Sample records for providing in-home aeds

  1. Current Practices in Home Management of Nasogastric Tube Placement in Pediatric Patients: A Survey of Parents and Homecare Providers. (United States)

    Northington, LaDonna; Lyman, Beth; Guenter, Peggi; Irving, Sharon Y; Duesing, Lori

    Enteral feeding tubes are used in pediatric patients to deliver nutrition, fluids or medications. The literature related to short-term feeding tube (nasogastric [NG], hereafter known as NGT, or orogastric [OGT],) use in pediatric homecare patients is sparse. This descriptive study sought to gather baseline information about these children and how their feeding tubes are managed at home. Specifically, we sought to better understand how the tubes are placed and the method(s) used for tube placement verification. Two surveys were distributed: one to parents and one to homecare providers who have direct patient contact. Responses were obtained from 144 parents and 66 homecare providers. Over half of the children were 12months of age or younger and had a 6 Fr feeding tube. Over 75% (108) had an NGT for 1year or less. Predominantly parents replaced the NGT but a few children self-inserted their tubes. Feeding tube placement was verified by auscultation (44%) or measurement of gastric pH (25%) in the parent's survey. Twenty-six percent of parents indicated they had misplaced an NGT at least once and 35 parents described symptoms of pulmonary misplacement. The homecare provider data indicated auscultation (39%) and pH measurement of gastric contents (28%) to verify NG tube placement location. Study results confirms a need for consistency of practice among health care professionals and in parent education for those children who require NGTs at home. It is troubling that auscultation is still widely used for NGT location confirmation despite practice alerts that warn against its use. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Meeting psychosocial needs for persons with dementia in home care services - a qualitative study of different perceptions and practices among health care providers. (United States)

    Hansen, Anette; Hauge, Solveig; Bergland, Ådel


    The majority of persons with dementia are home-dwelling. To enable these persons to stay in their own homes as long as possible, a holistic, individual and flexible care is recommended. Despite a requirement for meeting psychological, social and physical needs, home care services seem to focus on patients' physical needs. Accordingly, the aim of this study was to explore how the psychosocial needs of home-dwelling, older persons with dementia were perceived, emphasized and met by home care services. A descriptive, qualitative approach was used. Data were collected through semi-structured focus group interviews with 24 health care providers in home care services from four municipalities. Data were analysed using systematic text condensation. This study showed major differences in how health care providers perceived the psychosocial needs of older home-dwelling persons with dementia and how they perceived their responsibilities for meeting those psychosocial needs. The differences in the health care providers' perceptions seemed to significantly influence the provided care. Three co-existing logics of care were identified: the physical need-oriented logic, the renouncement logic and the integrated logic. The differences in how health care providers perceived the psychosocial needs of persons with dementia and their responsibilities for meeting those needs, influenced how the psychosocial needs were met. These differences indicates a need for a clarification of how psychosocial needs should be conceptualized and who should be responsible for meeting these needs. Further, increased competence and increased consciousness of psychosocial needs and how those needs can be met, are essential for delivering high-quality holistic care that enables persons with dementia to live in their own home for as long as possible.

  3. The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers (United States)

    Gantert, Thomas W.; McWilliam, Carol L.; Ward-Griffin, Catherine; Allen, Natalie J.


    Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider-client interactions have the…

  4. The key to me: seniors' perceptions of relationship-building with in-home service providers. (United States)

    Gantert, Thomas W; McWilliam, Carol L; Ward-Griffin, Catherine; Allen, Natalie J


    Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider-client interactions have the potential to undermine relationship building. While the former has been documented, how seniors perceive relationship building within the home has received little attention. The purpose of this study was to explore seniors' perspectives on relationship building with in-home providers, focusing particularly on the facilitators of and barriers to this experience. Applying interpretive phenomenology, in-depth interviews were conducted with a purposeful sample of senior clients and an immersion/crystallization analysis strategy was used to elicit the findings. Findings revealed that seniors perceived relationship building as a dynamic process that encompassed facilitators and barriers at both individual and contextual levels. The interpretive findings afford several insights into building provider-client relationships within the in-home context.

  5. Providing for energy efficiency in homes and small buildings: teacher guide

    Energy Technology Data Exchange (ETDEWEB)



    A teacher guide to the basic manual, providing for energy efficiency in homes and small buildings, is presented. Three parts to the manual are: understanding and practicing energy conservation in buildings; determining amount of energy lost or gained in a building; and determining which practices are most efficient and installing materials. The guide gives answers to questions in the student workbook and directions for special exercises and problems related to the subject.

  6. Providing for energy efficiency in homes and small buildings. Part II. Determining amount of energy lost or gained in a building

    Energy Technology Data Exchange (ETDEWEB)



    The training program is designed to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. There are 3 parts to the training program. They are entitled: Understanding and Practicing Energy Conservation in Buildings; Determining Amount of Energy Lost or Gained in a Building; and Determining Which Practices Are Most Efficient and Installing Materials. For Part Two, it is recommended that cooling and heating load calculation manual (GRP 158) ASHRAE, 1979, be used. Specific subjects covered in Part II are: Terms Used to Measure Energy in Buildings; Understanding Heat Losses and Gains in Buildings; Estimating Heating Loads in Buildings; Special Applications for Estimating Cooling Loads in Buildings; Estimating Cooling Loads in Buildings; and Determining Cost Benefits of Using Energy-Saving Practices.

  7. A randomized, controlled study to evaluate the role of an in-home asthma disease management program provided by respiratory therapists in improving outcomes and reducing the cost of care. (United States)

    Shelledy, David C; Legrand, Terry S; Gardner, Donna D; Peters, Jay I


    Asthma management programs (AMP) may reduce costs and improve outcomes in patients with moderate to severe asthma. However, it is not known which personnel are best able to deliver such interventions and what settings are most effective. The purpose of this study was to compare the effects of an in-home AMP provided by respiratory therapists (RTs) to an AMP provided by nurses (RNs) and to usual care (UC) provided in physician offices or clinics. Subjects (age 18-64) who had been admitted to the emergency department (ED) or hospital for acute asthma exacerbation were randomized to three groups: AMP-RT, AMP-RN or UC. The AMP groups received five (5) weekly home visits to provide assessment and instruction; the UC group was instructed to return to their physician for routine follow-up. Outcomes assessed at 6 months included hospitalizations, in patient days, hospitalization cost, ED visits and cost, clinic visits, pulmonary function, symptoms, health related quality of life (HRQOL), asthma episode self-management score (AESM), environmental assessment, and patient satisfaction (PS). Variables were compared using ANOVA with a Neuman-Keuls follow-up for multiple comparisons using an intent-to-treat approach. Upon enrollment, (n = 159) there were no differences (p > .05) between groups for age, gender, pulmonary function or HRQOL (SF-36 and St. Georges Respiratory Questionnaire - SGRQ). At 6 months, both AMP groups (AMP-RN n = 54; AMP-RT n = 46) had significantly fewer (p management program can be effectively delivered by respiratory therapists and may reduce hospitalizations, in-patient days, cost and improve measures of HRQOL and PS in a population prone to asthma exacerbation.

  8. A clinical trial of in-home CBT for depressed mothers in home visitation. (United States)

    Ammerman, Robert T; Putnam, Frank W; Altaye, Mekibib; Stevens, Jack; Teeters, Angelique R; Van Ginkel, Judith B


    Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs. Copyright © 2013. Published by Elsevier Ltd.

  9. A Clinical Trial of In-Home CBT for Depressed Mothers in Home Visitation (United States)

    Ammerman, Robert T.; Putnam, Frank W.; Altaye, Mekibib; Stevens, Jack; Teeters, Angelique R.; Van Ginkel, Judith B.


    Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs. PMID:23768664

  10. Underweight and malnutrition in home care: A multicenter study. (United States)

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


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

  11. Role of informal care providers in home based long term care in diabetes mellitus at Kaiwara Primary Health Center area, Karnataka, India

    Directory of Open Access Journals (Sweden)

    Arjunan Isaac


    Full Text Available Objective: To find the prevalence of diabetics, identify informal care providers for them in Kaiwara Primary Health Center (PHC area, assess the level of knowledge and skills of an informal care provider in home based long term care and improve the level of knowledge and skill of the informal care provider through a structured training capsule. Methods: A cross sectional and an interventional study was conducted on diabetics and their informal care providers in Kaiwara PHC area. Data were collected using pre-tested, structured questionnaire by an interview method. A structured training capsule was developed and implemented. Evaluation of the knowledge and skills was assessed at the beginning and at the end of the training. Student ’s paired/unpaired ‘t ’ tests and correlation analysis were done. Results: Improvement scores were calculated by subtracting the pre-evaluation scores from the post-evaluation scores. The mean improvement scores was (2.66暲0.32 and was statistically significant (P<0.001. No significant difference in mean values was found in the knowledge and skills scores in relation to the socio-demographic variables in the study. Conclusions: Knowledge and skills component of the informal care provider in home based care of diabetes could be perceived as a “felt need ”.

  12. Medication errors in home care: a qualitative focus group study. (United States)

    Berland, Astrid; Bentsen, Signe Berit


    To explore registered nurses' experiences of medication errors and patient safety in home care. The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. An exploratory qualitative design with focus group interviews was used. Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications. © 2017 John Wiley & Sons Ltd.

  13. Integrating Advanced Practice Nurses in Home Care. Recommendations for a Teaching Home Care Program. (United States)

    Mitty, Ethel; Mezey, Mathy


    A telephone survey of home care agencies and providers revealed a need for the following: evidence of the effectiveness of nurse practitioners in home care, regulatory and financial support for nurse practitioner home care, and development of home care agencies as clinical sites for training. (SK)

  14. Providing for energy efficiency in homes and small buildings. Part III. Determining which practices are most effective and installing materials

    Energy Technology Data Exchange (ETDEWEB)



    The training program is designed to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. A teacher guide and student workbook are available to supplement the basic manual. Subjects covered in Part III are: determining which practices are most efficient and economical; installing energy-saving materials; and improving efficiency of equipment.

  15. Providing for energy efficiency in homes and small buildings. Part I. Understanding and practicing energy conservation in buildings

    Energy Technology Data Exchange (ETDEWEB)

    Parady, W. Harold; Turner, J. Howard


    This is a training program to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. A teacher guide and student workbook are available to supplement the basic guide, which contains three parts. Part I considers the following: understanding the importance of energy; developing a concern for conserving energy; understanding the use of energy in buildings; care and maintenance of energy-efficient buildings; and developing energy-saving habits. A bibliography is presented.

  16. Providing Opportunities to Learn in Home-Based Child Care Settings: Observations of Learning Contexts and Behavior (United States)

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


    Research Findings: This observation study investigated the prevalence and correlates of learning contexts provided to preschool-age children in 133 registered child care homes in below-average-income neighborhoods in the U.S. Pacific Northwest. On average, 30% of the observed proportion of time was spent in structured teacher-led activities, 51%…

  17. A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study

    Directory of Open Access Journals (Sweden)

    Murray Mary-Anne


    Full Text Available Abstract Background Shared decision making (SDM is fundamental to informed consent and client-centered care. So far, SDM frameworks have been limited to the client-physician dyad, even though care is increasingly delivered by interprofessional (IP teams. IP collaboration is especially essential in home care, one of health care's most rapidly growing areas. This study will assess whether it is possible to practice SDM in IP home care. Methods/Design We will use a qualitative case study and a quantitative survey to capture the macro, meso and micro levels of stakeholders in home care. The case study will follow the knowledge-to-action process framework to evaluate the work of an IP home care team at a Quebec City health center. Sources of data will include one-on-one interviews with patients, family caregivers or surrogates and significant others, and administrators; a focus group of home care health professionals; organizational documents; and government policies and standards. The interview guide for the interviews and the focus group will explore current practices and clinical problems addressed in home care; factors that could influence the implementation of the proposed IP approach to SDM; the face and content validity of the approach; and interventions to facilitate the implementation and evaluation of the approach. The survey will ask 300 health professionals working in home care at the health center to complete a questionnaire based on the Theory of Planned Behaviour that measures their intentions to engage in an IP approach to SDM. We will use our analysis of the individual interviews, the focus group and the survey to elaborate a toolkit for implementing an IP approach to SDM in home care. Finally, we will conduct a pilot study in Alberta to assess the transferability of our findings. Discussion We believe that developing tools to implement IP SDM in home care is essential to strengthening Canada's healthcare system and furthering

  18. Safety in home care: A research protocol for studying medication management

    Directory of Open Access Journals (Sweden)

    Easty Anthony


    Full Text Available Abstract Background Patient safety is an ongoing global priority, with medication safety considered a prevalent, high-risk area of concern. Yet, we have little understanding of the supports and barriers to safe medication management in the Canadian home care environment. There is a clear need to engage the providers and recipients of care in studying and improving medication safety with collaborative approaches to exploring the nature and safety of medication management in home care. Methods A socio-ecological perspective on health and health systems drives our iterative qualitative study on medication safety with elderly home care clients, family members and other informal caregivers, and home care providers. As we purposively sample across four Canadian provinces: Alberta (AB, Ontario (ON, Quebec (QC and Nova Scotia (NS, we will collect textual and visual data through home-based interviews, participant-led photo walkabouts of the home, and photo elicitation sessions at clients' kitchen tables. Using successive rounds of interpretive description and human factors engineering analyses, we will generate robust descriptions of managing medication at home within each provincial sample and across the four-province group. We will validate our initial interpretations through photo elicitation focus groups with home care providers in each province to develop a refined description of the phenomenon that can inform future decision-making, quality improvement efforts, and research. Discussion The application of interpretive and human factors lenses to the visual and textual data is expected to yield findings that advance our understanding of the issues, challenges, and risk-mitigating strategies related to medication safety in home care. The images are powerful knowledge translation tools for sharing what we learn with participants, decision makers, other healthcare audiences, and the public. In addition, participants engage in knowledge exchange

  19. Digital transformation in home care. A case study. (United States)

    Bennis, Sandy; Costanzo, Diane; Flynn, Ann Marie; Reidy, Agatha; Tronni, Catherine


    Simply implementing software and technology does not assure that an organization's targeted clinical and financial goals will be realized. No longer is it possible to roll out a new system--by solely providing end user training and overlaying it on top of already inefficient workflows and outdated roles--and know with certainty that targets will be met. At Virtua Health's Home Care, based in south New Jersey, implementation of their electronic system initially followed this more traditional approach. Unable to completely attain their earlier identified return on investment, they enlisted the help of a new role within their health system, that of the nurse informaticist. Knowledgeable in complex clinical processes and not bound by the technology at hand, the informaticist analyzed physical workflow, digital workflow, roles and physical layout. Leveraging specific tools such as change acceleration, workouts and LEAN, the informaticist was able to redesign workflow and support new levels of functionality. This article provides a view from the "finish line", recounting how this role worked with home care to assimilate information delivery into more efficient processes and align resources to support the new workflow, ultimately achieving real tangible returns.

  20. The Feasibility of a Customized, In-Home, Game-Based Stroke Exercise Program Using the Microsoft Kinect Sensor

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    Rachel Proffitt


    Full Text Available The objective of this study was to determine the feasibility of a 6-week, game-based, in-home telerehabilitation exercise program using the Microsoft Kinect® for individuals with chronic stroke. Four participants with chronic stroke completed the intervention based on games designed with the customized Mystic Isle software. The games were tailored to each participant’s specific rehabilitation needs to facilitate the attainment of individualized goals determined through the Canadian Occupational Performance Measure. Likert scale questionnaires assessed the feasibility and utility of the game-based intervention. Supplementary clinical outcome data were collected. All participants played the games with moderately high enjoyment. Participant feedback helped identify barriers to use (especially, limited free time and possible improvements. An in-home, customized, virtual reality game intervention to provide rehabilitative exercises for persons with chronic stroke is practicable. However, future studies are necessary to determine the intervention’s impact on participant function, activity, and involvement.

  1. A Programming Language Approach to Safety in Home Networks

    DEFF Research Database (Denmark)

    Mortensen, Kjeld Høyer; Schougaard, Kari Rye; Schultz, Ulrik Pagh

    Home networks and the interconnection of home appliances is a classical theme in pervasive computing research. Security is usually addressed through the use of encryption and authentication, but there is a lack of awareness of safety: reventing the computerized house from harming the inhabitants......-based restrictions on operations. This model has been implemented in a middleware for home AV devices written in Java, using infrared communication and a FireWire network to implement location awareness....

  2. A Programming Language Approach to Safety in Home Networks

    DEFF Research Database (Denmark)

    Mortensen, Kjeld Høyer; Schougaard, Kari Sofie Fogh; Schultz, Ulrik Pagh


    Home networks and the interconnection of home appliances is a classical theme in pervasive computing research. Security is usually addressed through the use of encryption and authentication, but there is a lack of awareness of safety: preventing the computerized house from harming the inhabitants......-based restrictions on operations. This model has been implemented in a middleware for home AV devices written in Java, using infrared communication and a FireWire network to implement location awareness....

  3. Food safety in home kitchens: a synthesis of the literature

    National Research Council Canada - National Science Library

    Byrd-Bredbenner, Carol; Berning, Jacqueline; Martin-Biggers, Jennifer; Quick, Virginia


    ...; however, many consumers do not believe the home to be a risky place. Health care professionals need to be aware of consumers' food safety attitudes and behaviors in the home and deliver tailored food safety interventions that are theory-based...

  4. Marketing in home health care. A practical approach. (United States)

    Freitag, E M


    Home health marketing brings special problems and opportunities. One cannot rely on physical factors such as the physical plant and food service of a hospital or on the durability of a consumer product to judge home health. Opportunities exist within home health to identify activities that carry marketing value. Applying marketing principles to activities such as intake, customer service and public relations allows the home health agency to build referrals by meeting the wants and needs of the market. The home health organization needs to consider different wants and needs of those involved in the home health transaction: the decision maker, the purchaser, and the user. The success of the marketing function in meeting the organization's objectives will be aided by the placement of marketing at the senior management level.

  5. Food Safety in Home Kitchens: A Synthesis of the Literature

    Directory of Open Access Journals (Sweden)

    Virginia Quick


    Full Text Available Although foodborne illness is preventable, more than 56,000 people per year become ill in the U.S., creating high economic costs, loss of productivity and reduced quality of life for many. Experts agree that the home is the primary location where foodborne outbreaks occur; however, many consumers do not believe the home to be a risky place. Health care professionals need to be aware of consumers’ food safety attitudes and behaviors in the home and deliver tailored food safety interventions that are theory-based. Thus, the purpose of this paper is to synthesize/summarize the food safety literature by examining the following: consumers’ perceptions and attitudes towards food safety and their susceptibility to foodborne illness in the home, work, and school; common risky food safety practices and barriers to handling food safely; and the application of theory-based food safety interventions. Findings will help healthcare professionals become more aware of consumers’ food safety attitudes and behaviors and serve to inform future food safety interventions.

  6. Food Safety in Home Kitchens: A Synthesis of the Literature (United States)

    Byrd-Bredbenner, Carol; Berning, Jacqueline; Martin-Biggers, Jennifer; Quick, Virginia


    Although foodborne illness is preventable, more than 56,000 people per year become ill in the U.S., creating high economic costs, loss of productivity and reduced quality of life for many. Experts agree that the home is the primary location where foodborne outbreaks occur; however, many consumers do not believe the home to be a risky place. Health care professionals need to be aware of consumers’ food safety attitudes and behaviors in the home and deliver tailored food safety interventions that are theory-based. Thus, the purpose of this paper is to synthesize/summarize the food safety literature by examining the following: consumers’ perceptions and attitudes towards food safety and their susceptibility to foodborne illness in the home, work, and school; common risky food safety practices and barriers to handling food safely; and the application of theory-based food safety interventions. Findings will help healthcare professionals become more aware of consumers’ food safety attitudes and behaviors and serve to inform future food safety interventions. PMID:24002725

  7. A randomized, controlled trial of in-home drinking water intervention to reduce gastrointestinal illness. (United States)

    Colford, John M; Wade, Timothy J; Sandhu, Sukhminder K; Wright, Catherine C; Lee, Sherline; Shaw, Susan; Fox, Kim; Burns, Susan; Benker, Anne; Brookhart, M Alan; van der Laan, Mark; Levy, Deborah A


    Trials have provided conflicting estimates of the risk of gastrointestinal illness attributable to tap water. To estimate this risk in an Iowa community with a well-run water utility with microbiologically challenged source water, the authors of this 2000-2002 study randomly assigned blinded volunteers to use externally identical devices (active device: 227 households with 646 persons; sham device: 229 households with 650 persons) for 6 months (cycle A). Each group then switched to the opposite device for 6 months (cycle B). The active device contained a 1-microm absolute ceramic filter and used ultraviolet light. Episodes of "highly credible gastrointestinal illness," a published measure of diarrhea, nausea, vomiting, and abdominal cramps, were recorded. Water usage was recorded with personal diaries and an electronic totalizer. The numbers of episodes in cycle A among the active and sham device groups were 707 and 672, respectively; in cycle B, the numbers of episodes were 516 and 476, respectively. In a log-linear generalized estimating equations model using intention-to-treat analysis, the relative rate of highly credible gastrointestinal illness (sham vs. active) for the entire trial was 0.98 (95% confidence interval: 0.86, 1.10). No reduction in gastrointestinal illness was detected after in-home use of a device designed to be highly effective in removing microorganisms from water.

  8. In-home Telerehabilitation for Older Persons with Chronic Obstructive Pulmonary Disease: A Pilot Study

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    Michel Tousignant


    Full Text Available The purpose of this pilot study was to investigate the efficacy of in-home telerehabilitation for people with Chronic Obstructive Pulmonary Disease (COPD. Three community-living elders with COPD were recruited in a rehabilitation outpatient group and by direct referrals from pneumologists with outpatients who have COPD. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (15 sessions were conducted by two trained physio­therapists from a service center to the patient’s home. Locomotor function (walking performance and quality of life were measured in person prior to and at the end of the treatment by an independent assessor. Clinical outcomes improved for all subjects except for locomotor function in the first participant. In-home telerehabilitation for people with COPD is a realistic alternative to dispense rehabilitation services for patients requiring physical therapy follow-up. 

  9. A data mining approach in home healthcare: outcomes and service use

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    Curet Olivier


    Full Text Available Abstract Background The purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. In particular, discharge destination and length of stay have not been studied using a data mining approach which may provide insights not obtained through traditional statistical analyses. Methods The data were obtained from the 2000 National Home and Hospice Care Survey data for three specific conditions (chronic obstructive pulmonary disease, heart failure and hip replacement, representing nearly 580 patients from across the US. The data mining approach used was CART (Classification and Regression Trees. Our aim was twofold: 1 determining the drivers of home healthcare service outcomes (discharge destination and length of stay and 2 examining the applicability of induction through data mining to home healthcare data. Results Patient age (85 and older was a driving force in discharge destination and length of stay for all three conditions. There were also impacts from the type of agency, type of payment, and ethnicity. Conclusion Patients over 85 years of age experience differential outcomes depending on the condition. There are also differential effects related to agency type by condition although length of stay was generally lower for hospital-based agencies. The CART procedure was sufficiently accurate in correctly classifying patients in all three conditions which suggests continuing utility in home health care.

  10. Choosing a primary care provider (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Choosing a primary care provider URL of this page: // Choosing a primary care provider To ...

  11. Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents. (United States)

    Simonetti, Joseph A; Mackelprang, Jessica L; Rowhani-Rahbar, Ali; Zatzick, Douglas; Rivara, Frederick P


    Suicide is the second leading cause of death among US adolescents, and in-home firearm access is an independent risk factor for suicide. Given recommendations to limit firearm access by those with mental health risk factors for suicide, we hypothesized that adolescents with such risk factors would be less likely to report in-home firearm access. To estimate the prevalence of self-reported in-home firearm access among US adolescents, to quantify the lifetime prevalence of mental illness and suicidality (ie, suicidal ideation, planning, or attempt) among adolescents living with a firearm in the home, and to compare the prevalence of in-home firearm access between adolescents with and without specific mental health risk factors for suicide. Cross-sectional analysis of data from the National Comorbidity Survey-Adolescent Supplement, a nationally representative survey of 10,123 US adolescents (age range, 13-18 years) who were interviewed between February 2001 and January 2004 (response rate 82.9%). Risk factors for suicide, including a history of any mental health disorder, suicidality, or any combination of the 2. Self-reported access to a firearm in the home. One in three respondents (2778 [29.1%]) of the weighted survey sample reported living in a home with a firearm and responded to a question about firearm access; 1089 (40.9%) of those adolescents reported easy access to and the ability to shoot that firearm. Among adolescents with a firearm in home, those with access were significantly more likely to be older (15.6 vs 15.1 years), male (70.1% vs 50.9%), of non-Hispanic white race/ethnicity (86.6% vs 78.3%), and living in high-income households (40.0% vs 31.8%), and in rural areas (28.1% vs 22.6%) (P firearm access also had a higher lifetime prevalence of alcohol abuse (10.1% vs 3.8%, P firearm access. In multivariable analyses, adolescents with a history of mental illness without a history of suicidality (prevalence ratio [PR], 1.13; 95% CI, 0.98-1.29) and

  12. Restraint use in older adults in home care: A systematic review. (United States)

    Scheepmans, Kristien; Dierckx de Casterlé, Bernadette; Paquay, Louis; Milisen, Koen


    To get insight into restraint use in older adults receiving home care and, more specifically, into the definition, prevalence and types of restraint, as well as the reasons for restraint use and the people involved in the decision-making process. Systematic review. Four databases (i.e. Pubmed, CINAHL, Embase, Cochrane Library) were systematically searched from inception to end of April 2017. The study encompassed qualitative and quantitative research on restraint use in older adults receiving home care that reported definitions of restraint, prevalence of use, types of restraint, reasons for use or the people involved. We considered publications written in English, French, Dutch and German. One reviewer performed the search and made the initial selection based on titles and abstracts. The final selection was made by two reviewers working independently; they also assessed study quality. We used an integrated design to synthesise the findings. Eight studies were reviewed (one qualitative, seven quantitative) ranging in quality from moderate to high. The review indicated there was no single, clear definition of restraint. The prevalence of restraint use ranged from 5% to 24.7%, with various types of restraint being used. Families played an important role in the decision-making process and application of restraints; general practitioners were less involved. Specific reasons, other than safety for using restraints in home care were noted (e.g. delay to nursing home admission; to provide respite for an informal caregiver). Contrary to the current socio demographical evolutions resulting in an increasing demand of restraint use in home care, research on this subject is still scarce and recent. The limited evidence however points to the challenging complexity and specificity of home care regarding restraint use. Given these serious challenges for clinical practice, more research about restraint use in home care is urgently needed. Copyright © 2017. Published by Elsevier

  13. A cost-effect analysis of an intervention against radon in homes


    Hein Stigum; Terje Strand; Per Magnus


    Background  Key words  : Radon exposure, lung cancer, cost-effect analysis, attributable risk, models-mathematical: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m-3) and improving these, and of protecting future houses. The purpose of this paper is to calculate the costs and the effects of this interve...

  14. In-Home Display – a Review of Experiences from Research Projects

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    Krzysztof Billewicz


    Full Text Available There are many studies on smart metering. The aim of smart metering is not only automated billing and two-way communication with a smart meter. The measure of success of the implementation of smart metering is the level of customer engagement and their cooperation with energy companies, as well as the consequences of such involvement changing electricity-using habits. This article focuses on one device for smart metering – in-home display (IHD. The paper characterizes an IHD’s functions and describes international experiences of research and conclusions of studies.

  15. Data for Improvement and Clinical Excellence: a report of an interrupted time series trial of feedback in home care. (United States)

    Fraser, Kimberly D; Sales, Anne E; Baylon, Melba Andrea B; Schalm, Corinne; Miklavcic, John J


    There is substantial evidence about the effectiveness of audit with feedback, but none that we know have been conducted in home care settings. The primary purpose of the Data for Improvement and Clinical Excellence - Home Care (DICE-HC) project was to evaluate the effects of an audit and feedback delivered to care providers on home care client outcomes. The objective of this paper is to report the effects of feedback on four specific quality indicators: pain, falls, delirium, and hospital visits. A 10-month audit with feedback intervention study was conducted with care providers in seven home care offices in Alberta, Canada, which involved delivery of four quarterly feedback reports consisting of data derived from the Resident Assessment Instrument - Home Care (RAI-HC). The primary evaluation employed an interrupted time series design using segmented regression analysis to assess the effects of feedback reporting on the four quality indicators: pain, falls, delirium, and hospitalization. Changes in level and trend of the quality indicators were measured before, during, and after the implementation of feedback reports. Pressure ulcer reporting was analyzed as a comparator condition not included in the feedback report. Care providers were surveyed on responses to feedback reporting which informed a process evaluation. At initiation of feedback report implementation, the percentage of clients reporting pain and falls significantly increased. Though the percentage of clients reporting pain and falls tended to increase and reporting of delirium and hospital visits tended to decrease relative to the pre-intervention period, there was no significant effect of feedback reporting on quality indicators during the 10-month intervention. The percentage of clients reporting falls, delirium, and hospital visits significantly increased in the 6-month period following feedback reporting relative to the intervention period. About 50% of the care providers that read and understand

  16. Usability testing of a mobile robotic system for in-home telerehabilitation. (United States)

    Boissy, Patrick; Brière, Simon; Corriveau, Hélène; Grant, Andrew; Lauria, Michel; Michaud, François


    Mobile robots designed to enhance telepresence in the support of telehealth services are being considered for numerous applications. TELEROBOT is a teleoperated mobile robotic platform equipped with videoconferencingcapabilities and designed to be used in a home environment to. In this study, learnability of the system's teleoperation interface and controls was evaluated with ten rehabilitation professionals during four training sessions in a laboratory environment and in an unknown home environment while performing the execution of a standardized evaluation protocol typically used in home care. Results show that the novice teleoperators' performances on two of the four metrics used (number of command and total time) improved significantly across training sessions (ANOVAS, p<0.05) and that performance in these metrics in the last training session reflected teleoperation abilities seen in the unknown home environment during navigation tasks (r=0,77 and 0,60). With only 4 hours of training, rehabilitation professionals were able learn to teleoperate successfully TELEROBOT. However teleoperation performances remained significantly less efficient then those of an expert. Under the home task condition (navigating the home environment from one point to the other as fast as possible) this translated to completion time between 350 seconds (best performance) and 850 seconds (worse performance). Improvements in other usability aspects of the system will be needed to meet the requirements of in-home telerehabilitation.

  17. A National Study of Community Living: Impact of Type of Residence and Hours of In-Home Support (United States)

    Kim, Rah Kyung; Dymond, Stacy K.


    This study investigated the frequency of community participation and level of assistance needed to perform domestic and safety skills for individuals with severe disabilities who live successfully in the community, based on type of residence and hours of in-home support provided. Participants included residential specialists from small community…

  18. A retrospective examination of in-home educational visits to reduce childhood lead levels

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    Schultz, B. [Environmental Protection Agency, Washington, DC (United States)]|[Univ. of Wisconsin, Madison, WI (United States). Dept. of Preventive Medicine; Pawel, D. [QuanTech, Rosslyn, VA (United States); Murphy, A. [Milwaukee Health Dept., WI (United States)


    A number of human health effects from lead are well known. However, the means for reducing lead exposure in children has been a subject of uncertainty. This paper presents results of a retrospective study of educational lead reduction interventions in Milwaukee, Wisconsin for children who had elevated blood lead levels between 20 and 24 {micro}g/dl. The study examined Milwaukee Health Department (MHD) records of baseline and follow-up blood lead measurements. A study group of children received an in-home educational visit by an MHD paraprofessional. The educational visits last about an hour and the importance of reducing lead exposure, nutritional suggestions, and dust clean-up practices and behavioral changes that can reduce lead exposure are discussed. After the intervention, the average observed blood lead level declined by 4.2 {micro}g/dl or by about 21%. A decline of 1.2 {micro}g/dl (6%) was also observed in a reference group of 226 children who did not receive an MHD in-home visit. The decline in the reference group may be partially due to education at the clinics taking the blood samples. The study group had a decline in blood lead levels 3.1 {micro}g/dl (15%) greater than the reference group, with the difference between groups being statistically significant with a P value of less than 0.001. Although significant exposures remained in most of the children studied, important lead reductions were observed with this relatively inexpensive and simple intervention. Education in the homes of families at risk for lead poisoning may be an effective component of programs to reduce blood lead levels.

  19. Sex differences in home care performance: a population-based study. (United States)

    Lo, Amanda T; Gruneir, Andrea; Bronskill, Susan E; Bierman, Arlene S


    Home care services play an integral role in promoting independence, reducing hospital admission and readmission rates, and preventing or delaying nursing home admission among older adults. Despite important sex differences in functional status and use of services by recipients of home care, differences in home care performance measures by sex have not been examined. To assess sex differences in the quality of publicly funded home care services in Ontario, Canada. Validated, publicly reported home care quality indicators derived from the Resident Assessment Instrument for Home Care using the 2009 and 2010 Home Care Reporting System database were assessed for 119,795 Ontario home care clients aged 65 years and older. Unadjusted and risk-adjusted sex differences in performance were examined provincially and by health region. In unadjusted analyses, there were sex differences in health outcomes on all indicators examined (decline or failure to improve in activities of daily living, cognitive decline, depressive symptoms, and pain control). After risk adjustment, differences were minimal. For example, in unadjusted analyses, 23.1% of women and 18.7% of men reported poorly controlled pain. After risk adjustment, 21.2% of women and 21.6% of men reported poorly controlled pain, with a difference of -0.4% (95% CI, -0.4% to -0.3%). Across health regions risk adjustment eliminated sex differences. There was 1.3-fold to 2.6-fold variation in performance on indicators across health regions. After risk adjustment, no important sex differences in home care quality indicators were identified. Sizable regional variations observed indicate potential to improve home care outcomes for both women and men. Sex differences in unadjusted analyses demonstrate the value of examining both unadjusted and adjusted outcomes and suggest sex-specific strategies will likely be needed to improve home care quality. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All

  20. Homebound Patient and Caregiver Perceptions of Quality of Care in Home-Based Primary Care: A Qualitative Study. (United States)

    Shafir, Adi; Garrigues, Sarah K; Schenker, Yael; Leff, Bruce; Neil, Jessica; Ritchie, Christine


    To assess patient and caregiver perceptions of what constitutes quality care in home-based primary care (HBPC). Cross-sectional qualitative design; semistructured interview study. Academic home-based primary care program. Homebound patients (n = 13) and 10 caregivers (n = 10) receiving HBPC. Semistructured interviews explored experiences with a HBPC program and perceptions of quality care. Interviews were audio-recorded and transcribed. Qualitative content analysis was performed to identify major themes. Five major themes emerged related to participant perceptions of quality care: access, affordability, competency, care coordination, goal attainment. Participants felt that reliable, consistent access provided "peace of mind" and reduced hospital and emergency department use. Insurance coverage of program costs and coordinated care provided by an interdisciplinary team were positively regarded. Interpersonal skills and technical abilities of providers influenced patient perception of provider competency. Assessing and helping patients attain care goals contributed to a perception of quality care. Patients and caregivers associate high-quality HBPC with around-the-clock access to affordable interdisciplinary providers with strong interpersonal skills and technical competency. These results expand on prior research and are concordant with HBPC goals of around-the-clock access to multidisciplinary teams with the goals of reduced emergency department and hospital use. HBPC programs should be structured to optimize access, affordability, coordinated care, and goal ascertainment and alignment. Quality indicators should be created and validated with these patient and caregiver views of care quality in mind. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  1. Renal Denervation in a Real Life Setting: A Gradual Decrease in Home Blood Pressure.

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    Martine M A Beeftink

    Full Text Available To investigate the blood pressure dynamics after renal denervation through monthly home blood pressure measurements throughout the first 12 months.A cohort of 70 patients performed highly standardized monthly home blood pressure monitoring during the first year after denervation according to the European Society of Hypertension guidelines. At baseline and 12 months follow-up, office and ambulatory blood pressure as well as routine physical and laboratory assessment was performed.Home blood pressure decreased with a rate of 0.53 mmHg/month (95% CI 0.20 to 0.86 systolic and 0.26 mmHg/month (95% CI 0.08 to 0.44 diastolic throughout 12 months of follow-up, while the use of antihypertensive medication remained stable (+0.03 daily defined doses/month, 95% CI -0.01 to 0.08. On average, a 12 month reduction of 8.1 mmHg (95% CI 4.2 to 12.0 was achieved in home systolic blood pressure, 9.3 mmHg (95% CI -14.2 to -4.4 as measured by 24-hour ambulatory blood pressure monitoring and 15.9 mmHg (95% CI -23.8 to -7.9 on office measurements.Blood pressure reduction after renal denervation occurs as a gradual decrease that extends to at least one-year follow-up. Home monitoring seems a suitable alternative for ambulatory blood pressure monitoring after renal denervation.

  2. Reflexivity in a study of family carers in home palliative care: a personal account. (United States)

    Newbury, Jenny


    To discuss a personal account of the role of reflexivity in a qualitative, grounded theory study with family carers in home palliative care. The study explored the experience of carers of family members dying at home using semi-structured interviews before and after the death. It focused on carers' expectations and preparedness for the dying process. The findings suggested that carers play a leading role in a drama but there are no rehearsals because they have not been in this role before. They also have no script because they find it hard to read about the dying process. Consequently they feel anxious, uncertain and unprepared. They have direction from professionals and support from paid carers, but have mixed experiences of these services. Hence the research setting was charged with emotion and presented particular ethical challenges. Reflexivity is an important component of qualitative inquiry. It involves constant attention to the researcher's perspective, background and influence on the research process and the effects this has on the researcher, which may affect the research. Reflexivity was a prominent thread throughout my study, involving epistemological and personal aspects. It focused on my performance as researcher and the role of empathy and reciprocity in the researcher-participant relationship. The potential for therapeutic change for research participants was seen as beneficial, but it could cause conflict between my roles as nurse and researcher and risk of exploiting participants. Reflexivity also involved exploration of the emotional impact of doing the research and implications of the research setting. Reflexivity was an essential and dynamic component of this study, which involved constant interplay between the author and the research.

  3. [Case Study - A Successful Cooperation of Clinic Pharmacist and Pharmacies in Home Palliative Care with PCA Pump]. (United States)

    Kawana, Michiyo; Yuge, Haruko; Sakurai, Hirokazu; Hatsuta, Minoru; Osuga, Yuko; Hirohara, Masayoshi; Kushida, Kazuki


    To make a good end at home and provide good palliative care for patients with cancer are urgent issues in Setagaya ward, as shown by certain statistics. Medical opioids are greatly needed for palliative care; as patient controlled analgesia(PCA) develops, it can lead to decisions by patients and their families to receive end-of-life care at home because the patient can choose to receive the same advanced palliative care received at the hospital. With in-home palliative care, given the rapid change in the medical condition of the patient and the sentiment of the family, the role of pharmacists is to quickly and reliably supply the pharmaceuticals and medical equipment that doctors need. The following are important in order to enable this; 1 ) a pharmacy stocked with medicalopioids in accordance with needs, 2 ) a pharmacy with a system that can provide support quickly, 3 ) the presence of people who understand the area of resources, and 4 ) a constant face-to-face relationship. The "Sakura-HOPPS(Sakurashinmachi Homecare Pharmacists PartnershipS)"is a group intended to provide exchange and cooperation of pharmacists beyond the framework of organizationalaffil iation, and authors hope to encourage the participation of increasingly more pharmacists to develop a close-cooperation system of acute care hospitals and community medical/home care.

  4. Client-nurse relationships in home-based palliative care: a critical analysis of power relations. (United States)

    Oudshoorn, Abram; Ward-Griffin, Catherine; McWilliam, Carol


    To elicit an in-depth understanding of the sources of power and how power is exercised within client-nurse relationships in home-based palliative care. As in all social relations, power is present within client-nurse relationships. Although much research has focused on interpersonal relationships in nursing, the concept of power within the client-nurse relationship in palliative care settings has not been extensively investigated. Applying a critical lens, secondary qualitative data analysis was conducted. Seventeen nurse and 16 client transcripts from a primary study were selected for secondary data analysis. These 33 transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified. Data analysis involved analytic coding. Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used and potentially abused. In analysing the sources and exercise of power, the linkage between macro and micro levels of power is made explicit, as nurses functioned within a hierarchy of power. The findings suggest that educational/occupational status continues to be a source of power for nurses within the relationship. However, nurses also experience powerlessness within the home care context. For clients, being able to control one's own life is a source of power, but this power is over-shadowed by the powerlessness experienced in relationships with nurses. The exercise of power by clients and nurses creates experiences of both liberation and domination. Nurses who are willing to reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care. Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies and funding models implemented at

  5. A cost-effect analysis of an intervention against radon in homes

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    Hein Stigum


    Full Text Available Background  Key words  : Radon exposure, lung cancer, cost-effect analysis, attributable risk, models-mathematical: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m-3 and improving these, and of protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. Methods: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean=74.5 Bq/m3, and 7.6% above 200 Bq/m3. Results: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%. In cumulative present values the intervention would cost $238 (145, 310 million and save 892 (133, 1981 lives, each life saved costs $0.27 (0.09, 0.9 million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. Conclusions: Reducing the radon concentration in present and future homes to below 200 Bq/m3 will cost $0.27 (0.09, 0.9 million per life saved. The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. We therefore conclude that the intervention against radon in homes is justifiable. The willingness to pay is also larger that the upper uncertainty limit of the cost per life. Our conclusion is therefore robust against the uncertainties in the parameters.

