primarily on predicting the behavioral intentions and behaviors of patients. Results suggest that these models have relevance for studying the behavior of health care providers as well.

Applications of Light Emitting Diodes in Health Care.

Science.gov (United States)

Dong, Jianfei; Xiong, Daxi

2017-11-01

Light emitting diodes (LEDs) have become the main light sources for general lighting, due to their high lumen efficiency and long life time. Moreover, their high bandwidth and the availability of diverse wavelength contents ranging from ultraviolet to infrared empower them with great controllability in tuning brightness, pulse durations and spectra. These parameters are the essential ingredients of the applications in medical imaging and therapies. Despite the fast advances in both LED technologies and their applications, few reviews have been seen to link the controllable emission properties of LEDs to these applications. The objective of this paper is to bridge this gap by reviewing the main control techniques of LEDs that enable creating enhanced lighting patterns for imaging and generating effective photon doses for photobiomodulation. This paper also provides the basic mechanisms behind the effective LED therapies in treating cutaneous and neurological diseases. The emerging field of optogenetics is also discussed with a focus on the application of LEDs. The multidisciplinary topics reviewed in this paper can help the researchers in LEDs, imaging, light therapy and optogenetics better understand the basic principles in each other's field; and hence to stimulate the application of LEDs in health care.

[The GIPSY-RECPAM model: a versatile approach for integrated evaluation in cardiologic care].

Science.gov (United States)

Carinci, F

2009-01-01

Tree-structured methodology applied for the GISSI-PSICOLOGIA project, although performed in the framework of earliest GISSI studies, represents a powerful tool to analyze different aspects of cardiologic care. The GISSI-PSICOLOGIA project has delivered a novel methodology based on the joint application of psychometric tools and sophisticated statistical techniques. Its prospective use could allow building effective epidemiological models relevant to the prognosis of the cardiologic patient. The various features of the RECPAM method allow a versatile use in the framework of modern e-health projects. The study used the Cognitive Behavioral Assessment H Form (CBA-H) psychometrics scales. The potential for its future application in the framework of Italian cardiology is relevant and particularly indicated to assist planning of systems for integrated care and routine evaluation of the cardiologic patient.

Is a nurse-led telephone intervention a viable alternative to nurse-led home care and standard care for patients receiving oral capecitabine? Results from a large prospective audit in patients with colorectal cancer.

Science.gov (United States)

Craven, Olive; Hughes, Carol Anne; Burton, Amy; Saunders, Mark P; Molassiotis, Alex

2013-05-01

Home care nursing has been shown to be a valuable service for patients receiving oral chemotherapy; however, associated costs can be high and telephone-based services may be more cost-effective options. This prospective audit explored the usefulness of a nurse-led telephone intervention for supporting cancer patients treated with Capecitabine, comparing historical findings from a randomised trial evaluating a home-based intervention over standard care with a modified nurse-led telephone follow-up intervention. Self-reported toxicity and service use were assessed in 298 patients who received nurse-led telephone follow-up, compared with historical data from 164 patients (81 receiving standard care and 83 home care intervention). Findings suggested that nurse-led telephone follow-up can potentially lead to reduced toxicity (chest pain, vomiting, oral mucositis, nausea, insomnia) when compared with standard care, and that it has a similar impact on the management of some symptoms when compared with home care (i.e. vomiting, oral mucositis), although it was not as effective as the home care intervention for other toxicities (diarrhoea and insomnia). These encouraging findings need to be explored further using a randomised trial design before we reach any conclusions. Further research should also include a health economics study to assess the cost-effectiveness of the telephone-based services for patients receiving oral chemotherapy. © 2013 Blackwell Publishing Ltd.

Prospecting for customers in the small employer market: the experience of Arizona Health Care Group.

Science.gov (United States)

Christianson, J B; Liu, C F; Schroeder, C M

1994-01-01

The findings of this study provide an interesting profile of the small employer "prospects" for prepaid health plans, where a prospect is defined as an employer that responds to a mass mailing effort with a request for information and further contact. About 60% of these prospects already have insurance, with 40% having group insurance. Therefore, a substantial portion of prospects are seeking to replace their existing health benefit package with a different one. Of those who do not offer existing insurance, the most common reason is that it is "too expensive" or the employer is "not profitable." A very small proportion do not offer insurance because they do not qualify for it due to medical underwriting considerations. Prospects tend to be larger than non-prospects in terms of sales, but employ lower wage employees, on average. About half of prospects are in service industries, a proportion typical of small employers in general. Somewhat surprisingly, most prospects have been in operation for over five years. They are not new firms attempting to establish their benefit packages. This is consistent with the findings on gross sales, suggesting that some maturity is necessary before an employer considers offering group health insurance as a benefit. The prepaid plans in this study also appeared to target established employers for their marketing efforts. In responding to questions about their attitudes towards health insurance, over one-quarter of prospects indicated that they would be unwilling to offer insurance at rates so low that they would not normally apply to the coverages offered by prepaid plans. Thus, although they were "prospects" by the study's definition, they were unlikely to eventually contract with prepaid plans. Those prospects that had offered insurance previously, but had discontinued it, tended to cite premium increases as the reason. This suggests that prospects among small employers are likely to be very price sensitive, and that further

Application of Orem self-care theory on injection of interferon antiviral therapy in patients with

Directory of Open Access Journals (Sweden)

Xiujuan Tao

2015-01-01

Full Text Available Guided by Orem self-care theory, the nursing staff evaluate the injection of interferon antiviral therapy in patients, finding that patients with the presence of self-care was insufficient, so effective nursing care in different periods of application of different nursing system was necessary.

Regenerative medicine applications in combat casualty care.

Science.gov (United States)

Fleming, Mark E; Bharmal, Husain; Valerio, Ian

2014-03-01

The purpose of this report is to describe regenerative medicine applications in the management of complex injuries sustained by service members injured in support of the wars in Afghanistan and Iraq. Improvements in body armor, resuscitative techniques and faster transport have translated into increased patient survivability and more complex wounds. Combat-related blast injuries have resulted in multiple extremity injuries, significant tissue loss and amputations. Due to the limited availability and morbidity associated with autologous tissue donor sites, the introduction of regenerative medicine has been critical in managing war extremity injuries with composite massive tissue loss. Through case reports and clinical images, this report reviews the application of regenerative medicine modalities employed to manage combat-related injuries. It illustrates that the novel use of hybrid reconstructions combining traditional and regenerative medicine approaches are an effective tool in managing wounds. Lessons learned can be adapted to civilian care.

STAMP model and its application prospect in DCS safety analysis of nuclear power plant

International Nuclear Information System (INIS)

Yang Xiaohua; Liu Jie; Liu Zhaohui; Liu Hua; Yu Tonglan

2013-01-01

The application of DCS (Digit Control System) is a certain trend for the development of nuclear power. DCS not only improves the control capability of nuclear power system, but also increases the complexity of the system. Traditional safety analysis techniques based on event-chain model are facing challenges. In order to improve the safety performance of nuclear power DCS, the latest research achievement in the field of safety engineering should be focused, studied and applied into nuclear power safety. This paper introduces a new safety analysis model named STAMP (Systems-Theoretic Accident Modeling and Processes) based on the system theory, analyzes its advantages and disadvantages compared with the traditional ones, and explains the basic steps of STPA (STAMP-Based Hazard Analysis) technology. Finally, according to the application status of STAMP at home and abroad, it prospects the development of STAMP in China's nuclear power safety. (authors)

Point-of-care genetic testing for personalisation of antiplatelet treatment (RAPID GENE): a prospective, randomised, proof-of-concept trial.

Science.gov (United States)

Roberts, Jason D; Wells, George A; Le May, Michel R; Labinaz, Marino; Glover, Chris; Froeschl, Michael; Dick, Alexander; Marquis, Jean-Francois; O'Brien, Edward; Goncalves, Sandro; Druce, Irena; Stewart, Alexandre; Gollob, Michael H; So, Derek Y F

2012-05-05

Prospective assessment of pharmacogenetic strategies has been limited by an inability to undertake bedside genetic testing. The CYP2C19*2 allele is a common genetic variant associated with increased rates of major adverse events in individuals given clopidogrel after percutaneous coronary intervention (PCI). We used a novel point-of-care genetic test to identify carriers of the CYP2C19*2 allele and aimed to assess a pharmacogenetic approach to dual antiplatelet treatment after PCI. Between Aug 26, 2010, and July 7, 2011, 200 patients were enrolled into our prospective, randomised, proof-of-concept study. Patients undergoing PCI for acute coronary syndrome or stable angina were randomly assigned to rapid point-of-care genotyping or to standard treatment. Individuals in the rapid genotyping group were screened for the CYP2C19*2 allele. Carriers were given 10 mg prasugrel daily, and non-carriers and patients in the standard treatment group were given 75 mg clopidogrel daily. The primary endpoint was the proportion of CYP2C19*2 carriers with high on-treatment platelet reactivity (P2Y12 reactivity unit [PRU] value of more than 234) after 1 week of dual antiplatelet treatment, which is a marker associated with increased adverse cardiovascular events. Interventional cardiologists and data analysts were masked to genetic status and treatment. Patients were not masked to treatment allocation. All analyses were by intention to treat. This study is registered with ClinicalTrials.gov, NCT01184300. After randomisation, 187 patients completed follow-up (91 rapid genotyping group, 96 standard treatment). 23 individuals in each group carried at least one CYP2C19*2 allele. None of the 23 carriers in the rapid genotyping group had a PRU value of more than 234 at day 7, compared with seven (30%) given standard treatment (p=0·0092). The point-of-care genetic test had a sensitivity of 100% (95% CI 92·3-100) and a specificity of 99·3% (96·3-100). Point-of-care genetic testing after

How Prospective Physical Medicine and Rehabilitation Trainees Rank Residency Training Programs.

Science.gov (United States)

Auriemma, Michael J; Whitehair, Curtis L

2018-03-01

Since the inception of the National Resident Matching Program, multiple studies have investigated the factors applicants consider important to ranking prospective residency programs. However, only 2 previous studies focused on prospective physical medicine and rehabilitation (PM&R) trainees, and the most recent of these studies was published in 1993. It is unknown whether these previous studies are reflective of current prospective PM&R residents. To assess various factors that contribute to prospective PM&R residents' decision making in choosing a residency program and compare these findings with previous studies. An anonymous, voluntary questionnaire. A single PM&R residency program. All applicants to a single PM&R residency program. All applicants to our PM&R residency program were invited to participate in a 44-item, 5-point Likert-based questionnaire. Applicants were asked to rate the importance of various factors as they related to constructing their residency rank list. Means and standard deviations were calculated for items included in the survey. A response rate of 26% was obtained, with the responses of 98 applicants (20%) ultimately analyzed. The highest rated factors included "perceived happiness of current residents," "opportunities for hands-on procedure training," "perceived camaraderie among current residents," "perceived camaraderie among faculty and current residents," "perceived quality of current residents," and "perceived work/life balance among current residents." Although male and female respondents demonstrated similar ranking preferences, an apparent difference was detected between how genders rated the importance of "whether the program projects a favorable environment for women" and "whether the program projects a favorable environment for minorities." As compared with previous PM&R applicants, current prospective trainees seem to place greater importance on skill acquisition over didactic teaching. Prospective PM&R residents highly value

Identification of the predictors of cognitive impairment in patients with cancer in palliative care: a prospective longitudinal analysis.

Science.gov (United States)

Kurita, Geana Paula; Benthien, Kirstine Skov; Sjøgren, Per; Kaasa, Stein; Hjermstad, Marianne Jensen

2017-03-01

Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative care. Prospective longitudinal investigation derived from the European Palliative Care Cancer Symptom study (2011-2013) including patients with cancer in palliative care, ≥18 years, and with at least one assessment post-inclusion. For cognitive assessment, a 4-item version of the Mini Mental State Examination was applied at inclusion and after 4 to 16 weeks. Logistic regression model with multiple imputations was applied. The sample consisted of 1568 patients (50% male, mean age 65.5, 42% with 10-12 years schooling, mean Karnofsky Performance Status-KPS 68%). Longitudinal analysis of the patients with complete MMSE at both assessments (n = 801) showed that 64.5% were not impaired, 12.5% remained cognitively impaired, 11.4% developed impairment, and 11.6% improved. Those who improved cognitively also reported reduced pain intensity and increased appetite. The predictive model (n = 1351) showed that those with low KPS (OR = 1.6, 95% CI 1.0-2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2-0.7) had lower odds for impairment. During palliative care, a substantial number of patients remained cognitively impaired or developed cognitive impairment; however, it is noteworthy that improvement was also observed. Physical performance and cancer type may predict cognitive impairment.

Time spent in primary care for hip osteoarthritis patients once the diagnosis is set: a prospective observational study

Directory of Open Access Journals (Sweden)

van den Akker-Scheek Inge

2011-06-01

Full Text Available Abstract Background Previous research on time to referral to orthopaedic surgery has predominantly used hip complaints as starting point instead of the moment the diagnosis of osteoarthritis (OA of the hip is established, therefore little is known about the length of time a patient diagnosed with hip OA stays under the care of a general practitioner (GP. No knowledge on factors of influence on this time period is available either. Aim of this study was thus to determine the time an incident hip OA patient stays in the care of a GP until referral to an orthopaedic department. Influencing factors were also analyzed. Methods A prospective observational study was conducted based on data over a 10-year period from a general practice-based registration network (17 GPs, > 30,000 patients registered yearly. Patients with the diagnosis of hip OA were included. A survival analysis was used to determine time until referral to an orthopaedic department, and to determine factors of influence on this time. Results Of 391 patients diagnosed with hip OA, 121 (31% were referred; average survival time until referral was 82.0 months (95% CI 76.6-87.5. Less contact with the GP for hip complaints before the diagnosis of hip OA was established resulted in a decreased time to referral. Conclusions The results of this study show that patients with hip OA were under the care of a general practitioner, and thus in primary care, for a considerable amount of time once the diagnosis of hip OA was established.

Extent and application of patient diaries in Austria

DEFF Research Database (Denmark)

Heindl, Patrik; Bachlechner, Adelbert; Nydahl, Peter

2017-01-01

Background: Diaries written for patients in the intensive care unit (ICU) are offered in many European countries. In Austria, ICU diaries have been relatively unknown, but since 2012, they have started to emerge. Aim: The aim of this study was to explore the extent and application of ICU diaries...... in Austria in 2015. Method: The study had a prospective multiple methods design of survey and interviews. All ICUs in Austria were surveyed in 2015 to identify which ICUs used diaries. ICUs using diaries were selected for semi-structured key-informant telephone interviews on the application of ICU diaries...

Prevalence of hyponatremia in palliative care patients

Directory of Open Access Journals (Sweden)

Shoba Nair

2016-01-01

Conclusions: Prevalence of hyponatremia is significant in palliative care patients. A prospective study looking at the causes and clinical outcomes associated with hyponatremia in palliative care patients is needed.

To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis.

Science.gov (United States)

Glidewell, Liz; Willis, Thomas A; Petty, Duncan; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Davies, Andrew; Jamieson, Tony; Hunter, Cheryl; Hartley, Suzanne; Gray-Burrows, Kara; Clamp, Susan; Carder, Paul; Alderson, Sarah; Farrin, Amanda J; Foy, Robbie

2018-02-17

Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms-mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. 'graded tasks' and 'problem solving' for educational outreach). BCTs addressing the determinants 'environmental context' and 'social and professional roles' (e.g. 'restructuring the social and 'physical environment' and 'adding objects to the environment') were indicator specific. We found it challenging to operationalise BCTs targeting 'environmental context

Horner's syndrome in patients admitted to the intensive care unit that have undergone central venous catheterization: a prospective study.

Science.gov (United States)

Butty, Z; Gopwani, J; Mehta, S; Margolin, E

2016-01-01

PurposeCentral venous catheterization (CVC) is estimated to be performed in millions of patients per year. Swan-Ganz catheters used for CVC are most often inserted into the internal jugular vein and during this procedure they may come into contact with the sympathetic chain. This study aims to determine the incidence of Horner's syndrome in patients admitted to intensive care unit that have undergone internal jugular CVC insertion during their admission and to determine whether ultrasonography-assisted insertion has decreased the frequency of this complication.Patients and methodsA total of 100 prospective patients admitted to the ICU were examined for the presence of anisocoria and ptosis after undergoing recent CVC. Presence of Horner's syndrome was confirmed by testing with 0.5% apraclonidine and looking for the reversal of anisocoria.ResultsFrequency of Horner's syndrome after CVC was 2% in a sample of 100 prospectively examined patients.ConclusionHorner's syndrome remains a relatively rare but definitive complication of CVC. ICU physicians should be educated about its existence and prevalence and ophthalmologists should inquire about any history of ICU admission necessitating CVC insertion in any patient presenting with Horner's syndrome.

Antimicrobial peptides with selective antitumor mechanisms: prospect for anticancer applications.

Science.gov (United States)

Deslouches, Berthony; Di, Y Peter

2017-07-11

In the last several decades, there have been significant advances in anticancer therapy. However, the development of resistance to cancer drugs and the lack of specificity related to actively dividing cells leading to toxic side effects have undermined these achievements. As a result, there is considerable interest in alternative drugs with novel antitumor mechanisms. In addition to the recent approach using immunotherapy, an effective but much cheaper therapeutic option of pharmaceutical drugs would still provide the best choice for cancer patients as the first line treatment. Ribosomally synthesized cationic antimicrobial peptides (AMPs) or host defense peptides (HDP) display broad-spectrum activity against bacteria based on electrostatic interactions with negatively charged lipids on the bacterial surface. Because of increased proportions of phosphatidylserine (negatively charged) on the surface of cancer cells compared to normal cells, cationic amphipathic peptides could be an effective source of anticancer agents that are both selective and refractory to current resistance mechanisms. We reviewed herein the prospect for AMP application to cancer treatment, with a focus on modes of action of cationic AMPs.

Linking women who test HIV-positive in pregnancy-related services to HIV care and treatment services in Kenya: a mixed methods prospective cohort study.

Directory of Open Access Journals (Sweden)

Laura Ferguson

Full Text Available There has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV.This prospective cohort study of 100 HIV-positive women recruited within pregnancy-related services in a district hospital in Kenya employed quantitative methods to assess attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services. Qualitative methods were used to explore barriers and facilitators to navigating these services. Structured questionnaires were administered to cohort participants at enrolment and 90+ days later. Participants' medical records were monitored prospectively. Semi-structured qualitative interviews were carried out with a sub-set of 19 participants.Only 53/100 (53% women registered at an HIV clinic within 90 days of HIV diagnosis, of whom 27/53 (51% had a CD4 count result in their file. 11/27 (41% women were eligible for immediate antiretroviral therapy (ART; only 6/11 (55% started ART during study follow-up. In multivariable logistic regression analysis, factors associated with registration at the HIV clinic within 90 days of HIV diagnosis were: having cared for someone with HIV (aOR:3.67(95%CI:1.22, 11.09, not having to pay for transport to the hospital (aOR:2.73(95%CI:1.09, 6.84, and having received enough information to decide to have an HIV test (aOR:3.61(95%CI:0.83, 15.71. Qualitative data revealed multiple factors underlying high patient drop-out related to women's social support networks (e.g. partner's attitude to HIV status, interactions with health workers (e.g. being given unclear/incorrect HIV-related information and health services characteristics (e.g. restricted opening hours, long waiting times.HIV testing within pregnancy-related services is an important entry point to HIV care and treatment services, but few women successfully completed the steps needed for assessment of their treatment needs within three months of diagnosis

Proceedings of the tenth annual symposium on computer applications in medical care

International Nuclear Information System (INIS)

Orthner, H.F.

1988-01-01

This book covers the proceedings of the tenth annual symposium on Computer Applications in Medical Care. The papers include: Image processing in cardiovascular radiology and radiologic automated diagnosis (RAD)

The applicability of SERVQUAL in different health care environments.

Science.gov (United States)

Dean, A M

1999-01-01

This paper reports on a study that investigates the applicability of a modified SERVQUAL instrument as a means of measuring service quality in two types of health service environments; medical care and health care (incorporating medical, social, cognitive and emotional elements). The research confirms a four factor structure that is stable for both environments, and similar to the service quality dimensions recognised in the literature. However, the relative importance of the dimensions of quality is inconsistent for the two types of health services. These results confirm the suggestion that importance values should be part of the measurement tool. Finally, the extra diagnostic advantage achieved by the use of gap scores to measure service quality, when compared to perception only scores is demonstrated.

Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy.

Science.gov (United States)

Anyaehie, Usb; Nwakoby, Ban; Chikwendu, C; Dim, Cc; Uguru, N; Oluka, Cpi; Ogugua, C

2014-01-01

In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non-validation and non-implementation of this policy might have led to loss of interest in the partnership. The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges, constraints and prospects. Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi-stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA). Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215). PPP in health-care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation.

Prospective Trial of House Staff Time to Response and Intervention in a Surgical Intensive Care Unit: Pager vs. Smartphone.