  6. Walk-in homes for people living with cancer and their family members: A new Dutch communication and support approach

    NARCIS (Netherlands)

    A. Visser; R. den Hollander; A. van den Brom


    Dutch walk-in homes are a meeting place for people suffering from cancer and for their loved ones. A study was performed in order to assess to what extent the offered complementary activities and the psycho-social support in these houses are, as well as whether or not these homes are present,

  7. On the Design of Smart Homes: A Framework for Activity Recognition in Home Environment. (United States)

    Cicirelli, Franco; Fortino, Giancarlo; Giordano, Andrea; Guerrieri, Antonio; Spezzano, Giandomenico; Vinci, Andrea


    A smart home is a home environment enriched with sensing, actuation, communication and computation capabilities which permits to adapt it to inhabitants preferences and requirements. Establishing a proper strategy of actuation on the home environment can require complex computational tasks on the sensed data. This is the case of activity recognition, which consists in retrieving high-level knowledge about what occurs in the home environment and about the behaviour of the inhabitants. The inherent complexity of this application domain asks for tools able to properly support the design and implementation phases. This paper proposes a framework for the design and implementation of smart home applications focused on activity recognition in home environments. The framework mainly relies on the Cloud-assisted Agent-based Smart home Environment (CASE) architecture offering basic abstraction entities which easily allow to design and implement Smart Home applications. CASE is a three layered architecture which exploits the distributed multi-agent paradigm and the cloud technology for offering analytics services. Details about how to implement activity recognition onto the CASE architecture are supplied focusing on the low-level technological issues as well as the algorithms and the methodologies useful for the activity recognition. The effectiveness of the framework is shown through a case study consisting of a daily activity recognition of a person in a home environment.

  8. Fear causes tears - Perineal injuries in home birth settings. A Swedish interview study

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    Brink Åsa


    Full Text Available Abstract Background Perineal injury is a serious complication of vaginal delivery that has a severe impact on the quality of life of healthy women. The prevalence of perineal injuries among women who give birth in hospital has increased over the last decade, while it is lower among women who give birth at home. The aim of this study was to describe the practice of midwives in home birth settings with the focus on the occurrence of perineal injuries. Methods Twenty midwives who had assisted home births for between one and 29 years were interviewed using an interview guide. The midwives also had experience of working in a hospital delivery ward. All the interviews were tape-recorded and transcribed. Content analysis was used. Results The overall theme was "No rushing and tearing about", describing the midwives' focus on the natural process taking its time. The subcategories 1 preparing for the birth; 2 going along with the physiological process; 3 creating a sense of security; 4 the critical moment and 5 midwifery skills illuminate the management of labor as experienced by the midwives when assisting births at home. Conclusions Midwives who assist women who give birth at home take many things into account in order to minimize the risk of complications during birth. Protection of the woman's perineum is an act of awareness that is not limited to the actual moment of the pushing phase but starts earlier, along with the communication between the midwife and the woman.

  9. Effectiveness of Interventions to Reduce Tobacco Smoke Pollution in Homes: A Systematic Review and Meta-Analysis

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    Laura J. Rosen


    Full Text Available Introduction: Smoke-free homes can help protect children from tobacco smoke exposure (TSE. The objective of this study was to conduct a meta-analysis to quantify effects of interventions on changes in tobacco smoke pollution in the home, as measured by air nicotine and particulate matter (PM. Methods: We searched MEDLINE, PubMed, Web of Science, PsycINFO, and Embase. We included controlled trials of interventions which aimed to help parents protect children from tobacco smoke exposure. Two reviewers identified relevant studies, and three reviewers extracted data. Results: Seven studies were identified. Interventions improved tobacco smoke air pollution in homes as assessed by nicotine or PM. (6 studies, N = 681, p = 0.02. Analyses of air nicotine and PM separately also showed some benefit (Air nicotine: 4 studies, N = 421, p = 0.08; PM: 3 studies, N = 340, p = 0.02. Despite improvements, tobacco smoke pollution was present in homes in all studies at follow-up. Conclusions: Interventions designed to protect children from tobacco smoke are effective in reducing tobacco smoke pollution (as assessed by air nicotine or PM in homes, but contamination remains. The persistence of significant pollution levels in homes after individual level intervention may signal the need for other population and regulatory measures to help reduce and eliminate childhood tobacco smoke exposure.

  10. Moving beyond Depression: A Collaborative Approach to Treating Depressed Mothers in Home Visiting Programs (United States)

    Ammerman, Robert T.; Putnam, Frank W.; Teeters, Angelique R.; Van Ginkel, Judith B.


    Research indicates that up to half of mothers in home visiting experience clinically significant levels of depression during their participation in services. Depression alters maternal life course, negatively impacts child development, and contributes to poorer home visiting outcomes. This article describes the Moving Beyond Depression (MBD)…

  11. Shift work to balance everyday life - a salutogenic nursing perspective in home help service in Sweden. (United States)

    Agosti, Madelaine Törnquist; Andersson, Ingemar; Ejlertsson, Göran; Janlöv, Ann-Christin


    Nurses in Sweden have a high absence due to illness and many retire before the age of sixty. Factors at work as well as in private life may contribute to health problems. To maintain a healthy work-force there is a need for actions on work-life balance in a salutogenic perspective. The aim of this study was to explore perceptions of resources in everyday life to balance work and private life among nurses in home help service. Thirteen semi-structured individual interviews and two focus group interviews were conducted with home help service nurses in Sweden. A qualitative content analysis was used for the analyses. In the analyses, six themes of perceptions of recourses in everyday life emerged; (i) Reflecting on life. (ii) Being healthy and taking care of yourself. (iii) Having a meaningful job and a supportive work climate. (iv) Working shifts and part time. (v) Having a family and a supporting network. (vi) Making your home your castle. The result points out the complexity of work-life balance and support that the need for nurses to balance everyday life differs during different phases and transitions in life. In this salutogenic study, the result differs from studies with a pathogenic approach. Shift work and part time work were seen as two resources that contributed to flexibility and a prerequisite to work-life balance. To have time and energy for both private life and work was seen as essential. To reflect on and discuss life gave inner strength to set boundaries and to prioritize both in private life and in work life. Managers in nursing contexts have a great challenge to maintain and strengthen resources which enhance the work-life balance and health of nurses. Salutogenic research is needed to gain an understanding of resources that enhance work-life balance and health in nursing contexts.

  12. A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients. (United States)

    Touré, A; Duchamp, A; Peraldi, C; Barnoud, D; Lauverjat, M; Gelas, P; Chambrier, C


    Peripherally inserted central venous catheters (PICC) have become increasingly popular for medium to long-term parenteral nutrition (PN) but there is limited data on the complication rates in this sub-group. We aimed to compare the rates of complications associated with tunneled catheters (Broviac) and PICC in home PN (HPN) patients. All adult patients in an HPN program with a new Broviac or new PICC between 2009 and 2011 were included in this prospective observational study. Complication rates were compared by using Poisson regression and Kaplan Meier survival curves were used to compare the first complications that occurred. 204 catheters (133 Broviac and 71 PICC) were inserted in 196 adult patients. Mean follow-up from catheter insertions to their removal was 276 ± 219 days for Broviac (n = 86) vs. 74 ± 140.70 days for PICC (n = 56); p Complications were similar between Broviac and PICC (91/133 vs. 26/71). Catheter infection rate was lower in PICC (1.87 vs. 1.05 per 1000 catheter-days; p = 0.01). Catheter obstruction rates were similar for both catheters. Only PICC experienced venous thrombosis (0.4/1000). The proportion of catheters removed was lower in the Broviac group than in the PICC group (62.4% vs. 78.8%; p = 0.01) but those removed for complications were not different (28.6.7%vs. 25.3%; p = 0.64). In HPN patients, overall complications were similar in both the PICC and the Broviac groups. However, the Broviac catheter could be associated with an increase in catheter infection. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  13. Enabling a family caregiver-led assessment of support needs in home-based palliative care: Potential translation into practice. (United States)

    Aoun, Samar; Toye, Chris; Deas, Kathleen; Howting, Denise; Ewing, Gail; Grande, Gunn; Stajduhar, Kelli


    Systematic assessment of family caregivers' support needs and integrating these into service planning according to evidence-based research are vital to improving caregivers' outcomes and their capacity to provide care at end of life. To describe the experience with and feedback of nurses on implementing a systematic assessment of support needs with family caregivers in home-based palliative care, using the Carer Support Needs Assessment Tool. This study was conducted during 2012-2014 in Silver Chain Hospice Care Service in Western Australia. This article reports on one part of a three-part evaluation of a stepped wedge cluster trial. Forty-four nurses who trialled the intervention with 233 family caregivers gave their feedback via surveys with closed- and open-ended questions (70.5% response rate). Analyses of quantitative and qualitative data were undertaken. The feedback of nurses was overwhelmingly positive in terms of perceived benefits in comparison to standard practice both from the family caregiver and service provider perspectives. Using the Carer Support Needs Assessment Tool was described by nurses as providing guidance, focus and structure to facilitate discussion with family caregivers and as identifying needs and service responses that would not otherwise have been undertaken in a timely manner. Our study has successfully addressed the call for alternatives to the professional assessment paradigm using the Carer Support Needs Assessment Tool approach as a caregiver-led intervention facilitated by health professionals. Integrating the Carer Support Needs Assessment Tool in existing practice is fundamental to achieving better caregiver outcomes. © The Author(s) 2015.

  14. Functional status decline as a measure of adverse events in home health care: an observational study

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    Feldman Penny H


    Full Text Available Abstract Background Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research. Methods Data come from the Outcomes and Assessment Information Set (OASIS from a large urban home health care agency and other agency data. Prognostic data yields 49,437 episodes, while follow-up data yields 47,684 episodes. We tested three indices defined as substantial decline in three or more (gt3_ADLs, two or more (gt2_ADLs, and one or more (gt1_ADLs ADLs. Multivariate logistic regression determines the performance of the models for each index as measured by the c-statistic and Hosmer-Lemeshow chi square (χ2. Results Frequencies for gt3_ADLs, gt2_ADLs, and gt1_ADLs are 212 (0.43%, 783 (1.58%, and 4,271 (8.64% respectively. Follow-up results are comparable with frequencies of 218 (0.46%, 763 (1.60%, and 3,949 (8.28% for each index. Gt3_ADLs does not produce valid models. The model for gt2_ADLs consistently yields a higher c-statistic compared to gt1_ADLs (0.754 vs. 0.679, respectively. Both indices' models yield non-significant Hosmer-Lemeshow chi square indicating reasonable model fit. Findings for gt2_ADLs and gt1_ADLs are consistent over time as indicated by follow-up data results. Conclusion Gt2_ADLs yields the best models as indicated by a high c-statistic and a non-significant Hosmer-Lemeshow χ2, both of which exhibit exceptional consistency. We conclude that gt2_ADLs may be preferable in defining ADL adverse events in the context of home health care.

  15. Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology. (United States)

    Schildmeijer, Kristina Görel Ingegerd; Unbeck, Maria; Ekstedt, Mirjam; Lindblad, Marléne; Nilsson, Lena


    Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare. A study using retrospective record review and trigger tool methodology. Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 predefined triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed. The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs. The patients were aged 20-79 years, 280 men and 320 women. The review teams identified 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers. AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. A systematic review of the effectiveness of in-home community nurse led interventions for the mental health of older persons. (United States)

    Thompson, Penelope; Lang, Lyn; Annells, Merilyn


    The aim was to systematically review evidence about the effectiveness of in-home community nurse-led interventions for older persons with, or at risk of, mental health disorders, to inform best practice nursing care with this focus. The primary review question was 'How effective are in-home community nurse-led interventions for older persons with or at risk of mental health disorders for improving mental health?' The outcome indices of interest were nursing actions to determine incidence or prevalence of mental health disorders, any change in a patient's attitude towards their mental health condition, any change in objective measurement of mental health, or a change in diagnostic status. The rising incidence of mental health disorders in older persons is a major concern for community nurses in developed countries. Effectively facilitating improved mental health for older persons is necessary in this era of ageing populations with increased demands on health funding. Disseminating systematically reviewed evidence for in-home community nursing that positively impacts on the mental health of older persons is crucial to ensure effective care is provided to this vulnerable patient group. This review reveals that there is evidence to support the superiority of applying validated screening tools for mental health disorders over relying on community nurses' opinions and non-validated tools about this matter. Systematic review. Search of electronic databases. A clear need for replication and multi-centre trials of reviewed pertinent studies is identified. Relevance to clinical practice. Community nurses should consider using validated screening tools for this focus. Until such time as higher quality evidence is available about other nursing interventions, the reviewers suggest that the prime nursing action should be the identification of whether older persons receiving community nursing care might have a mental health disorder and, if so, then collaborative referral is made

  17. Decreasing In-home Smoking of Adults—Results from a School-based Intervention Program in Viet Nam

    Directory of Open Access Journals (Sweden)

    Le Thi Thanh Huong


    Full Text Available It is indicated that children are involuntarily exposed to secondhand smoke from adults, mainly at their home environment. This study aimed at describing the effectiveness of the school-based intervention to decrease the in-home smoking situation of adults so as to decrease children’s exposure to secondhand smoke at home during the year 2011–2012 in a rural district in Hanoi, Viet Nam. This school-based intervention program (intervention and control group involved 804 children aged 8 to 11 years from August 2011 to May 2012 in a rural district of Hanoi, Viet Nam. Children were taught in class about the harmful effects of secondhand smoke and about how to negotiate with fathers not to smoke in-home. Then children applied what they learnt, including staying away from secondhand smoke and persuading fathers not to smoke in-home in order to decrease children’s exposure to secondhand smoke. Chi square test, t-test and multinominal logistic regression were applied in data analysis. The results showed that children’s reported their father’s in-home smoking decreased from 83.0% pre-intervention to 59.8% post-intervention (p < 0.001 in the intervention school while no change happened in the control school. The study found that the better changed smoking location of adult smokers as reported by children associated with the school who received intervention activities (adjusted OR = 2.04; 95% CI: 1.28–3.24. Poorer changed attitudes towards secondhand smoke of children associated with a lower percentage of better change in smoking location of their fathers/other adult smokers (aOR = 0.51, 95% CI: 0.28–0.96. Children’s poorer changed knowledge towards secondhand smoke also associated with poorer changed smoking location of adult smokers (aOR = 2.88, 95% CI: 1.07–7.76. It is recommended by this study that similar school based intervention approaches should be applied in primary schools in Viet Nam to increase children’s awareness on the

  18. The impact of sleep on neuropsychological performance in cognitively intact older adults using a novel in-home sensor-based sleep assessment approach. (United States)

    Seelye, Adriana; Mattek, Nora; Howieson, Diane; Riley, Thomas; Wild, Katherine; Kaye, Jeffrey


    The relationship between recent episodes of poor sleep and cognitive testing performance in healthy cognitively intact older adults is not well understood. In this exploratory study we examined the impact of recent sleep disturbance, sleep duration, and sleep variability on cognitive performance in 63 cognitively intact older adults using a novel unobtrusive in-home sensor-based sleep assessment methodology. Specifically, we examined the impact of sleep the night prior, the week prior, and the month prior to a neuropsychological evaluation on cognitive performance. Results showed that mildly disturbed sleep the week prior and month prior to cognitive testing was associated with reduced working memory on cognitive evaluation. One night of mild sleep disturbance was not associated with decreased cognitive performance the next day. Sleep duration was unrelated to cognition. In-home, unobtrusive, sensor monitoring technologies provide a novel method for objective, long-term, and continuous assessment of sleep behavior and other everyday activities that might contribute to decreased or variable cognitive performance in healthy older adults.

  19. Experiences of community-dwelling older adults with the use of telecare in home care services: a qualitative systematic review. (United States)

    Karlsen, Cecilie; Ludvigsen, Mette Spliid; Moe, Carl Erik; Haraldstad, Kristin; Thygesen, Elin


    The aging population will lead to a rise in the number of people with age-related diseases, and increasing demand for home care services. Telecare is seen as a solution to this challenge by promoting aging in place. Nevertheless, there is still a poor understanding of older adults' experiences with the actual use of telecare. The aim of this review was to identify and synthesize the best available qualitative evidence of community-dwelling older adults' experience with the use of telecare in home care services. This review considered studies that focused on qualitative data, examining older adults' experiences with the use of active and passive technology devices, such as personal alarms and sensor technology, in the context of home care services. This review systematically searched the databases Scopus, CINAHL, PsycINFO, and SveMed+ to find both published and unpublished studies in English, Norwegian, Swedish and Danish, from 2005 to 2017. Methodological quality of the included studies was assessed independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative data were extracted from papers included in the review using the standardized Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument, and involved aggregation and synthesis of findings. A total of 118 findings from 11 studies were aggregated into 20 categories. The categories generated seven synthesized findings: 1) Aging in place is desired; however, it may also be related to feeling isolated and lonely. 2) Telecare contributes to safety, security, and aging in place. 3) Privacy is not seen as a problem by most older adults because the technology is intended to help them live safely in their own home. 4) Some telecare devices have side effects, especially new technology. Some devices do not work outside

  20. The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Ribbe Miel W


    Full Text Available Abstract Background The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. Methods This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1 Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF. Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2 The assessment outcomes are discussed in a Multidisciplinary Meeting (MM with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3 Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF. Outcome measures are Quality of Care indicators (LTCF based, Quality Adjusted Life Years (Euroqol, Functional health (SF12, COOP-WONCA, Disability (GARS, Patients care satisfaction (QUOTE, hospital and nursing home days and mortality, health care utilization and costs. Discussion This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on

  1. The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial (United States)

    Boorsma, Marijke; van Hout, Hein PJ; Frijters, Dinnus H; Ribbe, Miel W; Nijpels, Giel


    Background The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. Methods This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs. Discussion This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and

  2. The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial. (United States)

    Boorsma, Marijke; van Hout, Hein P J; Frijters, Dinnus H; Ribbe, Miel W; Nijpels, Giel


    The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs. This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. TRAIL

  3. Elder Care for Alzheimer's: Choosing a Provider (United States)

    ... elder care center for a loved one with Alzheimer's. What should I look for when considering a ... provide an opportunity for your loved one with Alzheimer's to receive assistance and therapeutic activities in a ...

  4. Telehealth etiquette in home healthcare: the key to a successful visit. (United States)

    Haney, Tina; Kott, Karen; Fowler, Christianne


    The use of telehealth by home healthcare agencies is growing. It has been shown to reduce rehospitalizations by up to 62%, reduce costs, and increase efficiency. Due to the use of telehealth technology, new and unique rules of etiquette must be followed to make both the patient and clinician comfortable and satisfied with the process. Little literature exists regarding telehealth etiquette. This article explores the techniques and methods that home care clinicians should utilize to assure that the telehealth experience is positive and effective. After providing a less successful scenario, steps for success are outlined and a suggested successful conclusion is provided for the scenario. Home care agencies will benefit greatly from expanding their ability to visit patients in different ways. Simple steps need to be taken to assure successful visits that follow the rules for assuring patient comfort, autonomy, and protection.

  5. SmartNursing - a mobile application to improve communication in home care

    DEFF Research Database (Denmark)

    Nyborg, Mads; Bashir, Khurram; Maknickaite, Asta


    This paper presents SmartNursing system and discusses how increasing capabilities of smartphone could benefit employees in working environment. A SmartNursing system is developed for home nurses working environment to fulfil their needs. The solution helps to improve communication among nurses, p......, provide customized information and increase work efficiency. Developed system consists of mobile application, web based server and database. This article discusses the solution SmartNursing from design to implementation....

  6. Variation in home range size of red foxes Vulpes vulpes along a gradient of productivity and human landscape alteration (United States)


    Home range size is a fundamental concept for understanding animal dispersion and ecological needs, and it is one of the most commonly reported ecological attributes of free-ranging mammals. Previous studies indicate that red foxes Vulpes vulpes display great variability in home range size. Yet, there has been little consensus regarding the reasons why home range sizes of red foxes vary so extensively. In this study, we examine possible causes of variation in red fox home range sizes using data from 52 GPS collared red foxes from four study areas representing a gradient of landscape productivity and human landscape alteration in Norway and Sweden. Using 90% Local Convex Hull home range estimates, we examined how red fox home range size varied in relation to latitude, elevation, vegetation zone, proportion of agricultural land and human settlement within a home range, and sex and age. We found considerable variation in red fox home range sizes, ranging between 0.95 km2 to 44 km2 (LoCoH 90%) and 2.4 km2 to 358 km2 (MCP 100%). Elevation, proportion of agricultural land and sex accounted for 50% of the variation in home range size found amongst foxes, with elevation having the strongest effect. Red foxes residing in more productive landscapes (those in more southern vegetation zones), had home ranges approximately four times smaller than the home ranges of foxes in the northern boreal vegetation zone. Our results indicate that home range size was influenced by a productivity gradient at both the landscape (latitude) and the local (elevation) scale. The influence of the proportion of agriculture land on home range size of foxes illustrates how human landscape alteration can affect the space use and distribution of red foxes. Further, the variation in home range size found in this study demonstrates the plasticity of red foxes to respond to changing human landscape alteration as well as changes in landscape productivity, which may be contributing to red fox population

  7. Feasibility of Measuring Tobacco Smoke Air Pollution in Homes: Report from a Pilot Study

    Directory of Open Access Journals (Sweden)

    Laura Rosen


    Full Text Available Tobacco smoke air pollution (TSAP measurement may persuade parents to adopt smoke-free homes and thereby reduce harm to children from tobacco smoke in the home. In a pilot study involving 29 smoking families, a Sidepak was used to continuously monitor home PM2.5 during an 8-h period, Sidepak and/or Dylos monitors provided real-time feedback, and passive nicotine monitors were used to measure home air nicotine for one week. Feedback was provided to participants in the context of motivational interviews. Home PM2.5 levels recorded by continuous monitoring were not well-accepted by participants because of the noise level. Also, graphs from continuous monitoring showed unexplained peaks, often associated with sources unrelated to indoor smoking, such as cooking, construction, or outdoor sources. This hampered delivery of a persuasive message about the relationship between home smoking and TSAP. By contrast, immediate real-time PM2.5 feedback (with Sidepak or Dylos monitor was feasible and provided unambiguous information; the Dylos had the additional advantages of being more economical and quieter. Air nicotine sampling was complicated by the time-lag for feedback and questions regarding shelf-life. Improvement in the science of TSAP measurement in the home environment is needed to encourage and help maintain smoke-free homes and protect vulnerable children. Recent advances in the use of mobile devices for real-time feedback are promising and warrant further development, as do accurate methods for real-time air nicotine air monitoring.

  8. Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits. (United States)

    Kristensen, Dorte V; Sundler, Annelie J; Eide, Hilde; Hafskjold, Linda; Ruud, Iren; Holmström, Inger K


    To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective. The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial. A descriptive design with a qualitative inductive approach was used. Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being. The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students. Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication. © 2017 John Wiley & Sons Ltd.

  9. Implementing a Pain Self-Management Protocol in Home Care: A Cluster-Randomized Pragmatic Trial. (United States)

    Reid, M Carrington; Henderson, Charles R; Trachtenberg, Melissa A; Beissner, Katherine L; Bach, Eileen; Barrón, Yolanda; Sridharan, Sridevi; Murtaugh, Christopher M


    To determine the effectiveness of a cognitive-behavioral pain self-management (CBPSM) protocol delivered by physical therapists (PTs) for use by older adults with activity-limiting pain receiving home care. A randomized pragmatic trial comparing delivery of the intervention plus usual care with usual care alone. Community. Individuals aged 55 and older admitted with orders for physical therapy who endorsed activity-limiting pain and reported pain scores of 3 or greater on a scale from 0 to 10 (N = 588). A CBPSM protocol delivered by PTs. Primary outcomes were assessed at 60 days using validated measures of pain-related disability, pain intensity, gait speed, and number of activity of daily living (ADL) deficits. Of 588 participants, 285 received care from a PT randomized to the intervention and 303 from a PT randomized to the usual care group. Both groups had significant reductions in pain-related disability, pain intensity, and ADL limitations and improved gait speed. No significant treatment differences were identified. There were no consistent treatment differences when interactions and subgroups were examined. This real-world pragmatic trial found no effect of implementation of a pain self-management intervention in a home care setting. Despite the lack of positive findings, future studies are indicated to determine how similar protocols that have been found to be effective in efficacy studies can be successfully implemented in routine clinical care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  10. Renal denervation in a real life setting : A gradual decrease in home blood pressure

    NARCIS (Netherlands)

    Beeftink, Martine M A; Spiering, Wilko|info:eu-repo/dai/nl/269114173; Bots, Michiel L.|info:eu-repo/dai/nl/110610032; Verloop, Willemien L.; De Jager, Rosa L.; Sanders, Margreet F.; Vonken, Evert Jan|info:eu-repo/dai/nl/188058796; Blankestijn, Peter J.|info:eu-repo/dai/nl/086704850; Voskuil, Michiel|info:eu-repo/dai/nl/254745954


    OBJECTIVES: To investigate the blood pressure dynamics after renal denervation through monthly home blood pressure measurements throughout the first 12 months. METHODS: A cohort of 70 patients performed highly standardized monthly home blood pressure monitoring during the first year after

  11. In-home versus laboratory sensory testing using non-expert consumers: A comparable study using testing of varieties of Danish strawberries as cases

    DEFF Research Database (Denmark)

    Østergaard, Peder

    The use of in-home versus experimental sensory testing not using sensory expert panels, normally gives reason for discussions of reliability and validity of the two approaches. The poster presents results from a Danish product development project aiming at testing the quality of existing and new...... and 2 well-known varieties of strawberries were tested. The testing used a split-over design where each person participated in sensory testing of 5 different varieties of strawberries. Besides all the participant in the experiment were asked to do an in-home test of 2 of the 5 varieties of strawberries....... Finally also objective sensory measures on the 11 varieties of strawberries were made, enabling a comparison of objective and subjective sensory results. Because many of the questions asked both under the experimental and during the in-home test were identical as well as the test-persons, it is possible...

  12. A pilot randomized, controlled trial of an in-home drinking water intervention among HIV + persons. (United States)

    Colford, John M; Saha, Sona R; Wade, Timothy J; Wright, Catherine C; Vu, Mai; Charles, Sandra; Jensen, Peter; Hubbard, Alan; Levy, Deborah A; Eisenberg, Joseph N S


    Although immunocompromised persons may be at increased risk for gastrointestinal illnesses, no trials investigating drinking water treatment and gastrointestinal illness in such patients have been published. Earlier results from San Francisco suggested an association (OR 6.76) between tap water and cryptosporidiosis among HIV + persons. The authors conducted a randomized, triple-blinded intervention trial of home water treatment in San Francisco, California, from April 2000 to May 2001. Fifty HIV-positive patients were randomized to externally identical active (N = 24) or sham (N = 26) treatment devices. The active device contained a filter and UV light; the sham provided no treatment. Forty-five (90%) of the participants completed the study and were successfully blinded. Illness was measured using 'highly credible gastrointestinal illness' (HCGI), a previously published measure. There were 31 episodes of HCGI during 1,797 person-days in the sham group and 16 episodes during 1,478 person-days in the active group. The adjusted relative risk was 3.34 (95% CI: 0.99-11.21) times greater in those with the sham device. The magnitude of the point estimate of the risk, its consistency with recently published observational data, and its relevance for drinking water choices by immunocompromised individuals support the need for larger trials.

  13. Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study. (United States)

    Dowding, Dawn W; Russell, David; Onorato, Nicole; Merrill, Jacqueline A


    Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care. To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure. Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states. In total, there were 61 participants across 6 focus groups. Three overarching themes emerged: continuity of care and communication on care transitions, maintaining continuity of care during a home care episode (with subthemes tracking signs and symptoms and patient teaching), and health information technology (HIT) characteristics to support communication and care continuity. Our study highlights areas of improvement for HIT solutions that could support care delivery for patients with heart failure in a home care setting. Home care agencies planning to introduce technology can use these findings to assess if and how potential systems can support nurses to provide continuity of care across healthcare organizations and home care visits.

  14. Metal concentrations in homing pigeon lung tissue as a biomonitor of atmospheric pollution. (United States)

    Cui, Jia; Halbrook, Richard S; Zang, Shuying; Han, Shuang; Li, Xinyu


    Atmospheric pollution in urban areas is a major worldwide concern with potential adverse impacts on wildlife and humans. Biomonitoring can provide direct evidence of the bioavailability and bioaccumulation of toxic metals in the environment that is not available with mechanical air monitoring. The current study continues our evaluation of the usefulness of homing pigeon lung tissue as a biomonitor of atmospheric pollution. Homing pigeons (1-2, 5-6, and 9-10+ year old (yo)) collected from Guangzhou during 2015 were necropsied and concentrations of cadmium (Cd), lead (Pb), and mercury (Hg) were measured in lung tissue. Lung Cd and Pb concentrations were significantly greater in 9-10+-year-old pigeons compared with those in other age groups, indicating their bioavailability and bioaccumulation. Lung Pb and Cd concentrations measured in 5-yo pigeons collected from Guangzhou during 2015 were significantly lower than concentrations reported in 5-yo homing pigeons collected from Guangzhou during 2011 and correlated with concentrations measured using mechanical air monitoring. In addition to temporal differences, spatial differences in concentrations of Cd, Pb, and Hg reported in ambient air samples and in pigeon lung tissues collected from Beijing and Guangzhou are discussed.

  15. Telemedicine follow-up facilitates more comprehensive diabetes foot ulcer care: A qualitative study in home based and specialist health care. (United States)

    Kolltveit, Beate-Christin Hope; Thorne, Sally; Graue, Marit; Gjengedal, Eva; Iversen, Marjolein M; Kirkevold, Marit


    To investigate the application of a telemedicine intervention in diabetes foot ulcer care, and its implications for the health care professionals in the clinical field. Contextual factors are found to be important when applying technology in health care and applying telemedicine in home-based care has been identified as particularly complex. We conducted field observations and individual interviews among health care professionals in home-based care and specialist health care in a diabetes foot care telemedicine RCT (Clin.Trial. gov: NCT01710774) during 2016. The current study was guided by Interpretive Description, an inductive qualitative methodology. Overall, we identified unequal possibilities for applying telemedicine in diabetes foot ulcer care within the hospital and home care contexts. Different circumstances and possibilities in home-based care made the application of telemedicine as intended more difficult. The health care professionals in both care contexts perceived the application of telemedicine to facilitate a more comprehensive approach towards the patients, but with different possibilities to enact it. Application of telemedicine in home-based care was more challenging than in the outpatient clinic setting. Introducing more updated equipment and minor structural adjustments in consultation time and resources could make the use of telemedicine in home-based care more robust. Application of telemedicine in diabetes foot ulcer follow up may enhance the nursing staff's ability to conduct comprehensive assessment and care of the foot ulcer as well as the patient's total situation. Access to adequate equipment and time, particularly in home-based care, is necessary to capitalize on this new technology. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  16. Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators. (United States)

    Houle, Sherilyn; MacKeigan, Linda


    As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing

  17. Family identification: A beneficial process for young adults who grow up in homes affected by parental intimate partner violence

    Directory of Open Access Journals (Sweden)

    Catherine Mary Naughton


    Full Text Available Exposure to parental intimate partner violence (parental IPV is a complex trauma. Research within social psychology establishes that identification with social groups impacts positively on how we appraise, respond to and recover from traumatic events. Intimate partner violence (IPV is also a highly stigmatized social phenomenon and social isolation is a major factor for families affected by IPV, yet strong identification with the family group may act as a beneficial psychological resource to young people who grew up in homes affected by IPV. The current study, an online survey of 355 students (M age = 20, 70% female, investigated if a psychosocial process, specifically identification with the family, may influence the relationship between the predictor, exposure to parental IPV, and outcomes, global self-esteem and state anxiety. Mediation analysis suggests that identification with the family has a positive influence on the relationship between exposure to parental IPV and psychological outcomes; exposure to parental IPV results in reduced family identification, but when family identification is strong it results in both reduced anxiety and increased self-esteem for young people. The findings highlight the importance of having a strong sense of belonging to the extended family for young people who were exposed to parental IPV, thus has implications for prevention, intervention and social policy.

  18. Understanding attitudes toward information and communication technology in home-care: Information and communication technology as a market good within Norwegian welfare services. (United States)

    Øyen, Karianne Røssummoen; Sunde, Olivia Sissil; Solheim, Marit; Moricz, Sara; Ytrehus, Siri


    The aim of this study was to better understand nurses' and other staff members' attitudes toward the usefulness of information and communication technology in home-care settings. Research has found that beliefs about the expected benefits of information and communication technology impact the use of technology. Furthermore, inexperience with using information and communication technology may cause negative attitudes. This article is based on a questionnaire to 155 nurses and other staff members in home-care in Sogn og Fjordane county in Norway. The results revealed minimal use of information and communication technology at work; however, participants had positive attitudes regarding the potential benefits of information and communication technology use in home-care. Individuals' extensive use of and familiarity with different solutions in private lives could be an important context for explaining employees' attitudes. Given that information and communication technology is both a welfare service and a market good, this may explain individuals' positive attitudes toward information and communication technology despite their lack of experience with it at work. Experiences with information and communication technology as a market good and the way new technologies can affect work routines will affect the implementation of information and communication technology in home-care.

  19. Depression and anxiety, an indicated prevention (DIP) protocol in homes for the elderly: feasibility and (cost) effectiveness of a stepped care programme

    NARCIS (Netherlands)

    Dozeman, E.; van Schaik, D.J.; Beekman, A.T.F.; Stalman, W.A.B.; Bosmans, J.E.; van Marwijk, H.W.J.


    Background. Depressive and anxiety disorders are a very common, serious and underdetected problem in homes for the elderly. Elderly persons in residential homes are at high risk for developing major depressive and anxiety disorders, and, therefore, deserve attention with regard to prevention.

  20. Independent Living Capacity Evaluation in Home-Based Primary Care: Considerations and Outcomes of a Quality Improvement Project. (United States)

    Feng, Michelle C; Murphy, Margaret R; Mlinac, Michelle


    This article describes results of a quality improvement project review of 5 years of capacity evaluations for independent living conducted in one Home-Based Primary Care (HBPC) Program. A retrospective chart review was conducted for all patients evaluated for independent living capacity through the Boston VA HBPC Program (N = 25) to identify differences in outcomes for those with and without capacity. Descriptive information included referral sources, capacity decisions, time remaining in the home, and trajectory of patients following evaluation. All patients evaluated had been diagnosed with a cognitive disorder, and on average, a relatively lower prevalence of mental illness compared with the national HBPC population. Referrals were made primarily by the HBPC team. Patients with capacity were found to have remained in their home longer than those who lacked capacity. Referral for a higher level of care was typically only recommended when no further intervention could be implemented and active risk in the home could not be managed. In home capacity evaluations are complex and challenging, yet results help family and HBPC team support patients' preferences for staying in their own home as long as possible.

  1. Providing Virtual Execution Environments: A Twofold Illustration

    CERN Document Server

    Grehant, Xavier


    Platform virtualization helps solving major grid computing challenges: share resource with flexible, user-controlled and custom execution environments and in the meanwhile, isolate failures and malicious code. Grid resource management tools will evolve to embrace support for virtual resource. We present two open source projects that transparently supply virtual execution environments. Tycoon has been developed at HP Labs to optimise resource usage in creating an economy where users bid to access virtual machines and compete for CPU cycles. SmartDomains provides a peer-to-peer layer that automates virtual machines deployment using a description language and deployment engine from HP Labs. These projects demonstrate both client-server and peer-to-peer approaches to virtual resource management. The first case makes extensive use of virtual machines features for dynamic resource allocation. The second translates virtual machines capabilities into a sophisticated language where resource management components can b...

  2. A qualitative study of in-home robotic telepresence for home care of community-living elderly subjects

    DEFF Research Database (Denmark)

    Boissy, Patrice; Corriveau, Hélène; Michaud, François


    categorized under three themes: potential applications, usability issues and user requirements. Teleoperated mobile robotic systems in the home were thought to be useful in assisting multidisciplinary patient care through improved communication between patients and healthcare professionals, and offering......We examined the requirements for robots in home telecare using two focus groups. The first comprised six healthcare professionals involved in geriatric care and the second comprised six elderly people with disabilities living in the community. The concept of an in-home telepresence robot...

  3. Energy Efficiency and Universal Design in Home Renovations - A Comparative Review. (United States)

    Kapedani, Ermal; Herssens, Jasmien; Verbeeck, Griet


    Policy and societal objectives indicate a large need for housing renovations that both accommodate lifelong living and significantly increase energy efficiency. However, these two areas of research are not yet examined in conjunction and this paper hypothesizes this as a missed opportunity to create better renovation concepts. The paper outlines a comparative review on research in Energy Efficiency and Universal Design in order to find the similarities and differences in both depth and breadth of knowledge. Scientific literature in the two fields reveals a disparate depth of knowledge in areas of theory, research approach, and degree of implementation in society. Universal Design and Energy Efficiency are part of a trajectory of expanding scope towards greater sustainability and, although social urgency has been a driver of the research intensity and approach in both fields, in energy efficiency there is an engineering, problem solving approach while Universal Design has a more sociological, user-focused one. These different approaches are reflected in the way home owners in Energy Efficiency research are viewed as consumers and decision makers whose drivers are studied, while Universal Design treats home owners as informants in the design process and studies their needs. There is an inherent difficulty in directly merging Universal Design and Energy Efficiency at a conceptual level because Energy Efficiency is understood as a set of measures, i.e. a product, while Universal Design is part of a (design) process. The conceptual difference is apparent in their implementation as well. Internationally energy efficiency in housing has been largely imposed through legislation, while legislation directly mandating Universal Design is either non-existent or it has an explicit focus on accessibility. However, Energy Efficiency and Universal Design can be complementary concepts and, even though it is more complex than expected, the combination offers possibilities to advance

  4. Cleaning and disinfection in home care: A comparison of 2 commercial products with potentially different consequences for respiratory health. (United States)

    Goodyear, Nancy; Markkanen, Pia; Beato-Melendez, Christian; Mohamed, Hagir; Gore, Rebecca; Galligan, Catherine; Sama, Susan; Quinn, Margaret


    Home care aides perform personal care and homemaking services in client homes, including cleaning and disinfection (C&D). Although C&D are performed to remove soil and dust, they are increasingly performed for infection prevention. Many C&D products contain respiratory irritants. The objective of this study was to evaluate 2 commercial products for C&D effectiveness on common household surfaces in seniors' homes. Two C&D visits were conducted in 46 seniors' homes. One visit applied a bleach-containing cleaning product and the other applied an environmentally preferable product. Before and after C&D, the study team performed organic soil bioluminometer measurements on surfaces and collected cotton swab and wipe samples for total bacteria count, Staphylococcus aureus, and Clostridium difficile identification. Both products removed microorganisms from tested surfaces. S aureus was found in 7 households, 1 strain of which was methicillin-resistant. Both products removed S aureus from all surfaces. Bleach-containing products removed somewhat more soil than environmentally preferable products, although results were statistically significant for only 1 surface. The study showed similar, not identical, C&D performance for 2 cleaning products with potentially different consequences for respiratory health. Additional research is needed to develop robust recommendations for safe, effective C&D in home care. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. Experimental Results on a Wireless Wattmeter Device for the Integration in Home Energy Management Systems

    Directory of Open Access Journals (Sweden)

    Eduardo M. G. Rodrigues


    Full Text Available This paper presents a home area network (HAN-based domestic load energy consumption monitoring prototype device as part of an advanced metering system (AMS. This device can be placed on individual loads or configured to measure several loads as a whole. The wireless communication infrastructure is supported on IEEE 805.12.04 radios that run a ZigBee stack. Data acquisition concerning load energy transit is processed in real time and the main electrical parameters are then transmitted through a RF link to a wireless terminal unit, which works as a data logger and as a human-machine interface. Voltage and current sensing are implemented using Hall effect principle-based transducers, while C code is developed on two 16/32-bit microcontroller units (MCUs. The main features and design options are then thoroughly discussed. The main contribution of this paper is that the proposed metering system measures the reactive energy component through the Hilbert transform for low cost measuring device systems.

  6. a qualitative study of providers' perspectives

    African Journals Online (AJOL)

    Background: Glaucoma management is challenging to patients as well as to the eye care providers.The study is aimed at describing the challenges faced by providers using qualitative methods. Methods: In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres ...

  7. Measuring Infiltration Rates in Homes as a Basis for Understanding Indoor Air Quality (United States)

    Jerz, G. G.; Lamb, B. K.; Pressley, S. N.; O'Keeffe, P.; Fuchs, M.; Kirk, M.


    Infiltration rates, or the rate of air exchange, of houses are important to understand because ventilation can be a dominate factor in determining indoor air quality. There are chemicals that are emitted from surfaces or point sources inside the home which are harmful to humans; these chemicals come from various objects including furniture, cleaning supplies, building materials, gas stoves, and the surrounding environment. The use of proper ventilation to cycle cleaner outdoor air into the house can be crucial for maintaining healthy living conditions in the home. At the same time, there can also be outdoor pollutants which infiltrate the house and contribute to poor indoor air quality. In either case, it is important to determine infiltration rates as a function of outdoor weather conditions, the house structure properties and indoor heating and cooling systems. In this work, the objective is to measure ventilation rates using periodic releases of a tracer gas and measuring how quickly the tracer concentration decays. CO2 will be used as the tracer gas because it is inert and harmless at low levels. An Arduino timer is connected to a release valve which controls the release of 9.00 SLPM of CO2 into the uptake vent within the test home. CO2 will be released until there is at least a 200 to 300 ppm increase above ambient indoor levels. Computers with CO2 sensors and temperature/pressure sensors attached will be used to record data from different locations within the home which will continuously record data up to a week. The results from these periodic ventilation measurements will be analyzed with respect to outdoor wind and temperature conditions and house structure properties. The data will be used to evaluate an established indoor air quality model.

  8. Community referral in home management of malaria in western Uganda: A case series study

    Directory of Open Access Journals (Sweden)

    Nsungwa-Sabiiti Jesca


    Full Text Available Abstract Background Home Based Management of fever (HBM was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children Methods A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral. Results Overall referral rate was 8% (117/1454. Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93% "urgent referrals" accessed referral care but 8 (31% delayed >24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50% were urgently referred; most delayed ≥ 2 days before accessing referral care. Conclusion The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa.

  9. Implementing Universal Maternal Depression Screening in Home Visiting Programs: A Pragmatic Overview (United States)

    Segre, Lisa S.; Taylor, Darby


    Maternal depression, although prevalent in low-income women, is not an inevitable consequence of poverty. Nevertheless, depression is a double burden for impoverished women: compromising infant development and diminishing mothers' ability to benefit from or effectively use home visiting services. Without universal screening, depression is often…

  10. Dealing with professional misconduct by colleagues in home care: a survey among nursing staff.

    NARCIS (Netherlands)

    Maurits, E.E.M.; Veer, A.J.E. de; Groenewegen, P.P.; Francke, A.L.


    Background<\\strong> Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or actually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of professional misconduct can be distinguished: misconduct

  11. Dealing with professional misconduct by colleagues in home care : A nationwide survey among nursing staff

    NARCIS (Netherlands)

    Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P.; Francke, Anneke L.


    Background: Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or actually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of professional misconduct can be distinguished: misconduct associated with

  12. Experiences in home care of cancer patients. A new approach in cancer nursing. (United States)

    Ophof, J; Leucht, R; Frohmüller, S; Dörsam, J; Ruoff, G; Schlag, P


    As a result of mutilating operative procedures, aggressive cytotoxic chemotherapy and terminal stage of the disease, tumor patients face frequent visits to the tumor center. They are often hospitalized and thereby excluded from family and home. To enable cancer therapy and supportive care on an ambulatory basis, a team consisting of two physicians, two nurses and one psychologist was settled in our department in November 1986. The purpose of this team was to transfer several oncological treatment modalities from the hospital to the homes of the patients. Apart from organizing the patients' discharge from the hospital and coordinating treatment, the main task of the team has been to follow the patient during the course of the disease and give psycological support. In our experience the possibility of home care has clearly improved the patients' quality of life.

  13. Fungal fragments in moldy houses: A field study in homes in New Orleans and Southern Ohio (United States)

    Reponen, Tiina; Seo, Sung-Chul; Grimsley, Faye; Lee, Taekhee; Crawford, Carlos; Grinshpun, Sergey A.

    Smaller-sized fungal fragments (mold-related health effects. Previous laboratory-based studies have shown that the number concentration of fungal fragments can be up to 500 times higher than that of fungal spores, but this has not yet been confirmed in a field study due to lack of suitable methodology. We have recently developed a field-compatible method for the sampling and analysis of airborne fungal fragments. The new methodology was utilized for characterizing fungal fragment exposures in mold-contaminated homes selected in New Orleans, Louisiana and Southern Ohio. Airborne fungal particles were separated into three distinct size fractions: (i) >2.25 μm (spores), (ii) 1.05-2.25 μm (mixture), and (iii) <1.0 μm (submicrometer-sized fragments). Samples were collected in five homes in summer and winter and analyzed for (1→3)- β- D-glucan. The total (1→3)- β- D-glucan varied from 0.2 to 16.0 ng m -3. The ratio of (1→3)- β- D-glucan mass in fragment size fraction to that in spore size fraction ( F/ S) varied from 0.011 to 2.163. The mass ratio was higher in winter (average=1.017) than in summer (0.227) coinciding with a lower relative humidity in the winter. Assuming a mass-based F/ S-ratio=1 and the spore size=3 μm, the corresponding number-based F/ S-ratio (fragment number/spore number) would be 10 3 and 10 6, for the fragment sizes of 0.3 and 0.03 μm, respectively. These results indicate that the actual (field) contribution of fungal fragments to the overall exposure may be very high, even much greater than that estimated in our earlier laboratory-based studies.

  14. Straight-line assimilation in home-leaving? A comparison of Turks, Somalis and Danes

    DEFF Research Database (Denmark)

    Nielsen, Rikke Skovgaard


    The purpose of this paper is to test the evidence for spatial assimilation and straight-line assimilation in the transition of leaving home in Denmark. Based on data from the extensive Danish registers, the paper analyses the home-leaving patterns of Danes, Turkish immigrants, Turkish descendants...... and Somali immigrants. Two main findings emerged. First, while spatial segregation patterns of home-leavers were clear, inter-generational mobility did take place, supporting the notion of straight-line assimilation. Second, inter-generational effects were identified. While there was no indication...... the hazard for moving to a non-ethnic neighbourhood. Similarity in the patterns of natives and the ethnic minority groups indicates that the processes taking place might be about more than assimilation between generations....

  15. Experienced discrimination in home mortgage lending

    DEFF Research Database (Denmark)

    Secchi, Davide; Seri, Raffaello


    the applicant’s nationality is considered. In addition to its findings, the study (a) provides an original econometric model on a two-step procedure to test perceived discrimination and (b) suggests a method and approach that may constitute a point of reference for those willing to study perceived......This article proposes a framework for the analysis of experienced discrimination in home mortgages. It addresses the problem of home mortgage lending discrimination in one of the richest areas of northern Italy. Employees of a local hospital were interviewed to study their perception (or experience......) of discriminatory behavior related to home financing. The analysis follows two steps. The first evaluates self-selection (the probability that individuals apply) and the second focuses on the likelihood that applications are accepted by the bank. Findings show that discrimination is likely to appear when...

  16. Using a new, low-cost air quality sensor to quantify second-hand smoke (SHS) levels in homes. (United States)

    Semple, Sean; Ibrahim, Azmina Engku; Apsley, Andrew; Steiner, Markus; Turner, Stephen


    To determine if a low-cost particle counter, the Dylos DC 1700, can be used in homes to quantify second-hand smoke (SHS) concentrations. Participants were recruited from a hospital-based study of attitudes on smoking. Two photometric devices (Dylos DC1700 and Sidepak AM510 Personal Aerosol Monitor) capable of measuring and logging concentrations of particulate matter were placed in smoking and non-smoking homes for approximately 24h. Acquired data were randomly allocated to one of two groups: one was used to generate a calibration equation using regression techniques; the second was used for validation of the generated model. The mean difference and limits of agreement between the two instruments were calculated using the validation dataset. Summary air-quality results were also compared across the entire dataset. Over 500 001 minute concentration measurements were collected from 34 homes. 25 301 randomly selected paired-measurements were used to generate a calibration equation (R(2) 0.86) converting the particle number concentration from the Dylos to a mass concentration of PM2.5 as measured by the Sidepak. The mean difference (limits of agreement) between the remaining 25 102 paired measurements was -0.09 (-49.7 to 49.5) with 3.2% of values outside the limits of agreement. Differences in the air quality information generated by the two instruments were generally small and unlikely to impact on user interpretation. The Dylos appears to be a valid instrument for measuring PM2.5 in household settings. The Dylos may be useful in air quality-based interventions designed to change smokers' behaviours with the possibility of encouraging cessation and/or smoke-free homes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  17. Wipe sampling for nicotine as a marker of thirdhand tobacco smoke contamination on surfaces in homes, cars, and hotels. (United States)

    Quintana, Penelope J E; Matt, Georg E; Chatfield, Dale; Zakarian, Joy M; Fortmann, Addie L; Hoh, Eunha


    Secondhand smoke contains a mixture of pollutants that can persist in air, dust, and on surfaces for months or longer. This persistent residue is known as thirdhand smoke (THS). Here, we detail a simple method of wipe sampling for nicotine as a marker of accumulated THS on surfaces. We analyzed findings from 5 real-world studies to investigate the performance of wipe sampling for nicotine on surfaces in homes, cars, and hotels in relation to smoking behavior and smoking restrictions. The intraclass correlation coefficient for side-by-side samples was 0.91 (95% CI: 0.87-0.94). Wipe sampling for nicotine reliably distinguished between private homes, private cars, rental cars, and hotels with and without smoking bans and was significantly positively correlated with other measures of tobacco smoke contamination such as air and dust nicotine. The sensitivity and specificity of possible threshold values (0.1, 1, and 10 μg/m(2)) were evaluated for distinguishing between nonsmoking and smoking environments. Sensitivity was highest at a threshold of 0.1 μg/m(2), with 74%-100% of smoker environments showing nicotine levels above threshold. Specificity was highest at a threshold of 10 μg/m(2), with 81%-100% of nonsmoker environments showing nicotine levels below threshold. The optimal threshold will depend on the desired balance of sensitivity and specificity and on the types of smoking and nonsmoking environments. Surface wipe sampling for nicotine is a reliable, valid, and relatively simple collection method to quantify THS contamination on surfaces across a wide range of field settings and to distinguish between nonsmoking and smoking environments.

  18. Evaluating fidelity in home-visiting programs a qualitative analysis of 1058 home visit case notes from 105 families.

    Directory of Open Access Journals (Sweden)

    Thomas Saïas

    Full Text Available Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011.To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses.During the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother's adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers' self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother's education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child's language development.In this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families' urgent needs

  19. Changes in vital signs as predictors of bacterial infection in home care: a multi-center prospective cohort study. (United States)

    Hamano, Jun; Tokuda, Yasuharu


    To explore whether the combination of changes in heart rate and body temperature can predict bacterial infection in home care patients. This multicenter, prospective cohort study was conducted in Japan from March 2012 through December 2013 and involved three clinics. The study population comprised all patients who received regular home visit services for at least 3 months and met one of the following inclusion criteria: 1) fever over 37.5°C at home visit, 2) physician's clinical suspicion of fever, or 3) physician's suspicion of bacterial infection. We collected temperature and heart rate data on the day of enrollment, and determined the probable causes of fever after treatment of febrile episodes. We defined the combination of changes in heart rate and body temperature as delta HR/BT. We calculated two types of delta HR/BT, averaged and assumed, using different baseline values for heart rate and body temperature. A total of 124 patients were enrolled and 194 episodes of fever were analyzed during the study period. The sensitivity, specificity, positive predictive value, and negative predictive value for the average delta HR/BT with a cut-off ≥ 20 were 20.4% (95% CI, 16.7-23.3), 84.2% (95% CI, 75.2-91.0), 75.7% (95% CI, 61.8-86.2), and 30.6% (95% CI, 27.3-33.0), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for the assumed delta HR/BT with a cut-off ≥ 5 was 91.2% (95% CI, 89.2-94.0), 8.9% (95% CI, 4.1-15.7), 70.9% (95% CI, 69.3-73.0), and 29.4% (95% CI, 13.6-51.8), respectively. The combination of changes in heart rate and body temperature could help physicians determine whether home care patients have bacterial infections.

  20. Demand and predictors for post-discharge medical counseling in home care patients: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Shih-Tan Ding

    Full Text Available RATIONALE: Post-discharge care is challenging due to the high rate of adverse events after discharge. However, details regarding post-discharge care requirements remain unclear. Post-discharge medical counseling (PDMC by telephone service was set-up to investigate its demand and predictors. METHODS: This prospective study was conducted from April 2011 to March 2012 in a tertiary referral center in northern Taiwan. Patients discharged for home care were recruited and educated via telephone hotline counseling when needed. The patient's characteristics and call-in details were recorded, and predictors of PDMC use and worsening by red-flag sign were analyzed. RESULTS: During the study period, 224 patients were enrolled. The PDMC was used 121 times by 65 patients in an average of 8.6 days after discharge. The red-flag sign was noted in 17 PDMC from 16 patients. Of the PDMC used, 50% (n = 60 were for symptom change and the rest were for post-discharge care problems and issues regarding other administrative services. Predictors of PDMC were underlying malignancy and lower Barthel index (BI. On the other hand, lower BI, higher adjusted Charlson co-morbidity index (CCI, and longer length of hospital stay were associated with PDMC and red-flag sign. CONCLUSIONS: Demand for PDMC may be as high as 29% in home care patients within 30 days after discharge. PDMC is needed more by patients with malignancy and lower BI. More focus should also be given to those with lower BI, higher CCI, and longer length of hospital stay, as they more frequently have red flag signs.

  1. Effect of Azilsartan on Day-to-Day Variability in Home Blood Pressure: A Prospective Multicenter Clinical Trial. (United States)

    Miyoshi, Toru; Suetsuna, Ryoji; Tokunaga, Naoto; Kusaka, Masayasu; Tsuzaki, Ryuichiro; Koten, Kazuya; Kunihisa, Kohno; Ito, Hiroshi


    The blood pressure variability (BPV) such as visit-to-visit, day-by-day, and ambulatory BPV has been also shown to be a risk of future cardiovascular events. However, the effects of antihypertensive therapy on BPV remain unclear. The purpose of this study was to evaluate the effect of azilsartan after switching from another angiotensin II receptor blocker (ARB) on day-to-day BPV in home BP monitoring. This prospective, multicenter, open-labeled, single-arm study included 28 patients undergoing treatment with an ARB, which was switched to azilsartan after enrollment. The primary outcome was the change in the mean of the standard deviation and the coefficient of variation of morning home BP for 5 consecutive days from baseline to the 24-week follow-up. The secondary outcome was the change in arterial stiffness measured by the cardio-ankle vascular index. The mean BPs in the morning and evening for 5 days did not statistically differ between baseline and 24 weeks. For the morning BP, the means of the standard deviations and coefficient of variation of the systolic BP were significantly decreased from 7.4 ± 3.6 mm Hg to 6.1 ± 3.2 mm Hg and from 5.4±2.7% to 4.6±2.3% (mean ± standard deviation, P = 0.04 and P = 0.04, respectively). For the evening BP, no significant change was observed in the systolic or diastolic BPV. The cardio-ankle vascular index significantly decreased from 8.3 ± 0.8 to 8.1 ± 0.8 (P = 0.03). Switching from another ARB to azilsartan reduced day-to-day BPV in the morning and improved arterial stiffness.

  2. An exploration and comparison of food and drink availability in homes in a sample of families of White and Pakistani origin within the UK. (United States)

    Bryant, Maria; Sahota, Pinki; Santorelli, Gillian; Hill, Andrew


    Knowledge of the types and quantities of foods and drinks available in family homes supports the development of targeted intervention programmes for obesity prevention or management, or for overall diet improvement. In the UK, contemporary data on foods that are available within family homes are lacking. The present study aimed to explore home food and drink availability in UK homes. An exploratory study using researcher-conducted home food availability inventories, measuring all foods and drinks within the categories of fruits, vegetables, snack foods and beverages. Bradford, a town in the north of the UK. Opportunistic sample of mixed ethnicity families with infants approximately 18 months old from the Born in Bradford birth cohort. All homes had at least one type of fruit, vegetable and snack available. Fresh fruits commonly available were oranges, bananas, apples, satsumas and grapes. Commonly available fresh vegetables included potatoes, cucumber, tomatoes and carrots. The single greatest non-fresh fruit available in homes was raisins. Non-fresh vegetables contributing the most were frozen mixed vegetables, tinned tomatoes and tinned peas. Ethnic differences were found for the availability of fresh fruits and sugar-sweetened beverages, which were both found in higher amounts in Pakistani homes compared with White homes. These data contribute to international data on availability and provide an insight into food availability within family homes in the UK. They have also supported a needs assessment of the development of a culturally specific obesity prevention intervention in which fruits and vegetables and sugar-sweetened beverages are targeted.

  3. Instrument comprising a cable or tube provided provided with a propulsion device

    NARCIS (Netherlands)

    Breedveld, P.


    The invention relates to an instrument (1) comprising a cable or tube (3), at a distal end of which a propulsion device (4) is provided for moving the cable or tube in a hollow space, the propulsion device being shaped like a donut lying in a plane at right angles to the longitudinal direction of

  4. The psychosocial impact of caregiving on the family caregivers of chronically ill AIDS and/or HIV patients in home-based care: A qualitative study in Zimbabwe

    Directory of Open Access Journals (Sweden)

    Claire van Deventer


    Full Text Available Background: The family caregiver has a pivotal role to play in the management of the chronically ill HIV and/or AIDS patients. The wellbeing of caregivers is therefore crucial because impairment of their physical or mental health could impact negatively on the management of their HIV-positive family member. The purpose of this qualitative study was to explore the psychosocial impact of caregiving on the family caregiver of the chronically ill HIV and/or AIDS patients in home-based care.Method: Unstructured interviews were conducted with 11 caregivers recruited at an adult HIV clinic at United Bulawayo Hospitals, Bulawayo, Zimbabwe. Relevant demographic information was collected from each participant. The interviews were then transcribed and analysed.Results: Caregivers’ biggest challenge was meeting care costs such as food, transport and medical costs. Certain conditions relating to the care-recipient’s health and family issues, such as abandonment of the ill patient as well as that of orphans, added to the burden of care. Carers also had to deal with their own health and physical problems. All the above resulted in a spectrum of emotions such as helplessness, sadness, anxiety and anger. Despite this, caregivers also reported on the positive aspects regarding their caregiving role.Conclusion: There were both negative and positive psychosocial experiences by caregivers of HIV and/or AIDS patients. The study highlighted practical areas where support could be provided.

  5. A Randomized Controlled Trial of In-Home Tele-behavioral Health Care Utilizing Behavioral Activation for Depression (United States)


    31) Key Words: suicide risk, patient safety, risk management, telehealth , telemedicine *This project is partially supported by the Department of the...KJ, Acierno, R. Managing suicidality in home-based telehealth . Journal of Telemedicine and Telecare 2011;17:332-335. doi: 10.1258/jtt.2011.101207 20...this trial alone. 15. SUBJECT TERMS Depression, Behavioral Activation, Telehealth 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18

  6. Impact of bottle size on in-home consumption of sugar-sweetened beverages: a feasibility and acceptability study

    Directory of Open Access Journals (Sweden)

    Eleni Mantzari


    and acceptability of running a randomised controlled trial to assess the impact of presenting a fixed volume of SSB in different bottle sizes on in-home consumption. However, methods that avoid consumption being influenced by the amount of cola supplied weekly by the study and that capture out of home consumption are needed before conducting a randomised controlled trial. Trial registration ISRCTN14964130 ; Registered on 18th May, 2015.

  7. The impact of sleep on neuropsychological performance in cognitively intact older adults using a novel in-home sensor based sleep assessment approach


    Seelye, Adriana; Mattek, Nora; Howieson, Diane; Riley, Thomas; Wild, Katherine; Kaye,Jeffrey


    The relationship between recent episodes of poor sleep and cognitive testing performance in healthy cognitively intact older adults is not well understood. In this exploratory study, we examined the impact of recent sleep disturbance, sleep duration, and sleep variability on cognitive performance in 63 cognitively intact older adults using a novel unobtrusive in-home sensor based sleep assessment methodology. Specifically, we examined the impact of sleep the night prior, the week prior, and t...

  8. Association between clean indoor air laws and voluntary smokefree rules in homes and cars. (United States)

    Cheng, Kai-Wen; Okechukwu, Cassandra A; McMillen, Robert; Glantz, Stanton A


    This study examines the influence that smokefree workplaces, restaurants and bars have on the adoption of smokefree rules in homes and cars, and whether there is an association with adopting smokefree rules in homes and cars. Bivariate probit models were used to jointly estimate the likelihood of living in a smokefree home and having a smokefree car as a function of law coverage and other variables. Household data were obtained from the nationally representative Social Climate Survey of Tobacco Control 2001, 2002 and 2004-2009; clean indoor air law data were from the American Nonsmokers' Rights Foundation Tobacco Control Laws Database. 'Full coverage' and 'partial coverage' smokefree legislation is associated with an increased likelihood of having voluntary home and car smokefree rules compared with 'no coverage'. The association between 'full coverage' and smokefree rule in homes and cars is 5% and 4%, respectively, and the association between 'partial coverage' and smokefree rules in homes and cars is 3% and 4%, respectively. There is a positive association between the adoption of smokefree rules in homes and cars. Clean indoor air laws provide the additional benefit of encouraging voluntary adoption of smokefree rules in homes and cars. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  9. Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things (United States)

    Pang, Zhibo; Zheng, Lirong; Tian, Junzhe; Kao-Walter, Sharon; Dubrova, Elena; Chen, Qiang


    In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients' home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.

  10. E-Learning--A Provider's Prospective. (United States)

    Cheong, Chew Seong


    Discusses the use of the Internet for electronic lifelong learning services. Highlights include electronic learning as a business; globalization and the knowledge economy; advantages of electronic learning; lifelong electronic learning; and the experiences of one global corporation that developed a Web Site to facilitate lifelong learning. (LRW)

  11. Providing a Healthy Environment for Interracial Children. (United States)

    Ladner, Joyce


    Children of intermarriages have special needs. They often encounter prejudice from other family members such as grandparents, and, in general, society does not know how to regard them. A bicultural approach to childbearing is necessary; it is most important that a child learn about the culture of the parent of color. (KH)

  12. The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial


    Ribbe Miel W; Frijters Dinnus H; van Hout Hein PJ; Boorsma Marijke; Nijpels Giel


    Abstract Background The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. Methods This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not term...

  13. Providing leadership in a culturally diverse workplace. (United States)

    Williamson, Geraldine


    Cultural diversity is an increasingly important characteristic of the work force. Occupational health nurses with sensitivity to the influence of culture on behavior and knowledge of strategies to deliver culturally competent services can lead to and/or help develop a culturally sensitive health care environment and influence corporate culture and policies.

  14. Providing a Structure for Adolescent Development. (United States)

    Ianni, Francis A. J.


    As teenagers mature, they seek to move away from the adult community's normative pressures. A 10-year survey of adolescents in 10 communities found more congruence than conflict between parent and adolescent world views. Seattle, Washington's innovative youth charter offers an ideal way to map out adult and adolescent roles. Includes nine…

  15. A Lead Provided by Bookmarks - Intelligent Browsers

    Directory of Open Access Journals (Sweden)

    Dan Balanescu


    Full Text Available Browsers are applications that allow Internet access. A defining characteristic is their unidirectionality: Navigator-> Internet. The purpose of this article is to support the idea of Intelligent Browsers that is defined by bidirectional: Navigator-> Internet and Internet-> Navigator. The fundamental idea is that the Internet contains huge resources of knowledge, but they are “passive”. The purpose of this article is to propose the “activation” of this knowledge so that they, through “Intelligent Browsers”, to become from Sitting Ducks to Active Mentors. Following this idea, the present article proposes changes to Bookmarks function, from the current status of Favorites to Recommendations. The article presents an analysis of the utility of this function (by presenting a research of web browsing behaviors and in particular finds that the significance of this utility has decreased lately (to the point of becoming almost useless, as will be shown, in terms data-information-knowledge. Finally, it presents the idea of a project which aims to be an applied approach that anticipates the findings of this study and the concept of Intelligent Browsers (or Active Browsers required in the context of the Big Data concept.

  16. ards of a 3PL provider

    Directory of Open Access Journals (Sweden)

    Carlos Osorio-Ramírez


    Full Text Available Definir la ubicación de las instalaciones para una cadena de su ministro, es considerada como una decisión de tipo estratégico. A menudo esta decisión se toma con base en criterio de mínimo costo o me jor nivel de servicio o de cobertura. Sin embargo, estos criter ios usualmente no son tenidos en cuenta de manera simultánea por la complejidad inherente que pueden tener los problemas de optimi zación con varios objetivos, los cuales generalmente están en conflict o. El presente trabajo muestra la aplicación del algoritmo evol utivo multi- objetivo NSGAII, en una situación real afrontada por un operado r logístico en Colombia, y sirve como punto de partida para dic ha empresa para evaluar alternativas de distribución.

  17. Instrument comprising a cable or tube provided provided with a propulsion device


    Breedveld, P.


    The invention relates to an instrument (1) comprising a cable or tube (3), at a distal end of which a propulsion device (4) is provided for moving the cable or tube in a hollow space, the propulsion device being shaped like a donut lying in a plane at right angles to the longitudinal direction of the cable or tube, wherein the donut-shaped propulsion device is, at least in part, externally delimited by at least one wire gauze (6) that is rotatable about a closed axis of the donut body, which ...

  18. Provider Opinions Regarding the Development of a Stigma-Reduction Intervention Tailored for Providers (United States)

    Mittal, Dinesh; Corrigan, Patrick; Drummond, Karen L.; Porchia, Sylvia; Sullivan, Greer


    Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input from health care providers to inform the design of a contact intervention intended to reduce provider stigma toward persons with serious mental illness. Using a purposive sampling strategy, data were…

  19. Barriers to palliative care in people with chronic obstructive pulmonary disease in home care: A qualitative study of the perspective of professional caregivers. (United States)

    Mousing, Camilla A; Timm, Helle; Lomborg, Kirsten; Kirkevold, Marit


    To examine the experiences with palliative care in people with chronic obstructive pulmonary disease among professional caregivers in a Danish home care setting. Many patients with advanced chronic obstructive pulmonary disease depend on professional caregivers in the primary sector to provide assistance and care. However, chronic obstructive pulmonary disease patients receive no or only very little palliative care compared to patients with cancer although they may have many burdensome symptoms. Qualitative explorative study. In 2013-2014, ten professional caregivers from three districts in a Danish municipality were followed during home visits to patients with chronic obstructive pulmonary disease and individual interviews about palliative care were subsequently conducted. In 2014, 66 professional caregivers, representing eleven home care districts, participated in ten group discussions about palliative care needs in this group of patients. Data were analysed using qualitative descriptive analysis. The study revealed a nonawareness of palliative care for patients with chronic obstructive pulmonary disease among the professional caregivers who expressed vague understanding of palliative care and lack of knowledge about the disease. Organisational barriers, such as lack of time and continuity in patient care, lack of opportunity to discuss palliative care and lack of peer learning were experienced as challenging in the provision of palliative care. Nonawareness and organisational barriers led to difficulties in identifying palliative care needs and reluctance to initiate conversations about palliative care. The findings indicate a need for education, training and reflection among professional caregivers in home care. Also, organisational changes may be needed to reduce the barriers to palliative care. The findings uncovered barriers to palliative care that must be addressed. Targeted educational programmes and organisational changes may increase the ability to

  20. Effects and meanings of a person-centred and health-promoting intervention in home care services - a study protocol of a non-randomised controlled trial. (United States)

    Bölenius, Karin; Lämås, Kristina; Sandman, Per-Olof; Edvardsson, David


    The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people's quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives' satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people. NCT02846246 .

  1. Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study. (United States)

    Lyngstad, Merete; Hofoss, Dag; Grimsmo, Anders; Hellesø, Ragnhild


    Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, Pnurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, Pcare nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home

  2. Secure Service Discovery in Home Networks

    NARCIS (Netherlands)

    Scholten, Johan; van Dijk, H.W.; De Cock, Danny; Preneel, Bart; Kung, Antonio; d'Hooge, Michel


    This paper presents an architecture for secure service discovery for use in home networks. We give an overview and rationale of a cluster-based home network architecture that bridges different, often vendor specific, network technologies. We show how it integrates security, communication, and

  3. Digital screen visits in home care services

    DEFF Research Database (Denmark)

    Zarakit, Mohamad; Nors Hansen, Louise; Evron, Lotte Orr


    The use of digital technology is increasing in home care services in Denmark. In the municipality of Copenhagen digital screens visits are being used as an alternative version of the traditional (physical) home visit to a selected population to increase quality and efficiency in the home care...

  4. Implementation of an Evidence-Based and Content Validated Standardized Ostomy Algorithm Tool in Home Care: A Quality Improvement Project. (United States)

    Bare, Kimberly; Drain, Jerri; Timko-Progar, Monica; Stallings, Bobbie; Smith, Kimberly; Ward, Naomi; Wright, Sandra

    Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.

  5. Engaging Families in In-Home Family Intervention (United States)

    Thompson, Ronald W.; Koley, Sarah


    Boys Town has created a program called In-Home Family Services to deliver help to families in stress. In-home family intervention programs have become widely used to help more families who are at risk and experiencing difficulties with a wide range of problems including domestic violence, child behavior problems, parent-child and family…

  6. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. (United States)

    Karinkanta, S; Heinonen, A; Sievänen, H; Uusi-Rasi, K; Pasanen, M; Ojala, K; Fogelholm, M; Kannus, P


    This study showed that combination of strength, balance, agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women. The finding supports the idea that it is possible to maintain good physical functioning by multi-component exercise program and thus postpone the age-related functional problems. This 1-year randomized, controlled exercise intervention trial assessed the effects of two different training programs and their combination on physical functioning and bone in home-dwelling elderly women. One hundred and forty-nine healthy women aged 70-78 years were randomly assigned into: group 1-resistance training (RES), group 2-balance-jumping training (BAL), group 3-combination of resistance and balance-jumping training (COMB), and group 4-controls (CON). Self-rated physical functioning, leg extensor force, dynamic balance, and bone mass and structure were measured. Self-rated physical functioning improved in the COMB group, but was reduced in the CON group; the mean inter-group difference was 10% (95% CI: 0-22%). Mean increase in the leg extensor force was higher in the RES (14%; 4-25%) and COMB (13%; 3-25%) compared with the CON groups. Dynamic balance improved in the BAL (6%; 1-11%) and in the COMB (8%; 3-12%) groups. There were no inter-group differences in BMC at the proximal femur. In those COMB women who trained at least twice a week, the tibial shaft structure weakened 2% (0-4%) less than those in the CON group. Strength, balance, agility, and jumping training (especially in combination) prevented functional decline in home-dwelling elderly women. In addition, positive effects seen in the structure of the loaded tibia indicated that exercise may also play a role in preventing bone fragility.

  7. Family physicians' experiences when collaborating with district nurses in home care-based medical treatment. A grounded theory study


    Modin, Sonja; T?rnkvist, Lena; Furhoff, Anna-Karin; Hylander, Ingrid


    Abstract Background This article concerns Swedish family physicians' (FPs) experiences collaborating with district nurses (DNs) when the DNs provide medical treatment for home care patients. The aim was to develop a model to illuminate this process from the FPs' perspective. Methods Semi-structured interviews were conducted with 13 FPs concerning one of their patients with home care by a DN. The interview focused on one patient's treatment and care by different care providers and the collabor...

  8. The Caring Home Program: In-Home Interventions for Alzheimer's Disease Patients and Their Caregivers. (United States)

    Pynoos, Jon; Ohta, Russell J.

    The home is clearly the major setting in which care is provided to individuals suffering from Alzheimer's disease. The Caring Home Program was a multi-disciplinary program designed to complement existing efforts to assist caregivers (N=12) with the in-home care of Alzheimer's disease patients. The program components consisted of an assessment of…

  9. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy (United States)

    Lawrence, Sharmila; Stephens, Samuel A.


    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  10. Contributions of Therapist Characteristics and Stability to Intensive In-Home Therapy Youth Outcomes (United States)

    Greeson, Johanna K. P.; Guo, Shenyang; Barth, Richard P.; Hurley, Sarah; Sisson, Jocelyn


    Objective: This study examines the influence of therapist and youth characteristics on post-discharge outcomes from intensive in-home therapy. Method: Data for 1,416 youth and 412 therapists were obtained from a behavioral health services provider. The Huber-White method was used to account for nested data; ordered logistic regression was employed…

  11. 77 FR 13236 - Exempting In-Home Video Telehealth From Copayments (United States)


    ... established for Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI) and Multiple Sclerosis (MS). Clinical... physical contact. However, in-home video telehealth care is provided in a veteran's home, eliminating the..., exercise plans, and medication management. The clinician may also monitor patient self-care by reviewing...

  12. Human Activity Recognition from Smart-Phone Sensor Data using a Multi-Class Ensemble Learning in Home Monitoring. (United States)

    Ghose, Soumya; Mitra, Jhimli; Karunanithi, Mohan; Dowling, Jason


    Home monitoring of chronically ill or elderly patient can reduce frequent hospitalisations and hence provide improved quality of care at a reduced cost to the community, therefore reducing the burden on the healthcare system. Activity recognition of such patients is of high importance in such a design. In this work, a system for automatic human physical activity recognition from smart-phone inertial sensors data is proposed. An ensemble of decision trees framework is adopted to train and predict the multi-class human activity system. A comparison of our proposed method with a multi-class traditional support vector machine shows significant improvement in activity recognition accuracies.

  13. eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop (United States)

    Barakat, Ansam; Woolrych, Ryan D; Sixsmith, Andrew; Kearns, William D


    Background The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions This paper describes the health care professionals

  14. Family physicians' experiences when collaborating with district nurses in home care-based medical treatment. A grounded theory study (United States)


    Background This article concerns Swedish family physicians' (FPs) experiences collaborating with district nurses (DNs) when the DNs provide medical treatment for home care patients. The aim was to develop a model to illuminate this process from the FPs' perspective. Methods Semi-structured interviews were conducted with 13 FPs concerning one of their patients with home care by a DN. The interview focused on one patient's treatment and care by different care providers and the collaboration among them. Grounded theory methodology (GTM) was used in the analyses. Results It was essential for FPs to collaborate with and rely on DNs in the medical treatment of home care patients. According to the FPs, factors such as the disease, FPs' working conditions and attitude determined how much of the initiative in this treatment FPs retained or left to DNs. Depending on the circumstances, two different roles were adopted by the individual FPs: medical conductors who retain the initiative and medical consultants who leave the initiative to DNs. Factors as the disease, DNs' attitudes towards collaboration and DNs' working conditions influenced whether or not the FPs felt that grounds for relying on DNs were satisfactory. Regardless of the role of the FP, conditions for medical treatment were judged by the FPs to be good enough when the grounds for relying on the DN were satisfactory and problematic when they were not. Conclusions In the role of conductor, the FP will identify when the grounds for relying on the DN are unsatisfactory and be able to take action, but in the role of consultant the FP will not detect this, leaving home care patients without appropriate support. Only when there are satisfactory grounds for relying on the DN, will conditions for providing home care medical treatment be good enough when the FP adopts a consultative role. PMID:20979649

  15. Family physicians' experiences when collaborating with district nurses in home care-based medical treatment. A grounded theory study

    Directory of Open Access Journals (Sweden)

    Hylander Ingrid


    Full Text Available Abstract Background This article concerns Swedish family physicians' (FPs experiences collaborating with district nurses (DNs when the DNs provide medical treatment for home care patients. The aim was to develop a model to illuminate this process from the FPs' perspective. Methods Semi-structured interviews were conducted with 13 FPs concerning one of their patients with home care by a DN. The interview focused on one patient's treatment and care by different care providers and the collaboration among them. Grounded theory methodology (GTM was used in the analyses. Results It was essential for FPs to collaborate with and rely on DNs in the medical treatment of home care patients. According to the FPs, factors such as the disease, FPs' working conditions and attitude determined how much of the initiative in this treatment FPs retained or left to DNs. Depending on the circumstances, two different roles were adopted by the individual FPs: medical conductors who retain the initiative and medical consultants who leave the initiative to DNs. Factors as the disease, DNs' attitudes towards collaboration and DNs' working conditions influenced whether or not the FPs felt that grounds for relying on DNs were satisfactory. Regardless of the role of the FP, conditions for medical treatment were judged by the FPs to be good enough when the grounds for relying on the DN were satisfactory and problematic when they were not. Conclusions In the role of conductor, the FP will identify when the grounds for relying on the DN are unsatisfactory and be able to take action, but in the role of consultant the FP will not detect this, leaving home care patients without appropriate support. Only when there are satisfactory grounds for relying on the DN, will conditions for providing home care medical treatment be good enough when the FP adopts a consultative role.

  16. Hospital information technology in home care. (United States)

    Zhang, Xiao-Ying; Zhang, Pei-Ying


    The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

  17. SERS substrate and a method of providing a SERS substrate

    DEFF Research Database (Denmark)


    Source: US2011116089A A substrate primarily for SERS determination, the substrate has a number of elongate elements with a density of at least 1x108 elongate elements per cm2 and having metal coated tips. When the elements may be made to lean toward each other, such as by providing a drop...

  18. Sealing device for providing a seal in a turbomachine

    Energy Technology Data Exchange (ETDEWEB)

    Lacy, Benjamin Paul; Kottilingam, Srikanth Chandrudu; Porter, Christopher Donald; Schick, David Edward; Weber, David Wayne


    Sealing device for providing seals between adjacent components, and turbomachines utilizing such sealing devices, are provided. A sealing device includes a seal plate insertable between the adjacent components, the seal plate comprising a first face and an opposing second face. The sealing device further includes a plurality of pins extending from one of the first face or the second face, the plurality of pins configured to space the one of the first face or the second face from contact surfaces of the adjacent components.

  19. Effects of a father-based in-home intervention on perceived stress and family dynamics in parents of children with autism. (United States)

    Bendixen, Roxanna M; Elder, Jennifer H; Donaldson, Susan; Kairalla, John A; Valcante, Greg; Ferdig, Richard E


    Parents of children with autism report high rates of stress. Parental differences in stress are inconsistent, with most research indicating that mothers report higher levels of stress than fathers. We explored parental differences before and after an in-home training program. Fathers were taught an intervention designed to improve their child's social reciprocity and communication; they then trained mothers. Stress was assessed with the Parenting Stress Index-Short Form, and family dynamics was assessed with the Family Adaptability and Cohesion Evaluation Scales II. Both mothers and fathers reported high preintervention levels of stress. After intervention, fathers' stress was reduced, but not significantly, possibly because of the variability in fathers' scores; mothers' stress scores were significantly reduced. Parenting styles were significantly different before and after intervention. Interdisciplinary teams, including occupational therapists, nurses, and special educators, can work.together to have a positive impact on the lives of families of children with autism.

  20. Can Composite Measures Provide a Different Perspective on Provider Performance Than Individual Measures? (United States)

    Shwartz, Michael; Rosen, Amy K; Burgess, James F


    Composite measures, which aggregate performance on individual measures into a summary score, are increasingly being used to evaluate facility performance. There is little understanding of the unique perspective that composite measures provide. To examine whether high/low (ie, high or low) performers on a composite measures are also high/low performers on most of the individual measures that comprise the composite. We used data from 2 previous studies, one involving 5 measures from 632 hospitals and one involving 28 measures from 112 Veterans Health Administration (VA) nursing homes; and new data on hospital readmissions for 3 conditions from 131 VA hospitals. To compare high/low performers on a composite to high/low performers on the component measures, we used 2-dimensional tables to categorize facilities into high/low performance on the composite and on the individual component measures. In the first study, over a third of the 162 hospitals in the top quintile based on the composite were in the top quintile on at most 1 of the 5 individual measures. In the second study, over 40% of the 27 high-performing nursing homes on the composite were high performers on 8 or fewer of the 28 individual measures. In the third study, 20% of the 61 low performers on the composite were low performers on only 1 of the 3 individual measures. Composite measures can identify as high/low performers facilities that perform "pretty well" (or "pretty poorly") across many individual measures but may not be high/low performers on most of them.