Science.gov (United States)

Tatum, James M; White, Terris; Kang, Christopher; Ley, Eric J; Melo, Nicolas; Bloom, Matthew; Alban, Rodrigo F

The objective of the study was to characterize house staff time to response and intervention when notified of a patient care issue by pager vs. smartphone. We hypothesized that smartphones would reduce house staff time to response and intervention. Prospective study of all electronic communications was conducted between nurses and house staff between September 2015 and October 2015. The 4-week study period was randomly divided into two 2-week study periods where all electronic communications between intensive care unit nurses and intensive care unit house staff were exclusively by smartphone or by pager, respectively. Time of communication initiation, time of house staff response, and time from response to clinical intervention for each communication were recorded. Outcomes are time from nurse contact to house staff response and intervention. Single-center surgical intensive care unit of Cedars-Sinai Medical Center in Los Angeles, California, an academic tertiary care and level I trauma center. All electronic communications occurring between nurses and house staff in the study unit during the study period were considered. During the study period, 205 nurse-house staff electronic communications occurred, 100 in the phone group and 105 in the pager group. House staff response to communication time was significantly shorter in the phone group (0.5 [interquartile range = 1.7] vs. 2 [3]min, p house staff intervention after response was also significantly more rapid in the phone group (0.8 [1.7] vs. 1 [2]min, p = 0.003). Dedicated clinical smartphones significantly decrease time to house staff response after electronic nursing communications compared with pagers. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study.

Science.gov (United States)

Presseau, Justin; Francis, Jill J; Campbell, Neil C; Sniehotta, Falko F

2011-07-15

The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control. Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour.

Nutritional care of medical inpatients: a health technology assessment

Directory of Open Access Journals (Sweden)

Kruse Filip

2006-02-01

Full Text Available Abstract Background The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. Methods Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. Results The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of

Application and development of solar energy in building industry and its prospects in China

International Nuclear Information System (INIS)

Li Zhisheng; Zhang Guoqiang; Li Dongmei; Zhou Jin; Li Lijuan; Li Lixin

2007-01-01

China is the second largest country in energy consumption. More and more energy demand pressures cause the Chinese government to review its economy and energy policies in order to support the sustainable development. In China, the building sector amounts to 27.8% total energy consumption, which is only behind the industry sector. China has abundant solar energy resource, which is extensively applied to buildings. Therefore, solar energy utilization in buildings has become one of the most important issues to help China optimize the energy proportion, increasing energy efficiency and protecting the environment. Solar energy resource and its district distribution in China are introduced in detail in this paper, and the representative solar energy application to the building sector is highlighted as well. The solar energy utilization obstacles, especially policy disadvantages in building sector in China, are reviewed. Moreover, the application prospects of solar energy in building sector are presented in combination with the China economic and household industry growth

[Refusal of care in the intensive care: how makes decision?].

Science.gov (United States)

Borel, M; Veber, B; Villette-Baron, K; Hariri, S; Dureuil, B; Hervé, C

2009-11-01

Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

Pro re nata prescribing in a population receiving palliative care: a prospective consecutive case note review.

Science.gov (United States)

Russell, Bethany J; Rowett, Debra; Currow, David C

2014-09-01

To document pro re nata (PRN) prescribing practices and to identify patterns with respect to clinical characteristics and the medications prescribed. Prospective consecutive case note review. Two interrelated consultative hospice and palliative care services in regional Victoria, Australia. Terminally ill inpatients and community-based individuals (N = 203) at the time of referral to a hospice or palliative care service. Number of medications that the referring physician prescribed on a PRN basis and on a regular basis for symptom control; comorbid disease, performance status, comorbidity burden, disease phase, and survival. Mean number of PRN medications prescribed was 3.0, with significantly higher rates in the last week of life (rate ratio (RR) = 1.30, 95% confidence interval (CI) = 1.07-1.59) and during the terminal phase of disease (RR = 1.36, 95% CI = 1.09-1.68). One-quarter of prescriptions were for medications that met the Beers consensus criteria for potentially inappropriate medication use in elderly persons. These descriptive baseline data are new. A mean of three different medications allows responsiveness to a variety of fluctuating symptoms, but there was a large range within the sample, indicating that some individuals and their caregivers have a high burden of administration-related decision-making. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Evaluating team-based inter-professional advanced life support training in intensive care-a prospective observational study.

Science.gov (United States)

Brewster, D J; Barrett, J A; Gherardin, E; O'Neill, J A; Sage, D; Hanlon, G

2017-01-01

Recent focus on national standards within Australian hospitals has prompted a focus on the training of our staff in advanced life support (ALS). Research in critical care nursing has questioned the traditional annual certification of ALS competence as the best method of delivering this training. Simulation and team-based training may provide better ALS education to intensive care unit (ICU) staff. Our new inter-professional team-based advanced life support program involved ICU staff in a large private metropolitan ICU. A prospective observational study using three standardised questionnaires and two multiple choice questionnaire assessments was conducted. Ninety-nine staff demonstrated a 17.8% (95% confidence interval 4.2-31, P =0.01) increase in overall ICU nursing attendance at training sessions. Questionnaire response rates were 93 (94%), 99 (100%) and 60 (61%) respectively; 51 (52%) staff returned all three. Criteria were assessed by scores from 0 to 10. Nurses reported improved satisfaction with the education program (9.4 to 7.1, P versus 7.9 and 8.2, P versus 7.4 and 7.8, P versus 8.1, P =0.04). The new program cost approximately an extra $16,500 in nursing salaries. We concluded that team-based, inter-professional ALS training produced statistically significant improvements in nursing attendance, satisfaction with ALS education, confidence and role understanding compared to traditional ALS training.

A PROSPECTIVE OBSERVATIONAL STUDY OF SHORT TERM MORBIDITY PATTERN IN PRETERM NEWBORNS DELIVERED IN A TERTIARY CARE HOSPITAL

Directory of Open Access Journals (Sweden)

Harsha

2015-08-01

Full Text Available OBJECTIVE: To study the short term morbidity pattern in preterm new born babies delivered in a tertiary care hospital with level III neonatal intensive care unit (NICU. MATERIAL AND METHODS: A prospective observational study was conducted in a level III NICU betwee n November 2009 to July 2010 at Grant medical college and JJ Group of hospitals, Mumbai. All the in born preterm babies were assessed for morbidity pattern from the time of admission till discharge or death. RESULT: 156 preterm babies were included in the study. 83(54.21% were male and 73(46.79% were female. The major morbidities observed in the preterm neonates were hyperbilirubinemia in 50.54%, Respiratory distress syndrome (RDS in25.64% and severe birth asphyxia in13.46%. Other common morbidities seen were retinopathy of prematurity in 12.17%, apnoea in 11.54% and anaemia in 10.9%. Preterm neonates also had in 9.62% culture proven sepsis, in 8.33% hypoglycaemia, in 7.05% Intraventricular haemorrhage (IVH and in 6.41% various congenital anomalies. CONCL USION: Hyperbilirubinemia, respiratory distress syndrome and severe birth asphyxia are major preterm morbidity

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

Science.gov (United States)

Dwinnells, Ronald; Misik, Lauren

2017-10-01

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

Application of theoretical and methodological components of nursing care

Directory of Open Access Journals (Sweden)

Rosa del Socorro Morales-Aguilar

2016-12-01

Full Text Available Introduction: the theoretical and methodological components are the proper expertise in nursing, and it refers to models, theories, care process, taxonomy of nursing diagnoses, system of nursing intervention classification, and system of outcomes classification, which base nursing care into professional practice. Methodology: research was performed on Google Scholar, reviewing the databases of Scielo, Ciberindex, Index Enfermería, Dialnet, Redalyc, Medline, identifying 70 published articles between 2005-2015, and selecting 52 of them. The keywords used were: nurse care, nursing diagnostic, classification, nursing theory, in spanish and portuguese. Results: training students, receive knowledge in the nursing process, NANDA International, classification of the interventions, nurse results and theoretical components. The Dorothea Orem, Callista Roy, Nola Pender, Virginia Henderson, Florence Nightingale, and Betty Neuman theories are applied. The application of the nursing process is limited and low familiarity with the international taxonomy by nurse professionals in the assistance area is noticed. Conclusions: the challenge of nursing is to continue to solidify the scientific knowledge and to undo the gap between theory and practice.

Application of comprehensive geophysical prospecting method in groundwater exploration

Science.gov (United States)

Yang, Fan; Gao, Pengju; Li, Dong; Ma, Hanwen; Cheng, Guoliang

2018-01-01

In order to solve the problem of shortage of water resources in northern Shaanxi, we selected rectangular large loop source transient electromagnetic method with high water affinity, and radioactive α measurement method which can delineate the water storage structure, comprehensive geophysical prospecting methods to look for groundwater. Algorithm has established a forward model, and compared all-time apparent resistivity in late-time apparent resistivity is better than late. We can find out the exact location of the groundwater and thus improving wells rate by comparatively using these two kinds of geophysical prospecting method. Hydrogeology drilling confirmed water inflow of a single well can be up to 40 m 3/h, it can fully cover native Domestic and Agricultural water, and provide an important basis for groundwater exploration.

Safety in GPR prospecting: a rarely-considered issue

Science.gov (United States)

Persico, Raffaele; Pajewski, Lara; Trela, Christiane; Carrick Utsi, Erica

2016-04-01

Safety issues (of people first of all, but also of the equipment and environment) are rarely considered in Ground-Penetrating Radar (GPR) prospecting and, more in general, in near-surface geophysical prospecting. As is right and fully understandable, the scientific community devotes greatest attention first of all to the theoretical and practical aspects of GPR technique, affecting the quality of attainable results, secondly to the efforts and costs needed to achieve them [1-2]. However, the (luckily) growing GPR market and range of applications make it worth giving serious consideration to safety issues, too. The existing manuals dealing with safety in geophysics are mainly concerned with applications requiring "deep" geophysical prospecting, for example the search for oilfields and other hydrocarbon resources [3]. Near-surface geophysics involves less dangers than deep geophysics, of course. Nevertheless, several accidents have already happened during GPR experimental campaigns. We have personally had critical experiences and collected reliable testimonies concerning occurred problems as mountain sicks, fractures of legs, stomach problems, allergic reactions, encounters with potentially-dangerous animals, and more. We have also noticed that much more attention is usually paid to safety issues during indoor experimental activities (in laboratory), rather than during outdoor fieldworks. For example, the Italian National research Council is conventioned with safety experts who hold periodical seminaries about safety aspects. Having taken part to some of them, to our experience we have never heard a "lecture" devoted to outdoor prospecting. Nowadays, any aspects associated to the use of the technologies should be considered. The increasing sensibility and sense of responsibility towards environmental matters impose GPR end-users to be careful not to damage the environment and also the cultural heritage. Near-surface prospecting should not compromise the flora and

Non-electrical Application of Nuclear Energy: Some General Issues and Prospects

International Nuclear Information System (INIS)

Kuznetsov, Yu. N.

2008-01-01

Co-generation power plants (CPP) are widely used in Russia with its harsh climate and low temperatures. The EU directive encourages further development of co-generation plants as the most efficient and rapid way of energy saving and reduction of CO 2 emissions. Nuclear power facilities can be used efficiently at co-generation power plants. The author discuss requirements for nuclear co-generation power plants (NCPP) from the viewpoint of power level, safety and economics, and look into various approaches towards development of dedicated reactor systems and nuclear units for NCPP so as to meet these requirements. It is shown that the most effective approach is consistent implementation of the principles of design simplicity and passive operation of the main reactors systems and components. The implementation of this approach is illustrated on the example of two Russian developments - VK-300 (Russian SBWR) and RUTA (a pool-type facility). The paper describes in detail the findings of a feasibility study on a project of a co-generation nuclear plant in the Arkhangelsk region of Russia. The CNPP's total power is planned to be 1000 MW(e) and district-heating heat production capacity 1600 Gcal /h. The study has proved the feasibility of NCPP construction in the Arkhangelsk region in terms of engineering solutions, economics and, importantly, from the viewpoint of social benefits. The prospects for NCPP development in Russia are analyzed. Considering the increasing global trend towards the use of desalination and the stable growth of demand for such techniques, Russia has been paying great attention to this technology.The authors look into the prospects of NCPP application for sea water desalination. A Nuclear Desalination Complex (NDC) with VK-300 reactor facility is described as an illustration. The most attractive option is coupling of a VK-300 energy source with distillation desalination units operating based on a multi-stage evaporation principle (MED). This is an

Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study.

Science.gov (United States)

Nordeman, Lena; Gunnarsson, Ronny; Mannerkorpi, Kaisa

2014-05-01

To investigate prognostic factors for future work ability in women with chronic low back pain (CLBP) consulting primary health care. A 2-year prospective longitudinal cohort study of female patients with CLBP within the primary health care was conducted. Patients were assessed at the first assessment and after 2 years. Prognostic factors for work ability (yes/no) were analyzed by multivariate regression. A total of 130 patients were included at first assessment. After 2 years, 123 patients (95%) were followed up. The 6-minute walk test, depression, and earlier work ability predicted work ability at the 2-year follow-up. A nomogram was constructed to assess the probability of future work ability. The 6-minute walk test, work ability, and depression predicted work ability for women with CLBP after 2 years.

Gamma ray spectrometry: applications in uranium prospecting and environment

International Nuclear Information System (INIS)

Lopez, Luis E.

1999-01-01

The experience in the use of gamma spectrometry for uranium prospecting and for the determination of natural radiation background is described. The basic principles of the techniques are also given. (author)

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care.

Science.gov (United States)

Philips, Hilde; Remmen, Roy; Van Royen, Paul; Teblick, Marc; Geudens, Leo; Bronckaers, Marc; Meeuwis, Herman

2010-07-30

Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.

Designing an E-Learning Application to Facilitate Health Care Professionals' Cross-Cultural Communication.

Science.gov (United States)

Balasubramaniam, Nagadivya; Kujala, Sari; Ayzit, Dicle; Kauppinen, Marjo; Heponiemi, Tarja; Hietapakka, Laura; Kaihlanen, Anu

2018-01-01

In recent times, health care professionals (HCP) have come across a number of migrants as their patients. The cultural differences lead to communicational challenges between the migrant patients and health care professionals. Our project aimed to discover HCPs' attitudes, challenges and needs on cross-cultural communication, so that we can develop an e-learning solution that would be helpful for them. By conducting interviews with HCPs, we identified five crucial categories of problems and the current solutions that experienced professionals use to tackle those problems. These interviews also helped us in understanding the motivational factors of HCPs, when using e-learning application. Health care professionals prefer a focus on examples and themes such as death and pain that they face in their everyday work. Changing attitudes by e-learning application is challenging. However, e-learning was recognized as a flexible way for supporting traditional training with HCPs who are busy at work most of the time.

Atomic layer deposition for photovoltaics: applications and prospects for solar cell manufacturing

International Nuclear Information System (INIS)

Van Delft, J A; Garcia-Alonso, D; Kessels, W M M

2012-01-01

Atomic layer deposition (ALD) is a vapour-phase deposition technique capable of depositing high quality, uniform and conformal thin films at relatively low temperatures. These outstanding properties can be employed to face processing challenges for various types of next-generation solar cells; hence, ALD for photovoltaics (PV) has attracted great interest in academic and industrial research in recent years. In this review, the recent progress of ALD layers applied to various solar cell concepts and their future prospects are discussed. Crystalline silicon (c-Si), copper indium gallium selenide (CIGS) and dye-sensitized solar cells (DSSCs) benefit from the application of ALD surface passivation layers, buffer layers and barrier layers, respectively. ALD films are also excellent moisture permeation barriers that have been successfully used to encapsulate flexible CIGS and organic photovoltaic (OPV) cells. Furthermore, some emerging applications of the ALD method in solar cell research are reviewed. The potential of ALD for solar cells manufacturing is discussed, and the current status of high-throughput ALD equipment development is presented. ALD is on the verge of being introduced in the PV industry and it is expected that it will be part of the standard solar cell manufacturing equipment in the near future. (paper)

An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit.

Science.gov (United States)

Macdonald, Mary Ellen; Liben, Stephen; Carnevale, Franco A; Cohen, S Robin

2012-09-01

Although the modern pediatric intensive care unit (PICU) has followed general pediatrics and adopted the family-centered care model, little is known about how families prospectively experience PICU care. The authors' goal was to better understand the experiences of families whose child was hospitalized in a PICU. They conducted a 12-month prospective ethnographic study in a PICU in a tertiary care hospital in a large North American urban center. Data were obtained via participant-observation and formal and informal interviews with 18 families and staff key informants. Findings revealed a disconnect between the espoused model of family-centered care and quotidian professional practices. This divergence emerged in the authors' analysis as a heuristic that contrasts a professional "office" to a sick child's "bedroom." PICU practices and protocols transformed the child into a patient and parents into visitors; issues such as noise, visitation, turf, and privacy could favor staff comfort and convenience over that of the child and family. The authors' discussion highlights suggestions to overcome this divergence in order to truly make the PICU family centered.

Wikis and collaborative writing applications in health care: a scoping review

NARCIS (Netherlands)

Archambault, P.M.; Belt, T.H. van de; Grajales, F.J., 3rd; Faber, M.J.; Kuziemsky, C.E.; Gagnon, S.; Bilodeau, A.; Rioux, S.; Nelen, W.L.D.M.; Gagnon, M.P.; Turgeon, A.F.; Aubin, K.; Gold, I.; Poitras, J.; Eysenbach, G.; Kremer, J.A.M.; Legare, F.

2013-01-01

BACKGROUND: Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge

Designing Robots for Care: Care Centered Value-Sensitive Design

OpenAIRE

van Wynsberghe, Aimee

2012-01-01

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship?what I refer to as care robots?require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What?s more, given the stage of their develo...

Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: An exploratory prospective study

Directory of Open Access Journals (Sweden)

Campbell Neil C

2011-07-01

Full Text Available Abstract Background The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Methods Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Results Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate. Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively in behaviour over and above intention and perceived behavioural control. Conclusions Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better

Future prospects of high T{sub c} superconductors-coated conductors and their applications

Energy Technology Data Exchange (ETDEWEB)

Shiohara, Yuh [International Superconductivity Technology Center, 10-13 Shinonome 1-Chome, Koto-ku, Tokyo 135-0062 (Japan); Yoshizumi, Masateru, E-mail: myoshizumi@istec.or.jp [International Superconductivity Technology Center, 10-13 Shinonome 1-Chome, Koto-ku, Tokyo 135-0062 (Japan); Takagi, Yuji; Izumi, Teruo [International Superconductivity Technology Center, 10-13 Shinonome 1-Chome, Koto-ku, Tokyo 135-0062 (Japan)

2013-01-15

Highlights: ► R and D results of M-PACC project and of rotating machinery are reviewed. ► Properties of coated conductors have been improved, meeting the market requirements. ► Future prospects of power applications and rotating machineries are discussed. -- Abstract: The research and development of high-temperature superconducting wires, especially yttrium-based coated conductors (CCs), and their energy applications have been expected to reduce CO{sub 2} emissions. This article reviews recent progress in this area, mainly focusing on the results obtained by national projects in Japan. The I{sub c} (critical current) × L (wire length) value of CCs has been improved to reach 466,752 A m (572 A/cm-W, 816 m), which exceeds that of Bi-system wires. CCs have also been improved in terms of in-field performance and AC loss reduction to meet market requirements. Power applications such as superconducting magnetic energy storage (SMES) systems, power cables and transformers have been developed using CCs in the current project. Because of fundamental research on high-capacity power cables, a low AC loss of 0.8 W/m-ph at 3 kA and 73.7 K was achieved. System design and fundamental research were performed on a 2GJ-class SMES system and a 20 MVA-class transformer. Based on the technologies developed by the end of the current project (FY2012), the innovation process of those applications will reach the implementation stage, where the long-term reliability tests will be performed. The process is expected to reach the penetration and propagation stage around 2020.

Wikis and Collaborative Writing Applications in Health Care: A Scoping Review

Science.gov (United States)

Grajales III, Francisco J; Faber, Marjan J; Kuziemsky, Craig E; Gagnon, Susie; Bilodeau, Andrea; Rioux, Simon; Nelen, Willianne LDM; Gagnon, Marie-Pierre; Turgeon, Alexis F; Aubin, Karine; Gold, Irving; Poitras, Julien; Eysenbach, Gunther; Kremer, Jan AM; Légaré, France

2013-01-01

Background Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. Objective Through the Levac six-stage methodology, a scoping review was undertaken to explore the depth and breadth of evidence about the effective, safe, and ethical use of wikis and collaborative writing applications (CWAs) in health care. Methods Multiple strategies were used to locate studies. Seven scientific databases and 6 grey literature sources were queried for articles on wikis and CWAs published between 2001 and September 16, 2011. In total, 4436 citations and 1921 grey literature items were screened. Two reviewers independently reviewed citations, selected eligible studies, and extracted data using a standardized form. We included any paper presenting qualitative or quantitative empirical evidence concerning health care and CWAs. We defined a CWA as any technology that enables the joint and simultaneous editing of a webpage or an online document by many end users. We performed qualitative content analysis to identify the factors that affect the use of CWAs using the Gagnon framework and their effects on health care using the Donabedian framework. Results Of the 111 studies included, 4 were experimental, 5 quasi-experimental, 5 observational, 52 case studies, 23 surveys about wiki use, and 22 descriptive studies about the quality of information in wikis. We classified them by theme: patterns of use of CWAs (n=26), quality of information in existing CWAs (n=25), and CWAs as KT tools (n=73). A high prevalence of CWA use (ie, more than 50%) is reported in 58% (7/12) of surveys conducted with health care professionals and students. However, we found only one

Clinical profile and outcome of myasthenic crisis in a tertiary care hospital: A prospective study.

Science.gov (United States)

Sharma, Sudhir; Lal, Vivek; Prabhakar, Sudesh; Agarwal, Ritesh

2013-04-01

The present understanding of the clinical course, complications, and outcome of myasthenic crisis (MC) is based chiefly on observational studies and retrospective case series. To study the baseline demographic and clinical variables, risk factors, complications, outcome, and mortality in patients of MC. All patients of myasthenia gravis (MG) who presented with myasthenic crisis between July 2009 and December 2010 were included. Ten patients of MC were included in this study. The median age of the patients was 40.5 years (range 14-71 years). Seven were females and three were males. Nine had generalized MG and one patient had oculobulbar involvement only. Median duration of disease was 3 years (range 1 month to17 years). Two patients had thymoma. Two patients had history of thymectomy in the past. Infection was the most common triggering factor accounting for five cases (50%) followed by inadequate treatment/drug withdrawal in three (30%) and steroid initiation and hypokalemia in the remaining two patients (20%). Median duration of MC was 12 days (range 3-28 days). Mortality was in 3 out of 10 (30%) during MC. Management in the intensive care unit (ICU) and treatment with plasma exchange/intravenous immunoglobulins were associated with good outcome. Ventilator support and management in intensive care unit are the most important components in the management of MC. The high mortality rate seen in present study may be more reflective of the actual ground reality in resource constrained developing countries, however, larger prospective studies are needed to confirm these findings.

Designing Robots for Care: Care Centered Value-Sensitive Design

NARCIS (Netherlands)

van Wynsberghe, Amy Louise

2013-01-01

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a

Depressive Disorders in Primary Health Care

OpenAIRE

Vuorilehto, Maria

2008-01-01

The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in prima...

Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study.

Science.gov (United States)

Wong, Carmen Ka Man; Liu, Zhaomin; Butler, Chris C; Wong, Samuel Yeung Shan; Fung, Alice; Chan, Dicken; Yip, Benjamin Hon Kei; Kung, Kenny

2016-01-21

Acute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients' presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians' perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7-101.1), patients' expectation for antibiotics (OR: 5.1, 95% CI: 1.7-11.6), anticipation (OR: 5.1, 95% CI: 1.6-15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0-49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7-3.7, all Pantibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further

Method for analysing radium in powder samples and its application to uranium prospecting

International Nuclear Information System (INIS)

Gong Xinxi; Hu Minzhi.

1987-01-01

The decayed daughter of Rn released from the power sample (soil) in a sealed bottle were collected on a piece of copper and the radium in the sample can be measured by counting α-particles with an Alphameter for uranium prospection, thus it is called the radium method. This method has many advantages, such as high sensitivity (the lowest limit of detection for radium sample per gram is 2.7 x 10 -15 g), high efficiency, low cost and easy to use. On the basis of measuring more than 700 samples taken along 20 sections in 8 deposits, the results show that the radium method is better than γ-measurement and equal to 210 Po method for the capability to descover anomalies. The author also summarizes the anomaly intensities of radium method, 210 Po method and γ-measurement respectively at the surface with deep blind ores, with or without surficial mineralization, and the figures of their profiles and the variation of Ra/ 210 Po ratios. According to the above-mentioned distinguishing features, the uranium mineralization located in deep and/or shallow parts can be distinguishd. The combined application of radium, 210 Po and γ-measurement methods may be regarded as one of the important methods used for anomaly assessment. Based on the experiments of the radium measurements with 771 stream sediments samples in an area of 100 km 2 , it is demonstrated that the radium mehtod can be used in the stages of uranium reconnaissance and prospecting

Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study.

Science.gov (United States)

Yang, Ming; Hu, Xiaoyi; Wang, Haozhong; Zhang, Lei; Hao, Qiukui; Dong, Birong

2017-04-01

The aim of this study is to assess the prevalence of sarcopenia and investigate the associations between sarcopenia and long-term mortality and readmission in a population of elderly inpatients in acute care wards. We conducted a prospective observational study in the acute care wards of a teaching hospital in western China. The muscle mass was estimated according to a previously validated anthropometric equation. Handgrip strength was measured with a handheld dynamometer, and physical performance was measured via a 4 m walking test. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia. The survival status and readmission information were obtained via telephone interviews at 12, 24, and 36 months during the 3 year follow-up period following the baseline investigation. Two hundred and eighty-eight participants (mean age: 81.1 ± 6.6 years) were included. Forty-nine participants (17.0%) were identified as having sarcopenia. This condition was similar in men and women (16.9% vs. 17.5%, respectively, P = 0.915). During the 3 year follow-up period, 49 men (22.7%) and 9 women (16.4%) died (P = 0.307). The mortality of sarcopenic participants was significantly increased compared with non-sarcopenic participants (40.8% vs. 17.1%, respectively, P sarcopenia was an independent predictor of 3 year mortality (adjusted hazard ratio: 2.49; 95% confidential interval: 1.25-4.95) and readmission (adjusted hazard ratio: 1.81; 95% confidential interval: 1.17-2.80). Sarcopenia, which is evaluated by a combination of anthropometric measures, gait speed, and handgrip strength, is valuable to predict hospital readmission and long-term mortality in elderly patients in acute care wards. © 2016 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.

Support vector machine: a tool for mapping mineral prospectivity

NARCIS (Netherlands)

Zuo, R.; Carranza, E.J.M

2011-01-01

In this contribution, we describe an application of support vector machine (SVM), a supervised learning algorithm, to mineral prospectivity mapping. The free R package e1071 is used to construct a SVM with sigmoid kernel function to map prospectivity for Au deposits in western Meguma Terrain of Nova

Enhancing life prospects of socially vulnerable youth through sport participation: a mixed methods study.

Science.gov (United States)

Super, Sabina; Hermens, Niels; Verkooijen, Kirsten; Koelen, Maria

2014-07-09

Sport participation has been associated with improved life prospects such as academic performance and employability prospects. As such, promoting sport participation might be a way to increase life prospects, especially for socially vulnerable youth because they are less physically active than their peers. However, the evidence for the causal effect of sport participation on these outcomes is still limited and little is known about factors that play a role in this possible effect. The aim of this study is four-fold. First, the causal effect of sport participation on life prospects is studied and the underlying mechanisms of this relation are explored. Secondly, the life experiences of the youngsters in the sport context, that may contribute to skill development, are studied. Thirdly, social conditions for a positive effect are explored, as sport is likely to have a positive effect under specific conditions. Fourthly, this study aims to provide insights on the elements of successful partnerships between youth care organisations and local sport clubs. This protocol reports on a mixed method study. An intervention that aims to increase the sport participation of socially vulnerable youth, between 12-23 years old, is implemented in three regions of a Rotterdam youth care organisation. The youngsters in the two control regions receive care-as-usual. The main outcome variables, collected via questionnaires, are the life prospect, sense of coherence and self-regulation skills of the youngsters after 6 and 18 months of follow-up. The Motivational Climate Scale is administered to explore the social conditions for a positive effect and interviews are conducted with sport coaches to explore their role in skill development. Interviews with the youngsters are conducted to gain insight on the life experiences that may lead to skill development. The elements of successful partnerships are collected during interviews with youth care professionals, sport coaches and other

Enhancing life prospects of socially vulnerable youth through sport participation: a mixed methods study

Science.gov (United States)

2014-01-01

Background Sport participation has been associated with improved life prospects such as academic performance and employability prospects. As such, promoting sport participation might be a way to increase life prospects, especially for socially vulnerable youth because they are less physically active than their peers. However, the evidence for the causal effect of sport participation on these outcomes is still limited and little is known about factors that play a role in this possible effect. The aim of this study is four-fold. First, the causal effect of sport participation on life prospects is studied and the underlying mechanisms of this relation are explored. Secondly, the life experiences of the youngsters in the sport context, that may contribute to skill development, are studied. Thirdly, social conditions for a positive effect are explored, as sport is likely to have a positive effect under specific conditions. Fourthly, this study aims to provide insights on the elements of successful partnerships between youth care organisations and local sport clubs. Methods and design This protocol reports on a mixed method study. An intervention that aims to increase the sport participation of socially vulnerable youth, between 12–23 years old, is implemented in three regions of a Rotterdam youth care organisation. The youngsters in the two control regions receive care-as-usual. The main outcome variables, collected via questionnaires, are the life prospect, sense of coherence and self-regulation skills of the youngsters after 6 and 18 months of follow-up. The Motivational Climate Scale is administered to explore the social conditions for a positive effect and interviews are conducted with sport coaches to explore their role in skill development. Interviews with the youngsters are conducted to gain insight on the life experiences that may lead to skill development. The elements of successful partnerships are collected during interviews with youth care professionals

Nursing informatics education and use: challenges and prospects in ...

African Journals Online (AJOL)

Nursing informatics education and use: challenges and prospects in Nigeria. ... that training in NI is critical in the delivery of safe and quality patient care. ... Director of Nursing Services and Principals as well as Nursing associations like ...

[Advantages and Application Prospects of Deep Learning in Image Recognition and Bone Age Assessment].

Science.gov (United States)

Hu, T H; Wan, L; Liu, T A; Wang, M W; Chen, T; Wang, Y H

2017-12-01

Deep learning and neural network models have been new research directions and hot issues in the fields of machine learning and artificial intelligence in recent years. Deep learning has made a breakthrough in the applications of image and speech recognitions, and also has been extensively used in the fields of face recognition and information retrieval because of its special superiority. Bone X-ray images express different variations in black-white-gray gradations, which have image features of black and white contrasts and level differences. Based on these advantages of deep learning in image recognition, we combine it with the research of bone age assessment to provide basic datum for constructing a forensic automatic system of bone age assessment. This paper reviews the basic concept and network architectures of deep learning, and describes its recent research progress on image recognition in different research fields at home and abroad, and explores its advantages and application prospects in bone age assessment. Copyright© by the Editorial Department of Journal of Forensic Medicine.

Application and Prospect of Big Data in Water Resources

Science.gov (United States)

Xi, Danchi; Xu, Xinyi

2017-04-01

Because of developed information technology and affordable data storage, we h ave entered the era of data explosion. The term "Big Data" and technology relate s to it has been created and commonly applied in many fields. However, academic studies just got attention on Big Data application in water resources recently. As a result, water resource Big Data technology has not been fully developed. This paper introduces the concept of Big Data and its key technologies, including the Hadoop system and MapReduce. In addition, this paper focuses on the significance of applying the big data in water resources and summarizing prior researches by others. Most studies in this field only set up theoretical frame, but we define the "Water Big Data" and explain its tridimensional properties which are time dimension, spatial dimension and intelligent dimension. Based on HBase, the classification system of Water Big Data is introduced: hydrology data, ecology data and socio-economic data. Then after analyzing the challenges in water resources management, a series of solutions using Big Data technologies such as data mining and web crawler, are proposed. Finally, the prospect of applying big data in water resources is discussed, it can be predicted that as Big Data technology keeps developing, "3D" (Data Driven Decision) will be utilized more in water resources management in the future.

Predictors of stress among parents in pediatric intensive care unit: a prospective observational study.

Science.gov (United States)

Aamir, Mohd; Mittal, Kundan; Kaushik, Jaya Shankar; Kashyap, Haripal; Kaur, Gurpreet

2014-11-01

To determine the sociodemographic and clinical factors leading to stress among parents whose children are admitted in pediatric intensive care unit (PICU). A prospective observational study was conducted in PICU of a tertiary care hospital of north India. Parents of children admitted to PICU for at least 48 h duration were eligible for participation. At the end of 48 h, parental stress was assessed using parental stress scale (PSS:PICU) questionnaire which was administered to the parents. Baseline demographic and clinical parameters of children admitted to PICU were recorded. The parental stress was compared with demographic and clinical characteristics of children using appropriate statistical methods. A total of 49 parents were finally eligible for participation. Mean (SD) parental stress scores was highest in domains of procedures [1.52 (0.66)] and behavior and emotional [1.32 (0.42)] subscales. Mean (SD) total parental stress score among intubated children [1.31 (0.25)] was significantly more than among non intubated children [0.97 (0.26)] (p parental stress score were comparable in terms of gender (p = 0.15) and socioeconomic status (p = 0.32). On subscale analysis, it was found that professional communication is a significant stressor in age groups 0-12 mo [0.61(0.41)] (p = 0.02). It was observed that parents of intubated children were significantly stressed by the physical appearance of their children (p parental role (p = 0.002). Total parental stress score had a positive correlation with PRISM score (r = 0.308). Indian parents are stressed maximally with environment of PICU. Factor leading to parental stress was intubation status of the child and was not affected by gender or socio demographic profile of the parents.

Caring for a Bedouin Female Patient with Breast Cancer: An Application of Leininger’s Theory of Culture Care Diversity and Universality

Directory of Open Access Journals (Sweden)

Abdul Qadir J. Nashwan

2013-01-01

Full Text Available Leininger’s theory is to provide care measures that are in harmony with an individual or group’s cultural beliefs, practices, and values. In the 1960’s she coined the term culturally congruent care, which is the primary goal of Transcultural nursing practice. Recently, there is a noticeable increase in the usage of the advanced hospitals’ health services by the Bedouin; as their awareness developed in term of health issues, and this put the health care providers (especially nurses in a great chance to face this Bedouin’s culture in clinical areas. So we have to enrich our understanding of the Bedouin’s culture to deliver a culturally congruent and satisfying care. A personal experience of two oncology nurses in working with a female patient with breast cancer and her Bedouin family described, with application of Madeleine Leininger’s theory of culture care diversity and universality. Concluding that understanding, considering and valuing cultural differences when delivering nursing care are vital to ensure providing a culturally congruent nursing care as well as avoid conflicts.

Caring for a Bedouin Female Patient with Breast Cancer: An Application of Leininger’s Theory of Culture Care Diversity and Universality

Directory of Open Access Journals (Sweden)

Abdul Qadir J. Nashwan

2013-07-01

Full Text Available Leininger’s theory is to provide care measures that are in harmony with an individual or group’s cultural beliefs, practices, and values. In the 1960’s she coined the term culturally congruent care, which is the primary goal of Transcultural nursing practice. Recently, there is a noticeable increase in the usage of the advanced hospitals’ health services by the Bedouin; as their awareness developed in term of health issues, and this put the health care providers (especially nurses in a great chance to face this Bedouin’s culture in clinical areas. So we have to enrich our understanding of the Bedouin’s culture to deliver a culturally congruent and satisfying care. A personal experience of two oncology nurses in working with a female patient with breast cancer and her Bedouin family described, with application of Madeleine Leininger’s theory of culture care diversity and universality. Concluding that understanding, considering and valuing cultural differences when delivering nursing care are vital to ensure providing a culturally congruent nursing care as well as avoid conflicts.

Short-Term Absenteeism and Health Care Utilization Due to Lower Extremity Injuries Among Novice Runners: A Prospective Cohort Study.

Science.gov (United States)

Smits, Dirk-Wouter; Huisstede, Bionka; Verhagen, Evert; van der Worp, Henk; Kluitenberg, Bas; van Middelkoop, Marienke; Hartgens, Fred; Backx, Frank

2016-11-01

To describe absenteeism and health care utilization (HCU) within 6 weeks after occurrence of running-related injuries (RRIs) among novice runners and to explore differences relating to injury and personal characteristics. Prospective cohort study. Primary care. One thousand six hundred ninety-six novice runners (18-65 years) participating in a 6-week running program ("Start-to-Run"). Injury characteristics were assessed by weekly training logs and personal characteristics by a baseline questionnaire. Data on absenteeism and HCU were collected using questionnaires at 2 and 6 weeks after the RRI occurred. A total of 185 novice runners (11%) reported an RRI during the 6-week program. Of these injured novice runners, 78% reported absence from sports, whereas only 4% reported absence from work. Fifty-one percent of the injured novice runners visited a health care professional, mostly physical therapists (PTs) rather than physicians. Absenteeism was more common among women than men and was also more common with acute RRIs than gradual-onset RRIs. As regards HCU, both the variety of professionals visited and the number of PT visits were higher among runners with muscle-tendon injuries in the ankle/foot region than among those with other RRIs. Among novice runners sustaining an RRI during a 6-week running program, over three quarters reported short-term absence from sports, whereas absence from work was very limited, and over half used professional health care. Both absence and HCU are associated with injury characteristics. In future running promotion programs (eg in Start-to-Run programs), specific attention should be paid to acute injuries and to muscle-tendon injuries in the ankle/foot region.

Analysis of home-based rehabilitation in patients with motor impairment in primary care: a prospective observational study.

Science.gov (United States)

Vega-Ramírez, Francisco Antonio; López-Liria, Remedios; Granados-Gámez, Genoveva; Aguilar-Parra, Jose Manuel; Padilla-Góngora, David

2017-07-14

The purpose of health and social policies is to encourage older people more longevity, remain free of disability and experience quality of life while living in their homes. The aim of this study was to describe the characteristics of 473 patients diagnosed with motor impairment in primary care, the objectives of home-based rehabilitation and its functional impact. This prospective observational study was conducted in the Almería Health District. The analysed variables included age, gender, secondary diagnosis, Barthel Index (BI), physiotherapeutic objectives and techniques, and number of sessions. The sample had a mean age of 83 years, and 59% were women. The assessed conditions with a high prevalence included osteoarticular pathology (55%), Alzheimer's disease (15.1%), cardiovascular disease (13.7%) and stroke (6.5%). The techniques applied mainly consisted of functional exercises (57.1%), caregiver education (13.8%), and technical assistance (5.7%). There were statistically significant differences (t = -15.79; p physiotherapy. Lower patient age was correlated with higher initial and final functional capacities in primary care. This study aimed to present a useful starting point for decision making among management and health administration regarding this population group by approaching the process from the reality of practice and in relation to the rehabilitation provided. ClinicalTrials.gov identifier: NCT02715245 ; Date of registration: 18 January 2016.

Point-of-care Beta-lactam Allergy Skin Testing by Antimicrobial Stewardship Programs: A Pragmatic Multicenter Prospective Evaluation.

Science.gov (United States)

Leis, Jerome A; Palmay, Lesley; Ho, Grace; Raybardhan, Sumit; Gill, Suzanne; Kan, Tiffany; Campbell, Jackie; Kiss, Alex; McCready, Janine B; Das, Pavani; Minnema, Brian; Powis, Jeff E; Walker, Sandra A N; Ferguson, Heather; Wong, Benny; Weber, Elizabeth

2017-06-01

Beta-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point-of-care. We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at three hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving non-preferred beta-lactam therapy due to severity of their allergy. The primary outcome was the proportion of patients receiving the preferred beta-lactam therapy. Of 827 patients with reported beta-lactam allergy over 15-months, beta-lactam therapy was preferred among 632(76%). During baseline periods, 50% (124/246) received preferred beta-lactam therapy based on history, compared with 60% (232/386) during the intervention periods (p=0.02), which improved further to 81% (313/386) upon provision of BLAST (pcare across three hospital ASPs resulted in greater use of preferred beta-lactam therapy without increasing the risk of adverse drug reactions. Longer term studies are needed to better assess the safety and clinical impact of this ASP intervention. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Partnership-Based Health Care: Suggestions for Effective Application

Directory of Open Access Journals (Sweden)

Teddie M Potter

2015-06-01

Full Text Available Societal transformation often starts with one visionary and a compelling idea. However, if there are no followers, the idea quickly becomes marginalized. It “takes a village” to build a movement, and the more system layers that can be addressed, the more likely the transformation will take hold. This article describes the framework for creating the necessary changes for partnership-based health care. It also makes suggestions for ensuring successful application of partnership-based systems change. This article is for all readers seeking to apply partnership principles in their own fields of influence.

Melt-processed LRE-Ba-Cu-O superconductors and prospects for their applications

International Nuclear Information System (INIS)

Yoo, S.I.; Fujimoto, H.; Sakai, N.; Murakami, M.

1997-01-01

We have recently found that control of the oxygen partial pressure (PO 2 ) during melt processing, named the oxygen-controlled melt-growth (OCMG) process, is critical for obtaining a high superconducting transition temperature (T c ) in the light rare earth (LRE)-Ba-Cu-O (LREBCO) superconductors particularly for Nd, Sm and Eu. Further, compared to a good melt-processed Y-Ba-Cu-O (YBCO) bulk superconductor, LREBCO bulks exhibit larger critical current density (J c ) in high magnetic field and a much improved irreversibility field (H irr ) at 77 K, implying that more effective flux pinning can be realized in a commercially feasible way. In this paper, properties and characteristic flux pinning of OCMG-processed LREBCO (LRE: Nd,Sm,Eu) superconductors are described on the basis of our study during the last several years. We also present the prospects for bulk-type applications, such as the magnetic bearings, flywheels and magnetically levitated (MAGLEV) trains. (orig.)

Rhamnolipid biosurfactants: evolutionary implications, applications and future prospects from untapped marine resource.