  1. Evaporative Cooler Use Influences Temporal Indoor Relative Humidity but Not Dust Mite Allergen Levels in Homes in a Semi-Arid Climate. (United States)

    Johnston, James D; Tuttle, Steven C; Nelson, Morgan C; Bradshaw, Rebecca K; Hoybjerg, Taylor G; Johnson, Julene B; Kruman, Bryce A; Orton, Taylor S; Cook, Ryan B; Eggett, Dennis L; Weber, K Scott


    Concerns about energy consumption and climate change make residential evaporative coolers a popular alternative to central air conditioning in arid and semi-arid climates. However, evaporative coolers have been shown to significantly increase indoor relative humidity and dust mite allergen levels in some studies, while showing no association in other studies. Improved measurement of temporal fluctuations in indoor relative humidity may help identify factors that promote mite growth in homes in dry climates. Dust samples and continuous indoor relative humidity measurements were collected from homes with central air conditioning and homes with evaporative coolers in Utah. Samples were collected over two seasons, winter/spring (Jan-Apr) and summer (July-Sept), 2014. Dust samples were analyzed for Der p 1 and Der f 1 using a two-site monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) analysis. Housing characteristics including age of home, occupant density, and age of mattresses, furniture, and carpeting were also measured. Positive Der p 1 or Der f 1 samples were found in 25.0% of the homes and there was no difference in mean allergen levels by type of air conditioning. Indoor relative humidity was significantly higher in homes with evaporative coolers compared to those with central air conditioning during the summer. Homes with evaporative coolers also spent significantly more time during summer above 55.0% and 65.0% relative humidity compared to central air homes, but not above 75.0%. Findings from this study suggest that increased humidity from evaporative coolers may not be sufficient to exceed the critical equilibrium humidity or maintain humidity excursions for sufficient duration in relatively larger single-family homes in semi-arid climates to support mite growth and reproduction.

  2. Evaporative Cooler Use Influences Temporal Indoor Relative Humidity but Not Dust Mite Allergen Levels in Homes in a Semi-Arid Climate.

    Directory of Open Access Journals (Sweden)

    James D Johnston

    Full Text Available Concerns about energy consumption and climate change make residential evaporative coolers a popular alternative to central air conditioning in arid and semi-arid climates. However, evaporative coolers have been shown to significantly increase indoor relative humidity and dust mite allergen levels in some studies, while showing no association in other studies. Improved measurement of temporal fluctuations in indoor relative humidity may help identify factors that promote mite growth in homes in dry climates. Dust samples and continuous indoor relative humidity measurements were collected from homes with central air conditioning and homes with evaporative coolers in Utah. Samples were collected over two seasons, winter/spring (Jan-Apr and summer (July-Sept, 2014. Dust samples were analyzed for Der p 1 and Der f 1 using a two-site monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA analysis. Housing characteristics including age of home, occupant density, and age of mattresses, furniture, and carpeting were also measured. Positive Der p 1 or Der f 1 samples were found in 25.0% of the homes and there was no difference in mean allergen levels by type of air conditioning. Indoor relative humidity was significantly higher in homes with evaporative coolers compared to those with central air conditioning during the summer. Homes with evaporative coolers also spent significantly more time during summer above 55.0% and 65.0% relative humidity compared to central air homes, but not above 75.0%. Findings from this study suggest that increased humidity from evaporative coolers may not be sufficient to exceed the critical equilibrium humidity or maintain humidity excursions for sufficient duration in relatively larger single-family homes in semi-arid climates to support mite growth and reproduction.

  3. Evaluating the Effectiveness of a Commercial Portable Air Purifier in Homes with Wood Burning Stoves: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Julie F. Hart


    Full Text Available Wood burning for residential heating is prevalent in the Rocky Mountain regions of the United States. Studies have shown that wood stoves can be a significant source of PM2.5 within homes. In this study, the effectiveness of an electrostatic filter portable air purifier was evaluated (1 in a home where a wood stove was the sole heat source and (2 in a home where a wood stove was used as a supplemental heat source. Particle count concentrations in six particle sizes and particle mass concentrations in two particle sizes were measured for ten 12-hour purifier on and ten purifier off trials in each home. Particle count concentrations were reduced by 61–85 percent. Similar reductions were observed in particle mass concentrations. These findings, although limited to one season, suggest that a portable air purifier may effectively reduce indoor particulate matter concentrations associated with wood combustion during home heating.

  4. [Difficulty in home care management of a young patient with terminal stage carcinoma--a case report]. (United States)

    Inoue, Akiko; Onose, Akira; Onishi, Hiroka; Isono, Hisayo; Miyamoto, Matakichi; Nagata, Hiroshi; Sakakibara, Terue


    A 48-year-old man with no remarkable medical history presented with upper abdominal pain for approximately 1 month. He was diagnosed as having pancreatic carcinoma with liver and lung metastasis and complicating carcinomatous peritonitis. Despite chemotherapy, his performance status worsened, his appetite deteriorated, and his pain became intolerable. The patient opted to return home for palliative care, and his parents, aged over 70 years, supported this decision. Although corticosteroid and opiate administration was attempted to improve appetite loss and pain, oral administration became difficult over a short span of time. Thus, treatment was switched from oxycodone to a fentanyl patch for opioid rotation. We also prescribed risperidone for the treatment of delirium. The patient once opted for "respite hospitalization" at a general hospital to relieve his aged parents' fatigue, and thereafter, he finally died at home. When rapid disease progression is expected, not only should a fully equipped environment for patients be ensured but concern for their caregivers should also be considered. For this purpose, cooperation and communication among multidisciplinary medical staff is indispensable.

  5. In-Home Treatment of Reactive Attachment Disorder in a Therapeutic Foster Care System: A Case Example. (United States)

    Sheperis, Carl J.; Renfro-Michel, Edina L.; Doggett, R. Anthony


    When trauma precedes a child's placement in the foster care system, it can lead to lasting mental health difficulties. Often, children who experience extreme, chronic trauma prior to age 5 develop Reactive Attachment Disorder (RAD). This article discusses the characteristics of RAD as well as diagnostic criteria and possible etiology. (Contains 26…

  6. What Makes Migrant Live-in Home Care Workers in Elder Care Be Satisfied with Their Job? (United States)

    Iecovich, Esther


    Purpose: The study aims to examine job satisfaction of migrant live-in home care workers who provide care to frail older adults and to examine the extent to which quality of relationships between the care provider and care recipient and workplace characteristics is associated with job satisfaction. Design and Methods: A convenience sample that…

  7. Effectiveness of interventions to reduce indoor air pollution and/or improve health in homes using solid fuel in lower and middle income countries: protocol for a systematic review. (United States)

    Quansah, Reginald; Ochieng, Caroline A; Semple, Sean; Juvekar, Sanjar; Emina, Jacques; Armah, Frederick Ato; Luginaah, Isaac


    Indoor air pollution (IAP) interventions are widely promoted as a means of reducing indoor air pollution/health from solid fuel use; and research addressing impact of these interventions has increased substantially in the past two decades. It is timely and important to understand more about effectiveness of these interventions. We describe the protocol of a systematic review to (i) evaluate effectiveness of IAP interventions to improve indoor air quality and/or health in homes using solid fuel for cooking and/or heating in lower- and middle-income countries, (ii) identify the most effective intervention to improve indoor air quality and/or health, and (iii) identify future research needs. This review will be conducted according to the National Institute for Health and Care Excellence (NICE) guidelines and will be reported following the PRISMA statement. Ovid MEDLINE, Ovid Embase, SCOPUS, and PubMed searches were conducted in September 2013 and updated in November 2014 (and include any further search updates in February 2015). Additional references will be located through searching the references cited by identified studies and through the World Health Organization Global database of household air pollution measurements. We will also search our own archives. Data extraction and risk of bias assessment of all included papers will be conducted independently by five reviewers. The study will provide insights into what interventions are most effective in reducing indoor air pollution and/or adverse health outcomes in homes using solid fuel for cooking or heating in lower- or middle-income countries. The findings from this review will be used to inform future IAP interventions and policy on poverty reduction and health improvement in poor communities who rely on biomass and solid fuels for cooking and heating. The review has been registered with PROSPERO (registration number CRD42014009768 ).

  8. Kinect-based choice reaching and stepping reaction time tests for clinical and in-home assessment of fall risk in older people: a prospective study. (United States)

    Ejupi, Andreas; Gschwind, Yves J; Brodie, Matthew; Zagler, Wolfgang L; Lord, Stephen R; Delbaere, Kim


    Quick protective reactions such as reaching or stepping are important to avoid a fall or minimize injuries. We developed Kinect-based choice reaching and stepping reaction time tests (Kinect-based CRTs) and evaluated their ability to differentiate between older fallers and non-fallers and the feasibility of administering them at home. A total of 94 community-dwelling older people were assessed on the Kinect-based CRTs in the laboratory and were followed-up for falls for 6 months. Additionally, a subgroup (n = 20) conducted the Kinect-based CRTs at home. Signal processing algorithms were developed to extract features for reaction, movement and the total time from the Kinect skeleton data. Nineteen participants (20.2 %) reported a fall in the 6 months following the assessment. The reaction time (fallers: 797 ± 136 ms, non-fallers: 714 ± 89 ms), movement time (fallers: 392 ± 50 ms, non-fallers: 358 ± 51 ms) and total time (fallers: 1189 ± 170 ms, non-fallers: 1072 ± 109 ms) of the reaching reaction time test differentiated well between the fallers and non-fallers. The stepping reaction time test did not significantly discriminate between the two groups in the prospective study. The correlations between the laboratory and in-home assessments were 0.689 for the reaching reaction time and 0.860 for stepping reaction time. The study findings indicate that the Kinect-based CRT tests are feasible to administer in clinical and in-home settings, and thus represents an important step towards the development of sensor-based fall risk self-assessments. With further validation, the assessments may prove useful as a fall risk screen and home-based assessment measures for monitoring changes over time and effects of fall prevention interventions.

  9. Responding to discriminatory requests for a different healthcare provider. (United States)

    Anstey, Kyle; Wright, Linda


    Patient requests for a healthcare provider of a particular race or sexual orientation create a conflict of obligations. On the one hand, providers have a duty to deliver clinically indicated care consistent with patient preferences. On the other hand, providers have legal, professional, and organizational assurances that they should not suffer workplace discrimination. Protecting healthcare providers from harm while maintaining obligations to patients requires unambiguous messaging to both parties. Providers need to be clear that their organization will not be complicit in discrimination against them, instead supporting their needs and preferences for management of the situation. In a context of patient-centered care, harm principle-based boundaries of respect for autonomy must be defined. A Caregiver preference guideline developed and used at University Health Network, Toronto provides a standardized way for the organization to decide when it will honor patient requests for providers of a particular background. This process stresses dialogue, assessment of clinical feasibility, and empowerment and support for affected care providers.

  10. Feasibility study of an electrodialysis system for in-home water desalination in urban India

    Directory of Open Access Journals (Sweden)

    Kishor G. Nayar

    Full Text Available Poor quality of drinking water delivered to homes by state utilities, and a large reliance on brackish ground water resources in parts of urban India, has resulted in the adoption of in-home water treatment solutions. The only existing in-home water treatment solution capable of desalination is reverse osmosis (RO. However, existing RO products can recover only 25–50% of the feed water supplied as usable product water. In this study, an alternative solution that relies on electrodialysis (ED was designed and experimentally shown to achieve a recovery of 80%, producing 12 L/h of water at the desired salinity of 350 ppm from a feed salinity of 3000 ppm. The cost and size of the proposed system were also found to be comparable to existing in-home RO systems. In-home ED water treatment systems could compete with existing RO products while providing the advantage of improved water-conservation in water-stressed India. Keywords: Electrodialysis, Desalination, Reverse osmosis, Brackish water

  11. In-home salivary melatonin collection: Methodology for children and adolescents. (United States)

    Mandrell, Belinda N; Avent, Yvonne; Walker, Breya; Loew, Megan; Tynes, Brooklee Lightsey; Crabtree, Valerie McLaughlin


    In-home salivary collection quality and adherence to a prescribed collection methodology for evaluation of dim light melatonin onset (DLMO) is unknown in children. Primary aims of this study were to 1) describe a novel family centered methodology for in-home salivary collection; 2) determine the acceptance and feasibility of this methodology; 3) measure adherence to collection instructions; and 4) identify patterns between participants' age and quality of samples collected. After receiving instructional handouts from the study team, families utilized in-home salivary melatonin collection. Participants (N = 64) included 39 children (21 female, mean age 9.5 ± 1.61 years) and 25 adolescents (11 female, mean age 15.9 ± 2.12 years) with craniopharyngioma. Participants were 90% adherent to collection schedule, and 89% of the samples collected were of sufficient quantity and quality, with no differences found between age (child vs. adolescent) and melatonin sample quantity and quality. In-home saliva collection provides an acceptable and feasible method to collect salivary melatonin and biomarkers in children and adolescents. © 2017 Wiley Periodicals, Inc.

  12. A management framework for training providers to improve skills ...

    African Journals Online (AJOL)

    Erna Kinsey

    Training providers need an internal management framework to enable them to improve workplace skills development. ... The management role of workplace training providers in the midst of the skills revolution is under ...... Benefit Analysis to determine a Return on Investment; TQM or Total. Quality Management; and PMF or ...

  13. Otolaryngology Needs in a Free Clinic Providing Indigent Care. (United States)

    Hu, Amanda; Sibert, Thomas; Zhao, Wei; Zarro, Vincent


    To determine the otolaryngology needs in a free clinic providing care to medically indigent patients, as perceived by the patients and health care providers. Cross-sectional survey. A survey was administered to patients and health care providers of a free clinic from September 2014 through January 2015 in an urban, inner-city location. One hundred and thirty-seven patients (35.8% male, age 50.8 ± 13.0 years) completed the survey. Mean household income was $29,838 ± $10,425; 32.1% spoke English; 54.7% were employed; 10.2% had health insurance; and 37.2% had seen a primary care provider outside of the free clinic. The top three otolaryngology symptoms among patients were sleep apnea/snoring (39.4%), heartburn/reflux (30.7%), and dizziness (29.9%). Eleven health care providers (45% male, age 50.5 ± 15.3 years, 63.6% physician, 36% nurse) completed the survey. Providers perceived the following otolaryngology complaints as the most prevalent, in descending order: cough, nasal congestion, reflux/heartburn, sore throat, and ear infection/otalgia. Providers felt that sleep apnea and hearing loss were the less common otolaryngology complaints, whereas surveyed patients indicated these symptoms with high frequency. The most requested diagnostic tool among patients and providers was chest X-rays. There are unmet otolaryngology needs in a free clinic. Medically indigent patients have significant barriers to accessing health care. Patient and provider perceptions of top otolaryngology complaints differed, but both identified access to chest X-rays as a major unmet need. Knowledge of patient perceptions may help providers elicit the breadth of otolaryngology complaints. 4. Laryngoscope, 126:1321-1326, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. An Experimental Program to Provide In-Home Vocational Training in Preschool and Day Care Work for Unskilled Disadvantaged Mothers and Child-Caring Adults. A Final Report. (United States)

    West Chester State Coll., PA.

    On the basis of interviews with mothers and baby-sitters of children enrolled in the Early Learning Programs of the Pennsylvania Research in Infant Development and Education Project in the West Chester, Pennsylvania, area, 12 low-income labor force nonparticipants identified as potential entrants into the job market were chosen to participate in…

  15. Bandwidth Reservations in Home Networks

    DEFF Research Database (Denmark)

    Nelis, Jelle; Verslype, Dieter; Develder, Chris


    In order for service providers to provide their users high quality services in the home network, Quality of Service (QoS) provisioning is needed to protect premium services. In this paper, we describe how a Universal Plug-and-Play (UPnP) based home network architecture solves this problem...... in a heterogeneous home network. We outline how it both relieves the end user from troublesome configuration and still offers control to the service provider. We particularly present performance assessment results for UPnP-QoS v3, based on a fully operational experimental implementation. The quantitative measurement...

  16. Working conditions and workplace health and safety promotion in home care: A mixed-method study from Swedish managers' perspectives. (United States)

    Gard, Gunvor; Larsson, Agneta


    Today, we can see a trend toward increased psychosocial strain at work among home-care managers and staff. The aim of this study is to describe home care managers' views on their own psychosocial working conditions and on how to promote workplace health and safety in a municipality in northern Sweden. A mixed-methods design was used, including questionnaire and qualitative focus group data. The qualitative data were analyzed by manifest content analysis. The results indicate that most managers perceived increased variety in work and opportunities for development at work, but at the same time increased demands. The managers suggested that workplace health and safety could be improved by risk assessment and improved communication, a clear communication chain by a real as well as a virtual platform for communication. In summary, workplace health and safety could be improved by risk assessments and by a physical as well as a virtual platform for communication.

  17. Customer-Provider Strategic Alignment: A Maturity Model (United States)

    Luftman, Jerry; Brown, Carol V.; Balaji, S.

    This chapter presents a new model for assessing the maturity of a ­customer-provider relationship from a collaborative service delivery perspective: the Customer-Provider Strategic Alignment Maturity (CPSAM) Model. This model builds on recent research for effectively managing the customer-provider relationship in IT service outsourcing contexts and a validated model for assessing alignment across internal IT service units and their business customers within the same organization. After reviewing relevant literature by service science and information systems researchers, the six overarching components of the maturity model are presented: value measurements, governance, partnership, communications, human resources and skills, and scope and architecture. A key assumption of the model is that all of the components need be addressed to assess and improve customer-provider alignment. Examples of specific metrics for measuring the maturity level of each component over the five levels of maturity are also presented.


    DEFF Research Database (Denmark)


    structured master surface (3a, 3b, 3c, 3d) having a lateral master pattern and a vertical master profile. The microscale structured master surface (3a, 3b, 3c, 3d) has been provided by localized pulsed laser treatment to generate microscale phase explosions. A method for producing a part with microscale...... protrusions. The microscale protrusions may be provided on a flange portion of a first part and are configured to act as energy directors when forming an ultrasonic joint with a cooperating flange portion of a second part....

  19. AAL Platform with a “De Facto” Standard Communication Interface (TICO: Training in Home Control in Special Education

    Directory of Open Access Journals (Sweden)

    Miguel A. Guillomía San Bartolomé


    Full Text Available Framed within a long-term cooperation between university and special education teachers, training in alternative communication skills and home control was realized using the “TICO” interface, a communication panel editor extensively used in special education schools. From a technological view we follow AAL technology trends by integrating a successful interface in a heterogeneous services AAL platform, focusing on a functional view. Educationally, a very flexible interface in line with communication training allows dynamic adjustment of complexity, enhanced by an accessible mindset and virtual elements significance already in use, offers specific interaction feedback, adapts to the evolving needs and capacities and improves the personal autonomy and self-confidence of children at school and home. TICO-home-control was installed during the last school year in the library of a special education school to study adaptations and training strategies to enhance the autonomy opportunities of its pupils. The methodology involved a case study and structured and semi-structured observations. Five children, considered unable to use commercial home control systems were trained obtaining good results in enabling them to use an open home control system. Moreover this AAL platform has proved efficient in training children in previous cognitive steps like virtual representation and cause-effect interaction.

  20. AAL Platform with a "De Facto" Standard Communication Interface (TICO): Training in Home Control in Special Education. (United States)

    Guillomía San Bartolomé, Miguel A; Falcó Boudet, Jorge L; Artigas Maestre, José Ignacio; Sánchez Agustín, Ana


    Framed within a long-term cooperation between university and special education teachers, training in alternative communication skills and home control was realized using the "TICO" interface, a communication panel editor extensively used in special education schools. From a technological view we follow AAL technology trends by integrating a successful interface in a heterogeneous services AAL platform, focusing on a functional view. Educationally, a very flexible interface in line with communication training allows dynamic adjustment of complexity, enhanced by an accessible mindset and virtual elements significance already in use, offers specific interaction feedback, adapts to the evolving needs and capacities and improves the personal autonomy and self-confidence of children at school and home. TICO-home-control was installed during the last school year in the library of a special education school to study adaptations and training strategies to enhance the autonomy opportunities of its pupils. The methodology involved a case study and structured and semi-structured observations. Five children, considered unable to use commercial home control systems were trained obtaining good results in enabling them to use an open home control system. Moreover this AAL platform has proved efficient in training children in previous cognitive steps like virtual representation and cause-effect interaction.

  1. Contradictory effects for prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    Dozeman, E.; van Marwijk, H.W.J.; van Schaik, D.J.F.; Smit, H.F.E.; Stek, M.L.; van der Horst, H.E.; Bohlmeijer, E.T.; Beekman, A.T.F.


    Background: The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes. Methods: A pragmatic randomized controlled trial was conducted to compare the intervention with usual

  2. Contradictory effects for prevention of depression and anxiety in residents in home for the elderly: a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    Dozeman, Els; van Marwijk, Harm; van Schaik, Digna J.F.; Smit, Filip; Stek, Max; van der Horst, Henriëtte E.; Bohlmeijer, Ernst Thomas; Beekman, Aartjan T.F.


    Background: The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes. Methods: A pragmatic randomized controlled trial was conducted to compare the intervention with usual

  3. Focused Ethnography as Research Method: A Case Study of Techno Music Producers in Home-Recording Studios

    Directory of Open Access Journals (Sweden)

    Jan Michael Kühn


    Full Text Available Translator's Introduction: Jan-Michael Kühn's essay introduces the reader to Hubert Knoblauch's focused ethnography [fokussierte Ethnographie] as an ethnographic fieldwork method. More than a decade after Knoblauch's first publications on this method, there are precious few guides to focused ethnography in the English language, save one (Knoblauch 2005. At any rate, there are certainly no introductions to this methodology that also use EDM scenes as a case study. Kühn's article was originally published in German in Soziologie Magazin, a student-run journal published from Martin Luther University in Halle (Saale but operated by an editorial network that spans Germany. As a result, Kühn orients his writing towards an audience of junior researchers, post-docs and graduate students, highlighting the ways in which focused ethnography suits the circumstances of early research careers, where one may have difficulty securing long-term research stays for fieldwork of broader scope. In particular, he notes that Knoblauch's methods require a very narrow scope for the project (i.e., a "field sector" rather than the whole field, a reliance on the researcher's previous knowledge of the field, and short bursts of intense ethnographic activity in order to create work that is tightly focused but still rigorous and generative of fresh knowledge and new concepts.KEYWORDS: qualitative methods; cultural production; music production; home-recording; technoculture

  4. An open trial of in-home CBT for depressed mothers in home visitation. (United States)

    Ammerman, Robert T; Putnam, Frank W; Stevens, Jack; Bosse, Nicole R; Short, Jodie A; Bodley, Amy L; Van Ginkel, Judith B


    Research has demonstrated that low income mothers participating in home visitation programs have high rates of depression. This study used an open trial design to evaluate In-Home Cognitive Behavioral Therapy (IH-CBT), an evidence-based treatment for depression that is delivered in the home setting and has been adapted to address the needs of low income mothers participating in home visitation. 64 depressed mothers recruited from a home visitation program and who had completed IH-CBT were compared to 241 mothers from the same setting who met identical screening criteria at enrollment but did not receive the treatment. In addition, pre- and post-treatment measures of depression and related clinical features were contrasted in the 64 mothers receiving IH-CBT. There was a significantly greater reduction in depressive symptoms in the IH-CBT group relative to their counterparts who did not receive the treatment. Results from pre-post comparisons showed that treated mothers had decreased diagnosis of major depression, lower reported stress, increased coping and social support, and increased positive views of motherhood at post-treatment. Findings suggest that IH-CBT is a promising approach to addressing maternal depression in the context of home visitation and warrants further study. Public health implications for home visiting programs are discussed.

  5. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review. (United States)

    Artico, Marco; Dante, Angelo; D'Angelo, Daniela; Lamarca, Luciano; Mastroianni, Chiara; Petitti, Tommasangelo; Piredda, Michela; De Marinis, Maria Grazia


    Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. Retrospective chart review. Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p 70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs.

  6. Effectiveness of a temperature control system in home induction hobs to reduce acrylamide formation during pan frying

    DEFF Research Database (Denmark)

    Guillen, S.; Oria, R.; Salvador, M. L.


    Three trials were conducted to determine the influence of the use of temperature control systems on physico-chemical characteristics and acrylamide formation in the domestic preparation of potatoes. French fries were pre-treated by soaking in water or acidified water, and then they were cooked...... using a range of home-cooking procedures. Soaking raw potatoes in acidified water (pH=3.17) before frying at a controlled temperature (180 °C) was the most efficient pretreatment for reducing acrylamide formation (76%). For the same temperature, roasted frozen par-fried potatoes contained less fat...... and acrylamide than similar pan-fried potatoes. Potatoes butter fried at 140 °C had an acrylamide concentration similar to that of potatoes fried in oil at 180 °C, but this value was reduced by 71% when the frying was carried out using a temperature control system. Controlling the frying temperature reduced...

  7. Electric field as a potential directional cue in homing of bone marrow-derived mesenchymal stem cells to cutaneous wounds. (United States)

    Zimolag, Eliza; Borowczyk-Michalowska, Julia; Kedracka-Krok, Sylwia; Skupien-Rabian, Bozena; Karnas, Elzbieta; Lasota, Slawomir; Sroka, Jolanta; Drukala, Justyna; Madeja, Zbigniew


    Bone marrow-derived cells are thought to participate and enhance the healing process contributing to skin cells or releasing regulatory cytokines. Directional cell migration in a weak direct current electric field (DC-EF), known as electrotaxis, may be a way of cell recruitment to the wound site. Here we examined the influence of electric field on bone marrow adherent cells (BMACs) and its potential role as a factor attracting mesenchymal stem cells to cutaneous wounds. We observed that in an external EF, BMAC movement was accelerated and highly directed with distinction of two cell populations migrating toward opposite poles: mesenchymal stem cells migrated toward the cathode, whereas macrophages toward the anode. Analysis of intracellular pathways revealed that macrophage electrotaxis mostly depended on Rho family small GTPases and calcium ions, but interruption of PI3K and Arp2/3 had the most pronounced effect on electrotaxis of MSCs. However, in all cases we observed only a partial decrease in directionality of cell movement after inhibition of certain proteins. Additionally, although we noticed the accumulation of EGFR at the cathodal side of MSCs, it was not involved in electrotaxis. Moreover, the cell reaction to EF was very dynamic with first symptoms occurring within <1min. In conclusion, the physiological DC-EF may act as a factor positioning bone marrow cells within a wound bed and the opposite direction of MSC and macrophage movement did not result either from utilizing different signalling or redistribution of investigated cell surface receptors. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  8. The effects of a psychomotor activation programme for use in groups of cognitively impaired people in homes for the elderly

    NARCIS (Netherlands)

    Hopman-Rock, M.; Staats, P.G.M.; Tak, E.C.P.M.; Dröes, R.M.


    Objectives. To test the effects of the Psychomotor Activation Programme (PAP) on the behaviour and cognition of demented elderly people. Design. Randomized controlled trial with an experimental group and a control group. Post-test after 6 months. Setting. Group care projects for demented elderly

  9. Selecting a provider: what factors influence patients' decision making? (United States)

    Abraham, Jean; Sick, Brian; Anderson, Joseph; Berg, Andrea; Dehmer, Chad; Tufano, Amanda


    Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.

  10. A Randomized Controlled Trial of In-Home Tele-Behavioral Health Care Utilizing Behavioral Activation for Depression (United States)


    Australia (n = 1); all studies targeted adults. Most of the studies involved treat- ments delivered via VTC (n = 13), whereas two studies were telephone...based family therapy. J Fam Psychother 2000; 11, 27-39. 57) Health Sciences South Carolina. Research permission management system (RPMS). http...Anderson, R. M., McGuire, J., Rubenstein, L., Sapir, N., & Gelberg, L. (2013). Chronic disease management for recently homeless veterans: A clinical

  11. Compliance & dexterity, factors to consider in home care and maintenance procedures Adherencia e destreza: factores a considerar en programas preventivos


    Victoria Criado; Andrew Tawse-Smith


    Mechanical plaque control appears to be the primary means of controlling supragingival dental plaque build-up. Although daily oral hygiene practices and periodic professional care are considered the basis for any program aimed at the prevention and treatment of oral diseases, these procedures are technically demanding, time consuming and can be affected by the compliance and manual dexterity of the patient. Individual skills and acquired behavior patterns determine effectiveness of a preventi...

  12. A Randomized Controlled Trial of In-Home Tele-Behavioral Health Care Utilizing Behavioral Activation for Depression (United States)


    not entirely disregarded in BA for PTSD; rumination and worry, as well as feelings of anxiety and panic, are common obstacles to the completion of...3-month follow-up visit. The primary outcome variables are safety and hopelessness. Secondary outcome variables include depression, anxiety , PTSD...technologies in psychotherapy for depression: A meta-analysis. Depression and Anxiety , 30, 1058-1067. doi: 10.1002/da.22165 Pruitt, L.D., Luxton

  13. Effects of the Resident Assessment Instrument in home care settings: results of a cluster randomized controlled trial. (United States)

    Stolle, C; Wolter, A; Roth, G; Rothgang, H


    Deficits in quality, a lack of professional process management and, most importantly, neglect of outcome quality are criticized in long-term care. A cluster randomized, controlled trial was conducted to assess whether the Resident Assessment Instrument (RAI) can help to improve or stabilize functional abilities (ADL, IADL) and cognitive skills (MMST), improve quality of life (EQ-5D), and reduce institutionalization, thereby, increasing outcome quality. A total of 69 home care services throughout Germany were included and randomized. The treatment group (n = 36) received training in RAI and was supported by the research team during the study (13 months). Comparison of mean differences between the treatment and control groups (n = 33) showed no significant effect. Although the multilevel regression results show that clients in the treatment group fared better in terms of ADLs and IADLs (smaller decline) and were less likely to move to nursing homes and be hospitalized, none of these effects is significant. The lack of significance might result from the small number of clients included in the study. Moreover, RAI was not fully implemented and even partial implementation required more time than expected.

  14. In-home contextual reality: a qualitative analysis using the Multiple Errands Test Home Version (MET-Home). (United States)

    Burns, Suzanne Perea; Pickens, Noralyn Davel; Dawson, Deirdre R; Perea, Jaimee D; Vas, Asha K; Marquez de la Plata, Carlos; Neville, Marsha


    Adults with stroke frequently experience executive dysfunction. Despite the range of assessments that examine the effects of executive dysfunction on daily tasks, there remains a paucity of literature that examines the influence of the environment on performance in the community. The MET-Home is an ecologically valid assessment for examining post-stroke executive dysfunction in the home environment. This qualitative study explores the relationship between the environment and MET-Home performance among home-dwelling adults with stroke and matched controls. Using a descriptive qualitative approach, we analysed video, interview, and observation notes from a MET-Home validation study. An overarching theme of interplay between everyday task performance and the home environment produced further themes: naturalistically emerging supports and barriers and environment as strategy. Within naturalistically emerging supports and barriers, five contextual sub-themes were discovered: physical environment, social environment, temporal context, virtual context, and personal context. Within environment as strategy, we identified four sub-themes: reducing distractions, using everyday technologies, planning in context, and seeking social support. These findings extend the conceptualisation of how we evaluate executive dysfunction in the context of the community to also consider the inherent influence of the environment.

  15. Compliance & dexterity, factors to consider in home care and maintenance procedures Adherencia e destreza: factores a considerar en programas preventivos

    Directory of Open Access Journals (Sweden)

    Victoria Criado


    Full Text Available Mechanical plaque control appears to be the primary means of controlling supragingival dental plaque build-up. Although daily oral hygiene practices and periodic professional care are considered the basis for any program aimed at the prevention and treatment of oral diseases, these procedures are technically demanding, time consuming and can be affected by the compliance and manual dexterity of the patient. Individual skills and acquired behavior patterns determine effectiveness of a preventive program and oral hygiene practice. Successful preventive programs and home care procedures clearly depend on the interaction and commitment between the dental professional and the patient. Identifying the capacity of the individual to comply with the professional recommendations and evaluating the dexterity of the patient to remove supragingival dental plaque will permit the implementation of an adequate preventive program and can help on the selection of adjunctive antimicrobial agents and devices needed to reach an effective oral care routine.El control de la placa dental parece ser el mecanismo primario para controlar el crecimiento de la placa dental supragingival. Aunque la práctica diaria de la higiene bucal y el cuidado profesional periódico, son considerados la base para cualquier programa dirigido a la prevención y tratamiento de las enfermedades de la cavidad bucal, estos procedimientos son técnicamente exigentes, consumen tiempo y pueden ser afectados por la aceptación y la destreza manual del paciente. Las destrezas individuales y los patrones de comportamiento adquiridos, determinan la efectividad de un programa preventivo y la práctica de la higiene bucal. El éxito de los programas preventivos y los procedimientos del cuidado bucal en el hogar dependen claramente de la interacción y compromiso entre el odontólogo y el paciente. La importancia de identificar la capacidad del individuo para cumplir con las recomendaciones y la

  16. Nurses' Use of iPads in Home Care-What Does It Mean to Patients?: A Qualitative Study. (United States)

    Vilstrup, Dorte Lindstrøm; Madsen, Esben Elholm; Hansen, Christl Fandt; Wind, Gitte


    Although the use of technology is growing, little is known about how patients perceive technology in the form of tools used by health professionals. The prevailing view in the literature is that technology is cold, compared with the warm hands of nurses, but research regarding nurses' use of technology such as tablets is scarce. Even scarcer is research on how patients perceive the use of technological tools. This study examines patients' perspectives on the use of iPads by home care nurses. Semistructured interviews were conducted with seven participants who were receiving home care in Denmark, aged 62 to 90 years, with different backgrounds and experiences with technology. Participants viewed nurses' use of iPads as an everyday occurrence, reflecting societal growth in the use of technology, and some perceived it as a sign of professionalism with the potential to enhance care. Their perceptions varied somewhat according to their baseline knowledge and experience with the technology. Although nurses may view technology as cold, the findings suggest that patients have a slightly warmer view of it. More patient-centered research into the use of technology in healthcare is needed.

  17. A literature review of transmission effectiveness and electromagnetic compatibility in home telemedicine environments to evaluate safety and security. (United States)

    Carranza, Noemí; Ramos, Victoria; Lizana, Francisca G; García, Jorge; del Pozo, Alejando; Monteagudo, José Luis


    The objective of this study was to determine already reported cases of transmission/reception failure and interferences to evaluate the safety and security of the new mobile home telemedicine systems. The literature published in the last 10 years (1998-2009) has been reviewed, by searching in several databases. Searches on transmission effectiveness and electromagnetic compatibility were made manually through journals, conference proceedings, and also the healthcare technology assessment agencies' Web pages. Search strategies developed through electronic databases and manual search identified a total of 886 references, with 44 finally being included in the results. They have been divided by technology in the transmission/reception effectiveness studies, and according to the type of medical device in the case of electromagnetic interferences studies. The study reveals that there are numerous publications on telemedicine and home-monitoring systems using wireless networks. However, literature on effectiveness in terms of connectivity and transmission problems and electromagnetic interferences is limited. From the collected studies, it can be concluded that there are transmission failures, low-coverage areas, errors in the transmission of packets, and so on. Moreover, cases of serious interferences in medical instruments have also been reported. These facts highlight the lack of studies and specific recommendations to be followed in the implementation of biomonitoring systems in domestic environments using wireless networks.

  18. Optimization of a phytase-containing micronutrient powder with low amounts of highly bioavailable iron for in-home fortification of complementary foods

    NARCIS (Netherlands)

    Troesch, B.; Egli, I.; Zeder, C.; Hurrell, R.F.; Pee, de S.; Zimmermann, M.B.


    Background: In-home fortification of complementary foods with micronutrient powders containing low amounts of iron may be potentially safer than powders containing high amounts of iron. However, low iron doses have little nutritional effect, unless iron absorption is high. Objective: The objective

  19. In-Home Training for Fathers of Children with Autism: A Follow up Study and Evaluation of Four Individual Training Components (United States)

    Elder, Jennifer H.; Donaldson, Susan O.; Kairalla, John; Valcante, Gregory; Bendixen, Roxanna; Ferdig, Richard; Self, Erica; Walker, Jeffrey; Palau, Christina; Serrano, Michele


    Literature regarding fathers of children with autism remains sparse, and because mothers are the more common intervening parent, few training methods have focused on fathers. Thus, we sought to evaluate effects of in-home training directed at fathers and their ability to train mothers in the same manner in which they were trained. Fathers were…

  20. Providing structure. Unraveling and building a psychiatric nursing intervention

    NARCIS (Netherlands)

    Voogt, L.A.


    Psychiatric nurses commonly refer to ‘providing structure’ (PS) as a key intervention. But, no consensus exists about what PS entails. PS can be understood as a complex intervention. In five studies a definition, activities and context-variables were described. On the basis of results of a

  1. Focused Ubiquity: A Purposeful Approach to Providing Students with Laptops (United States)

    Keppler, Mike; Weiler, Spencer C.; Maas, Dan


    Laptops have been introduced into classroom across the nation as a way to improve teaching and learning. In 2007 Littleton Public Schools (LPS) introduced a focused approach to providing all students with a laptop at a significantly lower cost to the traditional ubiquitous laptop programs. The purpose of this study was to document the LPS model…

  2. A Proposal of Secure Session Provider Service over NGN (United States)

    Kaji, Tadashi; Fujishiro, Takahiro; Susaki, Seiichi; Kawai, Eri; Hoshino, Kazuyoshi; Higashino, Teruo

    In these days, telecom operators in the world have been constructing Next Generation Network (NGN). NGN can provide QoS and security guaranteed communication to its users. However, the protection of communication is limited inside NGN. Therefore, when the interconnection between NGN and the Internet will be widely used in near future, it will become an important problem to solve how it protects the communications crossing over NGN and the Internet. This paper proposes a secure communication provider service that protects the confidentiality and integrity of communications crossing over NGN and the Internet by setting up and controlling the IPsec session in cooperation with NGN's call session control function (CSCF). In this service, the secure session control provider (sSCP) server and CSCF authenticate its user as Trusted Third Party on behalf of service providers. In addition, this service provides the ability of fast session establishment because sSCP distributes a security association for IPsec session between the user and service provider via the SIP session protected by NGN.

  3. Transitions in Pediatric Gastroenterology: Results of a National Provider Survey. (United States)

    Bensen, Rachel; McKenzie, Rebecca B; Fernandes, Susan M; Fishman, Laurie N


    Transition and transfer to adult-oriented health care is an important yet challenging task for adolescents and young adults with chronic medical conditions. Transition practices vary widely, but a paucity of data makes determination of best practices difficult. We described North American pediatric gastroenterologists' preferences and present transition practice patterns and explored whether experience affected providers' perspectives. An online survey was distributed via e-mail to members of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Participation was voluntary and answers were anonymous. Quantitative and qualitative analysis was performed. Almost three quarters of the 175 respondents describe providing transition or self-care management education, but only 23% use structured readiness assessments. Most respondents (88%) report having age cutoffs above which they no longer accept new referrals, with the most common age being 18 years (57%). One third report the ability to provide age-appropriate care to patients older than 21 years. Only 6% indicate that their practice or institution should provide care for individuals older than 25 years. Many (63%) indicate that their practice or institution has a policy regarding age of transfer, but most (79%) are flexible. Provider preferences for triggers to transfer to adult care diverge widely between age, milestones, and comorbidities. Overall, parent (81%) and patient (74%) attachment to pediatric health care providers are cited as the most common barriers to transition. Preferences and practices surrounding transition preparation and transfer to adult care vary widely, reflecting continued uncertainty regarding optimal transition strategies.

  4. Surrogate pregnancy: a guide for Canadian prenatal health care providers. (United States)

    Reilly, Dan R


    Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks of surrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support.


    DEFF Research Database (Denmark)


    from vaporised and/or ionised material. As a result, vaporised melt material is sprayed to the sides or upwards along the sides of a drilled hole. These squirts can either damage the surface around the processed area or result in an upward burr. The method according to the invention provides...... an additional local steam/plasma pressure causing the ejected material to change direction in such a manner that the surface of the material is not damaged or a stricking burr is not formed. The local steam/plasma pressure can, for instance, be provided by an intense secondary laser beam being emitted downwards...

  6. Storytelling: A Strategy for Providing Context for Learning. (United States)

    Billings, Diane M


    Storytelling--a narrative of events related to nursing and linked to evidence--provides a context for learning, particularly for learners who require a rich context to understand and integrate concepts related to patient care. This article offers suggestions for developing and using stories in nursing education. Copyright 2016, SLACK Incorporated.