Science.gov (United States)

Kiran, George Seghal; Ninawe, Arun Shivanth; Lipton, Anuj Nishanth; Pandian, Vijayalakshmi; Selvin, Joseph

2016-01-01

Rhamnolipid-biosurfactants are known to be produced by the genus Pseudomonas, however recent literature reported that rhamnolipids (RLs) are distributed among diverse microbial genera. To integrate the evolutionary implications of rhamnosyl transferase among various groups of microorganisms, a comprehensive comparative motif analysis was performed amongst bacterial producers. Findings on new RL-producing microorganism is helpful from a biotechnological perspective and to replace infective P. aeruginosa strains which ultimately ensure industrially safe production of RLs. Halotolerant biosurfactants are required for efficient bioremediation of marine oil spills. An insight on the exploitation of marine microbes as the potential source of RL biosurfactants is highlighted in the present review. An economic production process, solid-state fermentation using agro-industrial and industrial waste would increase the scope of biosurfactants commercialization. Potential and prospective applications of RL-biosurfactants including hydrocarbon bioremediation, heavy metal removal, antibiofilm activity/biofilm disruption and greener synthesis of nanoparticles are highlighted in this review.

Big Data and Predictive Analytics: Applications in the Care of Children.

Science.gov (United States)

Suresh, Srinivasan

2016-04-01

Emerging changes in the United States' healthcare delivery model have led to renewed interest in data-driven methods for managing quality of care. Analytics (Data plus Information) plays a key role in predictive risk assessment, clinical decision support, and various patient throughput measures. This article reviews the application of a pediatric risk score, which is integrated into our hospital's electronic medical record, and provides an early warning sign for clinical deterioration. Dashboards that are a part of disease management systems, are a vital tool in peer benchmarking, and can help in reducing unnecessary variations in care. Copyright © 2016 Elsevier Inc. All rights reserved.

Biomedical waste management in Ayurveda hospitals - current practices & future prospectives.

Science.gov (United States)

Rajan, Renju; Robin, Delvin T; M, Vandanarani

2018-03-16

Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

Proceedings of the ninth annual symposium on computer applications in medical care

International Nuclear Information System (INIS)

Ackerman, M.J.

1985-01-01

This book covers the proceedings of the ninth annual symposium on computer applications in medical care. Some topics covered are: Development of a portable report writer for radiology; A new CT - aided robotic stereotaxis system; and a local-area-network based oncology microcomputer system

Groundwater Prospecting in Luanda (Angola with the Application of Fuzzy Logics

Directory of Open Access Journals (Sweden)

Moises Catanha

2016-10-01

Full Text Available This study is aimed at obtaining a map for groundwater prospecting in the province of Luanda (Angola applying fuzzy logic. A favorability map was generated by integrating six variables (longitudinal conductance, delta H, digital elevation model, geological map, static elevation and apparent resistivity and using ArcSDM extension of Sig ArcView with gamma operator and index ϒ=0,7. This map made it possible to classify the province into three areas: less favorable, favorable and very favorable for prospecting for underground aquifers.

Job Prospects for Metallurgical Engineering.

Science.gov (United States)

Basta, Nicholas

1985-01-01

Job prospects in mining, metal-extraction, steel, and refining industries are depressed, but technological discoveries are opening up new fields for metallurgical engineers. Enrollment/employment opportunities and salaries in these areas are discussed a well as the roles of foreign competition, plastics applications, and ceramics research and…

Geography, prospects, problems

International Nuclear Information System (INIS)

Fischer, D.A.V.

1982-01-01

In assessing the application of IAEA safeguards to the world's nuclear industry it is shown that the continuing success of the system depends to a large degree on the political will of the Agency's Member States and of other parties to the Treaty on the Non-Proliferation of Nuclear Weapons in ensuring both that adequate resources are provided for the safeguards operation and also that safeguards are effectively and impartially applied. The present positions concerning NPT membership, non-NPT safeguards and future prospects with respect to the operation of safeguarded and unsafeguarded facilities are discussed. Political problems which impede the effective application of safeguards are considered. (U.K.)

Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.

Science.gov (United States)

Palese, A; Ambrosi, E; Fabris, F; Guarnier, A; Barelli, P; Zambiasi, P; Allegrini, E; Bazoli, L; Casson, P; Marin, M; Padovan, M; Picogna, M; Taddia, P; Salmaso, D; Chiari, P; Marognolli, O; Canzan, F; Saiani, L

2016-03-01

To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED). To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors. A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed. The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Balanced scorecard application in the health care industry: a case study.

Science.gov (United States)

Kocakülâh, Mehmet C; Austill, A David

2007-01-01

Balanced scorecards became a popular strategic performance measurement and management tool in the 1990s by Robert Kaplan and David Norton. Mainline companies accepted balanced scorecards quickly, but health care organizations were slow to adopt them for use. A number of problems face the health care industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how health care organizations, both profit and nonprofit, manage operations. This article discusses balanced scorecards generally from theoretical and technical views, and why they should be used by health care organizations. The authors argue that balanced scorecards are particularly applicable to hospitals, clinics, and other health care companies. Finally, the authors perform a case study of the development, implementation, and use of balance scorecards by a regional Midwestern health care system. The positive and negative aspects of the subject's balanced scorecard are discussed. Leaders in today's health care industry are under great pressure to meet their financial goals. The industry is faced with financial pressures from consumers, insurers, and governments. Inflation in the industry is much higher than it is within the overall economy. Employers can no longer bear the burden of rising group health insurance costs for its employees. Too many large companies have used bankruptcy law as a shield to reduce or shift some of their legal obligations to provide health insurance coverage to present or retired employees. Stakeholders of health care providers are demanding greater control over costs. As the segment of un- or underinsured within the United States becomes larger as a percentage of the population, voters are seriously beginning to demand some form of national health insurance, which will drastically change the health care industry.

Attitudes toward Palliative Care and End of Life Issues: A Prospective Survey in Patients with Metastatic Cancer

LENUS (Irish Health Repository)

Docherty, C

2016-05-01

Palliative care (PC) positively impacts patient outcomes, decreases hospital admissions and improves quality of life. Despite evidence, PC resources are reported as under-utilised. Few studies have explored patient attitudes towards PC. This study evaluated patient attitudes towards PC. It was a prospective study conducted in oncology outpatient clinics. A 26-item questionnaire was distributed to those with metastatic cancer (N = 44). Sixty percent believed PC can make people ‘feel better’, 63.4% believed PC is offered when nothing more can be done. Most were unsure or disagreed that opioids are addictive. Eighty percent reported symptom control is more important than prolonging life. Sixty-one percent strongly agreed or agreed that ‘losing hope makes people die sooner’. Although PC was deemed beneficial, a significant relationship exists between familiarity with PC and thinking it’s offered when ‘nothing more can be done’. Lack of knowledge about opioids, preference for symptom control over life prolonging measures and the importance of hope were also emphasised.

Domestic kraudfandinh: problems and prospects

Directory of Open Access Journals (Sweden)

L.V. Mihalchuk

2015-03-01

Full Text Available The description kraudfandinh as an innovative tool to attract private investment in promising business projects as a special type of financing over the Internet. Powered its classification and kraud lists of successful projects, clearly illustrated by comparison of the normal business process to create a product and a similar process using kraudfandinh, given the differences between them and the main advantages. Based on the summaries of the literature and current practices of foreign companies and kraud platforms, defined the prospects of its application by domestic enterprises in various industries, proved its positive impact on the economy of Ukraine. The main problem of the use of this instrument in the domestic business, according to national circumstances, given their explanations. Described the prospects for its implementation at Ukrainian enterprises in terms of economic instability. The characteristic of the first Ukrainian kraudfandinh platforms by their future prospects in this direction

Application of solar chargers to prospection instruments

International Nuclear Information System (INIS)

Caille, G.

1960-01-01

The use of conventional batteries has certain disadvantages, and for this reason high-voltage batteries have been gradually replaced in all prospection instruments by transistor supply systems, using less cumbersome sources of energy. All the same low voltages are still necessary, and in hot or damp countries the use of these batteries leads to consumptions out of all proportion to the services rendered. This is why the use of solar energy possesses real advantages. After a brief review of the basic ideas on semiconductors, this article describes a selenium solar battery which was developed by the Westinghouse brakes and signals society. (author) [fr

A remote data access architecture for home-monitoring health-care applications.

Science.gov (United States)

Lin, Chao-Hung; Young, Shuenn-Tsong; Kuo, Te-Son

2007-03-01

With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. Many remote home-monitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers and reduce visits to hospitals and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. The purpose of the study reported in this paper was to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The pros and cons of this novel architecture design are also discussed and summarized.

Prospective surveillance of device-associated health care-associated infection in an intensive care unit of a tertiary care hospital in New Delhi, India.

Science.gov (United States)

Kumar, Shilpee; Sen, Poornima; Gaind, Rajni; Verma, Pardeep Kumar; Gupta, Poonam; Suri, Prem Rose; Nagpal, Sunita; Rai, Anil Kumar

2018-02-01

Surveillance of health care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. In India, most of the surveillance of HAIs is reported from private sector hospitals that do not depict the situation of government sector hospitals. Other studies do not confirm with the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) surveillance criterion, or deal with ventilator-associated pneumonia (VAP) instead of ventilator-associated event (VAE). The aim of this study was to identify the incidences of 3 device-associated HAIs (DA-HAIs) (VAE, central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) by active surveillance using CDC's NHSN surveillance criteria and to identify the pathogens associated with these DA-HAIs. This was a prospective surveillance study (January 2015-December 2016) conducted in an intensive care unit (ICU) of a large, tertiary care, government hospital situated in Delhi, India. Targeted surveillance was done as per the CDC's NHSN 2016 surveillance criteria. There were 343 patients admitted to the ICU that were included in the study. The surveillance data was reported over 3,755 patient days. A DA-HAIs attack rate of 20.1 per 100 admissions and incidence of 18.3 per 1,000 patient days was observed. The duration of use for each device for patients with DA-HAIs was significantly longer than for patients without DA-HAIs. The device utilization ratios of central line, ventilator, and urinary catheters were 0.57, 0.85, and 0.72, respectively. The crude excess length of stay for patients with DA-HAI was 13 days, and crude excess mortality rate was 11.8%. VAE, CLABSI, and CAUTI rates were 11.8, 7.4, and 9.7 per 1,000 device days, respectively. Among 69 DA-HAIs reported, pathogens could be identified for 49 DA-HAI cases. Klebsiella spp was the most common organism isolated, accounting 28.5% for all DA

Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

Science.gov (United States)

Brophy, Alison; Cardinale, Maria; Andrews, Liza B; Kaplan, Justin B; Adams, Christopher; Opsha, Yekaterina; Brandt, Kimberly A; Dixit, Deepali; Nerenberg, Steven F; Saleh, Julie A

2018-01-01

The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

Radimetric autotransported prospecting survey

International Nuclear Information System (INIS)

Coco, A.L.; Azamor, L.A.; Agost, E.J.

1977-10-01

A procedure of prospection of minerals (''carborne''). It is characterized to be rapid and low costly if a sufficiently dense highway network is available or if transit with a vehicle across the fields is possible. Instruments, methods and results that may be obtained are given. The detector, a scintillation counter, is mounted on the top of an appropiate car registering continuously the measured values. Subsequently data are put on cartography, obtaining thus the values of iso-radiactivity which determine the values of ''background'' and the favorable zones for pursuing prospection work by other methods. The application of the method to the zone of the Chihuidos, province of Neuquen, is described in details and the obtained conclusions are given. (author) [es

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

Science.gov (United States)

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

2013-09-01

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

Molecular Characterization and Comparative Phylogenetic Analysis of Phytases from Fungi with Their Prospective Applications

Directory of Open Access Journals (Sweden)

Sharad Tiwari

2013-01-01

Full Text Available Plant seeds that have high phytate content are used as animal feed. Phytases, enzymes that catalyze the breakdown of phytate into inorganic phosphorus and myoinositol phosphate derivatives, have been intensively studied in recent years and gained immense attention because of their application in reducing phytate content in animal feed and food for human consumption, thus indirectly lowering environmental pollution caused by undigested phytate. This review is focused on summarising the current knowledge on recent developments of fungal and yeast phytases. Comparative account on diverse sources and physiological roles, molecular characteristics and regulation mechanisms of phytases are discussed. Phylogenetic relationship of phytases from different classes of fungi is studied in details. It is inferred on the basis of phylogeny that phytases from Ascomycetes and Basidiomycetes differ in the amino acid sequences, therefore they fall in separate clade in the tree. The prospective biotechnological applications of microbial phytases such as animal feed additives, probiotics, pharmaceuticals, as well as in aquaculture, food industry, paper manufacturing, development of transgenic plants and animals with special reference to its use as biofertilizers are also emphasised in this review.

[Research progress and application prospect of near infrared spectroscopy in soil nutrition analysis].

Science.gov (United States)

Ding, Hai-quan; Lu, Qi-peng

2012-01-01

"Digital agriculture" or "precision agriculture" is an important direction of modern agriculture technique. It is the combination of the modern information technique and traditional agriculture and becomes a hotspot field in international agriculture research in recent years. As a nondestructive, real-time, effective and exact analysis technique, near infrared spectroscopy, by which precision agriculture could be carried out, has vast prospect in agrology and gradually gained the recognition. The present paper intends to review the basic theory of near infrared spectroscopy and its applications in the field of agrology, pointing out that the direction of NIR in agrology should based on portable NIR spectrograph in order to acquire qualitative or quantitative information from real-time measuring in field. In addition, NIRS could be combined with space remote sensing to macroscopically control the way crop is growing and the nutrition crops need, to change the current state of our country's agriculture radically.

Preconception Care: Concepts and Perceptions: An ethical perspective

NARCIS (Netherlands)

B. van der Zee (Boukje)

2013-01-01

textabstractGeneral individual preconception care is a new strategy to improve the health of future children and their mothers –and to a lesser extent the prospective fathers’ health- through primary intervention. Improving their health through preconception care comprises two component actions.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

Science.gov (United States)

2014-08-22

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that

Prospect: A Picture Exchange Communication System (PECS)-based Instant Messaging Application for Autism Spectrum Condition

Science.gov (United States)

Raja, Pravind; Zainuri Saringat, Mohd; Mustapha, Aida; Zainal, Abidah

2017-08-01

Autism Spectrum Disorder (ASC) has widely gained the common attention from the public especially autistic communities. Individuals with ASC are said to have poor verbal skills and this affects them in carrying out their daily basis which they are afraid to expose themselves to the world due to their problems. ASC is diagnosed among children ranging from ages 5-12 years old and they suffer from the abnormal functioning of the brain which in turn causes lack of development activities. Thus, studies have shown that diagrammatic approaches help children with ASC to overcome their issues and improvise their visual and verbal skills. Picture Exchange Communication System or PECS consists of a series of illustrated cards and each cards has its own illustration with a caption on it. These children will understand the cards and they can compile several other cards to form sentences. This paper presents a mobile application called the Prospect, which has been developed using the agile development model for digital representation of PECS. The application is hoped to enhance the learning process and a better yielding results.

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

Science.gov (United States)

2015-08-17

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System

OpenAIRE

Zaidi, Syed Mohammad Asad; Labrique, Alain B.; Khowaja, Saira; Lotia-Farrukh, Ismat; Irani, Julia; Salahuddin, Naseem; Khan, Aamir Javed

2013-01-01

Background: Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi. Methodology and Principal: Findings A total of 6212 dog-bite cases were identified over t...

Current and future impact of osteoarthritis on health care

DEFF Research Database (Denmark)

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

2014-01-01

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

Effect of Health Care Professionals' Continuing Education ...

African Journals Online (AJOL)

Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...

Application of qualitative response models in a relevance study of older adults' health depreciation and medical care demand.

Science.gov (United States)

Weng, Shuo-Chun; Chen, Yu-Chi; Chen, Ching-Yu; Cheng, Yuan-Yang; Tang, Yih-Jing; Yang, Shu-Hui; Lin, Jwu-Rong

2017-04-01

The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death. Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652. © 2016 Japan Geriatrics Society.

MYRRHA. A European experimental ADS for R and D applications status at mid-2005 and prospective towards future

International Nuclear Information System (INIS)

Aiet Abderrahim, Hamid; D'hondt, Pierre

2005-01-01

Since 1998, SCK/CEN in partnership with many European research laboratories, is designing a multipurpose ADS for R and D applications - MYRRHA - and is conducting an associated R and D support program. MYRRHA is an Accelerator Driven System (ADS) under development at Mol in Belgium and aiming to serve as a basis for the European experimental ADS to provide protons and neutrons for various R and D applications. It consists of a linac proton accelerator delivering a 350 MeV*5 mA proton beam to a windowless liquid Pb-Bi spallation target that in turn couples to a Pb-Bi cooled, subcritical fast core of 50 MWth. In this paper we report on the status of the MYRRHA project at mid-2005 and prospective towards the future. (author)

Prospects for rebuilding primary care using the patient-centered medical home.

Science.gov (United States)

Landon, Bruce E; Gill, James M; Antonelli, Richard C; Rich, Eugene C

2010-05-01

Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the patient-centered medical home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.

Academic decision making and prospect theory.

Science.gov (United States)

Mowrer, Robert R; Davidson, William B

2011-08-01

Two studies are reported that investigate the applicability of prospect theory to college students' academic decision making. Exp. 1 failed to provide support for the risk-seeking portion of the fourfold pattern predicted by prospect theory but did find the greater weighting of losses over gains. Using a more sensitive dependent measure, in Exp. 2 the results of the first experiment were replicated in terms of the gain-loss effect and also found some support for the fourfold pattern in the interaction between probabilities and gain versus loss. The greatest risk-seeking was found in the high probability loss condition.

OMARC: An online multimedia application for training health care providers in the assessment of respiratory conditions.

Science.gov (United States)

Meruvia-Pastor, Oscar; Patra, Pranjal; Andres, Karen; Twomey, Creina; Peña-Castillo, Lourdes

2016-05-01

OMARC, a multimedia application designed to support the training of health care providers for the identification of common lung sounds heard in a patient's thorax as part of a health assessment, is described and its positive contribution to user learning is assessed. The main goal of OMARC is to effectively help health-care students become familiar with lung sounds as part of the assessment of respiratory conditions. In addition, the application must be easy to use and accessible to students and practitioners over the internet. OMARC was developed using an online platform to facilitate access to users in remote locations. OMARC's unique contribution as an educational software tool is that it presents a narrative about normal and abnormal lung sounds using interactive multimedia and sample case studies designed by professional health-care providers and educators. Its interface consists of two distinct components: a sounds glossary and a rich multimedia interface which presents clinical case studies and provides access to lung sounds placed on a model of a human torso. OMARC's contents can be extended through the addition of sounds and case studies designed by health-care educators and professionals. To validate OMARC and determine its efficacy in improving learning and capture user perceptions about it, we performed a pilot study with ten nursing students. Participants' performance was measured through an evaluation of their ability to identify several normal and adventitious/abnormal sounds prior and after exposure to OMARC. Results indicate that participants are able to better identify different lung sounds, going from an average of 63% (S.D. 18.3%) in the pre-test evaluation to an average of 90% (S.D. of 11.5%) after practising with OMARC. Furthermore, participants indicated in a user satisfaction questionnaire that they found the application helpful, easy to use and that they would recommend it to other persons in their field. OMARC is an online multimedia

Staff awareness of the application of Mental Health and Guardianship Legislation in the care of hospitalised older persons.

Science.gov (United States)

Panesar, Narinder; Valachova, Iveta; Schmidtman, Robert; Chan, Daniel Kam Yin

2018-02-01

The study aimed to survey hospital staff knowledge of the application of the Mental Health Act 2007 (NSW) (MHA) and the Guardianship Act 1987 (NSW) (GA) in the care and treatment of older persons in a teaching hospital in Sydney. Method Over a two-month period in 2017, a survey questionnaire was distributed to staff involved in older persons' care across the hospital. The majority of the hospital staff demonstrated basic theoretical knowledge of both the GA (76%) and of the MHA (84.5%). Fewer (64.5%) appeared to understand the practical application of the MHA in the hypothetical clinical situations. An even lower proportion of staff appeared to understand the application of the GA either to obtain consent for medical treatment or to appoint a guardian through the Guardianship Division of the NSW Civil and Administrative Tribunal (NCAT). Although clinical staff of the hospital displayed fair knowledge and awareness about the application of the MHA and the GA to inpatient care of older adults, further education is necessary, particularly about the application of the GA. The authors suggest similar findings may occur at other New South Wales hospitals, which may raise concern and need for education.

Determining the economic cost of ICU treatment: a prospective "micro-costing" study.

LENUS (Irish Health Repository)

McLaughlin, Anne Marie

2009-12-01

To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of "severity of illness" scores in estimating ICU cost.

Large-scale, high-definition Ground Penetrating Radar prospection in archaeology

Science.gov (United States)

Trinks, I.; Kucera, M.; Hinterleitner, A.; Löcker, K.; Nau, E.; Neubauer, W.; Zitz, T.