  7. Brief Mindfulness Practices for Healthcare Providers - A Systematic Literature Review. (United States)

    Gilmartin, Heather; Goyal, Anupama; Hamati, Mary C; Mann, Jason; Saint, Sanjay; Chopra, Vineet


    Mindfulness practice, where an individual maintains openness, patience, and acceptance while focusing attention on a situation in a nonjudgmental way, can improve symptoms of anxiety, burnout, and depression. The practice is relevant for health care providers; however, the time commitment is a barrier to practice. For this reason, brief mindfulness interventions (eg, ≤ 4 hours) are being introduced. We systematically reviewed the literature from inception to January 2017 about the effects of brief mindfulness interventions on provider well-being and behavior. Studies that tested a brief mindfulness intervention with hospital providers and measured change in well-being (eg, stress) or behavior (eg, tasks of attention or reduction of clinical or diagnostic errors) were selected for narrative synthesis. Fourteen studies met inclusion criteria; 7 were randomized controlled trials. Nine of 14 studies reported positive changes in levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms. No studies found an effect on provider behavior. Brief mindfulness interventions may be effective in improving provider well-being; however, larger studies are needed to assess an impact on clinical care. Published by Elsevier Inc.

  8. The epidemiology of skin care provided by nurses at home: a multicentre prevalence study. (United States)

    Kottner, Jan; Boronat, Xavier; Blume-Peytavi, Ulrike; Lahmann, Nils; Suhr, Ralf


    The aim of this study was to estimate the frequencies and patterns of skin care and applied skin care products in the home care nursing setting in Germany. Skin care belongs to the core activities of nursing practice. Especially in aged and long-term care settings, clients are vulnerable to various skin conditions. Dry skin is one of the most prevalent problems. Using mild skin cleansers and the regular application of moisturizing leave-on products is recommended. Until today, there are no quantitative empirical data about nursing skin care practice at home in the community. A multicentre cross-sectional study was conducted in July 2012. Home care clients from the German home care nursing setting were randomly selected. Instructed nurse raters performed the data collection using standardized forms. Variables included demographics, skin care needs and skin caring activities. Approximately 60% of home care clients received skin care interventions. The majority were washed and two-thirds received a leave-on product once daily. There was large heterogeneity in cleansing and skin care product use. Most often the product labels were unknown or product types were selected haphazardly. Skin care interventions play a significant role in home care and nurses have a considerable responsibility for skin health. Skin care provided does not meet recent recommendations. The importance of targeted skin cleansing and care might be underestimated. There are a confusing variety of skin care products available and often the labels provide little information regarding the ingredients or guidance about how they affect skin health. © 2014 John Wiley & Sons Ltd.

  9. Sealed Battery Block Provided With A Cooling System (United States)

    Verhoog, Roelof; Barbotin, Jean-Loup


    The present invention relates to a sealed battery block operating at a pressure of at least 1 bar relative, the battery including a container made of a plastics material and made up of a lid and of a case subdivided into wells by at least one partition, said battery being provided with a cooling system including two cheek plates made of a plastics material and co-operating with the outside faces of respective ones of two opposite walls of said case, each cheek plate co-operating with the corresponding wall to define a compartment provided with a plurality of ribs forming baffles for fluid flow purposes, and with an inlet orifice and an outlet orifice for the fluid, said battery being characterized in that each of said ribs extends in a direction that forms an angle relative to the plane of said partition lying in the range to

  10. A method for calculating active feedback system to provide vertical ...

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 68; Issue 4. A method for calculating active feedback system to provide vertical position control of plasma in a tokamak. Nizami Gasilov. Research ... Nizami Gasilov1. Faculty of Engineering, Baskent University, Eskisehir Yolu 20. km, Baglica, 06530 Ankara, Turkey ...

  11. The Attentional Blink Provides Episodic Distinctiveness: Sparing at a Cost (United States)

    Wyble, Brad; Bowman, Howard; Nieuwenstein, Mark


    The attentional blink (J. E. Raymond, K. L. Shapiro, & K. M. Arnell, 1992) refers to an apparent gap in perception observed when a second target follows a first within several hundred milliseconds. Theoretical and computational work have provided explanations for early sets of blink data, but more recent data have challenged these accounts by…

  12. The Attentional Blink Provides Episodic Distinctiveness : Sparing at a Cost

    NARCIS (Netherlands)

    Wyble, Brad; Bowman, Howard; Nieuwenstein, Mark

    The attentional blink (J. E. Raymond. K. L. Shapiro, & K. M. Arnett. 1992) refers to an apparent gap in perception observed when a second target follows a first within several hundred milliseconds. Theoretical and computational work have provided explanations for early sets of blink data, but more

  13. Allocation of advertising space by a web service provider using ...

    Indian Academy of Sciences (India)

    Internet has emerged as a powerful medium for trade and commerce. Online advertising over the internet has increased more than hundredfold since 2001. In the present work, we address problems faced by online advertisement service providers. In this paper, we propose a multi-slot and multi-site combinatorial auction ...

  14. A management framework for training providers to improve skills ...

    African Journals Online (AJOL)

    South Africa is in a skills revolution, launched by the Department of Labour via the Skills Development Act in 1998 and the Skills Development Levies Act in 1999. The skills revolution challenges workplace training providers through employers who pay a percentage of payroll towards skills levies and want to recover these ...

  15. Ethics and safety in home care: perspectives on home support workers. (United States)

    Storch, Janet; Curry, Cherie Geering; Stevenson, Lynn; Macdonald, Marilyn; Lang, Ariella


    Home support workers (HSWs) encounter unique safety issues in their provision of home care. These issues raise ethical concerns, affecting the care workers provide to seniors and other recipients. This paper is derived from a subproject of a larger Canada-wide study, Safety at Home: A Pan-Canadian Home Care Safety Study, released in June 2013 by the Canadian Patient Safety Institute. Semi-structured, face-to-face, audiotaped interviews were conducted with providers, clients and informal caregivers in British Columbia, Manitoba and New Brunswick to better understand their perceptions of patient safety in home care. Using the BC data only, we then compared our findings to findings of other BC studies focusing on safety in home care that were conducted over the past decade. Through our interviews and comparative analyses it became clear that HSWs experienced significant inequities in providing home care. Utilizing a model depicting concerns of and for HSWs developed by Craven and colleagues (2012), we were able to illustrate the physical, spatial, interpersonal and temporal concerns set in the context of system design that emphasized the ethical dilemmas of HSWs in home care. Our data suggested the necessity of adding a fifth domain, organizational (system design). In this paper, we issue a call for stronger advocacy for home care and improved collaboration and resource equity between institutional care and community care.

  16. When expressions make impressions-nurses' narratives about meeting severely ill patients in home nursing care: a phenomenological-hermeneutic approach to understanding. (United States)

    Devik, Siri Andreassen; Enmarker, Ingela; Hellzen, Ove


    Registered nurses (RNs) working in homecare encounter severely ill and palliative patients whose expressions may cause ethical challenges and influence their daily work. The aim of this qualitative study was to illuminate and interpret the meaning of nurses' lived experiences when meeting these patients. Narrative interviews were conducted with 10 RNs working in home nursing care. These interviews were audiotaped and transcribed verbatim to a text and interpreted by a phenomenological-hermeneutic method inspired by Ricoeur. The meaning of the RNs' lived experience of patients' expressions was formulated into four themes. The first theme, Being open for the presence of the Other, includes two subthemes: "Sensing vulnerability" and "Empathizing with." The second theme, Being satisfied, entails the subthemes, "Feeling exceptional" and "Being trusted." The third theme, Being frustrated, contains the subthemes, "Being disappointed" and "Being angry." The fourth and final theme, Being ambivalent, includes one subtheme: "Being generous or reserved." Patients' expressions that make impressions on nurses create emotional waves. Expressions leave impressions that call upon the nurse, and confront her with taking the risk of letting intuition and pre-reflexive feelings gain entry to her care. Allowing for the Other's presence is seen as a precondition, which means facing humanity and sensing a vulnerability in herself as well as in the Other. Understanding and balancing this emotional dimension in care seems to cause confusion and distress within the nurses. Realizing how their feelings may lead to either generosity or aloofness towards the patient is upsetting. Our interpretation suggests that these impressions echo confusion according to the role of being a professional nurse. There is a need to pay more attention to how the emotional dimension in care is understood and impacts the way nurses perform their professional role.

  17. Predictors of Treatment Response in Depressed Mothers Receiving In-Home Cognitive-Behavioral Therapy and Concurrent Home Visiting (United States)

    Ammerman, Robert T.; Peugh, James L.; Putnam, Frank W.; Van Ginkel, Judith B.


    Home visiting is a child abuse prevention strategy that seeks to optimize child development by providing mothers with support, training, and parenting information. Research has consistently found high rates of depression in mothers participating in home visiting programs and low levels of obtaining mental health treatment in the community.…

  18. Pain Management in CKD: A Guide for Nephrology Providers. (United States)

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


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

  19. 'I'm happy that I can still walk'--Participation of the elderly in home care as a specific group with specific needs and wishes. (United States)

    Bagchus, Charlotte; Dedding, Christine; Bunders, Joske F G


    Taking the needs, wishes and experiential knowledge of clients into account is considered to result in a better fit between the supply and demand of modern health care, contributing to the improvement of individual care, organizations, institutions and policy. However, the current generation of the elderly have had little experience of consumer-oriented public services. They are said to be less likely to discuss their needs and wishes with individual caregivers and health-care organisations. As a result, they might not receive care matching their needs and wishes. To examine how the elderly themselves refer to their age and their needs and wishes for individual and collective participation in home-based care to get a better understanding of their participation in their own health care. Content analysis of 20 semi-structured in-depth interviews with elderly recipients of care in the Netherlands. The need and ability of the elderly to discuss their experiences are strongly affected by physical and mental limitations, social cultural characteristics and their experiences of life. As a result, the elderly encounter many limitations in discussing their experiences with their individual caregivers and their home-care organisation. However, this does not mean that the elderly do not have needs and wishes that they want taken into account. The challenge is to create a more responsive environment and to find new, creative ways of facilitating the expression of the needs and wishes of the elderly, according to the specific values and norms of their generation. © 2014 John Wiley & Sons Ltd.

  20. Method for providing a low density high strength polyurethane foam (United States)

    Whinnery, Jr., Leroy L.; Goods, Steven H.; Skala, Dawn M.; Henderson, Craig C.; Keifer, Patrick N.


    Disclosed is a method for making a polyurethane closed-cell foam material exhibiting a bulk density below 4 lbs/ft.sup.3 and high strength. The present embodiment uses the reaction product of a modified MDI and a sucrose/glycerine based polyether polyol resin wherein a small measured quantity of the polyol resin is "pre-reacted" with a larger quantity of the isocyanate in a defined ratio such that when the necessary remaining quantity of the polyol resin is added to the "pre-reacted" resin together with a tertiary amine catalyst and water as a blowing agent, the polymerization proceeds slowly enough to provide a stable foam body.

  1. Polymerase Chain Reaction (PCR) provides a superior tool for the ...

    African Journals Online (AJOL)

    Polymerase Chain Reaction (PCR) provides a superior tool for the diagnosis of Pneumococcal Infection in Burkina Faso. Y Chaibou, M Congo/Ouedraogo, I Sanou, H Somlare, K Ouattara, CM Kienou, H Belem, E Sampo, SA Traore, R Traore/Ouedraogo, C Hatcher, L Mayer, X Wang, L Sangare ...

  2. Development of a system to provide diagnostics-while-drilling.

    Energy Technology Data Exchange (ETDEWEB)

    Wise, Jack LeRoy; Jacobson, Ronald David; Finger, John Travis; Mansure, Arthur James; Knudsen, Steven Dell


    This report describes development of a system that provides high-speed, real-time downhole data while drilling. Background of the project, its benefits, major technical challenges, test planning, and test results are covered by relatively brief descriptions in the body of the report, with some topics presented in more detail in the attached appendices.

  3. User and provider perspectives on emergency obstetric care in a ...

    African Journals Online (AJOL)

    The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems they were facing in the context ...

  4. Healthcare quality management in Switzerland--a survey among providers. (United States)

    Kaderli, Reto; Pfortmueller, Carmen A; Businger, Adrian P


    In the last decade assessing the quality of healthcare has become increasingly important across the world. Switzerland lacks a detailed overview of how quality management is implemented and of its effects on medical procedures and patients' concerns. This study aimed to examine the systematics of quality management in Switzerland by assessing the providers and collected parameters of current quality initiatives. In summer 2011 we contacted all of the medical societies in Switzerland, the Federal Office of Public Health, the Swiss Medical Association (FMH) and the head of Swiss medical insurance providers, to obtain detailed information on current quality initiatives. All quality initiatives featuring standardised parameter assessment were included. Of the current 45 initiatives, 19 were powered by medical societies, five by hospitals, 11 by non-medical societies, two by the government, two by insurance companies or related institutions and six by unspecified institutions. In all, 24 medical registers, five seals of quality, five circles of quality, two self-assessment tools, seven superior entities, one checklist and one combined project existed. The cost of treatment was evaluated by four initiatives. A data report was released by 24 quality initiatives. The wide variety and the large number of 45 recorded quality initiatives provides a promising basis for effective healthcare quality management in Switzerland. However, an independent national supervisory authority should be appointed to provide an effective review of all quality initiatives and their transparency and coordination.

  5. Coordination of primary care providers: a follow-up study. (United States)

    McAlister, W H; Hettler, D L


    Surveys were sent to family physicians in North Carolina to determine knowledge and attitudes concerning optometry. A similar survey was performed previously with physicians from Illinois. Responses varied in the states regarding the participants' knowledge and opinions of optometric capabilities, perhaps as a function of the scope of optometric practice according to the individual state laws. Optometry's perceived role as a health care provider seems to be affected by their legally permitted mode of practice.

  6. Is environmental sustainability a strategic priority for logistics service providers? (United States)

    Evangelista, Pietro; Colicchia, Claudia; Creazza, Alessandro


    Despite an increasing number of third-party logistics service providers (3PLs) regard environmental sustainability as a key area of management, there is still great uncertainty on how 3PLs implement environmental strategies and on how they translate green efforts into practice. Through a multiple case study analysis, this paper explores the environmental strategies of a sample of medium-sized 3PLs operating in Italy and the UK, in terms of environmental organizational culture, initiatives, and influencing factors. Our analysis shows that, notwithstanding environmental sustainability is generally recognised as a strategic priority, a certain degree of diversity in the deployment of environmental strategies still exists. This paper is original since the extant literature on green strategies of 3PLs provides findings predominantly from a single country perspective and mainly investigates large/multinational organizations. It also provides indications to help managers of medium-sized 3PLs in positioning their business. This is particularly meaningful in the 3PL industry, where medium-sized organizations significantly contribute to the generated turnover and market value. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. How do providers prioritize prevention? A qualitative study. (United States)

    Solomon, Jeffrey L; Gifford, Allen L; Asch, Steven M; Meuller, Nora; Thomas, Colin M; Stevens, John M; Bokhour, Barbara G


    Preventive care is an essential element of comprehensive primary care medicine, yet many providers do not address the full range of recommended preventive care services. There is little understanding of how, during time-constrained clinical encounters, providers prioritize preventive care services. To identify and compare how Department of Veterans Affairs (VA) primary care providers (PCPs) prioritized general preventive care services, including HIV testing. A semistructured, qualitative interview design. We conducted semistructured phone interviews with 31 PCPs across 2 urban VA facilities. Interviews entailed questions about the most common preventive care services in primary care, how decisions are made to address some preventive care services but not others, and the role of clinical reminders (CRs) in prioritizing care. Interviews were audio-recorded and transcribed verbatim. We conducted an iterative thematic analysis of interview transcripts, utilizing NVivo 8, a qualitative data management and coding software. Most PCPs indicated they did not utilize CRs as a primary means of prioritizing general preventive care. Instead, PCPs prioritized general preventive care by attending to patients' individual needs and/or keeping in mind influential clinical training experiences. Prioritizing HIV testing included 1 or a combination of the following strategies: being attuned to HIV risk factors prior to the appearance of the CR, being prompted by the CR, and having a positive attitude toward CR design. Prioritizing preventive care can be accomplished using various strategies, including CRs. Healthcare systems might benefit from encouraging PCPs to use a range of strategies.

  8. The choice of a health care provider in Eritrea. (United States)

    Habtom, GebreMichael Kibreab; Ruys, Pieter


    The purpose of the study was to assess the factors that affect patients' choice of health care service providers and to analyse the effect of each factor, and to examine the policy implications for future health care provision in Eritrea. The data for this study was collected in a 10-month period from January to October 2003. A total of 1657 households were included in the study. Our findings reveals that education, perceived quality, distance, user fees, severity of illness, socio-economic status and place of residence are statistically significant in the choice of a health care provider. Our study further shows that illness recognition is much lower for poor and less educated individuals. When an illness is recognized by the individual or household, a typical observation is that health care is less likely to be sought when the individual or household is poor and lives far from the facilities, and then only in case of a serious illness. Information on the choice of health care service providers is crucial for planning, organizing and evaluation of health services. The people's perception of disease/illness, their concept of health and the basis for their choice in health care has to be considered in order to respond with appropriate services and information, education and communication programs.

  9. Does social marketing provide a framework for changing healthcare practice? (United States)

    Morris, Zoë Slote; Clarkson, Peter John


    We argue that social marketing can be used as a generic framework for analysing barriers to the take-up of clinical guidelines, and planning interventions which seek to enable this change. We reviewed the literature on take-up of clinical guidelines, in particular barriers and enablers to change; social marketing principles and social marketing applied to healthcare. We then applied the social marketing framework to analyse the literature and to consider implications for future guideline policy to assess its feasibility and accessibility. There is sizeable extant literature on healthcare practitioners' non-compliance with clinical guidelines. This is an international problem common to a number of settings. The reasons for poor levels of take up appear to be well understood, but not addressed adequately in practice. Applying a social marketing framework brings new insights to the problem." We show that a social marketing framework provides a useful solution-focused framework for systematically understanding barriers to individual behaviour change and designing interventions accordingly. Whether the social marketing framework provides an effective means of bringing about behaviour change remains an empirical question which has still to be tested in practice. The analysis presented here provides strong motivation to begin such testing.

  10. Do Foreign Bank Operations Provide a Stabilizing Influence in Korea?


    Yongil Jeon; Miller, Stephen M.; Paul A. Natke


    This paper examines Korean data (1994-2001) to determine if foreign banks behave differently than domestic banks and if that behavior provides a stabilizing influence on the Korean banking system and economy. Moreover, this paper also considers the effect, if any, of the Asian financial crisis on foreign and domestic bank behavior. Foreign banks. financial ratios differ from Korean banks with two notable exceptions: provisions for loan losses and loan growth. Before the Asian financial crisis...

  11. Development of a Mobile App for Family Planning Providers. (United States)

    Halsall, Viannella; Rogers, Jennifer; Witt, Jacki; Song, Sejun; Nguyen, Hoang Duc Huy; Kelly, Patricia

    To provide an overview of lessons learned during the development process of an app for iOS and Android based on national recommendations for providing quality family planning services. After a review of existing apps was conducted to determine whether an app of clinical recommendations for family planning existed, a team of clinicians, training specialists, and app developers created a resource app by first drafting a comprehensive content map. A prototype of the app was then pilot tested using smart tablets by a volunteer convenience sample of women's healthcare professionals. Outcomes measured included usability, acceptability, download analytics, and satisfaction by clinicians as reported through an investigator-developed tool. Sixty-nine professionals tested a prototype of the app, and completed a user satisfaction tool. Overall, user feedback was positive, and a zoom function was added to the final version as a result of the pilot test. Within 3 months of being publicly available, the app was downloaded 677 times, with 97% of downloads occurring on smart phones, 76% downloads occurring on iOS devices, and 24% on Android devices. This trend persisted throughout the following 3 months. Clinicians with an interest in developing an app should consider a team approach to development, pilot test the app prior to wider distribution, and develop a web-based version of the app to be used by clinicians who are unable to access smart devices in their practice setting.

  12. Child center closures: Does nonprofit status provide a comparative advantage? (United States)

    Lam, Marcus; Klein, Sacha; Freisthler, Bridget; Weiss, Robert E


    Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30+) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy.

  13. Developing a Comprehensive Learning Community Program: Providing a Historical Perspective (United States)

    Workman, Jamie L.; Redington, Lyn


    This is the first of a three-part series which will share information about how a mid-size, comprehensive university developed a learning community program, including a residential curriculum. Through intentional collaboration and partnerships, the team, comprised of faculty and staff throughout the university, developed a "multi-year plan…


    Directory of Open Access Journals (Sweden)

    Luiz Ricardo Aguena Jacintho Gil de Castro


    Full Text Available This paper describes the implementation of the Activity-Based Cost (ABC method in a company of taxes and accounting services and outlines the positive and negative aspects encountered during implementation. It should be taken into account that this work has been developed in the fiscal area of cost verification. Bibliographical references, internal company documents and interviews with industry officials and the administrator responsible for the company were used. In the evolving of operations, the costs of the fiscal area and their main activities have been described monthly and through this information, drivers have been developed and the ABC (Activity-Based Costing method has been adopted. With the implementation it became clear that the system provides better visualization for the decision making process, it also provided learning for the company, so that the method should be used for an undetermined period of time.

  15. Providing Information about Reading Lists via a Dashboard Interface

    Directory of Open Access Journals (Sweden)

    Dr Jason Cooper


    Full Text Available As developers of the open source LORLS Resource/Reading List Management System we have developed a dashboard to better support academic staffs’ understanding of how their students use reading lists. This dashboard provides both graphical and tabulated information drawn from LORLS and the Aleph Integrated Library System. Development of the dashboard required changes to back-end functionality of LORLS such as logging views of reading lists and caching of loan data. Changes to the front end included the use of HTML5 canvas elements to generate pie charts and line graphs. Recently launched to academic staff at Loughborough University, the dashboard has already garnered much praise. It is hoped that further development of the dashboard will provide even more support for academics in the compilation of their reading lists.

  16. Efficient Job Provisioning for a Cloud Service Provider

    Directory of Open Access Journals (Sweden)

    Sharma Dharmvir


    Full Text Available Cloud Computing is a very fast emerging technology as every enterprise is moving fast towards this system. Cloud Computing is known as a provider of dynamic services. It optimizes a very large, scalable and virtualized resource. So lots of industries have joined this bandwagon nowadays. One of the major research issues is to maintain good Quality of Service (QoS of a Cloud Service Provider (CSP. The QoS encompasses different parameters, like, smart job allocation strategy, efficient load balancing, response time optimization, reduction in wastage of bandwidth, accountability of the overall system, etc. The efficient allocation strategy of the independent computational jobs among different Virtual Machines (VM in a Data center (DC is a distinguishable challenge in the Cloud Computing domain and finding out an optimal job allocation strategy guided by a good scheduling heuristic for such an environment is a mape-k loop problem. So different heuristic approaches may be used for better result and in this result we paper we implement worst fit in mape-k and evaluated the results.

  17. In-home mental health treatment for individuals with HIV. (United States)

    Reif, Susan S; Pence, Brian W; LeGrand, Sara; Wilson, Elena S; Swartz, Marvin; Ellington, Terry; Whetten, Kathryn


    Mental health problems are highly prevalent among individuals with HIV and are consistently associated with negative health outcomes. However, mental illness often remains untreated due to significant psychosocial and physical barriers to treatment participation. The Collaborative HIV/AIDS Mental Health Program (CHAMP) assessed the outcomes associated with providing 9 months of in-home mental health counseling for 40 individuals with HIV and a Major Axis I mental disorder. The evidence-based Illness Management and Recovery Model was adapted for use with HIV-positive individuals for the study using a community-based participatory research approach. Study participants were surveyed at baseline, 5 and 9 months to assess for changes in health outcomes. Thirty-five percent of study participants were female, 80% African American, 33% self-identified as MSM and the average participant age was 43. Forty percent of participants were on psychotropic medication at baseline. Participants had an average of 8 counseling visits (median 9). Statistically significant decreases in the global Brief Symptom Inventory (BSI) score and a number of BSI symptoms dimensions including anxiety, depression, obsessive compulsive, phobic anxiety and hostility were detected, indicating a reduction of psychiatric symptoms. Statistically significant improvement was also identified for the SF-12 mental health scale, adaptive coping, overall social support and emotional support. No differences in psychiatric outcomes were identified by gender, race/ethnicity, or sexual preference. Findings from the CHAMP Study suggest that the use of in-home mental health treatment may be beneficial in engaging and treating HIV-positive individuals with comorbid mental health disorders.

  18. The Efficacy of Telemedicine-Supported Discharge Within an In Home Model of Care. (United States)

    Greenup, Edwin P; McCusker, Melissa; Potts, Boyd A; Bryett, Andrew


    To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.

  19. Modelling catchment areas for secondary care providers: a case study. (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle


    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  20. Responses evoked by a vestibular implant providing chronic stimulation. (United States)

    Thompson, Lara A; Haburcakova, Csilla; Gong, Wangsong; Lee, Daniel J; Wall, Conrad; Merfeld, Daniel M; Lewis, Richard F


    Patients with bilateral vestibular loss experience dehabilitating visual, perceptual, and postural difficulties, and an implantable vestibular prosthesis that could improve these symptoms would be of great benefit to these patients. In previous work, we have shown that a one-dimensional, unilateral canal prosthesis can improve the vestibulooccular reflex (VOR) in canal-plugged squirrel monkeys. In addition to the VOR, the potential effects of a vestibular prosthesis on more complex, highly integrative behaviors, such as the perception of head orientation and posture have remained unclear. We tested a one-dimensional, unilateral prosthesis in a rhesus monkey with bilateral vestibular loss and found that chronic electrical stimulation partially restored the compensatory VOR and also that percepts of head orientation relative to gravity were improved. However, the one-dimensional prosthetic stimulation had no clear effect on postural stability during quiet stance, but sway evoked by head-turns was modestly reduced. These results suggest that not only can the implementation of a vestibular prosthesis provide partial restitution of VOR but may also improve perception and posture in the presence of bilateral vestibular hypofunction (BVH). In this review, we provide an overview of our previous and current work directed towards the eventual clinical implementation of an implantable vestibular prosthesis.

  1. Providing nursing leadership in a community residential mental health setting. (United States)

    Hughes, Frances A; Bamford, Anita


    The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies. Copyright 2011, SLACK Incorporated.

  2. EMC Corporation Provides Colleges with a Course in Storage Technologies (United States)

    Van Sickle, Ed


    EMC Corporation, the world leader in data storage, created the EMC Academic Alliance Program to educate students on storage and close the education gap that exists. EMC developed a Storage Technology course to teach students about the design of storage technologies and the "big picture" of an information infrastructure. The course is "open" and focused on storage technologies, not products. College and universities use the course to teach students about a very important topic in IT: Storage. EMC collaborates with colleges and universities by providing the course, knowledge transfer sessions to faculty and program support. There is no cost to join and no cost to obtain the courses. EMC requires partners to sign an agreement for course use. Several colleges are using the course as an upper level elective and the course is taught by faculty. The alliance program has reduced faculty time to develop a storage course and time to learn the topic. Faculty is responsible for credentialing students and they supplement the course with additional materials. Students are being recruited for jobs by EMC and others, including internships. The Alliance program provides academic institutions with a way to differentiate. This paper will explain the program and the Storage Technology course.

  3. Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: A systematic meta-review

    Directory of Open Access Journals (Sweden)

    Petticrew Mark


    Full Text Available Abstract Background The effects of psychosocial risk factors on population health and health inequalities has featured prominently in epidemiological research literature as well as public health policy strategies. We have conducted a meta-review (a review of reviews exploring how psychosocial factors may relate to population health in home and community settings. Methods Systematic review (QUORUM of literature reviews (published in any language or country on the health associations of psychosocial risk factors in community settings. The literature search included electronic and manual searches. Two reviewers appraised included reviews using criteria for assessing systematic reviews. Data from the more robust reviews were extracted, tabulated and synthesised. Results Thirty-one reviews met our inclusion criteria. These explored a variety of psychosocial factors including social support and networks, social capital, social cohesion, collective efficacy, participation in local organisations – and less favourable psychosocial risk factors such as demands, exposure to community violence or anti-social behaviour, exposure to discrimination, and stress related to acculturation to western society. Most of the reviews focused on associations between social networks/support and physical or mental health. We identified some evidence of favourable psychosocial environments associated with better health. Reviews also found evidence of unfavourable psychosocial risk factors linked to poorer health, particularly among socially disadvantaged groups. However, the more robust reviews each identified studies with inconclusive findings, as well as studies finding evidence of associations. We also identified some evidence of apparently favourable psychosocial risk factors associated with poorer health. Conclusion From the review literature we have synthesised, where associations have been identified, they generally support the view that favourable psychosocial

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

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh


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


    Directory of Open Access Journals (Sweden)

    Magdalena Vaverková


    Full Text Available This paper provides information about biodegradability of polymeric (biodegradable/degradable materials advertised as 100%-degradable or certified as compostable, which may be a part of biodegradable waste, in home composting conditions. It describes an experiment that took place in home wooden compost bins and contained 9 samples that are commonly available in retail chains in the Czech Republic and Poland. The experiment lasted for the period of 12 weeks. Based on the results thereof it can be concluded that polyethylene samples with additive (samples 2, 4, 7 have not decomposed, their color has not changed and that no degradation or physical changes have occurred. Samples 1, 3 and 5 certified as compostable have not decomposed. Sample 6 exhibited the highest decomposition rate. Samples 8, 9 (tableware exhibited high degree of decomposition. The main conclusion from this study is that degradable/biodegradable plastics or plastics certified as compostable are not suitable for home composting.

  6. Proposition of a multicriteria model to select logistics services providers

    Directory of Open Access Journals (Sweden)

    Miriam Catarina Soares Aharonovitz


    Full Text Available This study aims to propose a multicriteria model to select logistics service providers by the development of a decision tree. The methodology consists of a survey, which resulted in a sample of 181 responses. The sample was analyzed using statistic methods, descriptive statistics among them, multivariate analysis, variance analysis, and parametric tests to compare means. Based on these results, it was possible to obtain the decision tree and information to support the multicriteria analysis. The AHP (Analytic Hierarchy Process was applied to determine the data influence and thus ensure better consistency in the analysis. The decision tree categorizes the criteria according to the decision levels (strategic, tactical and operational. Furthermore, it allows to generically evaluate the importance of each criterion in the supplier selection process from the point of view of logistics services contractors.

  7. A need for otolaryngology education among primary care providers (United States)

    Hu, Amanda; Sardesai, Maya G.; Meyer, Tanya K.


    Objective Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs. PMID:22754276

  8. Provider documentation of patient education: a lean investigation

    Directory of Open Access Journals (Sweden)

    Jean P. Shipman, MSLS, AHIP, FMLA


    Full Text Available Purpose: The study evaluates how providers give patient education materials and identifies improvements to comply with Meaningful Use (MU requirements. Methods: Thirty-eight patient-provider interactions in two health care outpatient clinics were observed. Results: Providers do not uniformly know MU patient education requirements. Providers have individual preferences and find gaps in what is available. Accessing and documenting patient education varies among providers. Embedded electronic health record (EHR materials, while available, have technical access barriers. Conclusions: Providers’ EHR skills and knowledge levels contribute to non-standardized patient education delivery.

  9. A Framework for Fibromyalgia Management for Primary Care Providers (United States)

    Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.


    Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. PMID:22560527

  10. A Shifting Shield Provides Protection Against Cosmic Rays (United States)

    Kohler, Susanna


    The Sun plays an important role in protecting us from cosmic rays, energetic particles that pelt us from outside our solar system. But can we predict when and how it will provide the most protection, and use this to minimize the damage to both pilotedand roboticspace missions?The Challenge of Cosmic RaysSpacecraft outside of Earths atmosphere and magnetic field are at risk of damage from cosmic rays. [ESA]Galactic cosmic rays are high-energy, charged particles that originate from astrophysical processes like supernovae or even distant active galactic nuclei outside of our solar system.One reason to care about the cosmic rays arriving near Earth is because these particles can provide a significant challenge for space missions traveling above Earths protective atmosphere and magnetic field. Since impacts from cosmic rays can damage human DNA, this risk poses a major barrier to plans for interplanetary travel by crewed spacecraft. And roboticmissions arent safe either: cosmic rays can flip bits, wreaking havoc on spacecraft electronics as well.The magnetic field carried by the solar wind provides a protective shield, deflecting galactic cosmic rays from our solar system. [Walt Feimer/NASA GSFCs Conceptual Image Lab]Shielded by the SunConveniently, we do have some broader protection against galactic cosmic rays: a built-in shield provided by the Sun. The interplanetary magnetic field, which is embedded in the solar wind, deflects low-energy cosmic rays from us at the outer reaches of our solar system, decreasing the flux of these cosmic rays that reach us at Earth.This shield, however, isnt stationary; instead, it moves and changes as the strength and direction of the solar wind moves and changes. This results in a much lower cosmic-ray flux at Earth when solar activity is high i.e., at the peak of the 11-year solar cycle than when solar activity is low. This visible change in local cosmic-ray flux with solar activity is known as solar modulation of the cosmic ray flux

  11. Providing Assistive Technology Applications as a Service Through Cloud Computing. (United States)

    Mulfari, Davide; Celesti, Antonio; Villari, Massimo; Puliafito, Antonio


    Users with disabilities interact with Personal Computers (PCs) using Assistive Technology (AT) software solutions. Such applications run on a PC that a person with a disability commonly uses. However the configuration of AT applications is not trivial at all, especially whenever the user needs to work on a PC that does not allow him/her to rely on his / her AT tools (e.g., at work, at university, in an Internet point). In this paper, we discuss how cloud computing provides a valid technological solution to enhance such a scenario.With the emergence of cloud computing, many applications are executed on top of virtual machines (VMs). Virtualization allows us to achieve a software implementation of a real computer able to execute a standard operating system and any kind of application. In this paper we propose to build personalized VMs running AT programs and settings. By using the remote desktop technology, our solution enables users to control their customized virtual desktop environment by means of an HTML5-based web interface running on any computer equipped with a browser, whenever they are.

  12. Can quantum probability provide a new direction for cognitive modeling? (United States)

    Pothos, Emmanuel M; Busemeyer, Jerome R


    Classical (Bayesian) probability (CP) theory has led to an influential research tradition for modeling cognitive processes. Cognitive scientists have been trained to work with CP principles for so long that it is hard even to imagine alternative ways to formalize probabilities. However, in physics, quantum probability (QP) theory has been the dominant probabilistic approach for nearly 100 years. Could QP theory provide us with any advantages in cognitive modeling as well? Note first that both CP and QP theory share the fundamental assumption that it is possible to model cognition on the basis of formal, probabilistic principles. But why consider a QP approach? The answers are that (1) there are many well-established empirical findings (e.g., from the influential Tversky, Kahneman research tradition) that are hard to reconcile with CP principles; and (2) these same findings have natural and straightforward explanations with quantum principles. In QP theory, probabilistic assessment is often strongly context- and order-dependent, individual states can be superposition states (that are impossible to associate with specific values), and composite systems can be entangled (they cannot be decomposed into their subsystems). All these characteristics appear perplexing from a classical perspective. However, our thesis is that they provide a more accurate and powerful account of certain cognitive processes. We first introduce QP theory and illustrate its application with psychological examples. We then review empirical findings that motivate the use of quantum theory in cognitive theory, but also discuss ways in which QP and CP theories converge. Finally, we consider the implications of a QP theory approach to cognition for human rationality.

  13. Comics as a Medium for Providing Information on Adult Immunizations. (United States)

    Muzumdar, Jagannath M; Pantaleo, Nicholas L


    This study compared the following effects of two vaccine information flyers-one developed by the Centers for Disease Control and Prevention (CDC) versus one adapted from this information to a comic medium (comic)-on adults: (a) attitude toward the flyer; (b) perceived informativeness of the flyer; (c) intention to seek more information about adult immunizations after viewing the flyer; and (d) intention to get immunized after viewing the flyer. A between-group, randomized trial was used to randomly assign adults (age 18 years or older) at an ambulatory care center to review the CDC or comic flyer. Participants were asked to complete a survey to measure several outcome variables. Items were measured using a 7-point semantic differential scale. Independent-samples t-test was used for comparisons. A total of 265 surveys (CDC n = 132 vs comic n = 133) were analyzed. The comic flyer had a statistically significant effect on participants' attitudes and their perception of the flyer's informativeness compared to the CDC flyer. Flyer type did not have a statistically significant effect on intention-related variables. The study findings showed that the comic flyer was positively evaluated compared to the CDC flyer. These findings could provide a new direction for developing adult educational materials.

  14. A National Study of Primary Care Provided by Osteopathic Physicians. (United States)

    Licciardone, John C


    The establishment of a single accreditation system for graduate medical education in the United States suggests a convergence of osteopathic and allopathic medicine. To compare the characteristics of medical care provided by osteopathic and allopathic physicians. Five-year data from the National Ambulatory Medical Care Survey were used to study patient visits for primary care, including those for low back pain, neck pain, upper respiratory infection, hypertension, and diabetes mellitus. Patient status, primary reason for the visit, chronicity of the presenting problem, injury status, medication orders, physician referrals, source of payment, and time spent with the physician were used to compare osteopathic and allopathic patient visits. A total of 134,369 patient visits were surveyed, representing a population (SE) of 4.57 billion (220.2 million) patient visits. Osteopathic physicians provided 335.6 (29.9) million patient visits (7.3%), including 217.1 (20.9) million visits for primary care (9.7%). The 5 sentinel symptoms and medical diagnoses accounted for 233.0 (12.4) million primary care visits (10.4%). The mean age of patients seen during primary care visits provided by osteopathic physicians was 46.0 years (95% CI, 44.1-47.9 years) vs 39.9 years (95% CI, 38.8-41.0 years) during visits provided by allopathic physicians (POsteopathic patient visits were less likely to involve preventive care (OR, 0.55; 95% CI, 0.44-0.68) and more likely to include care for injuries (OR, 1.60; 95% CI, 1.43-1.78). Osteopathic physicians spent slightly less time with patients during visits (mean, 16.4 minutes; 95% CI, 15.7-17.2 minutes) than allopathic physicians (mean, 18.2 minutes; 95% CI, 17.2-19.3 minutes). The most distinctive aspect of osteopathic medical care involved management of low back pain. Therein, osteopathic physicians were less likely to order medication (OR, 0.33; 95% CI, 0.15-0.75) or to refer patients to another physician (OR, 0.47; 95% CI, 0.23-0.94), despite

  15. Optimization of a Virtual Power Plant to Provide Frequency Support.

    Energy Technology Data Exchange (ETDEWEB)

    Neely, Jason C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Johnson, Jay [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Gonzalez, Sigifredo [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Lave, Matthew Samuel [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Delhotal, Jarod James [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    Increasing the penetration of distributed renewable sources, including photovoltaic (PV) sources, poses technical challenges for grid management. The grid has been optimized over decades to rely upon large centralized power plants with well-established feedback controls, but now non-dispatchable, renewable sources are displacing these controllable generators. This one-year study was funded by the Department of Energy (DOE) SunShot program and is intended to better utilize those variable resources by providing electric utilities with the tools to implement frequency regulation and primary frequency reserves using aggregated renewable resources, known as a virtual power plant. The goal is to eventually enable the integration of 100s of Gigawatts into US power systems.

  16. Remotely Operated Vehicles (ROVs) Provide a "Big Data Progression" (United States)

    Oostra, D.; Sanghera, S. S.; Mangosing, D. C., Jr.; Lewis, P. M., Jr.; Chambers, L. H.


    This year, science and technology teams at the NASA Langley Science Directorate were challenged with creating an API-based web application using RockBlock Mobile sensors mounted on a zero pressure high-altitude balloon. The system tracks and collects meteorological data parameters and visualizes this data in near real time, using a MEAN development stack to create an HTML5 based tool that can send commands to the vehicle, parse incoming data, and perform other functions to store and serve data to other devices. NASA developers and science educators working on this project saw an opportunity to use this emerging technology to address a gap identified in science education between middle and high school curricula. As students learn about data analysis in elementary and middle school, they are taught to collect data from in situ sources. In high school, students are then asked to work with remotely sensed data, without always having the experience or understanding of how that data is collected. We believe that using ROVs to create a "big data progression" for students will not only enhance their ability to understand how remote satellite data is collected, but will also provide the outlet for younger students to expand their interest in science and data prior to entering high school. In this presentation, we will share and discuss our experiences with ROVs, APIs and data viz applications, with a focus on the next steps for developing this emerging capability.

  17. Abortion practice in Mexico: a survey of health care providers. (United States)

    Dayananda, Ila; Walker, Dilys; Atienzo, Erika E; Haider, Sadia


    Little is known about abortion practice in Mexico postlegalization of abortion in Mexico City in 2007. In 2009, we anonymously surveyed 418 Mexican health care providers at the Colegio Mexicano de Especialistas en Ginecologia y Obstetricia meeting using audio computer-assisted self-interview technology. The majority of respondents were obstetrician gynecologists (376, 90%), Catholic (341, 82%), 35-60 years old (332, 79%) and male (222, 53%) and worked with trainees (307, 74%). Prior to 2007, 11% (46) and 17% (71) provided medical and surgical abortions; now, 15% (62) and 21% (86) provide these services, respectively. Practitioners from Mexico City were more likely to provide services than those from other areas. Most medical abortion providers (50, 81%) used ineffective protocols. Surgical abortion providers mainly used either manual vacuum aspiration (39, 45%) or sharp curettage (27, 32%). Most abortion providers were trained in residency and wanted more training in medical (54, 87%) and surgical (59, 69%) abortion. Among nonproviders, 49% (175) and 27% (89) expressed interest in learning to perform medical and surgical abortion, respectively. Given the interest in learning to provide safe abortion services and the prevalent use of ineffective medical abortion regimens and sharp curettage, abortion training in Mexico should be strengthened. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. In-Home Family-Focused Reunification: An Experimental Study. (United States)

    Walton, Elaine; And Others


    Tested the effectiveness of intensive, in-home family reunification services in reunifying families separated by the placement of a child in out-of-home care. After 90 days, 93% of the families assigned to receive the intensive treatment were reunited, compared to 28% of families in a control group who received routine out-of-home care services.…

  19. Volunteer computers in homes to fight against Malaria in Africa

    CERN Document Server


    "Africa@home, a project conceived and coordinated by CERN1, was launched publicly this week. It is recruiting volunteer computers in homes and offices to run a computer-intensive simulation program called, developed by researchers at the Swiss Tropical Institute (STI)" (1 page)

  20. Providing a sense of touch to prosthetic hands. (United States)

    Nghiem, Bao Tram; Sando, Ian C; Gillespie, R Brent; McLaughlin, Bryan L; Gerling, Gregory J; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S


    Each year, approximately 185,000 Americans suffer the devastating loss of a limb. The effects of upper limb amputations are profound because a person's hands are tools for everyday functioning, expressive communication, and other uniquely human attributes. Despite the advancements in prosthetic technology, current upper limb prostheses are still limited in terms of complex motor control and sensory feedback. Sensory feedback is critical to restoring full functionality to amputated patients because it would relieve the cognitive burden of relying solely on visual input to monitor motor commands and provide tremendous psychological benefits. This article reviews the latest innovations in sensory feedback and argues in favor of peripheral nerve interfaces. First, the authors examine the structure of the peripheral nerve and its importance in the development of a sensory interface. Second, the authors discuss advancements in targeted muscle reinnervation and direct neural stimulation by means of intraneural electrodes. The authors then explore the future of prosthetic sensory feedback using innovative technologies for neural signaling, specifically, the sensory regenerative peripheral nerve interface and optogenetics. These breakthroughs pave the way for the development of a prosthetic limb with the ability to feel.

  1. Providing a Foundation for Analysis of Volatile Data Stores

    Directory of Open Access Journals (Sweden)

    Timothy Vidas


    Full Text Available Current threats against typical computer systems demonstrate a need for forensic analysis of memory-resident data in addition to the conventional static analysis common today.  Certain attacks and types of malware exist solely in memory and leave little or no evidentiary information on nonvolatile stores such as a hard disk drive.  The desire to preserve system state at the time of response may even warrant memory acquisition independent of perceived threats and the ability to analyze the acquired duplicate. Tools capable of duplicating various types of volatile data stores are becoming widely available.  Once the data store has been duplicated, current forensic procedures have no method for extrapolating further useful information from the duplicate.  This paper is focused on providing the groundwork for performing forensic investigations on the data that is typically stored in a volatile data store, such as system RAM.It is intended that, when combined with good acquisition techniques, it will be shown that it is possible to obtain more post incident response information along with less impact to potential evidence when compared to typical incident response procedures. 

  2. Administrative and clinical denials by a large dental insurance provider

    Directory of Open Access Journals (Sweden)

    Geraldo Elias MIRANDA


    Full Text Available The objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05. It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols.

  3. Life Insurance for Consumers: A Teacher's Guide. A Teacher Inservice Module for Secondary Level Consumer Education Units in Home Economics, Business Education, Social Studies and Related Areas. (United States)

    Thelen, Judith

    This teacher-oriented learning module for secondary level consumer education teachers, the first in a series of three, was developed to provide information on life insurance and ideas for conveying this content to students. The module begins with a definition and general goals of consumer economics, an overview, a pre-test, a performance objective…

  4. Can health care providers recognise a fibromyalgia personality? (United States)

    Da Silva, José A P; Jacobs, Johannes W G; Branco, Jaime C; Canaipa, Rita; Gaspar, M Filomena; Griep, Ed N; van Helmond, Toon; Oliveira, Paula J; Zijlstra, Theo J; Geenen, Rinie


    To determine if experienced health care providers (HCPs) can recognise patients with fibromyalgia (FM) based on a limited set of personality items, exploring the existence of a FM personality. From the 240-item NEO-PI-R personality questionnaire, 8 HCPs from two different countries each selected 20 items they considered most discriminative of FM personality. Then, evaluating the scores on these items of 129 female patients with FM and 127 female controls, each HCP rated the probability of FM for each individual on a 0-10 scale. Personality characteristics (domains and facets) of selected items were determined. Scores of patients with FM and controls on the eight 20-item sets, and HCPs' estimates of each individual's probability of FM were analysed for their discriminative value. The eight 20-item sets discriminated for FM, with areas under the receiver operating characteristic curve ranging from 0.71-0.81. The estimated probabilities for FM showed, in general, percentages of correct classifications above 50%, with rising correct percentages for higher estimated probabilities. The most often chosen and discriminatory items were predominantly of the domain neuroticism (all with higher scores in FM), followed by some items of the facet trust (lower scores in FM). HCPs can, based on a limited set of items from a personality questionnaire, distinguish patients with FM from controls with a statistically significant probability. The HCPs' expectation that personality in FM patients is associated with higher levels for aspects of neuroticism (proneness to psychological distress) and lower scores for aspects of trust, proved to be correct.

  5. Kiwi genome provides insights into evolution of a nocturnal lifestyle. (United States)

    Le Duc, Diana; Renaud, Gabriel; Krishnan, Arunkumar; Almén, Markus Sällman; Huynen, Leon; Prohaska, Sonja J; Ongyerth, Matthias; Bitarello, Bárbara D; Schiöth, Helgi B; Hofreiter, Michael; Stadler, Peter F; Prüfer, Kay; Lambert, David; Kelso, Janet; Schöneberg, Torsten


    Kiwi, comprising five species from the genus Apteryx, are endangered, ground-dwelling bird species endemic to New Zealand. They are the smallest and only nocturnal representatives of the ratites. The timing of kiwi adaptation to a nocturnal niche and the genomic innovations, which shaped sensory systems and morphology to allow this adaptation, are not yet fully understood. We sequenced and assembled the brown kiwi genome to 150-fold coverage and annotated the genome using kiwi transcript data and non-redundant protein information from multiple bird species. We identified evolutionary sequence changes that underlie adaptation to nocturnality and estimated the onset time of these adaptations. Several opsin genes involved in color vision are inactivated in the kiwi. We date this inactivation to the Oligocene epoch, likely after the arrival of the ancestor of modern kiwi in New Zealand. Genome comparisons between kiwi and representatives of ratites, Galloanserae, and Neoaves, including nocturnal and song birds, show diversification of kiwi's odorant receptors repertoire, which may reflect an increased reliance on olfaction rather than sight during foraging. Further, there is an enrichment of genes influencing mitochondrial function and energy expenditure among genes that are rapidly evolving specifically on the kiwi branch, which may also be linked to its nocturnal lifestyle. The genomic changes in kiwi vision and olfaction are consistent with changes that are hypothesized to occur during adaptation to nocturnal lifestyle in mammals. The kiwi genome provides a valuable genomic resource for future genome-wide comparative analyses to other extinct and extant diurnal ratites.

  6. A financing model for Spanish retail electricity providers

    National Research Council Canada - National Science Library

    Isabel Vela Cantalapiedra; José Luís Calvo González


    ...; and the definition and structure of the future-flow securitization process. Due to the lack of liquidity and the difficulty of obtaining funds in the financial sector, new electricity providers have to search for alternative financing...

  7. In-home video distribution for telecom operators

    NARCIS (Netherlands)

    Hendrix, B.; Hartog, F.T.H. den; Vlag, H. van der; Baken, N.


    We have investigated the various alternatives for in-home video distribution that might be applicable between now and 2010. Among these are wireless and so-called no-new-wires architectures, but also unconventional approaches based on analogue distribution. The latter actually led to a surprisingly

  8. "Literacy Nooks": Geosemiotics and Domains of Literacy in Home Spaces (United States)

    Rainbird, Sophia; Rowsell, Jennifer


    Conceptualizations of the home have changed, particularly in respect to children's rearing and development. An increased awareness of early intervention in meeting a child's learning needs has filtered down into the organization of space in homes. Maximizing learning opportunities by creating "literacy nooks", which involves carving out…

  9. Patient-provider conversations about sterilization: A qualitative analysis. (United States)

    Kimport, Katrina; Dehlendorf, Christine; Borrero, Sonya


    Although female sterilization is the second most commonly used contraceptive method in the US, research suggests that providers may serve as barriers to desired sterilization. We conducted a modified grounded theory analysis of audio-recorded contraceptive counseling visits with 52 women who specified on a previsit survey that they wanted no future children and a supplemental analysis of visits with 14 women who wanted or were unsure about future children in which sterilization was mentioned. Sterilization was discussed in only 19 of the 52 visits, primarily with patients who were older women with children. Although some framed sterilization positively, many clinicians discouraged patients from pursuing sterilization, encouraging them instead to use long-acting reversible methods and framing the permanence of sterilization as undesirable. In the 33 remaining sessions, sterilization was not mentioned, and clinicians largely failed to solicit patients' future reproductive intentions. We found no clear patterns regarding discussion of sterilization in the 14 supplemental cases. Clinicians did not discuss sterilization with all patients for whom it might have been appropriate and thus missed opportunities to discuss sterilization as part of the full range of appropriate methods. When they did discuss sterilization, they only infrequently presented the method in positive ways and more commonly encouraged patients to choose a long-acting reversible method instead. Clinicians may want to reflect on their counseling practices around sterilization to ensure that counseling is centered on patient preferences, rather than driven by their own assumptions about the desirability of reversibility. Clinicians often fail to discuss sterilization as a contraceptive option with potentially appropriate candidates and, when they do, often discourage its selection. Clinicians should consider assessing reproductive intentions to ensure that potentially relevant methods are included in

  10. Sustainable leadership in a Thai healthcare services provider. (United States)

    Kantabutra, Sooksan


    Rhineland leadership practices contrast sharply with the prevailing Anglo/US business model of short-term maximization of profitability, and are said to lead to greater corporate sustainability, at least in highly developed economies. However, the applicability of Rhineland leadership to less developed economies has not yet been demonstrated. This paper sets out to compare the business practices of a social enterprise that delivers healthcare services in Thailand and Avery's 19 sustainable leadership practices derived from Rhineland enterprises. Adopting a case study approach, multi-data collection methods included non-participant observations made during visits to the enterprise, and reference to internal and published documentation and information. Semi-structured interview sessions were held with many stakeholders, including top management, staff, patients and a former consultant. In the Thai healthcare organization studied, evidence was found for compliance with 15 of Avery's 19 sustainable leadership elements, but to varying degrees. The elements were grouped into six core sets of practices: adopting a long-term perspective, staff development, organizational culture, innovation, social responsibility, and ethical behavior. One element was found to be not applicable, and no evidence was found for conformity with Rhineland principles on the remaining three sustainable practices. The paper concludes that Avery's 19 Rhineland practices provide a useful framework for evaluating the corporate sustainability of this Thai enterprise. Healthcare enterprises in Thailand and possibly in other Asian countries that wish to sustain their organizational success could adopt Avery's 19 Sustainable Leadership Grid elements to examine their leadership practices, and adjust them to become more sustainable. The relevance of Rhineland sustainable leadership principles to enterprises in less developed economies remains to be investigated. This study attempts to uncover this unknown.


    Energy Technology Data Exchange (ETDEWEB)

    Bly, Aaron; Oxstrand, Johanna


    As technology continues to evolve and become more integrated into a worker’s daily routine in the Nuclear Power industry the need for easy access to data becomes a priority. Not only does the need for data increase but the amount of data collected increases. In most cases the data is collected and stored in various software applications, many of which are legacy systems, which do not offer any other option to access the data except through the application’s user interface. Furthermore the data gets grouped in “silos” according to work function and not necessarily by subject. Hence, in order to access all the information needed for a particular task or analysis one may have to access multiple applications to gather all the data needed. The industry and the research community have identified the need for a digital architecture and more importantly the need for a Seamless Digital Environment. An SDE provides a means to access multiple applications, gather the data points needed, conduct the analysis requested, and present the result to the user with minimal or no effort by the user. In addition, the nuclear utilities have identified the need for research focused on data analytics. The effort should develop and evaluate use cases for data mining and analytics for employing information from plant sensors and database for use in developing improved business analytics. Idaho National Laboratory is leading such effort, which is conducted in close collaboration with vendors, nuclear utilities, Institute of Nuclear Power Operations, and Electric Power Research Institute. The goal of the study is to research potential approaches to building an analytics solution for equipment reliability, on a small scale, focusing on either a single piece of equipment or a single system. The analytics solution will likely consist of a data integration layer, predictive and machine learning layer and the user interface layer that will display the output of the analysis in a straight

  12. Violence toward chronic pain care providers: A national survey. (United States)

    David, Kim; Anuj, Daftari; Nabil, Sibai


    This study measured the following: violence rates against chronic pain care providers (CPCPs), character/context/risk factors for violence and CPCPs' mitigation strategies. An e-mail survey was sent to members of the American Society of Interventional Pain Physicians (ASIIP) to collect demographics, rates/type of violence, injury, risk mitigation, and context of violence. Correlation with demographic factors calculated using one-way ANOVA and χ2 test (Fisher test). Security was called by 64.85% of CPCPs and 51.52% received threats. The threats involved a gun 7.05% of the time. Injury was reported by 2.73% of CPCPs. The most common risk mitigation was discharging patient (85.33%). Others used protective equipment (16.89%) of which a significant percentage carried a gun (54%). Opioid management was the highest context for violence (89.9%; P < 0.0001). Those who practiced part-time were more likely to be harmed (P = 0.0290). Females were less likely to be threatened (P = 0.0507). Anesthesiology was the most threatened vs other specialties (P = 0.0215). Urban practices were less likely to move or close the practice (P = 0.0292). CPCPs were at high risk for violence. Risk factors were older age, male, working part time, and anesthesiology. Risk was highest in the context of opioid management and disability. Discharging patient was the most common risk mitigation. A significant number of physicians carried firearms. Wiley Periodicals, Inc.

  13. A logical model provides insights into T cell receptor signaling.

    Directory of Open Access Journals (Sweden)

    Julio Saez-Rodriguez


    Full Text Available Cellular decisions are determined by complex molecular interaction networks. Large-scale signaling networks are currently being reconstructed, but the kinetic parameters and quantitative data that would allow for dynamic modeling are still scarce. Therefore, computational studies based upon the structure of these networks are of great interest. Here, a methodology relying on a logical formalism is applied to the functional analysis of the complex signaling network governing the activation of T cells via the T cell receptor, the CD4/CD8 co-receptors, and the accessory signaling receptor CD28. Our large-scale Boolean model, which comprises 94 nodes and 123 interactions and is based upon well-established qualitative knowledge from primary T cells, reveals important structural features (e.g., feedback loops and network-wide dependencies and recapitulates the global behavior of this network for an array of published data on T cell activation in wild-type and knock-out conditions. More importantly, the model predicted unexpected signaling events after antibody-mediated perturbation of CD28 and after genetic knockout of the kinase Fyn that were subsequently experimentally validated. Finally, we show that the logical model reveals key elements and potential failure modes in network functioning and provides candidates for missing links. In summary, our large-scale logical model for T cell activation proved to be a promising in silico tool, and it inspires immunologists to ask new questions. We think that it holds valuable potential in foreseeing the effects of drugs and network modifications.

  14. Networked Print Production: Does JDF Provide a Perfect Workflow?

    Directory of Open Access Journals (Sweden)

    Bernd Zipper


    Full Text Available The "networked printing works" is a well-worn slogan used by many providers in the graphics industry and for the past number of years printing-works manufacturers have been working on the goal of achieving the "networked printing works". A turning point from the concept to real implementation can now be expected at drupa 2004: JDF (Job Definition Format and thus "networked production" will form the center of interest here. The first approaches towards a complete, networked workflow between prepress, print and postpress in production are already available - the products and solutions will now be presented publicly at drupa 2004. So, drupa 2004 will undoubtedly be the "JDF-drupa" - the drupa where machines learn to communicate with each other digitally - the drupa, where the dream of general system and job communication in the printing industry can be first realized. CIP3, which has since been renamed CIP4, is an international consortium of leading manufacturers from the printing and media industry who have taken on the task of integrating processes for prepress, print and postpress. The association, to which nearly all manufacturers in the graphics industry belong, has succeeded with CIP3 in developing a first international standard for the transmission of control data in the print workflow.Further development of the CIP4 standard now includes a more extensive "system language" called JDF, which will guarantee workflow communication beyond manufacturer boundaries. However, not only data for actual print production will be communicated with JDF (Job Definition Format: planning and calculation data for MIS (Management Information systems and calculation systems will also be prepared. The German printing specialist Hans-Georg Wenke defines JDF as follows: "JDF takes over data from MIS for machines, aggregates and their control desks, data exchange within office applications, and finally ensures that data can be incorporated in the technical workflow

  15. "Upstream Thinking": the catchment management approach of a water provider (United States)

    Grand-Clement, E.; Ross, M.; Smith, D.; Anderson, K.; Luscombe, D.; Le Feuvre, N.; Brazier, R. E.


    directly held within the company, and second because it shows how local communities and groups are considered and valued by the company. Monitoring changes and providing a solid scientific base is also undertaken to prove the concept and justify any investment. The work carried out so far has highlighted that SWW's collaborative approach to catchment management is changing the relationship between private water suppliers in the UK and stakeholders or groups having an impact on water quality. This results in a progressive move from a situation where the polluter has to pay, to rewarding providers of clean water instead. The value of ecosystem payments of this kind is being discussed with the appropriate authorities (i.e. Natural England, and the Department for Environment, Food and Rural Affairs) so that it can form part of ensuring sustainable water supplies in future, with all the environmental and ecological benefits of clear raw waters in rivers, lakes and streams.

  16. The conduct and process of mental capacity assessments in home health care settings. (United States)

    Cliff, Charlotte; McGraw, Caroline


    The assessment of capacity to consent to treatment is key to shared practitioner-patient decision-making. It is the responsibility of the person closest to the decision being made to carry out the assessment. The aim was to examine the factors that influence mental capacity assessments in home health care settings and identify the facilitators and inhibitors to the conduct and process of assessments as perceived and experienced by non-medical health practitioners providing generalist community services. Semi-structured interviews with a purposive sample of community nurses, community physiotherapists and community occupational therapists in one NHS Trust in London. Data were analysed thematically. The main themes were issues relating to: intrinsic patient factors and behaviours; recognising, managing and utilising the influence of the family; practitioner motivation and competence; working together as a team to optimise shared decision making, and; the importance of place. While some issues appear germane to both hospital and home health care settings, others are unique to - or manifest very differently in - home health care settings. The findings suggest that the influence of family members, long-term practitioner-patient relationships and physical distance from co-workers make the conduct and process of mental capacity assessments in home health care settings an inherently complex endeavour.

  17. Subterranean systems provide a suitable overwintering habitat for Salamandra salamandra

    Directory of Open Access Journals (Sweden)

    Monika Balogová


    Full Text Available The fire salamander (Salamandra salamandra has been repeatedly noted to occur in natural and artificial subterranean systems. Despite the obvious connection of this species with underground shelters, their level of dependence and importance to the species is still not fully understood. In this study, we carried out long-term monitoring based on the capture-mark-recapture method in two wintering populations aggregated in extensive underground habitats. Using the POPAN model we found the population size in a natural shelter to be more than twice that of an artificial underground shelter. Survival and recapture probabilities calculated using the Cormack-Jolly-Seber model were very constant over time, with higher survival values in males than in females and juveniles, though in terms of recapture probability, the opposite situation was recorded. In addition, survival probability obtained from Cormack-Jolly-Seber model was higher than survival from POPAN model. The observed bigger population size and the lower recapture rate in the natural cave was probably a reflection of habitat complexity. Our study showed that regular visits are needed to detect the true significance of underground shelters for fire salamanders. The presence of larvae was recorded in both wintering sites, especially in bodies of water near the entrance. On the basis of previous and our observations we incline to the view, that karst areas can induce not only laying in underground shelters but also group wintering in this species. Our study highlights the strong connection of the life cycle of fire salamanders with underground shelters and their essential importance for the persistence of some populations during unfavourable conditions and breeding activity. In addition, the study introduces the POPAN and Cormac-Jolly-Seber models for estimating of population size, survival and recapture probability in wintering populations of the species, which could provide important information

  18. Activating mutations in ALK provide a therapeutic target in neuroblastoma. (United States)

    George, Rani E; Sanda, Takaomi; Hanna, Megan; Fröhling, Stefan; Luther, William; Zhang, Jianming; Ahn, Yebin; Zhou, Wenjun; London, Wendy B; McGrady, Patrick; Xue, Liquan; Zozulya, Sergey; Gregor, Vlad E; Webb, Thomas R; Gray, Nathanael S; Gilliland, D Gary; Diller, Lisa; Greulich, Heidi; Morris, Stephan W; Meyerson, Matthew; Look, A Thomas


    Neuroblastoma, an embryonal tumour of the peripheral sympathetic nervous system, accounts for approximately 15% of all deaths due to childhood cancer. High-risk neuroblastomas are rapidly progressive; even with intensive myeloablative chemotherapy, relapse is common and almost uniformly fatal. Here we report the detection of previously unknown mutations in the ALK gene, which encodes a receptor tyrosine kinase, in 8% of primary neuroblastomas. Five non-synonymous sequence variations were identified in the kinase domain of ALK, of which three were somatic and two were germ line. The most frequent mutation, F1174L, was also identified in three different neuroblastoma cell lines. ALK complementary DNAs encoding the F1174L and R1275Q variants, but not the wild-type ALK cDNA, transformed interleukin-3-dependent murine haematopoietic Ba/F3 cells to cytokine-independent growth. Ba/F3 cells expressing these mutations were sensitive to the small-molecule inhibitor of ALK, TAE684 (ref. 4). Furthermore, two human neuroblastoma cell lines harbouring the F1174L mutation were also sensitive to the inhibitor. Cytotoxicity was associated with increased amounts of apoptosis as measured by TdT-mediated dUTP nick end labelling (TUNEL). Short hairpin RNA (shRNA)-mediated knockdown of ALK expression in neuroblastoma cell lines with the F1174L mutation also resulted in apoptosis and impaired cell proliferation. Thus, activating alleles of the ALK receptor tyrosine kinase are present in primary neuroblastoma tumours and in established neuroblastoma cell lines, and confer sensitivity to ALK inhibition with small molecules, providing a molecular rationale for targeted therapy of this disease.

  19. Providing Climate Policy Makers With a Strong Scientific Base (Invited) (United States)

    Struzik, E.


    Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.

  20. Multiple Source Biosimilar Insulin, What's a Provider to Do? (United States)

    Carter, Alan


    In the United States the FDA designates generic products that are bioequivalent as AB substitutable (FDA rating signifying the approved application contains adequate scientific evidence establishing through in vivo and/or in vitro studies the bioequivalence of the product to a selected reference product) and are expected to produce the same therapeutic results as the innovator product. In the case of biological proteins that are similar to already approved innovator biologicals, such as recombinant human insulin, the insulin molecule and accompanying secondary and tertiary structures will differ between manufacturing sources. Even subtle differences between innovator (branded) and alternative "biosimilar" products may produce different therapeutic endpoints. Substitution of a branded insulin with a biosimilar insulin product may result in more, less, or equal therapeutic response making in difficult for the practitioner to assess glycemic control between patient follow-up visits. Significant therapeutic difference is possible, which could result in mild to severe hypoglycemia reaction or hyperglycemia induced tissue damage. Slight molecular changes along with different accompanying proteins, protein fragments, and other naturally occurring contaminants theoretically increase odds of insulin resistance or allergic reaction. Current review of medication product and device quality relies on manufacturer self-oversight and individual reporting of product adverse events after use. While this is usually sufficient for oral medications and many medical devices, critical use products such as sterile products, biosimilar insulin, insulin delivery devices, self-monitoring blood glucose monitoring systems, and test strips require much more vigorous oversight to prevent individual and/or large scale catastrophe. Health care providers should advocate for their patient to have access to affordable, consistent, quality-assured products to effectively and safely manage their

  1. How Geochemistry Provides Habitability: A Case Study of Iron Oxidation (United States)

    St Clair, B.; Shock, E.


    Two things have to be true for chemotrophic microbes to gain chemical energy from their environment. First, there must be a source of energy, provided by compounds in differing oxidation states that are out of thermodynamic equilibrium with one another. Second, there must be mechanistic difficulties that are keeping those compounds from reacting, preventing chemical energy from dissipating on its own. Using this energetic reference frame, geochemical habitability requires the combined presence of energy sources and kinetic barriers, which are determined by numerous variables including temperature, pH, and concentrations of reactants and products. Here we present habitable geochemical space visually as habitability diagrams. As an example, the pH and temperature ranges that can sustain life for a specific reaction can be delineated by the aforementioned kinetic and energetic boundaries, together with commonly attainable pH / temperatures of environments at Earth's surface. Other habitability diagrams can be constructed for any combination of relevant geochemical variables to better illustrate the inherently multidimensional problem. We have chosen iron oxidation reactions to illustrate this point, as kinetic and energetic boundaries can be found at conditions readily attainable in natural systems. By calculating energy availability (as affinity, A) in each system from compositional data where concentrations of all reactants and products are known, the energy boundary is defined by A=0. Evaluating the kinetic boundary means measuring the relative rates of the biotic and abiotic processes in situ, which we have done in Yellowstone hot springs, acid mine drainage in Arizona, and cold springs in the Swiss Alps. Many experiments have yielded biological rates, and all have yielded abiotic rates, which range from inconsequential to rates too rapid for biology to compete. These results encompass both sides of the kinetic boundary, defining its trajectory. When plotted in p

  2. In-Home Care for Optimizing Chronic Disease Management in the Community (United States)


    emergency department (ED) visit (MD: –1.32; 95% CI: –1.87 to –0.77). A beneficial effect of in-home care was also shown on activities of daily living (MD: –0.14; 95% CI: –0.27 to –0.01), including less difficulty dressing above the waist or below the waist, grooming, bathing/showering, toileting, and feeding. These results were based on moderate quality of evidence. Additional beneficial effects of in-home care were shown for HRQOL although this was based on low quality of evidence. Limitations Different characterization of outcome measures across studies prevented the inclusion of all eligible studies for analysis. Conclusions In summary, education-based in-home care is effective at improving outcomes of patients with a range of heart disease severity when delivered by nurses during a single home visit or on an ongoing basis. In-home visits by occupational therapists and physical therapists targeting modification of tasks and the home environment improved functional activities for community-living adults with chronic disease. Plain Language Summary It is assumed that patients with chronic disease will benefit if they are living at home and being looked after at home or in the community. In addition, there may be cost savings to the health care system when care is provided in the community or in the home instead of in hospitals and other health care settings. This evidence-based analysis examined whether in-home care given by different health care professionals improved patient and health system outcomes. Patients included those with heart failure, atrial fibrillation, coronary artery disease, stroke, chronic obstructive pulmonary disease, diabetes, chronic wounds, and with more than one chronic disease. The results show that in-home care delivered by nurses has a beneficial effect on patients’ health outcomes. Patient mortality and/or patient hospitalization were reduced. In-home care also improved patients’ activities of daily living when delivered by

  3. Simulated in-home teletreatment for anomia. (United States)

    Dechêne, Lambert; Tousignant, Michel; Boissy, Patrick; Macoir, Joël; Héroux, Serge; Hamel, Mathieu; Brière, Simon; Pagé, Catherine


    This pilot study explored the feasibility of in-home teletreatment for patients with post-stroke anomia. Three participants over 65 years of age suffering from post-stroke anomia were treated in this pre/post-intervention case study. They received 12 speech therapy teletreatments (two sessions/week for 6 weeks) aimed at improving confrontation naming skills. Half of the failed items from a set of 120 preselected stimuli were trained during treatment (Block A-trained stimuli) while the other half served as controls (Block B-untrained stimuli). Variables measured were: 1) efficacy of treatment (performance on Block-A vs. Block B Stimuli), and 2) participants' satisfaction with teletreatment (using a French adaptation of the Telemedicine satisfaction questionnaire). All participants showed a clinically relevant improvement on confrontation naming of trained items and less improvement for untrained items. The researchers also obtained high satisfaction scores on the questionnaire (above 57/60). This pilot study supports the feasibility of speech therapy teletreatments applied to neurological language disorders.

  4. In-home Smoking in Households with Women of Reproductive Age in Nepal: Does Women's Empowerment Matter? (United States)

    Pandey, Shanta; Murugan, Vithya; Karki, Yagya B; Mathur, Amit


    Authors examined the prevalence and predictors of in-home smoking in households with women of reproductive age. They analyzed data from 9,837 ever married women from 2011 Nepal Demographic Health Survey. About 17 percent of women and 66 percent of their husbands smoked and 58 percent of the women lived in homes that permitted in-home smoking. About 6 percent of the women were pregnant and 42 percent had given birth within the past five years. In-home tobacco use was equally prevalent in homes with and without young children and irrespective of women's pregnancy status. Husband's use of tobacco doubled the odds of in-home smoking (odds ratio [OR] = 2.36; 95% confidence interval [CI] = 1.52-3.69) and wife's use of tobacco quadrupled the odds of in-home smoking controlling for other factors (OR = 3.94; 95% CI = 3.30-4.70). In addition, employed women were 39 percent more likely to allow in-home smoking than their unemployed counterparts (OR = 1.39; 95% CI = 1.19-1.63). Protective factors against in-home smoking were women's education, intrahousehold decision-making ability, household wealth, and urban residence. To reduce in-home smoking, social workers should increase awareness about the adverse consequences of secondhand smoke by providing counseling services to male and female tobacco users. © 2016 National Association of Social Workers.

  5. A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing

    Directory of Open Access Journals (Sweden)

    Tourangeau Ann


    Full Text Available Abstract Background Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers. Methods Two phase mixed methods design is proposed (ISRCTN 12345678. Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers will evaluate differences in outcomes between two implementation strategies. Primary outcome: Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations. Intervention: In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a printed materials, b one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c three post-workshop teleconferences. Discussion This

  6. A concept of customer–provider relation monitoring system solution

    Directory of Open Access Journals (Sweden)

    Naděžda Chalupová


    Full Text Available The contribution deals with design of customer–provider relationship monitoring system solution with regard to needs of business managers and analytics and to possibilities of contemporaneous information and communication technologies.The attention is followed to targeted modelling, what brings possibilities of acquisition of bigger overview about things taking place in the relation. In consequence it describes the functionality of analytical systems producing these very strategically valuable models – to so-called business intelligence tools. Onward it deals with modern technologies conductive to above mentioned system implementation – with Ajax concept and with some XML applications: PMML for analytical models manipulation, XSLT for XML data transformations to various formats, SVG for representing pictures of statistical graphs etc. and MathML for description of mathematical formulas created in analytical systems.Following these basis it suggests technological solution of some parts of client–provider relationship watching and evaluating system and it discusses its potential advantages and problems, which can occur.

  7. The Flagpole Factory: Providing a Referent for Linear Equations. (United States)

    Connell, Michael L.; Ravlin, Susan B.

    A change of emphasis in mathematics education may be needed from a mechanical and computational focus to a problem-solving approach. A first step in facilitating this goal is to place children in situations emphasizing problem-solving skills, requiring them to develop and apply their own logic structures. This paper describes a microcomputer based…

  8. Leaf spring, and electromagnetic actuator provided with a leaf spring

    NARCIS (Netherlands)

    Berkhoff, Arthur P.; Lemmen, Remco Louis Christiaan


    The invention relates to a leaf spring for an electromagnetic actuator and to such an electromagnetic actuator. The leaf spring is formed as a whole from a disc of plate-shaped, resilient material. The leaf spring comprises a central fastening part, an outer fastening part extending therearound and

  9. CHOICES. A Resource for Literacy Providers and Homeless Families. (United States)

    Koehler, Gwen; And Others

    CHOICES, a literacy program for homeless families, piloted a program at the Women's Emergency Shelter in Champaign, Illinois and later expanded its services to A Woman's Place, a domestic violence shelter, in Urbana, Illinois. The CHOICES program offered weekly language activities for the children and gave mothers information about developing…

  10. Providing compensation for damage caused by wildlife: a case study ...

    African Journals Online (AJOL)

    In Kenya, a week hardly passes without a report in the local press of death or destruction of property by wildlife, or retaliatory attacks on wild animals by their victims. The result is that local communities in Kenya view wildlife as a liability instead of a heritage. In such circumstances, elephants will have increasing difficulty ...

  11. Nanotechnology Provides a New Perspective on Chemical Thermodynamics (United States)

    Haverkamp, Richard G.


    A small mechanical device, the atomic force microscope, measuring a force and the distance over which this force is applied, can be used on a single polysaccharide molecule to obtain the Gibbs energy of a conformational change within the polysaccharide. This well-defined conformational change within certain types of polysaccharide molecules is…

  12. Using integrated bio-physiotherapy informatics in home health-care settings: A qualitative analysis of a point-of-care decision support system. (United States)

    Canally, Culum; Doherty, Sean; Doran, Diane M; Goubran, Rafik A


    The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners. © The Author(s) 2014.

  13. Providing Personalized Services to Users in a Recommender System (United States)

    Oduwobi, Olukunle; Ojokoh, Bolanle Adefowoke


    Instructors recommend learning materials to a class of students not minding the learning ability and reading habit of each student. Learners are finding it problematic to make a decision about which available learning materials best meet their situation and will be beneficial to their course of study. In order to address this challenge, a new…

  14. Heterogeneous Context-Aware Robots Providing a Personalized Building Tour

    Directory of Open Access Journals (Sweden)

    Anna Hristoskova


    Full Text Available Existing robot guides offer a tour of a building, such as a museum or science centre, to one or more visitors. Usually the tours are predefined and lack support for dynamic interactions between the different robots. This paper focuses on the distributed collaboration of multiple heterogeneous robots (receptionist, companion guiding visitors through a building. Semantic techniques support the formal definition of tour topics, the available content on a specific topic, and the robot and person profiles including interests and acquired knowledge. The robot guides select topics depending on their participants' interests and prior knowledge. Whenever one guide moves into the proximity of another, the guides automatically exchange participants, optimizing the amount of interesting topics. Robot collaboration is realized through the development of a software module that allows a robot to transparently include behaviours performed by other robots into its own set of behaviours. The multi-robot visitor guide application is integrated into an extended distributed heterogeneous robot team, using a receptionist robot that was not originally designed to cooperate with the guides. Evaluation of the implemented algorithms presents a 90% content coverage of relevant topics for the participants.

  15. A Service Learning Program in Providing Nutrition Education to Children


    Falter, Rebecca A.; Pignotti-Dumas, Karla; Popish, Sarah J.; Petrelli, Heather M.W.; Best, Mark A.; Wilkinson, Julie J.


    Objective. To implement a service learning program in nutrition and assess its impact on pharmacy students' communication skills and professionalism and elementary school children's knowledge of nutrition concepts.

  16. A service learning program in providing nutrition education to children

    National Research Council Canada - National Science Library

    Falter, Rebecca A; Pignotti-Dumas, Karla; Popish, Sarah J; Petrelli, Heather M W; Best, Mark A; Wilkinson, Julie J


    To implement a service learning program in nutrition and assess its impact on pharmacy students' communication skills and professionalism and elementary school children's knowledge of nutrition concepts...

  17. What Makes or Breaks Provider--Researcher Collaborations in HIV Research? A Mixed Method Analysis of Providers' Willingness to Partner (United States)

    Pinto, Rogerio M.


    Research is lacking about what makes or breaks collaboration between researchers and HIV services providers. This study identified factors that influence providers' levels of willingness to collaborate in HIV prevention scientific research. Survey measures were grounded in in-depth interview data and included providers' "willingness to…

  18. A symbiotic shell-encrusting bryozoan provides subtidal whelks with ...

    African Journals Online (AJOL)

    The subtidal whelk Burnupena papyracea co-occurs with a voracious predator, the rock lobster Jasus lalandii, in situations where other potential prey are largely eliminated. The survival of B. papyracea has been ascribed to a symbiotic bryozoan, Alcyonidium nodosum, which characteristically encrusts the shells of this ...

  19. Could mini black holes provide a 'theory of everything'?

    CERN Multimedia

    Gribbin, J


    A Soviet astrophysicist is claiming that the Earth and other astronomical bodies may be riddled with mini black holes - objects smaller than atoms but with masses perhaps greater than planets. These could be responsible for a variety of phenomena inc the rings of Saturn (1/2 page).

  20. High School Child Development Courses Provide a Valuable Apprenticeship (United States)

    McCombie, Sally M.


    The current media are laden with reports of the many significant problems facing today's youth. In fact, parenting has become a national topic of discussion. Parenting instruction, a responsibility that had previously rested in the home, has become part of educational curricula. Courses in child development are offered for high school students in…

  1. Providers' perceptions of the implementation of a performance ...

    African Journals Online (AJOL)

    reported data on perceived outcomes and quality of services, and a discharge form that gathers data on the type of ... 6 Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA. Corresponding author: B Myers .... processes: 'We had a big question mark as to where exactly and in which week.

  2. polymerase chain reaction (pcr) provides a superior tool for the ...

    African Journals Online (AJOL)


    global estimates.Lancet.2009; 374: 893–902. 5. Tin TinHtar, M, Madhava, H., Balmer, P.,. Christopoulou, D., Menegas, D., Bonnet E. A. Review of the Impact of Pneumococcal. Polysaccharide Conjugate Vaccine (7-valent) on. Pneumococcal. Meningitis. Adv.Ther.2013;. 30:748–762. 6. Mackenzie, G.A., Plumb, I.D., Sambou, ...


    National Research Council Canada - National Science Library

    Luiz Ricardo Aguena Jacintho Gil de Castro; Fernando de Almeida Santos


    This paper describes the implementation of the Activity-Based Cost (ABC) method in a company of taxes and accounting services and outlines the positive and negative aspects encountered during implementation...

  4. Responses evoked by a vestibular implant providing chronic stimulation


    Thompson L.A.; Haburcakova C.; Gong W; Lee D.J.; Wall Iii C.; Merfeld D.M.; Lewis R.F.


    Patients with bilateral vestibular loss experience dehabilitating visual, perceptual, and postural difficulties, and an implantable vestibular prosthesis that could improve these symptoms would be of great benefit to these patients. In previous work, we have shown that a one-dimensional, unilateral canal prosthesis can improve the vestibulooccular reflex (VOR) in canal-plugged squirrel monkeys. In addition to the VOR, the potential effects of a vestibular prosthesis on more complex, highly in...

  5. Tellurium: providing a bright future for solar energy (United States)

    Goldfarb, Richard J.


    Tellurium is one of the least common elements on Earth. Most rocks contain an average of about 3 parts per billion tellurium, making it rarer than the rare earth elements and eight times less abundant than gold. Grains of native tellurium appear in rocks as a brittle, silvery-white material, but tellurium more commonly occurs in telluride minerals that include varied quantities of gold, silver, or platinum. Tellurium is a metalloid, meaning it possesses the properties of both metals and nonmetals.