2012-04-01

The future demands on professional archaeological prospection will be its ability to cover large areas in a time and cost efficient manner with very high spatial resolution and accuracy. The objective of the 2010 in Vienna established Ludwig Boltzmann Institute for Archaeological Prospection and Virtual Archaeology (LBI ArchPro) in collaboration with its eight European partner organisations is the advancement of state-of-the-art archaeological sciences. The application and specific further development of remote sensing, geophysical prospection and virtual reality applications, as well as of novel integrated interpretation approaches dedicated to non-invasive spatial archaeology combining near-surface prospection methods with advanced computer science is crucial for modern archaeology. Within the institute's research programme different areas for distinct case studies in Austria, Germany, Norway, Sweden and the UK have been selected as basis for the development and testing of new concepts for efficient and universally applicable tools for spatial, non-invasive archaeology. In terms of geophysical prospection the investigation of entire archaeological landscapes for the exploration and protection of Europe's buried cultural heritage requires new measurement devices, which are fast, accurate and precise. Therefore the further development of motorized, multichannel survey systems and advanced navigation solutions is required. The use of motorized measurement devices for archaeological prospection implicates several technological and methodological challenges. Latest multichannel Ground Penetrating Radar (GPR) arrays mounted in front off, or towed behind motorized survey vehicles permit large-scale GPR prospection surveys with unprecedented spatial resolution. In particular the motorized 16 channel 400 MHz MALÅ Imaging Radar Array (MIRA) used by the LBI ArchPro in combination with latest automatic data positioning and navigation solutions permits the reliable high

A systematic review of digital interactive television systems and their applications in the health and social care fields.

Science.gov (United States)

Blackburn, Steven; Brownsell, Simon; Hawley, Mark S

2011-01-01

We conducted a systematic review of the applications and technical features of digital interactive television (DITV) in the health and social care fields. The Web of Knowledge and IEEE Xplore databases were searched for articles published between January 2000 and March 2010 which related to DITV systems facilitating the communication of information to/from an individual's home with either a health or social care application. Out of 1679 articles retrieved, 42 met the inclusion criteria and were selected for review. An additional 20 articles were obtained from online grey literature sources. Twenty-five DITV systems operating in health and social care were identified, including seven commercial systems. The most common applications were related to health care, such as vital signs monitoring (68% of systems) and health information or advice (56% of systems). The most common technical features of DITV systems were two-way communication (88%), medical peripherals (68%), on-screen messaging (48%) and video communication (36%). Digital interactive television has the potential to deliver health and social care to people in their own homes. However, the requirement for a high-bandwidth communications infrastructure, the usability of the systems, their level of personalisation and the lack of evidence regarding clinical and cost-effectiveness will all need to be addressed if this approach is to flourish.

The problems and prospects of public health care development in ...

African Journals Online (AJOL)

The abysmal failure of public health care system in Nigeria has attracted comments and criticisms from local and national levels. The provision of adequate health care services to the citizens, particularly those residing at the rural areas has left much to be desired. In spite of media propaganda and the current health sector ...

Improving the effectiveness of geological prospecting with neutron activation analysis

International Nuclear Information System (INIS)

Fardy, J.J.

1984-01-01

Two examples of the use of neutron activation analysis to improve the effectiveness of geological prospecting are examined. The first is application to the direct hydrogeochemical prospecting for gold in surface waters. The second shows how multielement data banks produced by NAA for a geological formation provide a powerful method for the classification of ore bodies and sedimentary materials

A prospective cohort study examining the preferred learning styles of acute care registered nurses.

Science.gov (United States)

McCrow, Judy; Yevchak, Andrea; Lewis, Peter

2014-03-01

This paper reports on the preferred learning styles of Registered Nurses practicing in acute care environments and relationships between gender, age, post-graduate experience and the identified preferred learning styles. A prospective cohort study design was used. Participants completed a demographic questionnaire and the Felder-Silverman Index of Learning Styles (ILS) questionnaire to determine preferred learning styles. Most of the Registered Nurse participants were balanced across the Active-Reflective (n = 77, 54%), and Sequential-Global (n = 96, 68%) scales. Across the other scales, sensing (n = 97, 68%) and visual (n = 76, 53%) were the most common preferred learning style. There were only a small proportion who had a preferred learning style of reflective (n = 21, 15%), intuitive (n = 5, 4%), verbal (n = 11, 8%) or global learning (n = 15, 11%). Results indicated that gender, age and years since undergraduate education were not related to the identified preferred learning styles. The identification of Registered Nurses' learning style provides information that nurse educators and others can use to make informed choices about modification, development and strengthening of professional hospital-based educational programs. The use of the Index of Learning Styles questionnaire and its ability to identify 'balanced' learning style preferences may potentially yield additional preferred learning style information for other health-related disciplines. Copyright © 2013 Elsevier Ltd. All rights reserved.

Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care

OpenAIRE

Gallo, Joseph J; Morales, Knashawn H; Bogner, Hillary R; Raue, Patrick J; Zee, Jarcy; Bruce, Martha L; Reynolds, Charles F

2013-01-01

Objective To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Design Long term follow-up of multi-site practice randomized controlled trial (PROSPECT?Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Setting 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. Participants 1226 participants...

An overview of Medicaid managed care litigation.

Science.gov (United States)

Rosenbaum, S; Teitelbaum, J; Kirby, C; Priebe, L; Klement, T

1998-11-01

Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

Science.gov (United States)

Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

2013-01-01

Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. To describe the effects of different communication interventions and their problems. Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

The predictive validity of prospect theory versus expected utility in health utility measurement.

Science.gov (United States)

Abellan-Perpiñan, Jose Maria; Bleichrodt, Han; Pinto-Prades, Jose Luis

2009-12-01

Most health care evaluations today still assume expected utility even though the descriptive deficiencies of expected utility are well known. Prospect theory is the dominant descriptive alternative for expected utility. This paper tests whether prospect theory leads to better health evaluations than expected utility. The approach is purely descriptive: we explore how simple measurements together with prospect theory and expected utility predict choices and rankings between more complex stimuli. For decisions involving risk prospect theory is significantly more consistent with rankings and choices than expected utility. This conclusion no longer holds when we use prospect theory utilities and expected utilities to predict intertemporal decisions. The latter finding cautions against the common assumption in health economics that health state utilities are transferable across decision contexts. Our results suggest that the standard gamble and algorithms based on, should not be used to value health.

PATIENT SAFETY AND MEDICATION ERRORS IN THE PROVISION OF HEALTH CARE SERVICES-CHALLENGES FOR CONTEMPORARY PRACTICE

Directory of Open Access Journals (Sweden)

Tatjana Stojković

2016-06-01

Full Text Available Non-maleficence represents one of the basic ethical principles that health care providers should be guided by during service delivery. Establishment of patient safety is nowadays recognized as an issue of global concern in health care and a critical component of quality management. The aim of this paper is to provide a literature review of the patient safety and medication errors concept, with special attention given to defining the most significant terms, analyzing the causal factors and reviewing their classification. Raising awareness about the importance of patient safety has resulted in an increase in the number of medication error studies over the last decade. The traditional approach which makes health workers responsible for reduction of incidents is replaced by the modern concept which implies the involvement of all stakeholders at all levels of the system. In developed countries, the application of prospective risk management models for specific health care processes has already started. However, all these studies are mainly carried out at the secondary and tertiary levels of health care, while they are almost non-existent at the primary level. In the Republic of Serbia, a Rulebook on indicators of the quality of health care has been recently adopted, but a trend of significant lack of data regarding patient safety can be noticed due to inadequate reporting. It is necessary to continue with the homogenization of terminology and to increase the number of analyses of causal factors with the aim of prospective risk identification, particularly in developing countries such as the Republic of Serbia.

Clinical Performance and Management Outcomes with the DecisionDx-UM Gene Expression Profile Test in a Prospective Multicenter Study

Directory of Open Access Journals (Sweden)

Kristen Meldi Plasseraud

2016-01-01

Full Text Available Uveal melanoma management is challenging due to its metastatic propensity. DecisionDx-UM is a prospectively validated molecular test that interrogates primary tumor biology to provide objective information about metastatic potential that can be used in determining appropriate patient care. To evaluate the continued clinical validity and utility of DecisionDx-UM, beginning March 2010, 70 patients were enrolled in a prospective, multicenter, IRB-approved study to document patient management differences and clinical outcomes associated with low-risk Class 1 and high-risk Class 2 results indicated by DecisionDx-UM testing. Thirty-seven patients in the prospective study were Class 1 and 33 were Class 2. Class 1 patients had 100% 3-year metastasis-free survival compared to 63% for Class 2 (log rank test p=0.003 with 27.3 median follow-up months in this interim analysis. Class 2 patients received significantly higher-intensity monitoring and more oncology/clinical trial referrals compared to Class 1 patients (Fisher’s exact test p=2.1×10-13 and p=0.04, resp.. The results of this study provide additional, prospective evidence in an independent cohort of patients that Class 1 and Class 2 patients are managed according to the differential metastatic risk indicated by DecisionDx-UM. The trial is registered with Clinical Application of DecisionDx-UM Gene Expression Assay Results (NCT02376920.

Applicability of the 5S management method for quality improvement in health-care facilities: a review.

Science.gov (United States)

Kanamori, Shogo; Shibanuma, Akira; Jimba, Masamine

2016-01-01

The 5S management method (where 5S stands for sort, set in order, shine, standardize, and sustain) was originally implemented by manufacturing enterprises in Japan. It was then introduced to the manufacturing sector in the West and eventually applied to the health sector for organizing and standardizing the workplace. 5S has recently received attention as a potential solution for improving government health-care services in low- and middle-income countries. We conducted a narrative literature review to explore its applicability to health-care facilities globally, with a focus on three aspects: (a) the context of its application, (b) its impacts, and (c) its adoption as part of government initiatives. To identify relevant research articles, we researched public health databases in English, including CINAHL, PubMed, ScienceDirect, and Web of Science. We found 15 of the 114 articles obtained from the search results to be relevant for full-text analysis of the context and impacts of the 5S application. To identify additional information particularly on its adoption as part of government initiatives, we also examined other types of resources including reference books, reports, didactic materials, government documents, and websites. The 15 empirical studies highlighted its application in primary health-care facilities and a wide range of hospital areas in Brazil, India, Jordan, Senegal, Sri Lanka, Tanzania, the UK, and the USA. The review also found that 5S was considered to be the starting point for health-care quality improvement. Ten studies presented its impacts on quality improvements; the changes resulting from the 5S application were classified into the three dimensions of safety, efficiency, and patient-centeredness. Furthermore, 5S was adopted as part of government quality improvement strategies in India, Senegal, Sri Lanka, and Tanzania. 5S could be applied to health-care facilities regardless of locations. It could be not only a tool for health workers and

Can shared care deliver better outcomes for patients undergoing total hip replacement?

NARCIS (Netherlands)

Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

2000-01-01

Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

Prospect theory in the valuation of health.

Science.gov (United States)

Moffett, Maurice L; Suarez-Almazor, Maria E

2005-08-01

Prospect theory is the prominent nonexpected utility theory in the estimation of health state preference scores for quality-adjusted life year calculation. Until recently, the theory was not considered to be developed to the point of implementation in economic analysis. This review focuses on the research and evidence that tests the implementation of prospect theory into health state valuation. The typical application of expected utility theory assumes that a decision maker has stable preferences under conditions of risk and uncertainty. Under prospect theory, preferences are dependent on whether the decision maker regards the outcome of a choice as a gain or loss, relative to a reference point. The conceptual preference for standard gamble utilities in the valuation of health states has led to the development of elicitation techniques. Empirical evidence using these techniques indicates that when individual preferences are elicited, a prospect theory consistent framework appears to be necessary for adequate representation of individual health utilities. The relevance of prospect theory to policy making and resource allocation remains to be established. Societal preferences may not need the same attitudes towards risks as individual preferences, and may remain largely risk neutral.

Patient-Related Determinants of the Administration of Continuous Palliative Sedation in Hospices and Palliative Care Units: A Prospective, Multicenter, Observational Study.

Science.gov (United States)

van Deijck, Rogier H P D; Hasselaar, Jeroen G J; Verhagen, Stans C A H H V M; Vissers, Kris C P; Koopmans, Raymond T C M

2016-05-01

Knowledge of determinants that are associated with the administration of continuous palliative sedation (CPS) helps physicians identify patients who are at risk of developing refractory symptoms, thereby enabling proactive care planning. This study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life. A prospective multicenter observational study was performed in six Dutch hospices and three nursing home-based palliative care units. The association between patient-related variables at admission (age, gender, diagnosis, use of opioids or psycholeptics, number of medications, Karnofsky Performance Status scale score, Edmonton Symptom Assessment System distress score, and Glasgow Coma Scale score) and the administration of CPS at the end of life was analyzed. A total of 467 patients died during the study period, of whom 130 received CPS. In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age (P = 0.009), malignancy as a diagnosis (P = 0.05), higher Karnofsky Performance Status score (P = 0.03), the use of opioids (P Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance.

Science.gov (United States)

Almuneef, Maha; Memish, Ziad A; Balkhy, Hanan H; Alalem, Hala; Abutaleb, Abdulrahman

2004-09-01

To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients. This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions. Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP. The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

Exploring how pain leads to productivity loss in primary care consulters for osteoarthritis: a prospective cohort study.

Science.gov (United States)

Wilkie, Ross; Hay, Elaine M; Croft, Peter; Pransky, Glenn

2015-01-01

Osteoarthritis pain has become a leading cause of decreased productivity and work disability in older workers, a major concern in primary care. How osteoarthritis pain leads to decreased productivity at work is unclear; the aim of this study was to elucidate causal mechanisms and thus identify potential opportunities for intervention. Population-based prospective cohort study of primary care consulters with osteoarthritis. Path analysis was used to test proposed mechanisms by examining the association between pain at baseline, and onset of work productivity loss at three years for mediation by physical limitation, depression, poor sleep and poor coping mechanisms. High pain intensity was associated with onset of work productivity loss (Adjusted Odds Ratio 2.5; 95%CI 1.3, 4.8). About half of the effect of pain on work productivity was a direct effect, and half was mediated by the impact of pain on physical function. Depression, poor sleep quality and poor coping did not mediate the association between high pain intensity and onset of work productivity loss. As pain is a major cause of work productivity loss, results suggest that decreasing pain should be a major focus. However, successfully improving function may have an indirect effect by decreasing the impact of pain on work productivity, especially important as significant pain reduction is often difficult to achieve. Although depression, sleep problems, and coping strategies may be directly related to work productivity loss, addressing these issues may not have much effect on the significant impact of pain on work productivity.

77 FR 48130 - Prospective Grant of Exclusive Patent License

Science.gov (United States)

2012-08-13

... Exclusive Patent License AGENCY: National Institute of Standards and Technology, Commerce. ACTION: Notice of prospective grant of exclusive patent license. SUMMARY: This is a notice in accordance with 35 U.S.C. 209(e... Provisional Application for Patent Application No. 61,638,362 titled ``Flow Cytometer Systems and Associated...

Analyzing Short Message Services Application Effect on Diabetic Patients' Self-caring.

Science.gov (United States)

Naghibi, Seyed Abolhassan; Moosazadeh, Mahmood; Zhyanifard, Akram; Jafari Makrani, Zoreh; Yazdani Cherati, Jamshid

2015-01-01

Diabetes is the most prevalent metabolic disease with a growing spread rate in word wide. Short message service (SMS) is of the most common public communication networks, which have brought about a broad spectrum of applications like social, cultural and service products in the late decade. The objective of this research is, the investigate of using SMS on diabetes patients self-caring. In an interventional study, 228 diabetes patients have been selected from a community charity. With using of random sampling method, they were divided into two groups of 114 subjects as the control and case. The case group was sent messages reminding them about sports, caring foot, taking insulin and oral tablet for 4 weeks via mobile phone. After 4 weeks, a posttest questionnaire was completed. The data analysis was performed using a descriptive statistic, Chi-square, independent t-test, and paired t-test. There are not significant differences between case and control groups before intervention by studied dependent variables (P > 0.05). Performance score mean of taking care of foot, sport and taking oral tablet and insulin in case group before intervention were 29.90, 10, 11.16 and 3.75 respectively and after intervention were 20.11, 41.36, 13.09 and 4.90, respectively. Furthermore, the performance scores mean difference after intervention, taking care of foot (P tablet (P = 0.020) was meaningful in case and control groups. Regarding the study results on using cell phone, to utilize virtual training methods is recommended as an appropriate procedure for different health care, self-caring and follow-up training plans for various groups in society, especially diabetic and chronic patients.

Current situation and prospect of market on the latest radiation measuring instrument

International Nuclear Information System (INIS)

Ha, Chang Ho; Kim, Wang Geum; Cho, Gyu Seong

2009-12-01

This book deals with current situation and prospect of market on the latest radiation measuring instrument. The contents of this book are basic of technology on radiation measuring instrument with basic principle of various measuring instrument, current situation of technology and prospect of radiation measuring instrument, effect of spreading and application field of radiation measuring instrument, facility for making and research and development of radiation measuring instrument, prospect of market about radiation measuring instrument, strategy for market entry with the latest radiation measuring instrument and general prospect for the future.

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

Science.gov (United States)

Dybdal, Kristin; Blewett, Lynn A; Pintor, Jessie Kemmick; Johnson, Kelli

2015-01-01

An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

Prospect of small modular reactor development

International Nuclear Information System (INIS)

Li Huailin; Zhu Qingyuan; Wang Suli; Xia Haihong

2014-01-01

Small modular reactor has the advantages of modular construction, enhanced safety/robustness from simplified designs, better ecomonic, clean and carbon free, compatible with the needs of smaller utilities and diversified application. In this paper, the prospect of small modular reactor is discussed from technology development status, constraints, economic. (authors)

Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial.

Science.gov (United States)

Häske, David; Beckers, Stefan K; Hofmann, Marzellus; Lefering, Rolf; Grützner, Paul A; Stöckle, Ulrich; Papathanassiou, Vassilios; Münzberg, Matthias

2017-08-14

Prehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective training. Standardized courses, like PHTLS, are established for health care professionals to improve the prehospital care of trauma patients. The aim of the study was to investigate the subjective safety in prehospital trauma care and learning progress by paramedics in a longitudinal analysis. This was a prospective intervention trial and part of the mixed-method longitudinal EPPTC-trial, evaluating subjective and objective changes among participants and real patient care as a result of PHTLS courses. Participants were evaluated with pre/post questionnaires as well as one year after the course. We included 236 datasets. In the pre/post comparison, an increased performance could be observed in nearly all cases. The result shows that the expectations of the participants of the course were fully met even after one year (p = 0.002). The subjective safety in trauma care is significantly better even one year after the course (p < 0.001). Regression analysis showed that (ABCDE)-structure is decisive (p = 0.036) as well as safety in rare and common skills (both p < 0.001). Most skills are also rated better after one year. Knowledge and specific safety are assessed as worse after one year. The courses meet the expectations of the participants and increase the subjective safety in the prehospital care of trauma patients. ABCDE-structure and safety in skills are crucial. In the short term, both safety in skills and knowledge can be increased, but the courses do not have the power to maintain knowledge and specific subjective safety issues over a year. German Clinical Trials Register, ID DRKS00004713 , registered 14. February 2014.

Health care sensor--based systems for point of care monitoring and diagnostic applications: a brief survey.

Science.gov (United States)

Tsakalakis, Michail; Bourbakis, Nicolaos G

2014-01-01

Continuous, real-time remote monitoring through medical point--of--care (POC) systems appears to draw the interest of the scientific community for healthcare monitoring and diagnostic applications the last decades. Towards this direction a significant merit has been due to the advancements in several scientific fields. Portable, wearable and implantable apparatus may contribute to the betterment of today's healthcare system which suffers from fundamental hindrances. The number and heterogeneity of such devices and systems regarding both software and hardware components, i.e sensors, antennas, acquisition circuits, as well as the medical applications that are designed for, is impressive. Objective of the current study is to present the major technological advancements that are considered to be the driving forces in the design of such systems, to briefly state the new aspects they can deliver in healthcare and finally, the identification, categorization and a first level evaluation of them.

Burden and outcomes of pressure ulcers in cancer patients receiving the Kerala model of home based palliative care in India: Results from a prospective observational study

Directory of Open Access Journals (Sweden)

Biji M Sankaran

2015-01-01

Full Text Available Aim: To report the prevalence and outcomes of pressure ulcers (PU seen in a cohort of cancer patients requiring home-based palliative care. Materials and Methods: All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant. Results: Twenty-one of 108 (19.4% enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9% patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56. Conclusions: The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication. Clinical Trial Registry Number: CTRI/2014/03/004477

Prospective Evaluation of Self-Reported Aggression in Transgender Persons.