  6. Corruption in a Comprehensive School: Sociological Diagnosis and Educational Providence

    Directory of Open Access Journals (Sweden)

    Valdas Pruskus


    Full Text Available The article is about the phenomenon of corruption in a comprehensive school. It analyses the expression forms of corruption and their peculiarities and disputes the main reasons stimulating educators to take part in corrupt interchanges thus tolerate it. On the ground of empirical research in Vilnius secondary schools it discloses attitudes of teachers, schoolchildren and parents towards corruption. The research was carried out in Vilnius Salomėja Nėris gymnasium, Vilnius Mikalojus Daukša secondary school, Mindaugas secondary school, Užupys gymnasium, Antakalnis gymnasium, Naujamiestis secondary school and Stanevičius secondary school. Overall 500 respondents were questioned: 300 pupils of ninth – twelfth forms, 100 teachers and 100 parents of schoolchildren. Difficult financial circumstances were pointed out as the main reason stimulating teachers to take part in corrupt interchanges. This answer was chosen by 42 per cent of respondents. Most of them think that raising wages would reduce corruption crimes. The research data show it is an important problem in schools though 70 per cent of respondents state it is not the biggest problem in their school. Only 15 per cent of questioned schoolchildren, 4 per cent of parents and 14 percent of teachers safely state that corruption is the main problem in their school. About 20 per cent of respondents (21.4 per cent of schoolchildren, 19 per cent of parents and 21 per cent of teachers acknowledge of making a payoff or receiving an offer to take it. Respondents state that 30 per cent of their friends and relatives made a payoff to school staff. 26.7 percent of schoolchildren and 27 per cent of parents’ acquaintances made a payoff to school staff. Only the answers of teachers did not change – 21 per cent of their colleagues were offered a payoff. These results do not let affirm that corruption is very widely spread in schools and therefore could be named as the biggest problem here. Though

  7. Intraguild predation provides a selection mechanism for bacterial antagonistic compounds (United States)

    Leisner, J. J.; Haaber, J.


    Bacteriocins are bacterial proteinaceous toxins with bacteriostatic or bacteriocidal activity towards other bacteria. The current theory on their biological role concerns especially colicins, with underlying social interactions described as an example of spite. This leads to a rock–paper–scissors game between colicin producers and sensitive and resistant variants. The generality of this type of selection mechanism has previously been challenged with lactic acid bacterial (LAB) bacteriocins as an example. In the natural environment of LAB, batch cultures are the norm opposed to the natural habitats of Escherichia coli where continuous cultures are prevailing. This implies that fitness for LAB, to a large degree, is related to survival rates (bottleneck situations) rather than to growth rates. We suggest that the biological role of LAB bacteriocins is to enhance survival in the stationary growth phase by securing a supply of nutrients from lysed target cells. Thus, this social interaction is an example of selfishness rather than of spite. Specifically, it fits into an ecological model known as intraguild predation (IGP), which is a combination of competition and predation where the predator (LAB bacteriocin producer) and prey (bacteriocin susceptible bacteria) share similar and often limited resources. We hypothesize that IGP may be a common phenomenon promoting microbial production of antagonistic compounds. PMID:22951735

  8. Binaural cues provide for a release from informational masking. (United States)

    Tolnai, Sandra; Dolležal, Lena-Vanessa; Klump, Georg M


    Informational masking (IM) describes the insensitivity of detecting a change in sound features in a complex acoustical environment when such a change could easily be detected in the absence of distracting sounds. IM occurs because of the similarity between deviant sound and distracting sounds (so-called similarity-based IM) and/or stimulus uncertainty stemming from trial-to-trial variability (so-called uncertainty-based IM). IM can be abolished if similarity-based or uncertainty-based IM are minimized. Here, we modulated similarity-based IM using binaural cues. Standard/deviant tones and distracting tones were presented sequentially, and level-increment thresholds were measured. Deviant tones differed from standard tones by a higher sound level. Distracting tones covered a wide range of levels. Standard/deviant tones and distracting tones were characterized by their interaural time difference (ITD), interaural level difference (ILD), or both ITD and ILD. The larger the ITD or ILD was, the better similarity-based IM was overcome. If both interaural differences were applied to standard/deviant tones, the release from IM was larger than when either interaural difference was used. The results show that binaural cues are potent cues to abolish similarity-based IM and that the auditory system makes use of multiple available cues. (c) 2015 APA, all rights reserved).

  9. A compact STED microscope providing 3D nanoscale resolution. (United States)

    Wildanger, D; Medda, R; Kastrup, L; Hell, S W


    The advent of supercontinuum laser sources has enabled the implementation of compact and tunable stimulated emission depletion fluorescence microscopes for imaging far below the diffraction barrier. Here we report on an enhanced version of this approach displaying an all-physics based resolution down to (19 +/- 3) nm in the focal plane. Alternatively, this single objective lens system can be configured for 3D imaging with resolution down to 45 x 45 x 108 nm in a cell. The obtained results can be further improved by mathematical restoration algorithms. The far-field optical nanoscale resolution is attained in a variety of biological samples featuring strong variations in the local density of features.

  10. Issues for service providers: a response to points raised


    Furedi, A.


    The issue of abortion has evolved since 1967. In this paper, the shift in the discourses of abortion are discussed. The article suggests that abortion is used as a "back-up" method of family planning and that this is broadly acceptable. Although there is little public opposition to abortion as such, there are influences that undermine abortion provision as it now exists. Growing concern about the status of the fetus shapes a number of debates. For example the issue of what the fetus feels dur...

  11. Can engineering solutions really provide a sustainable future?

    DEFF Research Database (Denmark)

    Boisen, Anja


    Sustainability is a word which is very often (mis)used in various public debates. In engineering, however, it is perhaps easier to define the term, then in other academic fields. We advocate the principle that only those activities, which can be sustained for at least a few centuries using known...... technology and resources, should be called sustainable. Using this definition of sustainability one particularly big challenge field is energy supply, but the importance of the issue - “The energy problem” - is clear. To illustrate one central aspect of the energy problem we introduce the “1 TW benchmark...

  12. A Study of Mathematical Content Provided in Illustrated Children's Books (United States)

    Yilmaz Genc, Melek Merve; Akinci Cosgun, Aysegul; Pala, Sengul


    Purpose: Early childhood is of critical importance in terms of cognitive, affective and physical development. Undoubtedly, a substantially stimulating environment and opportunities offered to children, as well as appropriate educational materials, have an impact on their development. The object of this study is to investigate the mathematical…

  13. Bilingualism provides a neural reserve for aging populations. (United States)

    Abutalebi, Jubin; Guidi, Lucia; Borsa, Virginia; Canini, Matteo; Della Rosa, Pasquale A; Parris, Ben A; Weekes, Brendan S


    It has been postulated that bilingualism may act as a cognitive reserve and recent behavioral evidence shows that bilinguals are diagnosed with dementia about 4-5 years later compared to monolinguals. In the present study, we investigated the neural basis of these putative protective effects in a group of aging bilinguals as compared to a matched monolingual control group. For this purpose, participants completed the Erikson Flanker task and their performance was correlated to gray matter (GM) volume in order to investigate if cognitive performance predicts GM volume specifically in areas affected by aging. We performed an ex-Gaussian analysis on the resulting RTs and report that aging bilinguals performed better than aging monolinguals on the Flanker task. Bilingualism was overall associated with increased GM in the ACC. Likewise, aging induced effects upon performance correlated only for monolinguals to decreased gray matter in the DLPFC. Taken together, these neural regions might underlie the benefits of bilingualism and act as a neural reserve that protects against the cognitive decline that occurs during aging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Will a hiding box provide stress reduction for shelter cats?

    NARCIS (Netherlands)

    Vinke, Claudia|info:eu-repo/dai/nl/235196053; Godijn, L.M.; van der Leij, Ruth|info:eu-repo/dai/nl/412860430


    Domestic cats (Felis sylvestris catus) can experience serious stress in shelters. Stressful experiences can have a major impact on the cats’ welfare and may cause higher incidences of infectious diseases in the shelters due to raised cortisol levels causing immuno deficiency.Though several studies

  15. Information Interaction: Providing a Framework for Information Architecture. (United States)

    Toms, Elaine G.


    Discussion of information architecture focuses on a model of information interaction that bridges the gap between human and computer and between information behavior and information retrieval. Illustrates how the process of information interaction is affected by the user, the system, and the content. (Contains 93 references.) (LRW)

  16. Providing Focus via a Social Media Exploitation Strategy (United States)


    getting information about particular person of interest, groups, organizations.  Social Network Analysis Social networks Genealogy Location...Analysis Social networks Genealogy Location Event posting  In-depth content about a subject or content Profile  Structure of orgs  Understanding

  17. Providing a Sounding Board for Second Language Writers (United States)

    Kim, E. Julia


    English as a second language (ESL) writing teachers face distinct challenges as they try to help students write in the language that is appropriate and natural to the native-English-speaking audience. It is disheartening when the writings of even advanced-level second language students often contain many awkward sentences and non-English-like…

  18. Allocation of advertising space by a web service provider using ...

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    organization name “Center For Media Research.” The main page includes an archive. (below the day's posting). Unfortunately, the archive headlines do not mention the source of the research. 9We consider highest the bid for a bundle and the ties are broken in favour of early bids. 10Source: e-Marketing [7] ...

  19. Hydroxyzine premedication - does it provide better anxiolysis than a ...

    African Journals Online (AJOL)

    intramuscular hydroxyzine appeared only slightly superior to placebo in alleviating apprehension in patients undergoing minor gynaecological procedures. Fifty-four per cent of patients were calmed with hydroxyzine, compared with 34% with the placebo.2A comparison of alprazolam with hydroxyzine as oral premedication ...

  20. A method for calculating active feedback system to provide vertical ...

    Indian Academy of Sciences (India)

    not difficult to see that ϕ (+∞)=+∞. Therefore, for the equation ϕ (γ)=0to have no positive root, the fulfillment of the following condition is necessary: ϕ (0) = (R−1w, a) − w0 ≥ 0. (12). We will call (12) as the necessary condition of vertical position control by active feedbacks. 5. Problem of selection of active feedback system.

  1. Eolian Features Provide a Glimpse of Candor Chasma Mineralology (United States)


    This image of Candor Chasma's eastern end was taken by the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) at 0655 UTC (2:55 a.m. EDT) on March 24, 2007. CRISM's image captured 544 colors covering 0.36-3.92 micrometers, and shows features as small as 100 meters (330 feet) across. The region covered is roughly 10 kilometers (6.2 miles) at its narrowest point. Designed to look for a variety of materials on the walls and floor of Candor Chasma, this CRISM observation is somewhat unique in that it is extended along an extended path across the chasma floor to capture extra territory at the expense of spatial resolution. Candor Chasma is a deep, elongated, steep-sided depression some 813 kilometers (505 miles) in length. It is one of two large chasmata that make up the northern end of the Valles Marineris system. The top image, which illustrates the long path CRISM's cameras scanned to extend the observation in the along-track direction, shows the CRISM image on top of a mosaic of images from the Thermal Emission Imaging System (THEMIS) on Mars Odyssey. The lower two false-color images offer a glimpse of the topography and mineralogy contained within this large chasma. These views were constructed by draping the CRISM images over topography, and viewing the surface in perspective from the northeast. The southern part of CRISM's swath (to the left) covers interior layered deposits along with low ridges (far left) that are an erosional remnant of the chasma wall. The northern end (to the right) reveals the older, eroded chasma wall material, as well as the chasma floor. White lines in the images represent gaps in the data due to the stretching of the image. The erosive Martian wind appears to have removed dust and debris covering monohydrated sulfate-rich mineral deposits (bright green). Wind-abraded ridges of layered sediments (image center) reveal these deposits more readily, while ridges to the north and south also appear to retain more of a cover of

  2. Coupled uncertainty provided by a multifractal random walker

    Energy Technology Data Exchange (ETDEWEB)

    Koohi Lai, Z. [Department of Physics, Firoozkooh Branch, Islamic Azad University, Firoozkooh (Iran, Islamic Republic of); Vasheghani Farahani, S. [Department of Physics, Tafresh University, P.O. Box 39518-79611, Tafresh (Iran, Islamic Republic of); Movahed, S.M.S. [Department of Physics, Shahid Beheshti University, G.C., Evin, Tehran 19839 (Iran, Islamic Republic of); The Abdus Salam International Centre for Theoretical Physics, Strada Costiera, 11, Trieste 34151 (Italy); Jafari, G.R., E-mail: [Department of Physics, Shahid Beheshti University, G.C., Evin, Tehran 19839 (Iran, Islamic Republic of)


    The aim here is to study the concept of pairing multifractality between time series possessing non-Gaussian distributions. The increasing number of rare events creates “criticality”. We show how the pairing between two series is affected by rare events, which we call “coupled criticality”. A method is proposed for studying the coupled criticality born out of the interaction between two series, using the bivariate multifractal random walk (BiMRW). This method allows studying dependence of the coupled criticality on the criticality of each individual system. This approach is applied to data sets of gold and oil markets, and inflation and unemployment. - Highlights: • The coupled criticality between two systems is modeled by the bivariate multifractal random walk. • This coupled criticality is generally directed. • This coupled criticality is inversely proportional to the criticality of either of the systems. • The coupled criticality can emerge when at least one of the systems posses a Gaussian distribution.

  3. Providing a sound habitat for man in space (United States)

    Stranger-Johannessen, Maria

    Microbiological growth on materials in an indoor environment contributes to the well known "sick building syndrome". The inhabitants' health and well-being is affected by injurious vapours and odours given off to the air. This is particularly pronounced in new and better tightened houses with unconventional building materials and wider employment of air conditioning. The European Space Agency has recognized the problems to be expected in a totally closed and self-supported long-term habitat and has induced work on the selection of materials, resistant to microbiological growth, and on other microbial contamination control measures. Requirements and procedures are being established as a basis for the microbiological cleanliness of the manned space environment and for the avoidance of microbiological growth on materials and equipment. Methods are being developed, suitable for testing and predicting the resistivity to microbiological growth of materials to be used in long-term space habitats.

  4. Science Communications: Providing a Return on Investment to the Taxpayer (United States)

    Horack, John M.; Borchelt, Rick E.


    Nowhere is the disconnect between needing to better communicate science and technology and the skills and techniques used for that communication more evident than in the Federal research enterprise. As Federal research budgets stagnate or decline, and despite public clamor for more and better scientific information, communication of basic research results continues to rank among the lowest agency priorities, mortgaged against traditional public-relations activities to polish an agency's image or control negative information flow to the press and public. Alone among the Federal agencies, NASA articulates in its strategic plan the need " advance and communicate scientific knowledge and understanding..." These words emphasize the reality that if new knowledge is generated but not communicated, only half the job has been done. This is a reflection of the transition of NASA from primarily an engineering organization used to help win the Cold War to a producer of new knowledge and technology in the National interest for the 21st century.

  5. The ATLS course, a survey of 228 ATLS providers (United States)

    Kennedy, D; Gentleman, D


    Advanced Trauma Life Support (ATLS) courses teach a system for the initial assessment and management of trauma patients that aims to optimise initial care and reduce mortality and morbidity, and have been adopted worldwide. This questionnaire survey characterised those who took up this particular educational resource in Scotland during a four year period after its introduction, and analysed how they felt it had affected their clinical competence. Irrespective of their previous level of training and experience, nearly all surgeons and anaesthetists who took this course felt that it had improved their clinical skills and other professional attributes. The significance of these results is discussed in the context of postgraduate surgical and anaesthetic training in Scotland. PMID:11310464

  6. Sociologist as a Service Provider. Using Psychology to Support Selling

    Directory of Open Access Journals (Sweden)

    N Е Aimautova


    Full Text Available The article helms the reader to the results of the sociological services market observation. A basic selling scheme is outlined with the components of interactions space as well as the set of "must-have" psychological skills and competencies essential for the seller highlighted as factors of high priority. The principal stages of the selling process are identified. The notion of "offeror" who meets the desires of the client purchasing sociological services is introduced. The prominent role of psychological selling techniques is emphasized in the guidelines to be abided by the sociologist in order to prevent potential misunderstandings and conflicts as well as to establish new contacts and keep old ties with the client after making a deal.

  7. Electric heating provides a high level of home comfort - economically

    Energy Technology Data Exchange (ETDEWEB)

    Haapakoski, M.


    Research and development at IVO in the area of electric heating boasts a tradition going back almost thirty years. Research aimed at further progress is continuing. IVO and power companies launched the `Electrically heated houses of the century` project four years ago. The first results show that electric heating continues to be very competitive with other heating systems. It is an economical way of heating the home and it also increases the comfort of those living there

  8. Extracellular vesicles provide a means for tissue crosstalk during exercise

    DEFF Research Database (Denmark)

    Whitham, Martin; Parker, Benjamin L; Friedrichsen, Martin


    Exercise stimulates the release of molecules into the circulation, supporting the concept that inter-tissue signaling proteins are important mediators of adaptations to exercise. Recognizing that many circulating proteins are packaged in extracellular vesicles (EVs), we employed quantitative...... vesicles. Pulse-chase and intravital imaging experiments suggested EVs liberated by exercise have a propensity to localize in the liver and can transfer their protein cargo. Moreover, by employing arteriovenous balance studies across the contracting human limb, we identified several novel candidate...

  9. Who will push my wheelchair? Choosing a family eldercare provider

    Directory of Open Access Journals (Sweden)

    Sofia Cristina Iost Pavarini


    Full Text Available The emotional ties and personal relationships we form during our lives affect the quality of our family relationships when we grow older. The objective of this study was to evaluate family functioning among elderly people attending adult literacy classes and to identify who they would choose to care for them in their older age. It was a descriptive and transverse study, based on the principles of the quantitative and qualitative research method. To the family functioning assessment, it was used the Family Apgar, proposed by SMILKSTEIN (1978 and data were statistically analyzed in frequency measures. 93 elderly people were evaluated. To the comprehension of caregiver choice it was made in-depth interviews with 9 participants, three of them from each Apgar category. Interviews were analyzed, following the Content Analyze Model, Thematic Analyze Category, proposed by BARDIN (1977. Ethical guidelines for research with human participants were followed. Results obtained with the Family Apgar Scale indicate that 81 participants were from well functioning families, 8 presented moderate family dysfunction and 4 presented high family dysfunction. In-depth interviews were conducted with three participants from each category. In all three groups, the caregiver of choice was the same with respect to: gender (female, family relationship (daughter and family composition (multigenerational. The definition of “Who will push my wheelchair” is a choice determined by socio-cultural values and individual life histories; the choice is a multivariate issue, affected by lifelong processes.

  10. A Primer on Insulin Pump Therapy for Health Care Providers. (United States)

    McCrea, Deborah L


    An estimated 1 million people use an insulin pump to manage their diabetes. Few medical professionals understand or feel comfortable caring for people who use an insulin pump. This article will help the medical professional understand the reasons why the insulin pump helps the user to achieve better glycemic control, have more flexibility, and enjoy a better quality of life. Additionally, this article discusses the advantages, disadvantages, candidate selection, contraindications, basic functions, and troubleshooting of the insulin pump. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Seychelles Lagoon Provides Corals with a Refuge from Bleaching

    Directory of Open Access Journals (Sweden)

    David Iluz


    Full Text Available An extensive bleaching event in the summer of the year 1997-1998 affected most reefs along East Africa's shores. In the aftermath of that episode, the reefs of Île Alphonse in the Seychelles were examined and it was found that reefs along the seaward slopes of the island lost >95% of their branching coral colonies, with considerably higher survival of massive species. Île Alphonse features a nearly circular shallow lagoon, with steep seaward slopes. Contrary to our expectations, mortality in the warmer lagoon was far lower than of coral colonies on the surrounding slopes, bathed in deeper and cooler waters. We suggest that corals in the lagoon were protected from UV radiation by leachate stemming from seagrass leaves steeped in the lagoon. Our measurements in the lagoon showed a strong attenuation of ultraviolet radiation, not observed in the waters outside the lagoon, and laboratory examination confirmed that the strong UV absorption of substances leached into seawater from decomposing leaves of the seagrass Thalassodendron (=Cymodocea testudinaceum. Our findings demonstrate the synergism between elevated seawater temperature and UV radiation in triggering bleaching on shallow reefs.

  12. Speed Dating: Providing a Menu of Possible Futures

    Directory of Open Access Journals (Sweden)

    John Zimmerman

    Full Text Available As user experience (UX design continues to grow and expand, designers often work in areas with few design patterns or social mores. It is easy to make things that people do not want or will not adopt. To help avoid this problem, we developed a method called speed dating. This method allows design teams to explore possible futures with target users. Speed dating helps to reduce the risk of making things that people will not adopt. It also discloses opportunities and user needs that design teams might not observe during fieldwork. Over the last decade, we have used this method in many research projects, teaching it to hundreds of UX design students. This article describes the speed dating method, presenting cases to show how speed dating aids UX design.

  13. Oracle support provides a range of new tutorials

    CERN Multimedia


    CERN IT-DB Group is pleased to announce a new series of Oracle tutorials, with the proposed schedule:   Tuesday 23 April Introduction to Oracle & Tools (30-7-018 - Kjell Johnsen Auditorium) Tuesday 30 April Database Design & Security (30-7-018 - Kjell Johnsen Auditorium) Wednesday 8 May SQL (40-S2-C01 - Salle Curie)   Tuesday 21 May PL/SQL (30-7-018 - Kjell Johnsen Auditorium)   Monday 27 May Troubleshooting Performance (40-S2-C01 - Salle Curie) Wednesday 5 June Troubleshooting Performance - Case Studies (40-S2-C01 - Salle Curie) There is no need to register in advance. For more information, see the Indico agenda.

  14. Oracle support provides a range of new tutorials

    CERN Multimedia


    The IT DB is pleased to announce a new series of Oracle tutorials, with the proposed schedule. Note that these tutorials will take place in the Filtration Plant (Building 222) and that no registration is required.   4 June (Monday) 09:00 Oracle Architecture, Przemyslaw Adam Radowiecki The objective is to go through Oracle database physical and logical structures, highlighting the consequences of some of Oracle's internal design choices for developers of database applications. The presentation defines Oracle-related basic terms and illustrates them based on the database architecture. The following topics will be discussed: • Database with its physical and logical structures (tablespace, segment, extent, block, database user, schema, user's quota) • Single instance (significant memory structures: buffer cache, shared pool) • Real Application Cluster (RAC) • Connecting to the database (TNS, database service) • SQL statement processing (h...

  15. Family-Based Recovery: An Innovative In-Home Substance Abuse Treatment Model for Families with Young Children. (United States)

    Hanson, Karen E; Saul, Dale H; Vanderploeg, Jeffrey J; Painter, Mary; Adnopoz, Jean


    Family-based in-home treatment can effectively meet the needs of mothers and fathers struggling with the dual challenges of substance abuse recovery and parenting infants and toddlers. This article describes one such program, Family-Based Recovery (FBR), which integrates substance abuse treatment for parents and infant mental health intervention with the goal of preventing child maltreatment and family disruption. Program design, implementation, and results are provided. Outcome data suggest that FBR is a promising model.

  16. Emotional intelligence competencies provide a developmental curriculum for medical training. (United States)

    Stoller, James K; Taylor, Christine A; Farver, Carol F


    Since healthcare faces challenges of access, quality, and cost, effective leadership for healthcare is needed. This need is especially acute among physicians, whose demanding training focuses on scientific and clinical skills, eclipsing attention to leadership development. Among the competencies needed by leaders, emotional intelligence (EI) - defined as the ability to understand and manage oneself and to understand others and manage relationships - has been shown to differentiate between great and average leaders. In this context, teaching EI as part of the medical training curriculum is recommended. Furthermore, because physicians' developmental needs evolve over the course of prolonged training, specific components of EI (e.g., teambuilding, empathy, and negotiation) should be taught at various phases of medical training. Consistent with the concept of a spiral curriculum, such EI competencies should be revisited iteratively throughout training, with differing emphasis and increasing sophistication to meet evolving needs. For example, teamwork training is needed early in undergraduate medical curricula to prompt collaborative learning. Teamwork training is also needed during residency, when physicians participate with differing roles on patient care teams. Training in EI should also extend beyond graduate medical training to confer the skills needed by clinicians and by faculty in academic medical centers.

  17. Acquiring taste in home economics?

    DEFF Research Database (Denmark)

    Stenbak Larsen, Christian

    that the pupils were encouraged to use their senses: listen to things frying, touch the meat to check if it was done and taste the food in the process of seasoning it. But while some children learned what the teachers expected: to produce well tasting food, others learned to cook very salty and hot food...... appreciated by the group of boys, and others again learned to stick with their idiosyncrasies when pressured by the teacher. Conclusions: Children were acquiring taste in the home economic lessons, but not only the kind of tastes that the teacher had planned for. This leads to reflections on the very complex...... process of taste acquiring and to a call for further research into taste acquiring in complex real life contexts as home economics lessons....

  18. A reappraisal of private employers' role in providing health insurance. (United States)

    Carrasquillo, O; Himmelstein, D U; Woolhandler, S; Bor, D H


    In 1996, according to official figures, 61 percent of Americans received health insurance through employers. However, this estimate includes persons who relied primarily on government insurance such as Medicare, workers whose employers arranged their insurance but contributed nothing toward the premiums, and government employees whose private coverage was paid for by taxpayers. To estimate the number of persons whose principal health insurance was paid for in whole or in part by employers in the private sector and the number receiving government-funded insurance, we analyzed data from the March 1997 Current Population Survey. Approximately 130,000 persons representative of the noninstitutionalized U.S. population were sampled. We considered people to be covered principally by health insurance paid for by private-sector employers if they had no public insurance coverage and were covered by insurance from a non-governmental employer who paid all or part of their premiums. Those who were covered by Medicaid, Medicare, insurance resulting from former or current military service, or the Indian Health Service were considered to be receiving government insurance. In 1996, 43.1 percent of the population (90 percent confidence interval, 42.7 to 43.5 percent) depended principally on health insurance paid for by private-sector employers, 34.2 percent (90 percent confidence interval, 33.8 to 34.6 percent) had publicly funded insurance, 7.1 percent (90 percent confidence interval, 6.8 to 7.6 percent) purchased their own coverage, and 15.6 percent (90 percent confidence interval, 15.3 to 15.9 percent) were uninsured. In only six states was more than half the population covered principally by health insurance paid for by private-sector employers. Current definitions of health insurance overemphasize the role of private employers and underestimate the extent to which government pays for health insurance.

  19. The Boston keratoprosthesis provides a wide depth of focus. (United States)

    Sayegh, Rony R; Dohlman, Claes H; Greenstein, Scott H; Peli, Eli


    To measure the through-focus curve for eyes implanted with a type 1 Boston keratoprosthesis (KPro) and compare it to that of pseudophakic controls with fixed pupil sizes. The results should assist in evaluating postoperative visual quality after surgery. They should also help to determine the necessary KPro inventories in terms of refractive power steps. Autorefraction and manifest refraction were performed on all eyes. The monocular through-focus acuity curve was plotted in reference to the best-corrected visual acuity by spectacle plane defocus ranging from +5.00 to -5.00 dioptres in 0.50 dioptre increments. These measurements were obtained on KPro-implanted eyes, pseudophakic eyes as controls, and on the same control eyes after fixing the pupil diameter to 3 and 2 mm using black painted iris contact lenses. Ten KPro eyes and five control eyes were included. Good agreement was noted between the subjective refractions and autorefraction in KPro eyes. The average through-focus curve for the control eyes was significantly steeper than that of the KPro curve, but became comparable after fixing the control pupil to 2 and 3 mm. The KPro's wide depth-of-focus makes the visual acuity less dependent on an exact refractive correction at distance and explains the 'pseudoaccomodation' experienced by these patients. This is primarily due to the small pupil diameter of the KPro. The current manufacturing steps in 0.50 dioptre increments appears to be sufficient. © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.

  20. Nurse Delegation in Home Care: Research Guiding Policy Change. (United States)

    Young, Heather M; Farnham, Jennifer; Reinhard, Susan C


    The current study evaluated nurse delegation in home care, a pilot program introduced in 2007 in New Jersey to promote home care options for consumers needing assistance with medical/nursing tasks. Findings on readiness for the program, barriers and facilitating factors, experience with the program, and recommendations are summarized and presented. Methods included surveys and interviews with participants in nurse delegation, observations of planning and implementation meetings, and review meeting minutes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high readiness and increasing satisfaction with experience in delegation, perception of nurse delegation in home care as a valued option, and the challenges of ensuring adequate staffing. Subsequent changes in regulation in New Jersey are underway, translating this research into policy. [Journal of Gerontological Nursing, 42(9), 7-15.]. Copyright 2016, SLACK Incorporated.

  1. Age, gender, will, and use of home-visit nursing care are critical factors in home care for malignant diseases; a retrospective study involving 346 patients in Japan (United States)


    Background We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases. Methods Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records. Results Median age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02). Conclusions Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing. PMID:22044683

  2. Concomitant changes in clinical and posturographic data in elderly fallers during the course of an in-home anti-falling multimodal program--a preliminary investigation. (United States)

    Carette, P; Kemoun, G; Watelain, E; Dugué, B


    The objective of this preliminary study was to evaluate the effectiveness, in terms of fall reduction, of an in-home strategy that we have developed for elderly fallers. We also aimed at finding links between the expected changes in the data obtained in static posturography and in clinical balance tests through our program. Twelve elderly patients living at home who were diagnosed as fallers (5 males and 7 females; 77.9±4.1 years) participated in the study. Our multimodal intervention lasted 6 months. Before this period, and one year later, an evaluation was conducted using cognitive (MMSE), clinical balance tests (i.e. Berg Balance Scale, Balance One leg, Timed Up and Go, and Functional Reach tests) and static posturography (where the area of body sway, velocity and medio-lateral and antero-posterior amplitudes were recorded twice, first with eyes open and then with eyes closed). Among the 12 patients who were diagnosed as fallers, eight became non-fallers. When comparing data obtained after the intervention with those obtained beforehand, we found significant changes in all of the clinical balance tests and in the posturographic-derived variables indicating improvements in the balance control in our group of subjects. We also found significant correlations between the changes in the Berg Balance Scale scores and the changes in the area of body sway data, in antero-posterior amplitude both with eyes open and with eyes closed, and also in the medio-lateral amplitude in the eyes closed condition. We prospectively demonstrated the relevance of our anti-falling intervention at home and of the use of posturography for clinical follow-up. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  3. Age, gender, will, and use of home-visit nursing care are critical factors in home care for malignant diseases; a retrospective study involving 346 patients in Japan

    Directory of Open Access Journals (Sweden)

    Kodama Yuko


    Full Text Available Abstract Background We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases. Methods Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records. Results Median age of the patients was 77 years (range, 11-102, and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308, performance status of 3-4 (n = 261, and dementia (n = 121. At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712. 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109, change of attending physicians (n = 8, and others (n = 5. The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03, the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02, women (HR = 1.81, CI: 1.11-2.94, p = 0.02, and age (HR = 0.98, CI: 0.97-1.00, p = 0.02. Conclusions Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing.

  4. Use of a portable, single-use negative pressure wound therapy device in home care patients with low to moderately exuding wounds: a case series. (United States)

    Hurd, Theresa; Trueman, Paul; Rossington, Alan


    Negative pressure wound therapy (NPWT) is widely used in the management of acute and chronic wounds. The purpose of this 8-week study was to evaluate outcomes of using a new canisterless, portable, single-use NPWT system in patients with wounds treated in a Canadian community healthcare setting. The device is designed to provide negative pressure at 80±20 mm Hg, 24 hours a day of continuous usage, for a maximum wear time of 7 days. Data on wound outcomes, including exudate levels, wound appearance, and wound area, were collected weekly by a Registered Nurse as part of routine practice. When treatment was discontinued, patients and nurses were asked to rate their satisfaction with the device. Data from patients who had used a conventional NPWT device to manage their wounds were retrospectively abstracted from their medical records. In the prospective study, conducted between October 2011 and July 2012, 326 patients (median age=61 years; range 17-91 years) with wounds of mixed etiology (53 pressure ulcers, 21 venous leg ulcers, 16 diabetic foot ulcers, and 15 traumatic and 221 surgical wounds) were treated for a maximum of 8 weeks with the portable NPWT device. The majority of patients (228 out of 326; 68%) achieved complete wound closure within 8 weeks of treatment. The Kaplan-Meier estimate of median time to healing of all wounds was 9 weeks. The majority of patients (318 patients, 97%) reported they were pleased or satisfied with the dressing performance. Nurses indicated satisfaction with the dressing performance for all but two patients (99%). The majority (89%) of patients managed with conventional NPWT (n=539) had an open surgical wound with moderate or high levels of exudate. Healing rates in the portable and conventional NPWT group were similar (10% to 11% per week). Portable, single-use NPWT has the potential to deliver good wound outcomes in community care settings and simplify the use of negative pressure for nurses and patients. Additional research is

  5. A method of providing a barrier in a fracture-containing system

    DEFF Research Database (Denmark)


    The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking into an el......The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking...

  6. A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing

    National Research Council Canada - National Science Library

    Gifford, Wendy A; Davies, Barbara; Graham, Ian D; Lefebre, Nancy; Tourangeau, Ann; Woodend, Kirsten


    ..., and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors...

  7. A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation. (United States)

    Wang, Duojin; Wu, Jing; Lin, Qinglian


    The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships. A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs. The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.

  8. Cost analysis of in-home telerehabilitation for post-knee arthroplasty. (United States)

    Tousignant, Michel; Moffet, Hélène; Nadeau, Sylvie; Mérette, Chantal; Boissy, Patrick; Corriveau, Hélène; Marquis, François; Cabana, François; Ranger, Pierre; Belzile, Étienne L; Dimentberg, Ronald


    Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation. The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits. The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student's t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs). The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient's home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P

  9. Acceptability and validity of a home exercise diary used in home-based pulmonary rehabilitation: A secondary analysis of a randomised controlled trial. (United States)

    Lahham, Aroub; McDonald, Christine F; Mahal, Ajay; Lee, Annemarie L; Hill, Catherine J; Burge, Angela T; Cox, Narelle S; Moore, Rosemary; Nicolson, Caroline; O'halloran, Paul; Gillies, Rebecca; Holland, Anne E


    Evaluating adherence to home-based pulmonary rehabilitation (PR) could be challenging due to lack of direct supervision and the complex nature of the rehabilitation model. To measure adherence to home-based PR in the HomeBase trial, participants were encouraged to work towards a goal of at least 30 min of whole-body exercise on most days of the week and report their participation using a home exercise diary. This project aimed to evaluate the acceptability and validity of the home exercise diary. Diary return and completion rates assessed acceptability of the home exercise diary. Home participants underwent physical activity (PA) monitoring using the Sensewear armband during the final week of an 8-week PR. The correlation between self-documented and objective daily exercise minutes was calculated. Objective exercise minutes were defined as bouts of ≥10 min spent in ≥ moderate PA. Differences in self-documented weekly exercise minutes between sufficiently active (≥7000 daily steps) and inactive participants were computed. Diaries were returned by 92% of programme completers. Of those who returned diaries, 72% have completed exercise documentation. Fifteen programme completers underwent PA monitoring [mean age 69 (9) (SD) years, FEV 1 55 (19) %predicted]. A moderate correlation was observed between self-documented and objective mean daily exercise minutes (r = .59, P = .02). Active participants [n = 6, 10 253 (1521) daily steps] documented more exercise (111 min) during week eight compared with inactive participants [n = 9, 2705 (1772) daily steps, P = .002]. The self-documented home exercise diary is an acceptable and valid method to reflect exercise participation during home-based PR. © 2018 John Wiley & Sons Ltd.

  10. Passive in-home health and wellness monitoring: overview, value and examples. (United States)

    Alwan, Majd


    Modern sensor and communication technology, coupled with advances in data analysis and artificial intelligence techniques, is causing a paradigm shift in remote management and monitoring of chronic disease. In-home monitoring technology brings the added benefit of measuring individualized health status and reporting it to the care provider and caregivers alike, allowing timely and targeted preventive interventions, even in home and community based settings. This paper presents a paradigm for geriatric care based on monitoring older adults passively in their own living settings through placing sensors in their living environments or the objects they use. Activity and physiological data can be analyzed, archived and mined to detect indicators of early disease onset or changes in health conditions at various levels. Examples of monitoring systems are discussed and results from field evaluation pilot studies are summarized. The approach has shown great promise for a significant value proposition to all the stakeholders involved in caring for older adults. The paradigm would allow care providers to extend their services into the communities they serve.

  11. The diversity of arthropods in homes across the United States as determined by environmental DNA analyses. (United States)

    Madden, Anne A; Barberán, Albert; Bertone, Matthew A; Menninger, Holly L; Dunn, Robert R; Fierer, Noah


    We spend most of our lives inside homes, surrounded by arthropods that impact our property as pests and our health as disease vectors and producers of sensitizing allergens. Despite their relevance to human health and well-being, we know relatively little about the arthropods that exist in our homes and the factors structuring their diversity. As previous work has been limited in scale by the costs and time associated with collecting arthropods and the subsequent morphological identification, we used a DNA-based method for investigating the arthropod diversity in homes via high-throughput marker gene sequencing of home dust. Settled dust samples were collected by citizen scientists from both inside and outside more than 700 homes across the United States, yielding the first continental-scale estimates of arthropod diversity associated with our residences. We were able to document food webs and previously unknown geographic distributions of diverse arthropods - from allergen producers to invasive species and nuisance pests. Home characteristics, including the presence of basements, home occupants and surrounding land use, were more useful than climate parameters in predicting arthropod diversity in homes. These noninvasive, scalable tools and resultant findings not only provide the first continental-scale maps of household arthropod diversity, but our analyses also provide valuable baseline information on arthropod allergen exposures and the distributions of invasive pests inside homes. © 2016 John Wiley & Sons Ltd.

  12. Effects of changes in depressive symptoms and cognitive functioning on physical disability in home care elders. (United States)

    Li, Lydia W; Conwell, Yeates


    This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability. Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigan's community-based long-term care programs (N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim. Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability. Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.

  13. In-Home Synchronous Telespeech Therapy to Improve Functional Communication in Chronic Poststroke Aphasia: Results from a Quasi-Experimental Study. (United States)

    Macoir, Joël; Sauvageau, Vincent Martel; Boissy, Patrick; Tousignant, Marilyn; Tousignant, Michel


    Although the use of telepractice in speech-language therapy for assessment purposes is well documented, its effectiveness and potential for rehabilitation in poststroke aphasia remain largely unknown. The purpose of this study was to investigate the effectiveness of a remotely delivered synchronous pragmatic telespeech language therapy for improving functional communication in aphasia. A pre-/post-test design was chosen in which each participant was his or her own control. Using a telerehabilitation platform and software (Oralys TeleTherapy) based on the Promoting Aphasics' Communicative Effectiveness (PACE) approach, 20 participants with chronic poststroke aphasia received 9 speech therapy sessions over a 3-week period. Teletreatment with the PACE pragmatic rehabilitation approach led to improvements in functional communication, marked by (a) an increase in communication effectiveness, reflecting significantly improved autonomy in functional communication; (b) a decrease in communication exchange duration, meaning that the treatment made communication faster and more efficient; (c) a decrease in the number of communication acts, meaning that, after treatment, less information was needed to be efficiently understood by the communication partner; and (d) an increase in the number of different communication strategies used, meaning that the treatment fostered the use of a variety of alternative communication modes. This study provides additional arguments about the benefits of telerehabilitation for poststroke patients with aphasia. It showed that multimodal language therapy delivered through synchronous telerehabilitation had positive effects on functional communication in chronic aphasia.

  14. Feeling safe and motivated to achieve better health: Experiences with a partnership-based nursing practice programme for in-home patients with chronic obstructive pulmonary disease. (United States)

    Leine, Marit; Wahl, Astrid Klopstad; Borge, Christine Råheim; Hustavenes, Magne; Bondevik, Hilde


    To explore chronic obstructive pulmonary disease patients' experiences with a partnership-based nursing practice programme in the home setting. Patients with chronic obstructive pulmonary disease suffer from psychological and physiological problems, especially when they return home after hospitalisation from exacerbation. Many express a need for information and knowledge about chronic obstructive pulmonary disease. Partnership as practice is a patient-centred framework providing an individualised practice for each patient. This study intends to achieve a nuanced and improved understanding of chronic obstructive pulmonary disease patients' experiences with a partnership-based nursing practice programme comprising home visits from a respiratory nurse after hospital discharge, alongside interdisciplinary collaboration. This study has a qualitative design with interviews. Six individual semi-structured interviews collected in 2012-2013 constitute the material. Interviews were recorded, transcribed to written text and analysed using systematic text condensation. Three key themes were identified: to be seen, talked with and understood; healthcare support at home-continuity, practical support and facilitation; and exchange of knowledge. However, there were two generic themes that permeated the material: feeling safe and comforted, and motivation to achieve better health. Patients with chronic obstructive pulmonary disease can experience feeling safe and comforted, and be motivated to make changes in order to achieve better health after participating in a partnership-based nursing practice programme that includes home visits from a respiratory nurse and interdisciplinary cooperation after hospital discharge. To feel safe is of great importance, and how this relates to the patient's ability to cope with illness should be explored in further research. The results suggest that the partnership-based nursing practice programme that includes home visits and interdisciplinary

  15. Systems and methods for providing power to a load based upon a control strategy

    Energy Technology Data Exchange (ETDEWEB)

    Perisic, Milun; Kajouke, Lateef A; Ransom, Ray M


    Systems and methods are provided for an electrical system. The electrical system includes a load, an interface configured to receive a voltage from a voltage source, and a controller configured to receive the voltage from the voltage source through the interface and to provide a voltage and current to the load. Wherein, when the controller is in a constant voltage mode, the controller provides a constant voltage to the load, when the controller is in a constant current mode, the controller provides a constant current to the load, and when the controller is in a constant power mode, the controller provides a constant power to the load.