Science.gov (United States)

Defreyne, Justine; T'Sjoen, Guy; Bouman, Walter Pierre; Brewin, Nicola; Arcelus, Jon

2018-05-01

Although research on the relation between testosterone and aggression in humans is inconclusive, guidelines (including the World Professional Association for Transgender Health Standards of Care, edition 7) have warned for an increase in aggression in transgender men taking testosterone treatment. To investigate the association between levels of testosterone and aggression in treatment-seeking transgender people and explore the role of mental health psychopathology (anxiety and depressive symptoms) and social support in aggression in this population. Every transgender person invited for assessment at a national transgender health clinic in the United Kingdom during a 3-year period (2012-2015) completed self-report measures for interpersonal problems, including levels of aggression (Inventory of Interpersonal Problems [IIP-32]), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), social support (Multidimensional Scale of Perceived Social Support), and experiences of transphobia before and 1 year after the initiation of gender-affirming hormonal therapy. Correlations between prospective scores for the IIP-32 factor "too aggressive" and prospective levels of sex steroids, prospective psychological (HADS), and baseline psychosocial measurements were tested. Prospective scores for the factor "too aggressive" were not correlated to prospective serum testosterone levels. Results of 140 people (56 transgender men, 84 transgender women) were analyzed. A prospective increase in scores for the factor "too aggressive" of the IIP-32 in transgender men 1 year after being treated with testosterone treatment or a decrease of the IIP-32 aggression scores in transgender women 1 year after gender-affirming hormonal therapy was not found. However, a positive correlation was found between increasing HADS anxiety scores and increasing scores for the IIP-32 "too aggressive" score in the entire study population and a positive correlation with lower support

Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study.

Science.gov (United States)

Bloos, F; Müller, S; Harz, A; Gugel, M; Geil, D; Egerland, K; Reinhart, K; Marx, G

2009-08-01

Adherence to guidelines to avoid complications associated with mechanical ventilation is often incomplete. The goal of this study was to assess whether staff training in pre-defined interventions (bundle) improves the quality of care in mechanically ventilated patients. This study was performed on a 50-bed intensive care unit of a tertiary care university hospital. Application of a ventilator bundle consisting of semirecumbent positioning, lung protective ventilation in patients with acute lung injury (ALI), ulcer prophylaxis, and deep vein thrombosis prophylaxis (DVTP) was assessed before and after staff training in post-surgical patients requiring mechanical ventilation for at least 24 h. A total of 133 patients before and 141 patients after staff training were included. Overall bundle adherence increased from 15 to 33.8% (Pposition was achieved in 24.9% of patient days before and 46.9% of patient days after staff training (P90% was achieved in both groups. Median tidal volume in patients with ALI remained unaltered. Days on mechanical ventilation were reduced from 6 (interquartile range 2.0-15.0) to 4 (2.0-9.0) (P=0.017). Rate of ventilator-associated pneumonia (VAP), ICU length of stay, and ICU mortality remained unaffected. In patients with VAP, the median ICU length of stay was reduced by 9 days (P=0.04). Staff training by an ICU change team improved compliance to a pre-defined ventilator bundle. This led to a reduction in the days spent on mechanical ventilation, despite incomplete bundle implementation.

Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors.

NARCIS (Netherlands)

Lubberding, S.; van Uden-Kraan, C.F.; te Velde, E.A.; Cuijpers, P.; Leemans, C.R.; Verdonck-de Leeuw, I.M.

2015-01-01

Aims and objectives: To gain insight into cancer survivors' needs towards an eHealth application monitoring quality of life and targeting personalised access to supportive care. Background: Supportive care in cancer addresses survivors' concerns and needs. However, many survivors are not taking

Radiation detectors: needs and prospects

International Nuclear Information System (INIS)

Armantrout, G.A.

1981-01-01

Important applications for x- and γ-ray spectroscopy are found in prospecting, materials characterization, environmental monitoring, the life sciences, and nuclear physics. The specific requirements vary for each application with varying degrees of emphasis on either spectrometer resolution, detection efficiency, or both. Since no one spectrometer is ideally suited to this wide range of needs, compromises are usually required. Gas and scintillation spectrometers have reached a level of maturity, and recent interest has concentrated on semiconductor spectrometers. Germanium detectors are showing continuing refinement and are the spectrometers of choice for high resolution applications. The new high-Z semiconductors, such as CdTe and HgI 2 , have shown steady improvement but are limited in both resolution and size and will likely be used only in applications which require their unique properties

The new superconductors: Prospects for applications

International Nuclear Information System (INIS)

Wolsky, A.M.; Giese, R.F.; Daniels, E.J.

1989-01-01

Two years ago several groups around the world, excited by the discovery by K. Alex Mueller and J. Georg Bednorz of the IBM Zurich Research Laboratory of a superconducting ceramic oxide, developed an yttrium-barium-copper oxide that superconducted at 90 K. Since then other investigators have found two separate families of copper oxides, one incorporating bismuth and the other thallium, that superconduct at between 110 and 120 K. These high-temperature superconductors could be cooled to 77 degrees K with liquid nitrogen, which is cheap and abundant. This immediately suggested that certain applications of superconductivity long considered not to be economic or practical might be feasible. Yet many of the envisioned applications-generators and motors, energy storage, magnetically levitating trains-raise the same issues to which Onnes referred. It is not yet known whether the new materials can be made easily workable-strong and flexible enough to fashion into wire and other useful forms. Nor is it known whether they can be made to carry large currents and operate in intense magnetic fields. Whether the new discoveries will prove fruitful will depend on the progress made toward achieving design requirements for known applications and on identifying new applications as yet unforeseen. Indeed, such new applications may well have the greater impact. No one foresaw today's most important commercial use of superconductivity, magnetic-resonance imaging for medical diagnosis, in the 1960's, when niobium-3-tin and niobium-titanium were found to remain superconducting while carrying high currents in the presence of sizable magnetic fields. Leaving aside the unforeseen, an informed view of the economic and technical advantages of the new superconductors can help guide attempts to achieve the applications now being envisioned

Shared Care in Diabetes?

DEFF Research Database (Denmark)

Bødker, Keld

2006-01-01

The Danish National Board of Health has recently released a report that is intended to mark the start of a new project to establish it support for shared care in diabetes. In this paper I raise a number of concerns where lack of attention towards participation from prospective users constitute...

The situation and prospects of interventional nursing care in China

International Nuclear Information System (INIS)

Li Xiaorong; Xu Xiufang; Cheng Yongde

2009-01-01

Through the exploration and practice,the interventional nursing care has become an important part of Interventional Radiology, which bears a close relations to the pros and cons of the interventional therapeutic quality. The interventional nursing has been developing along the direction to become an independent nursing specialty. At the same time,various issues that affect the interventional nursing development start to emerge. At present, the setting up of a system to strengthen the establishment of the special care unit and human resources is urgently needed. The following measures are indispensable to promote the sustainable development of interventional care: to raise special awareness, to work out nursing routine and quality control standards, to explore the proficiency in order to stabilize nursing team, to pay attention to specialty education and to establish an integration mode for standardized training and professional development. (authors)

12 CFR 41.28 - Effective date, compliance date, and prospective application.

Science.gov (United States)

2010-01-01

... TREASURY FAIR CREDIT REPORTING Affiliate Marketing § 41.28 Effective date, compliance date, and prospective... an affiliate to make solicitations to a consumer if the bank receives such information prior to...

Mobile Health Applications for Caring of Older People: Review and Comparison.

Science.gov (United States)

Anthony Berauk, Victoria Laput; Murugiah, Muthu Kumar; Soh, Yee Chang; Chuan Sheng, Yap; Wong, Tin Wui; Ming, Long Chiau

2018-05-01

Mobile devices and applications (apps) that act as access tools for health care management aid in the improvement of clinical decision making and patient outcomes. However, the tremendous amount of mobile health (mHealth) apps available in commercial app stores makes it hard for the lay users as well as health care professionals to choose the right one for their individual needs. The contents and features of these apps have not been systematically reviewed and compared. This study aims to assess the contents and features of mHealth apps for caring of older people. A review and comparison of mHealth apps for caring of older people available in Google's Play Store (Android system) and Apple's App Store (iOS system) were performed. Systematic review of previous relevant literature were conducted. The assessment criteria used for comparison were requirement for Internet connection, information of disease, size of app, diagnostics and assessment tools, medical calculator, dosage recommendations and indications, clinical updates, drugs interaction checker, and information on disease management. Twenty-five mHealth apps were assessed. Medscape and Skyscape Medical Library are the most comprehensive mHealth apps for general drug information, medical references, clinical score, and medical calculator. Alzheimer's Disease Pocketcard and Confusion: Delirium & Dementia: A Bedside Guide apps are recommended for clinical assessment, diagnosis, drug information, and management of geriatric patients with Alzheimer disease, delirium, and dementia. More studies about mHealth apps for caring of older people are warranted to ensure the quality and reliability of the mHealth apps.

Managing health care costs: strategies available to small businesses.

Science.gov (United States)

Higgins, C W; Finley, L; Kinard, J

1990-07-01

Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.

Next generation terminology infrastructure to support interprofessional care planning.

Science.gov (United States)

Collins, Sarah; Klinkenberg-Ramirez, Stephanie; Tsivkin, Kira; Mar, Perry L; Iskhakova, Dina; Nandigam, Hari; Samal, Lipika; Rocha, Roberto A

2017-11-01

Develop a prototype of an interprofessional terminology and information model infrastructure that can enable care planning applications to facilitate patient-centered care, learn care plan linkages and associations, provide decision support, and enable automated, prospective analytics. The study steps included a 3 step approach: (1) Process model and clinical scenario development, and (2) Requirements analysis, and (3) Development and validation of information and terminology models. Components of the terminology model include: Health Concerns, Goals, Decisions, Interventions, Assessments, and Evaluations. A terminology infrastructure should: (A) Include discrete care plan concepts; (B) Include sets of profession-specific concerns, decisions, and interventions; (C) Communicate rationales, anticipatory guidance, and guidelines that inform decisions among the care team; (D) Define semantic linkages across clinical events and professions; (E) Define sets of shared patient goals and sub-goals, including patient stated goals; (F) Capture evaluation toward achievement of goals. These requirements were mapped to AHRQ Care Coordination Measures Framework. This study used a constrained set of clinician-validated clinical scenarios. Terminology models for goals and decisions are unavailable in SNOMED CT, limiting the ability to evaluate these aspects of the proposed infrastructure. Defining and linking subsets of care planning concepts appears to be feasible, but also essential to model interprofessional care planning for common co-occurring conditions and chronic diseases. We recommend the creation of goal dynamics and decision concepts in SNOMED CT to further enable the necessary models. Systems with flexible terminology management infrastructure may enable intelligent decision support to identify conflicting and aligned concerns, goals, decisions, and interventions in shared care plans, ultimately decreasing documentation effort and cognitive burden for clinicians and

Palliative sedation, not slow euthanasia: a prospective, longitudinal study of sedation in Flemish palliative care units.

Science.gov (United States)

Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

2011-01-01

Palliative sedation remains a much debated and controversial issue. The limited literature on the topic often fails to answer ethical questions concerning this practice. The aim of this study was to describe the characteristics of patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death. A prospective, longitudinal, descriptive design was used to assess data in eight PCUs. The total sample consisted of 266 patients. Information on demographics, medication, food and fluid intake, decision making, level of consciousness, and symptom experience were gathered by nurses and researchers three times a week. If patients received palliative sedation, extra information was gathered. Of all included patients (n=266), 7.5% received palliative sedation. Sedation started, on average, 2.5 days before death and for half of these patients, the form of sedation changed over time. At the start of sedation, patients were in the end stage of their illness and needed total care. Patients were fully conscious and had very limited oral food or fluid intake. Only three patients received artificial fluids at the start of sedation. Patients reported, on average, two refractory symptoms, the most important ones being pain, fatigue, depression, drowsiness, and loss of feeling of well-being. In all cases, the patient gave consent to start palliative sedation because of increased suffering. This study revealed that palliative sedation is only administered in exceptional cases where refractory suffering is evident and for those patients who are close to the ends of their lives. Moreover, this study supports the argument that palliative sedation has no life-shortening effect. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

CRISPR-Cas9 technology: applications in genome engineering, development of sequence-specific antimicrobials, and future prospects.

Science.gov (United States)

de la Fuente-Núñez, César; Lu, Timothy K

2017-02-20

The development of CRISPR-Cas9 technology has revolutionized our ability to edit DNA and to modulate expression levels of genes of interest, thus providing powerful tools to accelerate the precise engineering of a wide range of organisms. In addition, the CRISPR-Cas system can be harnessed to design "precision" antimicrobials that target bacterial pathogens in a DNA sequence-specific manner. This capability will enable killing of drug-resistant microbes by selectively targeting genes involved in antibiotic resistance, biofilm formation and virulence. Here, we review the origins and mechanistic basis of CRISPR-Cas systems, discuss how this technology can be leveraged to provide a range of applications in both eukaryotic and prokaryotic systems, and finish by outlining limitations and future prospects.

[Continuity of care from the acute care hospital: Results].

Science.gov (United States)

Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia

2015-01-01

To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Iterative learning control with applications in energy generation, lasers and health care.

Science.gov (United States)

Rogers, E; Tutty, O R

2016-09-01

Many physical systems make repeated executions of the same finite time duration task. One example is a robot in a factory or warehouse whose task is to collect an object in sequence from a location, transfer it over a finite duration, place it at a specified location or on a moving conveyor and then return for the next one and so on. Iterative learning control was especially developed for systems with this mode of operation and this paper gives an overview of this control design method using relatively recent relevant applications in wind turbines, free-electron lasers and health care, as exemplars to demonstrate its applicability.

Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study

DEFF Research Database (Denmark)

Prompers, L.; Huijberts, M.; Apelqvist, J.

2008-01-01

Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres...... suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot...... across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study...

Application of anatectic mineralization to prospecting in-situ leachable sandstone type uranium ore in South Songliao Basin

International Nuclear Information System (INIS)

Zhao Zhonghua

2001-01-01

The deep ore-forming origin is a new theory for prospecting in-situ leachable sandstone type uranium. Tectonics, lithologic and geochemistry are basic forecasting criteria. Previous unconsolidated sand, source area and geochemical barrier are three essential conditions for forming uranium deposit. Metallogenic environment and prospective region are found. Tertiary system is prospective layer for prospecting in-situ leachable sandstone type uranium ore in south Songliao Basin

Health services research in patients with breast cancer (CAMISS-prospective): study protocol for an observational prospective study

OpenAIRE

García-Gutierrez, Susana; Orive, Miren; Sarasqueta, Cristina; Legarreta, Maria Jose; Gonzalez, Nerea; Redondo, Maximino; Rivero, Amado; Serrano-Aguilar, Pedro; Castells, Xavier; Quintana, Jose Maria; Sala, Maria

2018-01-01

Background Though breast cancer remains a major health problem, there is a lack of information on health care provided to patients with this disease and associated costs. In addition, there is a need to update and validate risk stratification tools in Spain. Our purpose is to evaluate the health services provided for breast cancer in Spain, from screening and diagnosis to treatment and prognosis. Methods Prospective cohort study involving 13 hospitals in Spain with a follow-up period of up to...

Does prospect theory warrant a paradigm shift in the economics of risk?

Directory of Open Access Journals (Sweden)

PL Mohapi

2014-07-01

Full Text Available This paper assesses whether a paradigm shift should be made from expected utility framework to prospect theory framework – in the economics of choice under risk. A brief overview of the subject is outlined, starting with expected utility theory and noting its descriptive limitations. Proposed theories to make up for these limitations is also provided. Prospect theory emerged as the most serious challenger to expected utility theory. A review of some descriptive predictions of prospect theory, suggests that there is no scientific reason why expected utility should not be ousted from dominance by prospect theory. The shift to prospect theory however is not without costs. Conceptual complexities and non-universality of application associated with prospect theory should be embraced with the shift while not entirely abandoning expected utility theory.

The South African Surgical Outcomes Study: A 7-day prospective ...

African Journals Online (AJOL)

To investigate the perioperative mortality and need for critical care admission in patients undergoing inpatient non-cardiac surgery in SA. Methods. A 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient noncardiac surgery between 19 and 26 May 2014 at ...

Point-of-care estimation of haemoglobin concentration in neonates ...

African Journals Online (AJOL)

Objective. The HemoCue is a point-of-care analytical system for haemoglobin concentration (Hb) measurement. Point-of-care testing has been validated in hospitals and outpatient departments to assist with urgent patient management by providing rapid laboratory test results. Method. In this prospective study we compared ...

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis.

Science.gov (United States)

Street, Maryann; Phillips, Nicole M; Kent, Bridie; Colgan, Stephen; Mohebbi, Mohammadreza

2015-06-01

While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs. A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs. This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs. Published by the BMJ Publishing Group

Informed consent in paediatric critical care research--a South African perspective.

Science.gov (United States)

Morrow, Brenda M; Argent, Andrew C; Kling, Sharon

2015-09-09

Medical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources. Ethical oversight is essential for safe, appropriate research conduct. Informed consent by the parent or legal guardian is usually required for child research participation, but obtaining consent may be challenging in paediatric critical care research. Local regulations may also impede important research if overly restrictive. By narratively synthesising and contextualising the results of a comprehensive literature review, this paper describes ethical principles and regulations; potential barriers to obtaining prospective informed consent; and consent options in the context of paediatric critical care research in South Africa. Voluntary prospective informed consent from a parent or legal guardian is a statutory requirement for child research participation in South Africa. However, parents of critically ill or injured children might be incapable of or unwilling to provide the level of consent required to uphold the ethical principle of autonomy. In emergency care research it may not be practical to obtain consent when urgent action is required. Therapeutic misconceptions and sociocultural and language issues are also barriers to obtaining valid consent. Alternative consent options for paediatric critical care research include a waiver or deferred consent for minimal risk and/or emergency research, whilst prospective informed consent is appropriate for randomised trials of novel therapies or devices. We propose that parents or legal guardians of critically ill or injured children should only be approached to consent for their child's participation in clinical research when it is ethically justifiable and in the best interests of both

78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period

Science.gov (United States)

2013-05-17

.... Beneficiaries can experience improved health outcomes and encounters in the health care system when providers... providers that are working to redesign care to meet these goals. Payment approaches that reward providers... Care Improvement initiative. Acute care hospitals paid under the inpatient prospective payment systems...

Fire Engine Support and On-scene Time in Prehospital Stroke Care - A Prospective Observational Study.

Science.gov (United States)

Puolakka, Tuukka; Väyrynen, Taneli; Erkkilä, Elja-Pekka; Kuisma, Markku

2016-06-01

Introduction On-scene time (OST) previously has been shown to be a significant component of Emergency Medical Services' (EMS') operational delay in acute stroke. Since stroke patients are managed routinely by two-person ambulance crews, increasing the number of personnel available on the scene is a possible method to improve their performance. Hypothesis Using fire engine crews to support ambulances on the scene in acute stroke is hypothesized to be associated with a shorter OST. All patients transported to hospital as thrombolysis candidates during a one-year study period were registered by the ambulance crews using a case report form that included patient characteristics and operational EMS data. Seventy-seven patients (41 [53%] male; mean age of 68.9 years [SD=15]; mean Glasgow Coma Score [GCS] of 15 points [IQR=14-15]) were eligible for the study. Forty-five cases were managed by ambulance and fire engine crews together and 32 by the ambulance crews alone. The median ambulance response time was seven minutes (IQR=5-10) and the fire engine response time was six minutes (IQR=5-8). The number of EMS personnel on the scene was six (IQR=5-7) and two (IQR=2-2), and the OST was 21 minutes (IQR=18-26) and 24 minutes (IQR=20-32; P =.073) for the groups, respectively. In a following regression analysis, using stroke as the dispatch code was the only variable associated with short (engine crews to support ambulances in acute stroke care was not associated with a shorter on-scene stay when compared to standard management by two-person ambulance crews alone. Using stroke as the dispatch code was the only variable that was associated independently with a short OST. Puolakka T , Väyrynen T , Erkkilä E-P , Kuisma M . Fire engine support and on-scene time in prehospital stroke care - a prospective observational study. Prehosp Disaster Med. 2016;31(3):278-281.

Problems and prospects of neutron imaging

International Nuclear Information System (INIS)

Kobayashi, Hisao

2008-01-01

Technical problems and future prospects of neutron imaging and neutron radiography are reviewed and discussed for further development. For technical problems, neutron sources together with cold neutron, ultra-cold neutron, epithermal and fast-neutron beams, energy converters, and the intensity of neutron beam, dynamic range associated with imaging procedure, etc, are reviewed. As standardization, such indicators as beam purity, sensitivity, image quality, and beam quality are discussed and limitation of neutron radiography is also presented. As neutron imaging has developed as a nondestructive testing technique in industrial applications, further problems and prospects of quality control and qualification to perform neutron radiography, standardization and international cooperation of neutron imaging are discussed. (S. Ohno)

Mobile Applications for Women's Health and Midwifery Care: A Pocket Reference for the 21st Century.

Science.gov (United States)

Arbour, Megan W; Stec, Melissa A

2018-05-15

Midwives and other women's health care providers are charged with providing high-quality care to women based on the most current available evidence. Quick, reliable, and accurate access to evidence-based information is essential. Numerous smartphone and mobile device applications (apps) are available to assist clinicians in providing care for women. This article discusses clinical reference apps, including those for evidence-based care guidelines, women's health care, pharmacologic reference, laboratory and diagnostic guides, as well as apps for information storage and management, electronic health records, and client education. Midwives and other clinicians are encouraged to thoughtfully integrate mobile apps into their clinical practices to improve client outcomes and clinician and client satisfaction. Although the thousands of health care apps that are available may seem daunting, this article highlights key apps that may help clinicians improve their care of women. By adding one app at a time, midwives and other women's health care providers can successfully integrate mobile apps into clinical practice. © 2018 by the American College of Nurse-Midwives.

Methicillin-resistant Staphylococcus aureus: Prevalence, incidence, risk factors, and effects on survival of patients in a specialist palliative care unit: A prospective observational study.

Science.gov (United States)

Gleeson, Aoife; Larkin, Philip; Walsh, Cathal; O'Sullivan, Niamh

2016-04-01

Little is known about the impact of methicillin-resistant Staphylococcus aureus in palliative care settings. To date, the clinical impact of methicillin-resistant Staphylococcus aureus in palliative care is unknown. To determine prevalence and incidence of methicillin-resistant Staphylococcus aureus colonisation in a specialist palliative care setting, to identify risk factors for methicillin-resistant Staphylococcus aureus colonisation, to determine the eradication success rate and to determine the impact of methicillin-resistant Staphylococcus aureus on survival. Prospective cohort study. Data were collected for consecutive admissions to an inpatient palliative care service. Patients were screened for methicillin-resistant Staphylococcus aureus colonisation on admission and 1 week post admission. Methicillin-resistant Staphylococcus aureus eradication was attempted in methicillin-resistant Staphylococcus aureus positive patients. Data were collected from 609 admissions for 466 individual patients. Admission screening data were available in 95.5%. Prevalence of methicillin-resistant Staphylococcus aureus colonisation was 11.59% (54 patients). One week incidence of methicillin-resistant Staphylococcus aureus colonisation was 1.2%. Risk factors for methicillin-resistant Staphylococcus aureus colonisation were determined using Chi-Squared test and included high Waterlow score (p resistant Staphylococcus aureus status prior to admission (p resistant Staphylococcus aureus was eradicated in 8.1% of admissions, while 46 patients commenced on the protocol (62.2%) died before completing it. Methicillin-resistant Staphylococcus aureus did not significantly impact survival but was significantly associated with having infection episodes and longer length of stay. This study identified risk factors for methicillin-resistant Staphylococcus aureus colonisation in palliative care patients. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of patients. Hence

A monitoring/auditing mechanism for SSL/TLS secured service sessions in Health Care Applications.

Science.gov (United States)

Kavadias, C D; Koutsopoulos, K A; Vlachos, M P; Bourka, A; Kollias, V; Stassinopoulos, G

2003-01-01

This paper analyzes the SSL/TLS procedures and defines the functionality of a monitoring/auditing entity running in parallel with the protocol, which is decoding, checking the certificate and permitting session establishment based on the decoded certificate information, the network addresses of the endpoints and a predefined access list. Finally, this paper discusses how such a facility can be used for detection impersonation attempts in Health Care applications and provides case studies to show the effectiveness and applicability of the proposed method.

Racial differences in parental satisfaction with neonatal intensive care unit nursing care.

Science.gov (United States)

Martin, A E; D'Agostino, J A; Passarella, M; Lorch, S A

2016-11-01

Nurses provide parental support and education in the neonatal intensive care unit (NICU), but it is unknown if satisfaction and expectations about nursing care differ between racial groups. A prospective cohort was constructed of families with a premature infant presenting to primary care between 1 January 2010 and 1 January 2013 (N=249, 52% white, 42% black). Responses to questions about satisfaction with the NICU were analyzed in ATLAS.ti using the standard qualitative methodology. One hundred and twenty (48%) parents commented on nursing. Fifty-seven percent of the comments were positive, with black parents more negative (58%) compared with white parents (33%). Black parents were most dissatisfied with how nurses supported them, wanting compassionate and respectful communication. White parents were most dissatisfied with inconsistent nursing care and lack of education about their child. Racial differences were found in satisfaction and expectations with neonatal nursing care. Accounting for these differences will improve parental engagement during the NICU stay.

Development of a Health Care Information System for the Elderly at Home

Directory of Open Access Journals (Sweden)

Wang Dong

2016-01-01

Full Text Available The growing population aging is a serious social problem in the world today. Accidental death at home is increasing because abnormal conditions can not be discovered in time, especially to the elderly who live alone. Besides, according to statistics, over 80 percent of the elderly need the service of home care in China. A health care information system for the elderly at home is developed to monitor the real–time state of the elderly remotely in this thesis. The system can show the current positions of the elderly in the house and judge whether they are in dangerous locations or have dangerous activities. In the case of emergency, the elderly can press the emergency button. The system also provides some help for the elderly’s daily life. The system offers the advantage for living at home more safely and more comfortably, and has better application prospect

Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center - an Indian perspective.

Science.gov (United States)

Samudrala, Suvarna; Dandakeri, Sukumar; Bhat, Ramesh M

2018-05-01

Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5-8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit. A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed. A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%). This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India. © 2018 The International Society of Dermatology.

Living and dying: responsibility for end-of-life care in care homes without on-site nursing provision - a prospective study.

Science.gov (United States)

Handley, Melanie; Goodman, Claire; Froggatt, Katherine; Mathie, Elspeth; Gage, Heather; Manthorpe, Jill; Barclay, Stephen; Crang, Clare; Iliffe, Steve

2014-01-01

The aim of the study was to describe the expectations and experiences of end-of-life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed-method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were interviewed. The review of care home notes demonstrated that residents had a wide range of healthcare problems. Length of time in the care homes, functional ability or episodes of ill-health were not necessarily meaningful indicators to staff that a resident was about to die. General Practitioner and district nursing services provided a frequent but episodic service to individual residents. There were two recurring themes that affected how staff engaged with the process of advance care planning with residents; 'talking about dying' and 'integrating living and dying'. All participants stated that they were committed to providing end-of-life care and supporting residents to die in the care home, if wanted. However, the process was complicated by an ongoing lack of clarity about roles and responsibilities in providing end-of-life care, doubts from care home and primary healthcare staff about their capacity to work together when residents' trajectories to death were unclear. The findings suggest that to support this population, there is a need for a pattern of working between health and care staff that can encourage review and discussion between multiple participants over sustained periods of time. © 2013 John Wiley & Sons Ltd.

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

Directory of Open Access Journals (Sweden)

Regina Linder

2012-08-01

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

State of the art and prospective of large scale applications of YBCO thick films grown on metallic substrates

International Nuclear Information System (INIS)

Boffa, Vincenzo

1997-09-01

In the framework of the high temperature superconducting materials, YBa 2 Cu 3 O 7 (YBCO) shows very interesting intrinsic superconducting transport properties at temperature higher than the liquid nitrogen temperature. These properties are very important in large scale applications: transport of energy, magnets, transformers, etc. Unfortunately the potential of this material cannot be achieved today, since it is very difficult to manufacture YBCO based tapes or cables. In the last years several groups have tried to overcome the problems with new fabrication techniques. In the present report the state of the art and the prospective in the field of YBCO film fabrication on metallic substrates are presented

Quantifying the demand for hospital care services: a time and motion study.

Science.gov (United States)

van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T

2015-01-22

The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.

The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES study: background, design and rationale

Directory of Open Access Journals (Sweden)

McCargar Linda

2010-10-01

Full Text Available Abstract Background Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery. Methods/design Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada, with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

Science.gov (United States)

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

Hydrogeochemistry of uranium, daughter products and associated elements (lanthanides), application to ore prospection

International Nuclear Information System (INIS)

Toulhoat, P.

1987-09-01

The behavior in ground water of uranium, daughter products with long half life (U 234 , Th 230 , Ra 226 ) and stable (radiogenic lead) and lanthanides is studied by two complementary methods: 1) In situ multielement tracing in fracturated granitic rocks and porous sedimentary rocks of low permeability allowing to understand interactions between hydrodynamics and geochemistry. 2) Study of the properties of U 234 and Pb 236 which are mineralization tracers and are relatively independent of redox conditions, on the contrary U 238 has a low solubility in reducing medium. Three areas are studied: Bazois and Lodeve basin (France) and Cigar Lake (Canada). Radioactive disequilibriums are thoroughly studied when required by ore/rock interaction. Adsorption-desorption phenomena are of great importance in proposed prospection models. If prospection models based on alpha activity ratio U 234 /U 238 and lead isotope ratio in ground water can be applied, an integrated prospection model requires more in situ and laboratory experiments [fr

Nurses' experiences of using a smart mobile device application to assist home care for patients with chronic disease: a qualitative study.

Science.gov (United States)

Chiang, Kuei-Feng; Wang, Hsiu-Hung

2016-07-01

To examine nurses' experiences regarding the benefits and obstacles of using a smart mobile device application in home care. The popularity of mobile phones and Internet technology has established an opportunity for interaction between patients and health care professionals. Line is an application allowing instant communication that is available for free globally. However, the literature relating to use of Line in this area is limited. A qualitative study involving individual in-depth interviews. Participants included community nurses (N = 17) from six home care facilities in southern Taiwan who had used Line for home care of chronically ill patients for at least six months. The study was conducted using semi-structured in-depth interviews, which were recorded and converted into transcripts for content analysis. Seven themes emerged from data analysis: reduction in medical care consumption and costs, reduction in workload and stress, facilitating improvement in the quality of care, promotion of the nurse-patient relationship, perceived risk, lack of organisational incentives and operating procedures and disturbance to personal life. Nurses considered Line valuable for use in home care. While this application has diverse functions, its video transfer function could in particular help nursing staff make prompt decisions about patients' problems and promote nurse-patient relationships. However, there might be hidden risks including legal consequences, safety risks to patients, possible violations of professionalism and increased risk of nurse burnout. Increasing nursing staff awareness of using mobile messaging software applications is necessary. This study provides relevant information about the benefits, disadvantages, risks and limitations of nurses' use of Line. The study also provides suggestions for software programmers and future organisational strategy and development. © 2016 John Wiley & Sons Ltd.

Living and dying: responsibility for end-of-life care in care homes without on-site nursing provision - a prospective study

OpenAIRE

Handley, M; Goodman, C; Froggatt, K; Mathie, E; Gage, H; Manthorpe, J; Barclay, S; Crang, C; Iliffe, S

2014-01-01

The aim of the study was to describe the expectations and experiences of end-of-life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed-method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were intervie...

Pilot Study for Managing Complex Chronic Care Medicaid Patients With Diabetes Using a Mobile Health Application Achieves "Triple Aim" Improvement in a Primary Care Setting.

Science.gov (United States)

Bovbjerg, Marit L; Lee, Jenney; Wolff, Rosa; Bangs, Bobby; May, Michael A

2017-10-01

IN BRIEF Cost-effective innovations to improve health and health care in patients with complex chronic diseases are urgently needed. Mobile health (mHealth) remote monitoring applications (apps) are a promising technology to meet this need. This article reports on a study evaluating patients' use of a tablet device with an mHealth app and a cellular-enabled glucose meter that automatically uploaded blood glucose values to the app. Improvements were observed across all three components of the Patient Protection and Affordable Care Act's "triple aim." Self-rated wellness and numerous quality-of-care metrics improved, billed charges and paid claims decreased, but no changes in clinical endpoints were observed.

Effect of the maternal care manual from the perinatal education ...

African Journals Online (AJOL)

Objectives. To assess changes in the quality of antenatal and intrapartum care rendered by midwives following intervention with the Maternal Care Manual from the Perinatal Education Programme (PEP). Design. A prospective controlled study. Setting. A study town and two control towns in the Eastern Cape. Subjects.

Supporting and improving community health services-a prospective evaluation of ECHO technology in community palliative care nursing teams.

Science.gov (United States)

White, Clare; McIlfatrick, Sonja; Dunwoody, Lynn; Watson, Max

2015-12-01

Project ECHO (Extension for Community Healthcare Outcomes) uses teleconferencing technology to support and train healthcare providers (HCPs) remotely, and has improved care across the USA. A 6-month pilot was trialled in a community palliative care nursing setting to determine if ECHO would be effective in the UK in providing education and support to community hospice nurses (CHN). The pilot involved weekly 2 hour sessions of teaching and case-based discussions facilitated by hospice staff linking with nine teams of CHN using video conferencing technology. A mixed-methods prospective longitudinal cohort study was used to evaluate the pilot. Each CHN provided demographic data, and completed a written knowledge assessment and a self-efficacy tool before and after the pilot. Two focus groups were also performed after the pilot. 28 CHNs completed the evaluation. Mean knowledge score improved significantly from 71.3% to 82.7% (p=0.0005) as did overall self-efficacy scores following the ECHO pilot. Pre-ECHO (p=0.036) and Retro-Pretest ECHO (p=0.0005) self-efficacy were significantly lower than post-ECHO. There was no significant difference between Pretest and Retro-Pretest ECHO self-efficacy (p=0.063). 96% recorded gains in learning, and 90% felt that ECHO had improved the care they provided for patients. 83% would recommend ECHO to other HCPs. 70% stated the technology used in ECHO had given them access to education that would have been hard to access due to geography. This study supports the use of Project ECHO for CHNs in the UK by demonstrating how a 6-month pilot improved knowledge and self-efficacy. As a low-cost high-impact model, ECHO provides an affordable solution to addressing growing need. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Comparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.

Science.gov (United States)

Alexander, John C; Minhajuddin, Abu; Joshi, Girish P

2017-08-01

Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. This is a prospective trial comparing correlation between a clinically utilized vital sign monitor (Propaq CS, WelchAllyn, Skaneateles Falls, NY, USA) and four smartphone application-based monitors Instant Blood Pressure, Instant Blood Pressure Pro, Pulse Oximeter, and Pulse Oximeter Pro. We performed measurements of heart rate (HR), systolic blood pressures (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) using standard monitor and four smartphone applications. Analysis of variance was used to compare measurements from the applications to the routine monitor. The study was completed on 100 healthy volunteers. Comparison of routine monitor with the smartphone applications shows significant differences in terms of HR, SpO 2 and DBP. The SBP values from the applications were not significantly different from those from the routine monitor, but had wide limits of agreement signifying a large degree of variation in the compared values. The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.

Quality of interhospital transport of critically ill patients: a prospective audit

NARCIS (Netherlands)

Ligtenberg, JJM; Arnold, LG; Stienstra, Y; van der Werf, TS; Tulleken, JE; Zijlstra, JG; Meertens, John H. J. M.

Introduction The aim of transferring a critically ill patient to the intensive care unit (ICU) of a tertiary referral centre is to improve prognosis. The transport itself must be as safe as possible and should not pose additional risks. We performed a prospective audit of the quality of

Does Care Matter?

DEFF Research Database (Denmark)

Loft, Lisbeth Trille Gylling; Hogan, Dennis P.

2014-01-01

The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of child care and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources...... for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national context. In the presented application of care capital, we examine mothers’ entry to paid......-parental child care prior to employment is independently and positively associated with the timing of maternal employment entry. This finding applies both to first-time mothers (n = 3,800) and to mothers of multiple children (n = 6,600). Although data currently available for investigating child care capital...

Exploring the Potential of Predictive Analytics and Big Data in Emergency Care.

Science.gov (United States)

Janke, Alexander T; Overbeek, Daniel L; Kocher, Keith E; Levy, Phillip D

2016-02-01

Clinical research often focuses on resource-intensive causal inference, whereas the potential of predictive analytics with constantly increasing big data sources remains largely unexplored. Basic prediction, divorced from causal inference, is much easier with big data. Emergency care may benefit from this simpler application of big data. Historically, predictive analytics have played an important role in emergency care as simple heuristics for risk stratification. These tools generally follow a standard approach: parsimonious criteria, easy computability, and independent validation with distinct populations. Simplicity in a prediction tool is valuable, but technological advances make it no longer a necessity. Emergency care could benefit from clinical predictions built using data science tools with abundant potential input variables available in electronic medical records. Patients' risks could be stratified more precisely with large pools of data and lower resource requirements for comparing each clinical encounter to those that came before it, benefiting clinical decisionmaking and health systems operations. The largest value of predictive analytics comes early in the clinical encounter, in which diagnostic and prognostic uncertainty are high and resource-committing decisions need to be made. We propose an agenda for widening the application of predictive analytics in emergency care. Throughout, we express cautious optimism because there are myriad challenges related to database infrastructure, practitioner uptake, and patient acceptance. The quality of routinely compiled clinical data will remain an important limitation. Complementing big data sources with prospective data may be necessary if predictive analytics are to achieve their full potential to improve care quality in the emergency department. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Unhappiness and dissatisfaction in doctors cannot be predicted by selectors from medical school application forms: A prospective, longitudinal study

Directory of Open Access Journals (Sweden)

Ferguson E

2005-12-01

Full Text Available Abstract Background Personal statements and referees' reports are widely used on medical school application forms, particularly in the UK, to assess the suitability of candidates for a career in medicine. However there are few studies which assess the validity of such information for predicting unhappiness or dissatisfaction with a career in medicine. Here we combine data from a long-term prospective study of medical student selection and training, with an experimental approach in which a large number of assessors used a paired comparison technique to predict outcome. Methods Data from a large-scale prospective study of students applying to UK medical schools in 1990 were used to identify 40 pairs of doctors, matched by sex, for whom personal statements and referees' reports were available, and who in a 2002/3 follow-up study, one pair member was very satisfied and the other very dissatisfied with medicine as a career. In 2005, 96 assessors, who were experienced medical school selectors, doctors, medical students or psychology students, used information from the doctors' original applications to judge which member of each pair of doctors was the happier, more satisfied doctor. Results None of the groups of assessors were significantly different from chance expectations in using applicants' personal statements and the referees' reports to predict actual future satisfaction or dissatisfaction, the distribution being similar to binomial expectations. However judgements of pairs of application forms from pairs of doctors showed a non-binomial distribution, indicating consensus among assessors as to which doctor would be the happy doctor (although the consensus was wrong in half the cases. Assessors taking longer to do the task concurred more. Consensus judgements seem mainly to be based on referees' predictions of academic achievement (even though academic achievement is not actually a valid predictor of happiness or satisfaction. Conclusion

Antenatal care visits' absenteeism at a secondary care medical facility in Southwest Nigeria.

Science.gov (United States)

Oloko, Olakunle; Ogunbode, Olayinka Oladunjoye; Roberts, Olumuyiwa; Arowojolu, Ayodele Olatunji

2016-11-01

Antenatal care (ANC) is a specialised pattern of care organised for pregnant women with the goal of maintaining good health and promoting safe delivery of healthy infants. It is an indispensable part of effective maternity care services. This study identified the factors responsible for absenteeism from ANC follow-up visits. It was a hospital-based prospective cross-sectional descriptive study conducted at a faith based secondary healthcare facility in Ibadan, Nigeria. Relevant data were retrieved using interviewer-administered structured questionnaires and antenatal health record cards. The major reasons identified for absenteeism were delay in receiving hospital services due to long queues at service points and understaffing. The pregnant women aged 35 years and above were the most likely to miss the visits. Therefore, there is the need for hospital administrators and health care givers to make the services patient-friendly.

Information vs advertising in the market for hospital care.

Science.gov (United States)

Montefiori, Marcello

2008-09-01

Recent health care reforms have introduced prospective payments and have allowed patients to choose their preferred providers. The expected outcome is efficiency in production and an increase in the quality level. The former objective should be obtained by the prospective payment scheme; the latter by the demand mechanism, through the competition between providers. Unfortunately, because of asymmetry of information, patients are unable to observe the true quality and the demand for health care services depends on a perceived quality as influenced by the hospital advertising. Inefficiency in the resource allocation and social welfare loss are the two likely effects. In this paper we show how the purchaser can implement effective policies to overcome these undesired effects.

Applications of prospecting geochemical techniques to the search for and to the study of uranium deposits in metropolitan France

International Nuclear Information System (INIS)

Grimbert, Arnold

1957-01-01

After having recalled facts which leaded the CEA to use new geochemical techniques for the prospecting of uranium deposits through sampling and analysis of soils and waters, the author describes the organisation and methods implemented for this prospecting activity: team composition for sampling and analysis, role of each engineer and technician in the prospecting stages (preliminary study, routine prospecting, result interpretation), sampling and analysis processes. He also reports campaigns of geochemical prospecting: study of the La Chapelle Largeau deposit (objectives, geological context, preliminary study, routine prospecting, study of geochemical anomalies), tactical research on Verneix indices (study of radioactivity anomaly discovered by radio-prospecting), strategical searches in a non prospected area in the South of Avallon. The author discusses the issues of efficiency and cost price of this geochemical prospecting technique in soils and in waters. Appendices present the equipment and operation modality for soil sampling, and for soil sample preparation, and principles, equipment and products for soil analysis and for water analysis [fr

Medicaid prospective payment: Case-mix increase

Science.gov (United States)

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

Patient Decision Aids Improve Decision Quality and Patient Experience and Reduce Surgical Rates in Routine Orthopaedic Care: A Prospective Cohort Study.

Science.gov (United States)

Sepucha, Karen; Atlas, Steven J; Chang, Yuchiao; Dorrwachter, Janet; Freiberg, Andrew; Mangla, Mahima; Rubash, Harry E; Simmons, Leigh H; Cha, Thomas

2017-08-02

Patient decision aids are effective in randomized controlled trials, yet little is known about their impact in routine care. The purpose of this study was to examine whether decision aids increase shared decision-making when used in routine care. A prospective study was designed to evaluate the impact of a quality improvement project to increase the use of decision aids for patients with hip or knee osteoarthritis, lumbar disc herniation, or lumbar spinal stenosis. A usual care cohort was enrolled before the quality improvement project and an intervention cohort was enrolled after the project. Participants were surveyed 1 week after a specialist visit, and surgical status was collected at 6 months. Regression analyses adjusted for clustering of patients within clinicians and examined the impact on knowledge, patient reports of shared decision-making in the visit, and surgical rates. With 550 surveys, the study had 80% to 90% power to detect a difference in these key outcomes. The response rates to the 1-week survey were 70.6% (324 of 459) for the usual care cohort and 70.2% (328 of 467) for the intervention cohort. There was no significant difference (p > 0.05) in any patient characteristic between the 2 cohorts. More patients received decision aids in the intervention cohort at 63.6% compared with the usual care cohort at 27.3% (p = 0.007). Decision aid use was associated with higher knowledge scores, with a mean difference of 18.7 points (95% confidence interval [CI], 11.4 to 26.1 points; p < 0.001) for the usual care cohort and 15.3 points (95% CI, 7.5 to 23.0 points; p = 0.002) for the intervention cohort. Patients reported more shared decision-making (p = 0.009) in the visit with their surgeon in the intervention cohort, with a mean Shared Decision-Making Process score (and standard deviation) of 66.9 ± 27.5 points, compared with the usual care cohort at 62.5 ± 28.6 points. The majority of patients received their preferred treatment, and this did not differ

Determinants of prenatal health care utilisation by low-risk women: a prospective cohort study.

Science.gov (United States)

Feijen-de Jong, Esther I; Jansen, Danielle E M C; Baarveld, Frank; Boerleider, Agatha W; Spelten, Evelien; Schellevis, François; Reijneveld, Sijmen A

2015-06-01

Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. We used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care. We collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care. Inadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Magnesium, calcium and phosphorus in the intensive care unit: Do ...

African Journals Online (AJOL)

Magnesium, calcium and phosphorus are important electrolytes involved in the regulation of homeostasis. However the utility in monitoring them in critically ill patients is still unclear. We therefore undertook a prospective, non-interventional, single center study in the intensive care unit of a tertiary care hospital in ...

In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

DEFF Research Database (Denmark)

Mondrup, Frederik; Brabrand, Mikkel; Folkestad, Lars

2011-01-01

, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. METHOD: S: A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty...

Nurses' Needs for Care Robots in Integrated Nursing Care Services.

Science.gov (United States)

Lee, Jai-Yon; Song, Young Ae; Jung, Ji Young; Kim, Hyun Jeong; Kim, Bo Ram; Do, Hyun-Kyung; Lim, Jae-Young

2018-05-13

To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in an integrated nursing care services. Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced 'integrated nursing care services'; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. The study applied a cross-sectional survey. In 2016, we conducted a multi-center survey involving 302 registered nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. Trial center nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top three desired primary roles for care robots were 'measuring/monitoring', 'mobility/activity' and 'safety care'. 'Reduction in workload', especially in terms of 'other nursing services' which were categorized as non-value-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. Care robots are expected to be effective in integrated nursing care services, particularly in 'measuring/monitoring'. Such robots should decrease nurses' workload and minimize non-value-added nursing activities efficiently. No matter how excellent care robots are, they must co-operate with and be controlled by nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

OpenAIRE

Carlo Frondini; Maria L. Lunardelli

2013-01-01

Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary res...

Point-of-care ultrasound in aerospace medicine: known and potential applications.

Science.gov (United States)

Wagner, Michael S; Garcia, Kathleen; Martin, David S

2014-07-01

Since its initial introduction into the bedside assessment of the trauma patient via the Focused Assessment with Sonography for Trauma (FAST) exam, the use of point-of-care ultrasound has expanded rapidly. A growing body of literature demonstrates ultrasound can be used by nonradiologists as an extension of the physical exam to accurately diagnose or exclude a variety of conditions. These conditions include, but are not limited to, hemoperitoneum, pneumothorax, pulmonary edema, long-bone fracture, deep vein thrombosis, and elevated intracranial pressure. As ultrasound machines have become more compact and portable, their use has extended outside of hospitals to places where the physical exam and diagnostic capabilities may be limited, including the aviation environment. A number of studies using focused sonography have been performed to meet the diagnostic challenges of space medicine. The following article reviews the available literature on portable ultrasound use in aerospace medicine and highlights both known and potential applications of point-of-care ultrasound for the aeromedical clinician.

Primary Patient-Derived Cancer Cells and Their Potential for Personalized Cancer Patient Care

Directory of Open Access Journals (Sweden)

David P. Kodack

2017-12-01

Full Text Available Personalized cancer therapy is based on a patient’s tumor lineage, histopathology, expression analyses, and/or tumor DNA or RNA analysis. Here, we aim to develop an in vitro functional assay of a patient’s living cancer cells that could complement these approaches. We present methods for developing cell cultures from tumor biopsies and identify the types of samples and culture conditions associated with higher efficiency of model establishment. Toward the application of patient-derived cell cultures for personalized care, we established an immunofluorescence-based functional assay that quantifies cancer cell responses to targeted therapy in mixed cell cultures. Assaying patient-derived lung cancer cultures with this method showed promise in modeling patient response for diagnostic use. This platform should allow for the development of co-clinical trial studies to prospectively test the value of drug profiling on tumor-biopsy-derived cultures to direct patient care.

Early Child Care and Adolescent Functioning at the End of High School: Results from the NICHD Study of Early Child Care and Youth Development

Science.gov (United States)

Vandell, Deborah Lowe; Burchinal, Margaret; Pierce, Kim M.

2016-01-01

Relations between early child care and adolescent functioning at the end of high school (EOHS; M age = 18.3 years) were examined in a prospective longitudinal study of 1,214 children. Controlling for extensive measures of family background, early child care was associated with academic standing and behavioral adjustment at the EOHS. More…

Medical and Personal Care Applications of Bacteriocins Produced by Lactic Acid Bacteria

Science.gov (United States)

Dicks, L. M. T.; Heunis, T. D. J.; van Staden, D. A.; Brand, A.; Noll, K. Sutyak; Chikindas, M. L.

The frequent use of antibiotics has led to a crisis in the antibiotic ­resistance of pathogens associated with humans and animals. Antibiotic resistance and the emergence of multiresistant bacterial pathogens have led to the investigation of alternative antimicrobial agents to treat and prevent infections in both humans and animals. Research on antimicrobial peptides, with a special interest on bacteriocins of lactic acid bacteria, is entering a new era with novel applications other than food preservation. Many scientists are now focusing on the application of these peptides in medicinal and personal care products. However, it is difficult to assess the success of such ventures due to the dearth of information that has been published and the lack of clinical trials.

Prognosis of abdominal pain in children in primary care : A prospective cohort study

NARCIS (Netherlands)

Lisman-van Leeuwen, Yvonne; Spee, Leo A A; Benninga, Marc A; Bierma-Zeinstra, Sita M A; Berger, Marjolein Y

2013-01-01

PURPOSE: Abdominal pain is a common complaint in children. Because few data exist on its natural history, we wanted to investigate the prognosis of abdominal pain in children in general practice. METHODS: In a prospective cohort study of children (aged 4 to 17 years) complaining of abdominal pain,

Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

Directory of Open Access Journals (Sweden)

Vi Am Dinh

2015-01-01

Full Text Available Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS, standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course. Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course. Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows’ proficiency and confidence with ultrasound use in both the short- and long-term settings.

An exploration of the applicability of situational segmentation in the health care market: development of a situational taxonomy.

Science.gov (United States)

Gehrt, K C; Pinto, M B

1990-01-01

Competition in the health care market has intensified in recent years. Health care providers are increasingly adopting innovative marketing techniques to secure their positions in the marketplace. This paper examines an innovative marketing technique, situational segmentation, and assesses its applicability to the health care market. Situational segmentation has proven useful in many consumer goods markets but has received little attention in the context of health care marketing. A two-stage research process is used to develop a taxonomy of situational factors pertinent to health care choice. In stage one, focus group interviews are used to gather information which is instrumental to questionnaire development. In stage two, the responses of 151 subjects to a 51 item questionnaire are factor analyzed. The results demonstrate that situational segmentation is a viable strategy in the health care market.

Prospective analysis of skin findings in surgical critically Ill patients intensive care unit

Directory of Open Access Journals (Sweden)

Suzan Demir Pektas

2017-01-01

Full Text Available Background: Intensive Care Units (ICUs are places where critically ill patients are managed. Aim: We aimed to investigate skin disorders that developed in critically ill surgical patients during their stay in the ICU. Methods: The prevalence of dermatological disorders and factors affecting their clinical features was prospectively analyzed in surgical ICU patients. We recorded age, sex, type of ICU, comorbidities, skin disorders, time to consultation, duration of ICU stay, and mortality rate. Results: Our study included 605 patients (mean age of 60.1 ± 20.2 years; 56.4% males. Seventy-three (12.1% patients were consulted with the Dermatology Department, among which 28.8% had infectious dermatological lesions, 26% dermatoses, and 45.2% drug reactions. The most common infectious dermatological disorder was wound infection (55.6%, the most common drug reaction was maculopapular drug eruption (75.8%, and the most common dermatosis was frictional blisters (47.4%. Multiple comorbidities, hypertension, diabetes mellitus, coronary artery disease, Parkinson disease, and stroke increased dermatological disorders (P < 0.05. The consulted patients had a median ICU stay of 7 days (range 2–53 days; consultation was significantly more common when it exceeded 10 days (74% vs. 26%, P < 0.05. The consulted patients died more commonly (P < 0.05. Infectious dermatological disorders and dermatoses were more common in patients older and younger than 50 years, respectively (P < 0.05. Dermatoses were more common among women (P < 0.05. The median time to consultation was 6 (2–30 days; it was longest for dermatological infections and shortest for dermatoses (P < 0.05. Infectious dermatological disorders were significantly more common among the deceased patients (P < 0.05. Conclusion: Multiple factors including multiple comorbidities, duration of ICU stay, time to consultation, and mortality increase dermatological disorders among surgical ICU patients.

Mobile Applications for Patient-centered Care Coordination: A Review of Human Factors Methods Applied to their Design, Development, and Evaluation.

Science.gov (United States)

Baysari, M T; Westbrook, J I

2015-08-13

To examine if human factors methods were applied in the design, development, and evaluation of mobile applications developed to facilitate aspects of patient-centered care coordination. We searched MEDLINE and EMBASE (2013-2014) for studies describing the design or the evaluation of a mobile health application that aimed to support patients' active involvement in the coordination of their care. 34 papers met the inclusion criteria. Applications ranged from tools that supported self-management of specific conditions (e.g. asthma) to tools that provided coaching or education. Twelve of the 15 papers describing the design or development of an app reported the use of a human factors approach. The most frequently used methods were interviews and surveys, which often included an exploration of participants' current use of information technology. Sixteen papers described the evaluation of a patient application in practice. All of them adopted a human factors approach, typically an examination of the use of app features and/or surveys or interviews which enquired about patients' views of the effects of using the app on their behaviors (e.g. medication adherence), knowledge, and relationships with healthcare providers. No study in our review assessed the impact of mobile applications on health outcomes. The potential of mobile health applications to assist patients to more actively engage in the management of their care has resulted in a large number of applications being developed. Our review showed that human factors approaches are nearly always adopted to some extent in the design, development, and evaluation of mobile applications.

Pharmacist Advancement of Transitions of Care to Home (PATCH) Service.

Science.gov (United States)

Trang, Joseph; Martinez, Amanda; Aslam, Sadaf; Duong, Minh-Tri

2015-11-01

There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists. To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs). A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care. Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS. Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

Development of the teaching simulator based on animated film to strengthening pedagogical competencies of prospective teachers

Science.gov (United States)

Fatimah, Siti; Setiawan, Wawan; Kusnendar, Jajang; Rasim, Junaeti, Enjun; Anggraeni, Ria

2017-05-01

Debriefing of pedagogical competence through both theory and practice which became a requirement for prospective teachers were through micro teaching and teaching practice program. But, some reports from the partner schools stated that the participants of teaching practice program have not well prepared on implementing the learning in the classroom because of lacking the debriefing. In line with the development of information technology, it is very possible to develop a media briefing of pedagogical competencies for prospective teachers through an application so that they can use it anytime and anywhere. This study was one answer to the problem of unpreparedness participants of the teaching practice program. This study developed a teaching simulator, which was an application for learning simulation with the animated film to enhance the professional pedagogical competence prospective teachers. By the application of this teaching simulator, students as prospective teacher could test their own pedagogic competence through learning models with different varied characteristics of students. Teaching Simulator has been equipped with features that allow users to be able to explore the quality of teaching techniques that they employ for the teaching and learning activities in the classroom. These features included the election approaches, the student's character, learning materials, questioning techniques, discussion, and evaluation. Teaching simulator application provided the ease of prospective teachers or teachers in implementing the development of lessons for practice in the classroom. Applications that have been developed to apply simulation models allow users to freely manage a lesson. Development of teaching simulator application was passed through the stages which include needs assessment, design, coding, testing, revision, improvement, grading, and packaging. The application of teaching simulator was also enriched with some real instructional video as a comparison

Prospects, achievements, challenges and opportunities for scaling-up malaria chemoprevention in pregnancy in Tanzania

DEFF Research Database (Denmark)

Mubyazi, Godfrey M.; Bygbjerg, Ib Christian; Magnussen, Pascal

2008-01-01

To describe the prospects, achievements, challenges and opportunities for implementing intermittent preventive treatment for malaria in pregnancy (IPTp) in Tanzania in light of national antenatal care (ANC) guidelines and ability of service providers to comply with them....

Family Practitioners' Advice about Taking Time Off Work for Lower Respiratory Tract Infections: A Prospective Study in Twelve European Primary Care Networks.

Science.gov (United States)

Godycki-Cwirko, Maciek; Nocun, Marek; Butler, Christopher C; Little, Paul; Verheij, Theo; Hood, Kerenza; Fleten, Nils; Kowalczyk, Anna; Melbye, Hasse

2016-01-01

Acute cough and lower respiratory tract infections (LRTIs) are one of the most important causes of lost working hours. to explore variation and predictors in family practitioners (FPs) advice to patients with LRTIs about taking time off work in different European countries. Prospective observational study in primary care networks in 12 countries, with multilevel mixed-effects binomial logistic regression. 324 FPs recruited 1616 employed adults who presented to primary care with LRTIs. The proportion of patients advised to take time off work varied from 7.6% in the Netherlands to 89.2% in Slovakia, and of these, 88.2% overall were advised to stay off work for seven days or less. None of Finnish or Dutch patients were advised to take more than 7 days off, in contrast to 35.5% of Polish and 27.0% of Slovak patients. The strongest predictors of FPs' advice about time off work were: patient symptoms interfering with normal activities (OR 4.43; Pwork, which is not explained by differences in patients' reported illness duration, but might be explained by differences in regulations around certification and sick pay. Evidence based guidance for advising patients about taking time off work for this common condition is needed.

Learning by doing? Prospective elementary teachers' developing understandings of scientific inquiry and science teaching and learning

Science.gov (United States)

Haefner, Leigh Ann; Zembal-Saul, Carla

This study examined prospective elementary teachers' learning about scientific inquiry in the context of an innovative life science course. Research questions included: (1) What do prospective elementary teachers learn about scientific inquiry within the context of the course? and (2) In what ways do their experiences engaging in science investigations and teaching inquiry-oriented science influence prospective elementary teachers' understanding of science and science learning and teaching? Eleven prospective elementary teachers participated in this qualitative, multi-participant case study. Constant comparative analysis strategies attempted to build abstractions and explanations across participants around the constructs of the study. Findings suggest that engaging in scientific inquiry supported the development more appropriate understandings of science and scientific inquiry, and that prospective teachers became more accepting of approaches to teaching science that encourage children's questions about science phenomena. Implications include careful consideration of learning experiences crafted for prospective elementary teachers to support the development of robust subject matter knowledge.

[Application and evalauation of care plan for patients admitted to Intensive Care Units].

Science.gov (United States)

Cuzco Cabellos, C; Guasch Pomés, N

2015-01-01

Assess whether the use of the nursing care plans improves outcomes of nursing care to patients admitted to the intensive care unit (ICU). The study was conducted in a University Hospital of Barcelona in Spain, using a pre- and post-study design. A total of 61 patient records were analysed in the pre-intervention group. A care plan was applied to 55 patients in the post-intervention group. Specific quality indicators in a medical intensive care unit to assess the clinical practice of nursing were used. Fisher's exact test was used to compare the degree of association between quality indicators in the two groups. A total of 116 records of 121 patients were evaluated: 61 pre-intervention and 55 post-intervention. Fisher test: The filling of nursing records, p=.0003. Checking cardiorespiratory arrest equipment, p <.001. Central vascular catheter related bacteraemia (B-CVC) p=.622. Ventilator associated pneumonia (VAP) p=.1000. Elevation of the head of the bed more than 30° p=.049, and the pain management in non-sedated patients p=.082. The implementation of nursing care plans in patients admitted to the intensive care area may contribute to improvement in the outcomes of nursing care. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

International prospects for clean coal technologies (Focus on Asia)

Energy Technology Data Exchange (ETDEWEB)

Gallaspy, D.T. [Southern Energy, Inc., Atlanta, GA (United States)

1997-12-31

The purpose of this paper is to propose Asia as a focus market for commercialization of CCT`s; describe the principles for successful penetration of CCT`s in the international market; and summarize prospects for CCT`s in Asia and other international markets. The paper outlines the following: Southern Company`s clean coal commitment; acquisition of Consolidated Electric Power Asia (CEPA); the prospects for CCT`s internationally; requirements for CCT`s widespread commercialization; CEPA`s application of CCT`s; and gas turbine power plants as a perfect example of a commercialization driver.

Acute renal failure in acute poisoning: prospective study from a tertiary care centre of South India.

Science.gov (United States)

Sweni, Shah; Meenakshisundaram, Ramachandran; Sakthirajan, R; Rajendiran, Chinnasamy; Thirumalaikolundusubramanian, Ponniah

2012-03-01

Cases of people presenting with poisoning are likely to develop acute renal failure (ARF), which may be due to multiple mechanisms/aetiologies. These cases need careful observation and appropriate treatment. To find the risk of ARF among acute poisoning cases, identify the underlying causes and to analyse the outcome. In this prospective study with nested case control, 1,250 cases admitted to the Poison Control, Training and Research Centre of Government General Hospital, Madras Medical College were monitored and evaluated for development of ARF. Patients with history of diabetes/hypertension, known chronic kidney disease, chronic NSAID therapy, those on drugs that increase serum creatinine by inhibiting creatinine secretion and other co-morbid illnesses were excluded. Data were interpreted after subjecting them to bivariate logistic regression and then step wise multivariate analysis. Thirty-two cases developed ARF. Twenty-four were due to snake bite, the rest due to chemical poisons. Chances of developing ARF were greater (6.15%) among the poisoning due to bites and stings than chemical poisoning (0.9%). Five in the former and seven in the latter expired. Among cases bitten by snakes, only 22 (7%) cases bitten by Russell Viper Daboia russelii developed renal failure. Copper sulphate and rat killer poisonings were the commonest causes of chemical induced ARF, dichromate, indigenous medicines and vasmol 33 (paraphenelyne diamine) were the least causes for ARF. None of the patients with organophosphate developed ARF nor did any of the 150 admitted for overdose of medicines developed ARF. The risk of ARF among the cases of poisoning was 2.5%. The outcome of ARF among bites and stings was better than chemical poisoning, and the difference was highly significant (p= 0.005, OR = 0.04-1.0, 95% CI = 0.004-0.38). Early recognition and appropriate measures reduce the occurrence of ARF. © 2011 European Dialysis and Transplant Nurses Association/European Renal Care

New concept of age(ing: Prospective age

Directory of Open Access Journals (Sweden)

Devedžić Mirjana

2012-01-01

indicators was constructed, redefined more precisely, based on prospective age: (prospective share of the elderly, (prospective median age and (prospective old age dependency ratio. With respect to the remaining years of life in the calculation of demographic aging, world’s population will be in rejuvenation process by 2035, longer and more intense than defined by proportion of the elderly. Prospective approach found that longer life expectancy in developing countries is not only a result of the decrease in infant and child mortality, but also the decrease of the old population mortality. Data used in this paper are from period life tables and censuses, for period 1953-2010. Prospective age threshold in Serbia was always higher than retrospective age (60,17 in 1953 .and 63,15 in 2010. for total population , or the proportion of people with a life expectancy less than 15 years has consistently been higher than the share of people older than 65 years (17.86% vs. 16.92% in 2010. According to prospective criteria, differences between men and women almost do not existent, so that it calls into question the widely accepted feminization of the elderly. The same conclusion stands when we discuss (prospective median age, population is older using prospective (47,15 years than traditional (41.41 indicator in 2010, also, compared with rest of the region or with more developed countries, prospective median age is higher in Serbia. Also, prospective old-age dependency ratio is higher than conventional one during analyzed period. Prospective concept and amendments are necessary in public policy, especially pension and health care system, because in combination with traditional approaches can create more justified distribution for older and younger generations.

41 CFR 102-81.30 - What information must job applicants at child care centers reveal?

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What information must... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 81-SECURITY Security § 102-81.30 What information must job applicants at child care centers reveal...

Indonesian heath care and the economic crisis: is managed care the needed reform?