  16. Supporting family carers in home-based end-of-life care: using participatory action research to develop a training programme for support workers and volunteers. (United States)

    Caswell, Glenys; Hardy, Beth; Ewing, Gail; Kennedy, Sheila; Seymour, Jane


    Family carers are crucial in enabling dying people to stay at home, but are often not prepared for their caring role, receiving little support from formal health and social care services. It is increasingly likely that any help or support family carers receive will be provided by a third sector organisation on either a voluntary basis or by untrained carer support workers. To produce a training programme designed to equip carer support workers and volunteers with the basic skills and knowledge needed to support family carers. Participatory action research, a collaborative form of working in which those who are affected by an issue take a lead role in the research, was used. Bereaved carers acting as research partners, support workers and representatives of third sector organisations took an active part in designing, developing, piloting and refining the programme in a number of interlinked stages. During development, the programme was piloted on four occasions and evaluated by 36 trainees and 3 trainers. The outcome of the project is an innovative, 1-day training programme, offering an introduction to supporting family carers who are looking after someone approaching the end of life. The use of participatory action research methods enabled the development of a programme that addresses support needs identified by bereaved carers and training needs identified by carer support workers.The finished programme includes all the materials necessary to run a training day for support workers and volunteers: facilitator's notes, trainee workbook, slides, promotional poster and pre-course reading for trainees. Knowledge of issues involved in end-of-life and palliative care is not required, although some experience in delivering training is advisable. The programme evaluated well during development, but further research is required to examine the transfer of learning into the workplace. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  17. Automated In-Home Fall Risk Assessment and Detection Sensor System for Elders (United States)

    Rantz, Marilyn; Skubic, Marjorie; Abbott, Carmen; Galambos, Colleen; Popescu, Mihail; Keller, James; Stone, Erik; Back, Jessie; Miller, Steven J.; Petroski, Gregory F.


    Purpose of the Study: Falls are a major problem for the elderly people leading to injury, disability, and even death. An unobtrusive, in-home sensor system that continuously monitors older adults for fall risk and detects falls could revolutionize fall prevention and care. Design and Methods: A fall risk and detection system was developed and installed in the apartments of 19 older adults at a senior living facility. The system includes pulse-Doppler radar, a Microsoft Kinect, and 2 web cameras. To collect data for comparison with sensor data and for algorithm development, stunt actors performed falls in participants’ apartments each month for 2 years and participants completed fall risk assessments (FRAs) using clinically valid, standardized instruments. The FRAs were scored by clinicians and recorded by the sensing modalities. Participants’ gait parameters were measured as they walked on a GAITRite mat. These data were used as ground truth, objective data to use in algorithm development and to compare with radar and Kinect generated variables. Results: All FRAs are highly correlated (p Radar velocity is correlated (p < .05) to all the FRAs and highly correlated (p < .01) to most. Real-time alerts of actual falls are being sent to clinicians providing faster responses to urgent situations. Implications: The in-home FRA and detection system has the potential to help older adults remain independent, maintain functional ability, and live at home longer. PMID:26055784

  18. Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles (United States)

    Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy


    Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis…

  19. A novel method of providing a library of n-mers or biopolymers

    DEFF Research Database (Denmark)


    The present invention relates to a method of providing a library of n-mer sequences, wherein the library is composed of an n-mer sequence. Also the invention concerns a method of providing a library of biopolymer sequences having one or more n-mers in common. Further provided are specific primers...

  20. Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting. (United States)

    Sivan, Manoj; Gallagher, Justin; Makower, Sophie; Keeling, David; Bhakta, Bipin; O'Connor, Rory J; Levesley, Martin


    Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 - 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently

  1. Does investment in home visitors lead to better psychological health for HIV-affected families? Results from a quasi-experimental evaluation in South Africa. (United States)

    Thurman, Tonya R; Kidman, Rachel; Taylor, Tory M


    Children and families affected by HIV are at considerable risk for psychological distress. Community-based home visiting is a common mechanism for providing basic counseling and other services to HIV-affected families. While programs emphasize home visitor training and compensation as means to promote high-quality service delivery, whether these efforts result in measurable gains in beneficiaries' well-being remains largely unanswered. This study employs a longitudinal quasi-experimental design to explore whether these kinds of investments yield concomitant gains in psychological outcomes among beneficiaries. Baseline and follow-up data were collected over a two-year period from children aged 10-17 at the time of program enrollment and their caregivers, with 80% retention. In this sample of 1487 children and 918 caregivers, the psychological health outcomes of those enrolled in programs with home visitors who receive intensive training, organizational support, and regular compensation (termed "paraprofessional") were compared to those enrolled in programs offering limited home visiting services from lay volunteers. Applying multilevel logistic regression, no measurable improvements were found among paraprofessional enrollees, and three outcomes were significantly worse at follow-up regardless of program model. Children's behavior problems became more prevalent even after adjusting for other factors, increasing from 29% to 35% in girls and from 28% to 43% in boys. Nearly one-quarter of girl and boys reported high levels of depression at follow-up, and this was a significant rise over time for boys. Rates of poor family functioning also significantly worsened over time, rising from 30% to 59%. About one-third of caregivers reported high levels of negative feelings at follow-up, with no improvements observed in the paraprofessional group. Results highlight that children's and caregivers' psychological outcomes may be relatively impervious to change even in

  2. Visiting nurses' posthospital medication management in home health care

    DEFF Research Database (Denmark)

    Kollerup, Mette Geil; Curtis, Tine; Schantz Laursen, Birgitte


    . Thus, many patients are discharged with complex medication regimen instructions, accentuating the risk of medication errors that may cause readmission, adverse drug events and a need for further health care. AIM: The aim of this study was to explore visiting nurses' medication management in home health...... care after hospital discharge and to identify key elements in patient medication for improved patient safety. METHOD: Inspired by the ethnographic research cycle, participant observations and informal interviews were conducted at 12 initial visits by a nurse in a patient's home after hospital discharge...

  3. A 3-month double-blind randomised study comparing an olive oil- with a soyabean oil-based intravenous lipid emulsion in home parenteral nutrition patients. (United States)

    Vahedi, K; Atlan, P; Joly, F; Le Brun, A; Evard, D; Perennec, V; Roux-Haguenau, D; Bereziat, G; Messing, B


    Intravenous lipid emulsions (ILE) have demonstrated advantages including prevention of essential fatty acid (EFA) deficiency; however, too much EFA can down regulate fatty acid elongation leading to an imbalance of nutritional compounds in plasma and cell membranes. An olive oil-based ILE containing long-chain triacylglycerols (LCT) with a low content (20 %) of PUFA was administered for home parenteral nutrition (HPN) and compared with a conventional soyabean oil-based ILE (PUFA content, 60 %). Thirteen patients (26-92 years) with stable intestinal failure were randomised after a 1-month run-in period with a medium-chain triacylglycerols-LCT-based ILE, to receive 3 months of HPN with either olive oil- (n 6) or soyabean oil-based (n 7) ILE. The nutritional impact and safety of HPN, oral intakes and absorption rates, phospholipid fatty acids in plasma and lymphocyte cell membrane were assessed. The only clinical event reported was one case of pneumonia (soya group). In both groups, 20 : 3n-9:20 : 4n-6 ratios remained within normal ranges (0.03-0.07). There was a significant increase of gamma-linolenic acid (gamma-LA) in plasma and lymphocyte cell membrane (P=0.02) and of oleic acid in plasma (Poil-based ILE.

  4. Are Prompts Provided by Electronic Books as Effective for Teaching Preschoolers a Biological Concept as Those Provided by Adults? (United States)

    Strouse, Gabrielle A.; Ganea, Patricia A.


    Research Findings: Prior research indicates that shared book reading is an effective method for teaching biological concepts to young children. Adult questioning during reading enhances children's comprehension. We investigated whether adult prompting during the reading of an electronic book enhanced children's understanding of a biological…

  5. A study of depression, perceived loneliness, cognitive function and independence in daily activities in home and institution based older people: A cross sectional comparative study

    Directory of Open Access Journals (Sweden)

    Riddhi Desai


    Full Text Available Context: Old age homes are on the rise in India. Older people staying in such institutions have specific psychosocial issues that may affect their cognitive performance and daily living. Materials and Methods: 71 older people, 39 institution based and 32 community-based were recruited with serial sampling after screening on mini-mental state examination and were evaluated with geriatric depression scale, University of California, Los Angeles scale, Lawton′s instrumental activities of daily living scale and montreal cognitive assessment scale. Results: Prevalence of depression was significantly higher in older people who were institution based, widowers and females. The severity of perceived loneliness was higher in females, institution based and depressed older people. The severity of depression correlated with independence in daily activities, cognition, and perceived loneliness only in institution based older people. Discussion: Older people in institutions have a higher psychosocial burden than the community-based older people. Family support prevents the attrition effect of depression on cognition and independence in daily activities in the community-based older people.

  6. Palliative care in home care: perceptions of occupational therapists

    Directory of Open Access Journals (Sweden)

    Séfora Gomez Portela


    Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

  7. Increasing ventilation as an intervention in homes of asthmatic children

    DEFF Research Database (Denmark)

    Hogaard, Nina Viskum; Rubak, Sune Leisgaard Mørck; Halken, Susanne


    In children asthma is the most frequent chronic disease and house dust mite (HDM) allergy the most frequent cause of allergic asthma. Indoors most of the time, children are exposed to many indoor air pollutants that may act as asthma triggers. Reducing this exposure may improve asthma control...... in children. We conducted a double-blind, placebo-controlled intervention study with 46 asthmatic, house dust mite allergic children. The aim was to investigate the association between indoor air quality in homes and severity of asthma, in particular the effect of increased ventilation rate and expected lower...

  8. Evaluating an in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail community-dwelling older people: Design of a randomised control trial [NCT01358032

    Directory of Open Access Journals (Sweden)

    van Rossum Erik


    Full Text Available Abstract Background Concerns about falls are frequently reported by older people. These concerns can have serious consequences such as an increased risk of falls and the subsequent avoidance of activities. Previous studies have shown the effectiveness of a multicomponent group programme to reduce concerns about falls. However, owing to health problems older people may not be able to attend a group programme. Therefore, we adapted the group approach to an individual in-home programme. Methods/Design A two-group randomised controlled trial has been developed to evaluate the in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail older people living in the community. Persons were eligible for study if they were 70 years of age or over, perceived their general health as fair or poor, had at least some concerns about falls and associated avoidance of activity. After screening for eligibility in a random sample of older people, eligible persons received a baseline assessment and were subsequently allocated to the intervention or control group. Persons assigned to the intervention group were invited to participate in the programme, while those assigned to the control group received care as usual. The programme consists of seven sessions, comprising three home visits and four telephone contacts. The sessions are aimed at instilling adaptive and realistic views about falls, as well as increasing activity and safe behaviour. An effect evaluation, a process evaluation and an economic evaluation are conducted. Follow-up measurements for the effect evaluation are carried out 5 and 12 months after the baseline measurement. The primary outcomes of the effect evaluation are concerns about falls and avoidance of activity as a result of these concerns. Other outcomes are disability and falls. The process evaluation measures: the population characteristics reached; protocol adherence by

  9. A Self-Oscillating Control Scheme for a Boost Converter Providing a Controlled Output Current

    DEFF Research Database (Denmark)

    Knott, Arnold; Pfaffinger, Gerhard R.; Andersen, Michael A. E.


    Most switched mode power supplies provide a regulated voltage at their output. However, there are applications requiring a controlled current. Among others are battery chargers, test equipment for converters driven by solar cells, and LED drivers. This paper describes a dc–dc power converter real...

  10. The Effects of Ventilation in Homes on Health

    DEFF Research Database (Denmark)

    Wargocki, Pawel


    and to reduce emissions. Often, especially in existing buildings, this strategy is difficult to implement, in which case exposures are controlled by providing sufficient, presumably clean, outdoor ventilation air to dilute and remove the contaminants. The present paper attempts to find out how much ventilation...... in existing homes. No data were found indicating that buildings having dedicated natural ventilation systems perform less well than the dwellings in which mechanical ventilation systems are installed. Newly installed mechanical ventilation systems were observed to improve health conditions. In homes...... Guidelines for Indoor Air Quality and improving ventilation measurements). Exposures should also be controlled using different ventilation methods for comparison. Future studies should also advance the understanding of how ventilation systems should be operated to achieve optimal performance. These data...

  11. I Confess, I've Changed--Confessions of a Child Care Provider, and a Parent. (United States)

    Schweikert, Gigi


    Explores problems occurring in the communication between child care providers and parents, through the eyes of a child care educator who is also a parent. Describes how her opinion changed as a result of experiencing the frustration of working parents, and provides ideas on how to achieve a better communication and understanding among parents and…

  12. 12 CFR 551.80 - How do I provide a registered broker-dealer confirmation? (United States)


    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false How do I provide a registered broker-dealer... How do I provide a registered broker-dealer confirmation? (a) If you elect to satisfy § 551.70 by providing the customer with a registered broker-dealer confirmation, you must provide the confirmation by...

  13. Systems and methods for providing power to a load based upon a control strategy

    Energy Technology Data Exchange (ETDEWEB)

    Perisic, Milun; Lawrence, Christopher P; Ransom, Ray M; Kajouke, Lateef A


    Systems and methods are provided for an electrical system. The electrical system, for example, includes a first load, an interface configured to receive a voltage from a voltage source, and a controller configured to receive the voltage through the interface and to provide a voltage and current to the first load. The controller may be further configured to, receive information on a second load electrically connected to the voltage source, determine an amount of reactive current to return to the voltage source such that a current drawn by the electrical system and the second load from the voltage source is substantially real, and provide the determined reactive current to the voltage source.

  14. Medicare Provider Data - Hospice Providers (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  15. Automated Technology for In-home Fall Risk Assessment and Detection Sensor System (United States)

    Rantz, Marilyn J.; Skubic, Marjorie; Abbott, Carmen; Galambos, Colleen; Pak, Youngju; Ho, Dominic K.C.; Stone, Erik E.; Rui, Liyang; Back, Jessica; Miller, Steven J.


    Falls are a major problem for older adults. A continuous, unobtrusive, environmentally mounted in-home monitoring system that automatically detects when falls have occurred or when the risk of falling is increasing could alert health care providers and family members so they could intervene to improve physical function or mange illnesses that are precipitating falls. Researchers at the University of Missouri (MU)Center for Eldercare and Rehabilitation Technology are testing such sensor systems for fall risk assessment and detection in older adults’ apartments in a senior living community. Initial results comparing ground truth fall risk assessment data and GAITRite gait parameters with gait parameters captured from Mircosoft Kinect and Pulse-Dopplar radar are reported. PMID:23675644

  16. The Agreement between the MMSE and IQCODE Tests in a Community-Based Sample of Subjects Aged 70 Years or Older Receiving In-Home Nursing: An Explorative Study

    Directory of Open Access Journals (Sweden)

    Øyvind Kirkevold


    Full Text Available Aim: It was the aim of this study to compare the Mini-Mental State Examination (MMSE with the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE and to explore the characteristics of subjects with possible dementia with only one of the two tools. Methods: We used a random sample of patients aged 70+ receiving social service or in-home nursing. The patients were tested with the MMSE, and the next of kin was interviewed using the following: the IQCODE, the Cornell Scale for Depression in Dementia (CSDD, the Neuropsychiatric Inventory (NPI, instrumental activities of daily living (IADL, personal ADL (PADL and the General Medical Health Rating (GMHR. Results: Subjects with dementia defined only according to the MMSE showed a pattern of scores on IADL, PADL, CSDD, NPI-10 and GMHR similar to the no-dementia group according to both the MMSE and the IQCODE. Those with dementia defined only according to the IQCODE showed a pattern of scores similar to the possible dementia group according to both the MMSE and the IQCODE.

  17. Correlates of self-report chronic insomnia disorders with 1-6 month and 6-month durations in home-dwelling urban older adults - the Shih-Pai Sleep Study in Taiwan: a cross-sectional community study. (United States)

    Chiou, Jing-Hui; Chen, Hsi-Chung; Chen, Kuang-Hung; Chou, Pesus


    To examine the correlates of insomnia disorder with different durations in home-dwelling older adults. A cross-sectional survey in the Shih-Pai area of Taipei City, Taiwan (The Shih-Pai Sleep Study). A total 4047 subjects over the age of 65 years completed the study (2259 men and 1788 women). The Pittsburgh Sleep Quality Index and the duration of insomnia symptoms were used to identify DSM-IV 1-6 month and 6-month insomnia disorders. The prevalence of DSM-IV defined insomnia disorder was 5.8 %; two-thirds of these case lasted for ≥6 months. The shared correlates for both 1-6 and 6-month insomnia disorders were gender (women), depression and moderate pain. Pulmonary diseases were exclusively associated with 1-6 month insomnia disorder (OR: 2.57, 95 % CI: 1.46-4.52). In contrast, heart disease (OR: 1.73, 95 % CI: 1.21-2.49) and severe pain (OR: 2.34, 95 % CI: 1.14-4.40) were associated with 6-month insomnia disorder. The prevalence of persistent insomnia disorder is higher than short-term insomnia disorder. Correlates for less persistent and more persistent insomnia disorder appears to be partially different. Duration quantifiers may be important in the identification of the etiology of insomnia and further studies with follow-ups are needed to examine the order of developing insomnia disorder and associated conditions.

  18. Levels of radon gas concentration and progeny in homes of Potosi City, Bolivia to 4000 m; Niveles de concentracion de gas radon y progenie en viviendas de la Ciudad de Potosi, Bolivia a 4000 msnm

    Energy Technology Data Exchange (ETDEWEB)

    Mamani M, R. [Universidad Autonoma Tomas Frias, Carrera de Fisica, Av. del maestro s/n, Edif. Central Potosi, Villa Imperial de Potosi (Bolivia, Plurinational State of); Claros J, J. [Universidad Autonoma Tomas Frias, Facultad de Minas Potosi, Centro de Investigacion, Av. Serrudo y Arce s/n, Villa Imperial de Potosi (Bolivia, Plurinational State of); Vasquez A, R., E-mail: [Instituto Boliviano de Biologia de Altura, Calle Hoyos 953, La Paz (Bolivia, Plurinational State of)


    Full text: In this work the presence of radon gas was determined, which is a radioactive contaminant that comes from underground, able to penetrate the houses. The danger is that when mixed air and when inhaled can cause serious damage to the lungs, for the short life time that has radon and progeny for decay, damaging the pulmonary alveoli and reducing breathing capacity of the habitants, then causing polycythemia in some cases. The study was carried out in homes in the city of Potosi, Bolivia located at 4000 m. The quantification of radon gas and progeny was performed with the equipment Alpha-Zaeller-2 (Az-2), quantification was realized in 6 zones of the city of Potosi, chosen randomly. In each zone were carried out measurements in 40 homes (2 rooms more permanent), both day and night, for a period of 3 days in two different seasons and with concentrations of average humidity of 20, 50 and 80%. The values obtained for each period vary depending on the season and 30 to 50% of the allowable values given by the EPA and Who for housing. (Author)

  19. Exploring an informed decision-making framework using in-home sensors: older adults' perceptions. (United States)

    Chung, Jane; Reeder, Blaine; Lazar, Amanda; Joe, Jonathan; Demiris, George; Thompson, Hilaire J


    Sensor technologies are designed to assist independent living of older adults. However, it is often difficult for older adults to make an informed decision about adopting sensor technologies. To explore Bruce's framework of informed decision making (IDM) for in-home use of sensor technologies in community-dwelling elders. The IDM framework guided development of a semi-structured interview. A theory-driven coding approach was used for analysis. Participants supported most of the elements of the framework, but not all aspects of each element were addressed. Perceived usefulness of technologies was identified as an area for framework extension. This paper provides useful information for health care professionals to consider how to enhance IDM of older adults regarding the use of sensor technologies. The results also illuminate elements of the IDM framework that may be critical to facilitating independent living for older adults.

  20. The sexual consumer: characteristics, expectations, and experiences of women attending in-home sex toy parties. (United States)

    Schick, Vanessa; Herbenick, Debby; Jozkowski, Kristen N; Jawed-Wessel, Sofia; Reece, Michael


    Sexuality education efforts tend to focus on adolescents and risk-reduction strategies. Outside of clinical settings, there are few sexuality education opportunities focusing on enhancing the sexual lives (e.g., desire, arousal, orgasm) of adult women in long-term monogamous relationships. In-home sex toy parties may enrich women's sexual experiences by providing attendees with an opportunity to learn in a nontraditional setting. In the present study, more than 2,500 party attendees were surveyed regarding their party experience and sexual history. Participants reported high scores on the Female Sexual Function Index with repeat attendees scoring significantly higher than their counterparts. Recommendations are discussed regarding the use of parties as a source for sexuality information distribution and screening for therapeutic referrals.

  1. Combined hepatitis A and B vaccine: providing a bright future for preventing hepatitis. (United States)

    Hewlett, Alex T


    The first combined hepatitis A and B vaccine has been available in the United States since 2001. The vaccine provides protection against viral hepatitis with rapid seroprotection and lasting immunogenicity. This review outlines the product's components, clinical efficacy and opportunities for use in special circumstances. The vaccine has a good safety profile and has good tolerability. The combined hepatitis A and B vaccine is a well studied vaccine that provides rapid seroconversion with a good safety profile.

  2. A novel Dance Dance Revolution (DDR) system for in-home training of stepping ability: basic parameters of system use by older adults. (United States)

    Smith, S T; Sherrington, C; Studenski, S; Schoene, D; Lord, S R


    This series of studies was conducted to develop and establish characteristics of exercise videogame play in older adults. The videogame was a modified version of the popular Dance Dance Revolution (DDR; Konomi). Participants aged ≥70 were asked to make simple step movements in response to vertically drifting arrows presented on a video screen. Step responses were detected by a modified USB DDR mat, and characteristics of stepping performance such as step timing, percentage of missed target steps and percentage of correct steps were recorded by purpose-built software. Drift speed and step rate of visual stimuli were modified to increase task difficulty. Significant linear relationships between stepping performance and stimulus characteristics were observed. Performance of older adults decreased as stimulus speed and step rate were increased. Optimal step performance occurred for a stimulus speed of 17° of visual angle per second and a step rate of one step every 2 s. At fast drift speeds (up to 35°/s), participants were more than 200 ms too slow in coordinating their steps with the visual stimulus. Younger adults were better able to perform the stepping task across a wider range of drift speeds than older adults. The findings suggest that older adults are able to interact with video games based upon DDR but that stepping performance is determined by characteristics of game play such as arrow drift speed and step rate. These novel "exergames" suggest a low-cost method by which older adults can be engaged in exercises that challenge balance and which can be conducted in their own homes.

  3. End uses of electric energy in homes of a group of dwellings; Usos finales de la energia electrica en hogares de un conjunto habitacional

    Energy Technology Data Exchange (ETDEWEB)

    Campero Littlewood, E.; Romero Cortes, J.; Alarcon Maldonado, E.; Silva Oliver, J.; Ortiz Segura, J.; Vargas Rubio, J. [Departamento de Energia, Universidad Autonoma Metropolitana - Unidad Azcapotzalco, Mexico, D. F. (Mexico)


    This paper reports the results of an inquiry conducted to a sample of homes of a group of dwellings. The objective of this inquiry was to know the number of dwellers, the electric household appliances and the type of artificial lighting characteristic of a three-bed room apartment of approximately 65 square meters. In the Introduction is given the information related to the distribution of the monthly consumption of the entire group of dwellings for two separate periods for more than six years, which allows to determine the yearly average rates of growth. The information collected in the inquiry is presented in graphical form of frequency of electric household appliances and the light bulb rating of the more typical electric appurtenances. The results correspond to the answers in 188 inquiries judged reliable (230 questionnaires were delivered to the homes). The analysis of the information allows the knowledge of the electricity consumption capacity that the sampled homes have and to infer the consumption capacity of the entire group of dwellings. [Espanol] En este trabajo se reportan los resultados de una encuesta aplicada a una muestra de hogares en un conjunto habitacional. El objetivo de la encuesta es conocer el numero de habitantes, el equipamiento en electrodomesticos y la iluminacion artificial que caracteriza a un departamento de tres recamaras de aproximadamente 65 m{sup 2}. En la introduccion se suministra la informacion de la distribucion del consumo mensual promedio de toda la unidad habitacional para dos periodos separados por mas de seis anos, lo que permite determinar las tasas promedio anuales de crecimiento. La informacion recopilada en la encuesta se presenta a manera de graficas de frecuencias de los electrodomesticos, de las capacidades de los focos o de las caracteristicas mas importantes de los aparatos electricos. Los resultados corresponden a las respuestas de 188 encuestas declaradas confiables (se entregaron cuestionarios a 230 hogares

  4. Concentration of the genera Aspergillus, Eurotium and Penicillium in 63-μm house dust fraction as a method to predict hidden moisture damage in homes

    Directory of Open Access Journals (Sweden)

    Assadian Ojan


    Full Text Available Abstract Background Quantitative measurements of mould enrichment of indoor air or house dust might be suitable surrogates to evaluate present but hidden moisture damage. Our intent was to develop a house-dust monitoring method to detect hidden moisture damage excluding the influence of outdoor air, accumulated old dust, and dust swirled up from room surfaces. Methods Based on standardized measurement of mould spores in the 63-μm fraction of house dust yielded by carpets, the background concentrations were determined and compared to simultaneously obtained colony numbers and total spore numbers of the indoor air in 80 non-mouldy living areas during summer and winter periods. Additionally, sampling with a vacuum-cleaner or manual sieve was compared to sampling with a filter holder or sieving machine, and the evaluative power of an established two-step assessment model (lower and upper limits was compared to that of a one-step model (one limit in order to derive concentration limits for mould load in house dust. Results Comparison with existing evaluation procedures proved the developed method to be the most reliable means of evaluating hidden moisture damage, yielding the lowest false-positive results (specificity 98.7%. Background measurements and measurements in 14 mouldy rooms show that even by evaluating just the indicator genera in summer and winter, a relatively certain assessment of mould infestation is possible. Conclusion A one-step evaluation is finally possible for house dust. The house-dust evaluation method is based on analysis of the indicator genera Aspergillus, Eurotium and Penicillium spp., which depend on the total fungal count. Inclusion of further moisture indicators currently appears questionable, because of outdoor air influence and the paucity of measurements.

  5. Concentration of the genera Aspergillus, Eurotium and Penicillium in 63-μm house dust fraction as a method to predict hidden moisture damage in homes (United States)

    Baudisch, Christoph; Assadian, Ojan; Kramer, Axel


    Background Quantitative measurements of mould enrichment of indoor air or house dust might be suitable surrogates to evaluate present but hidden moisture damage. Our intent was to develop a house-dust monitoring method to detect hidden moisture damage excluding the influence of outdoor air, accumulated old dust, and dust swirled up from room surfaces. Methods Based on standardized measurement of mould spores in the 63-μm fraction of house dust yielded by carpets, the background concentrations were determined and compared to simultaneously obtained colony numbers and total spore numbers of the indoor air in 80 non-mouldy living areas during summer and winter periods. Additionally, sampling with a vacuum-cleaner or manual sieve was compared to sampling with a filter holder or sieving machine, and the evaluative power of an established two-step assessment model (lower and upper limits) was compared to that of a one-step model (one limit) in order to derive concentration limits for mould load in house dust. Results Comparison with existing evaluation procedures proved the developed method to be the most reliable means of evaluating hidden moisture damage, yielding the lowest false-positive results (specificity 98.7%). Background measurements and measurements in 14 mouldy rooms show that even by evaluating just the indicator genera in summer and winter, a relatively certain assessment of mould infestation is possible. Conclusion A one-step evaluation is finally possible for house dust. The house-dust evaluation method is based on analysis of the indicator genera Aspergillus, Eurotium and Penicillium spp., which depend on the total fungal count. Inclusion of further moisture indicators currently appears questionable, because of outdoor air influence and the paucity of measurements. PMID:19615082

  6. Concentration of the genera Aspergillus, Eurotium and Penicillium in 63-microm house dust fraction as a method to predict hidden moisture damage in homes. (United States)

    Baudisch, Christoph; Assadian, Ojan; Kramer, Axel


    Quantitative measurements of mould enrichment of indoor air or house dust might be suitable surrogates to evaluate present but hidden moisture damage. Our intent was to develop a house-dust monitoring method to detect hidden moisture damage excluding the influence of outdoor air, accumulated old dust, and dust swirled up from room surfaces. Based on standardized measurement of mould spores in the 63-microm fraction of house dust yielded by carpets, the background concentrations were determined and compared to simultaneously obtained colony numbers and total spore numbers of the indoor air in 80 non-mouldy living areas during summer and winter periods. Additionally, sampling with a vacuum-cleaner or manual sieve was compared to sampling with a filter holder or sieving machine, and the evaluative power of an established two-step assessment model (lower and upper limits) was compared to that of a one-step model (one limit) in order to derive concentration limits for mould load in house dust. Comparison with existing evaluation procedures proved the developed method to be the most reliable means of evaluating hidden moisture damage, yielding the lowest false-positive results (specificity 98.7%). Background measurements and measurements in 14 mouldy rooms show that even by evaluating just the indicator genera in summer and winter, a relatively certain assessment of mould infestation is possible. A one-step evaluation is finally possible for house dust. The house-dust evaluation method is based on analysis of the indicator genera Aspergillus, Eurotium and Penicillium spp., which depend on the total fungal count. Inclusion of further moisture indicators currently appears questionable, because of outdoor air influence and the paucity of measurements.

  7. Comparison of Wireless Communication Technologies used in a Smart Home : Analysis of wireless sensor node based on Arduino in home automation scenario


    Horyachyy, Oleh


    Context. Internet of Things (IoT) is an extension of the Internet, which now includes physical objects of the real world. The main purpose of Internet of Things is to increase a quality of people’s daily life. A smart home is one of the promising areas in the Internet of Things which increases rapidly. It allows users to control their home devices anytime from any location in the world using Internet connectivity and automate their work based on the physical environment conditions and user pr...

  8. A Proposed Theoretical Framework Addressing the Effects of Informal Caregivers on Health-Related Outcomes of Elderly Recipients in Home Health Care

    Directory of Open Access Journals (Sweden)

    Eunhee Cho, PhD, MPH, MSN, RN


    Conclusion: The proposed theoretical framework suggests that health-related outcomes of elderly recipients are the result of interactions among types of informal caregivers, the nature of the caregiving relationship, caregiving as a function of such relationships, and the internal processes of the care recipient.

  9. An Investigation of the Effectiveness of a Design to Initiate Curriculum Change in Home Economics. Pilot Study: Phase 1, Occupational Research Development Monograph No. 5. (United States)

    Kievit, Mary B.

    To test the effectiveness of a design for stimulating curriculum change, seven home economics teachers were trained to serve as leaders of seven 2-hour inservice workshops which were designed to motivate the experimental group of 79 secondary home economics teachers to incorporate wage-earning emphases in their programs. All the participants,…

  10. Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study. (United States)

    Olsen, Christine; Pedersen, Ingeborg; Bergland, Astrid; Enders-Slegers, Marie-José; Jøranson, Nina; Calogiuri, Giovanna; Ihlebæk, Camilla


    Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time. The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data. Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However

  11. Validity and reliability of HOP-Up: a questionnaire to evaluate physical activity environments in homes with preschool-aged children. (United States)

    Cheng, Carolyn; Martin-Biggers, Jennifer; Quick, Virginia; Spaccarotella, Kim; Byrd-Bredbenner, Carol


    Early identification of physical activity (PA) opportunities in the home and neighborhood environment may help obesity prevention efforts in households with young children. This cross-sectional study's purpose was to develop a brief, easy-to-use, self-report inventory called Home Opportunities for Physical activity check-Up (HOP-Up), to evaluate the availability and accessibility of PA space and equipment in and near homes with preschool children, and establish its validity and reliability. The HOP-Up was field tested by two trained researchers and parents of preschool-aged children (n = 50; 71% white). To establish criterion validity, researchers were the 'gold standard' and visited participants' homes to assess their PA environments using the HOP-Up, while participants separately completed their HOP-Up. Two weeks later, parents completed the HOP-Up online for test-retest reliability. After minor survey refinements, exploratory and confirmatory factor analysis using a split-half cross validation procedure was conducted in a larger sample of participants (n = 655, 60% white) who completed the HOP-Up online to examine its factor structure. To establish convergent validity, correlations were conducted to compare HOP-Up scales from the factor solution generated with PA behavior and cognitions, and reported screen time. Intra-class correlations (ICCs) examining HOP-Up item agreement between researcher and parents revealed slight to substantial agreement (range 0.22 to 0.81) for all items. ICCs for all HOP-Up items ranged from fair to substantial agreement between parent responses at both time points (range 0.42 to 0.95). Exploratory factor analysis revealed a five factor solution (18 items), supported eigen values, scree plots, review for contextual sense, and confirmatory factor analysis. Additionally, there were significant (p environment-inside, outside, and the neighborhood- impacts preschool children's physical activity levels.

  12. Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients. (United States)

    Dauber, Sarah; John, Tiffany; Hogue, Aaron; Nugent, Jessica; Hernandez, Gina


    Perinatal maternal depression (MD), substance use (SU), and intimate partner violence (IPV) are critical public health concerns with significant negative impacts on child development. Bolstering the capacity of home visiting (HV) programs to address these significant risk factors has potential to improve child and family outcomes. This study presents a description and mixed-methods feasibility evaluation of the "Home Visitation Enhancing Linkages Project (HELP)," a screen-and-refer approach to addressing MD, SU, and IPV within HV aimed at improving risk identification and linkage to treatment among HV clients. HELP was a three-phase intervention that included three evidence-based interventions: screening, motivational interviewing (MI), and case management (CM). This study presents quantitative fidelity data from 21 home visitors reporting on 116 clients in 4 HV programs, as well as qualitative data from structured interviews with 14 home visitors. Nearly all clients were screened and 22% screened positive on at least one risk domain. Rates of MI and CM implementation were lower than expected, however home visitors implemented general supportive interventions at high rates. Home visitor interviews revealed the following factors that may have impacted HELP implementation: client disclosure of risk, barriers to treatment access, systems integration, home visitor role perception, and integration of HELP into the broader HV curriculum. Implications of study findings for the design of future attempts to address maternal risk within HV are discussed.

  13. Differences in home food availability of high- and low-fat foods after a behavioral weight control program are regional not racial

    Directory of Open Access Journals (Sweden)

    West Delia


    Full Text Available Abstract Background Few studies, if any, have examined the impact of a weight control program on the home food environment in a diverse sample of adults. Understanding and changing the availability of certain foods in the home and food storage practices may be important for creating healthier home food environments and supporting effective weight management. Methods Overweight adults (n = 90; 27% African American enrolled in a 6-month behavioral weight loss program in Vermont and Arkansas. Participants were weighed and completed measures of household food availability and food storage practices at baseline and post-treatment. We examined baseline differences and changes in high-fat food availability, low-fat food availability and the storage of foods in easily visible locations, overall and by race (African American or white participants and region (Arkansas or Vermont. Results At post-treatment, the sample as a whole reported storing significantly fewer foods in visible locations around the house (-0.5 ± 2.3 foods, with no significant group differences. Both Arkansas African Americans (-1.8 ± 2.4 foods and Arkansas white participants (-1.8 ± 2.6 foods reported significantly greater reductions in the mean number of high-fat food items available in their homes post-treatment compared to Vermont white participants (-0.5 ± 1.3 foods, likely reflecting fewer high-fat foods reported in Vermont households at baseline. Arkansas African Americans lost significantly less weight (-3.6 ± 4.1 kg than Vermont white participants (-8.3 ± 6.8 kg, while Arkansas white participants did not differ significantly from either group in weight loss (-6.2 ± 6.0 kg. However, home food environment changes were not associated with weight changes in this study. Conclusions Understanding the home food environment and how best to measure it may be useful for both obesity treatment and understanding patterns of obesity prevalence and health disparity.

  14. A cost and clinical effectiveness analysis among moist wound healing dressings versus traditional methods in home care patients with pressure ulcers. (United States)

    Souliotis, Kyriakos; Kalemikerakis, Ioannis; Saridi, Maria; Papageorgiou, Manto; Kalokerinou, Athena


    The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing. In addition, we assessed the overall economic burden on the Healthcare System. Treatment method for each patient was chosen randomly by using sealed opaque envelopes. The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process. The healing progress was estimated by using surface measurement transparent films. To estimate treatment costs, the authors took into account labor costs, cost of dressings, as well the cost of other materials such as cleansing gauzes, normal saline, syringes, examination gloves, antiseptics and adhesive tape. The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1 ± 8,6 and had an average ulcer surface of 43.5 ± 30.70 cm(2) ; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02 ± 8.02 and had an average ulcer surface 41.52 ± 29.41 cm(2) (p = 0.25, 95% CI, Student's t test). The average healing time for the moist wound healing dressings group' was 85.56 ± 52.09 days, while 121.4 ± 52.21 days for the "gauze group" (p = 0.0001, 95% CI, Student's t test). The dressing change frequency per patient was reduced in the "moist wound healing dressings group," 49.5 ± 29.61, compared with a dressing change frequency per patient of 222.6 ± 101.86 for the "gauze group" (p = 0.0001, 95% CI, Student's t test). The use of moist wound healing dressings had a lower total treatment cost of 1,351 € per patient compared with, the use of gauzes (3,888 €). © 2016 by the Wound Healing Society.

  15. Provider Profiling: A Population Health Improvement Tool for the Southeast Military Health System

    National Research Council Canada - National Science Library

    Pemberton, Phillip


    ...). Profiling with Provider Perspectives, a Primary Care Management Tool, provides the SEMHS with a standardized performance measurement system that offers feedback in a user friendly and non-threatening format...

  16. [Catheter-related infection in home-based parenteral nutrition: outcomes from the NADYA group and presentation of a new protocol]. (United States)

    Cuerda, Compés C; Bretón, Lesmes I; Bonada Sanjaume, A; Planas Vila, M


    Hom parenteral nutrition (HPN) is a nutritional support modality that allows for the supply of parenteral nutrition bags to the patient's home. Since its first use in the late 60s, this therapy has allowed maintaining patients with intestinal failure alive that previously were doomed to death. In our country, this therapy is used by 2.15 patients pmp. According to the NADYA data, catheter-related infections account for 50% of all HPN-related complications. In larger series, infection rates are 0.5-2 infections/1000 days or 0.3-0.5 infections/patient/year. Most of them are produced by gram-positive organisms that migrate from the skin or from catheter connections to the tip. These infections are diagnosed by means of clinical data and with different microbiological cultures. When treating these infections, it is important to keep the catheter in place, and administering antibiotics through it, conventionally or with the antibioticolade technique.

  17. Older adult stroke survivors discussing poststroke depressive symptoms with a healthcare provider: a preliminary analysis. (United States)

    Klinedinst, N Jennifer; Clark, Patricia C; Dunbar, Sandra B


    The purposes of this study were to examine the relationship between the poststroke depressive symptoms, older adult stroke survivors' perceptions of the depressive symptoms, and the congruence with an informal caregiver about the presence of depressive symptoms, and comfort talking to the health care provider with whether or not older stroke survivors discussed their depressive symptoms with a health care provider. A cross-sectional study where 44 caregiver/older adult stroke survivor dyads completed questionnaires including the Center for Epidemiologic Studies Depression Scale, Symptom Perception Questionnaire, and reporting of depressive symptoms to the health care provider via one time interview. Thirty-seven percent (n = 16) of all older stroke survivors reported depressive symptoms to their health care provider. Of the stroke survivors who had high levels of depressive symptoms (CESD ≥ 16; n = 11), seven reported the depressive symptoms to their health care provider. Identifying the symptoms as possible depression and attributing the cause of the depressive symptoms to the stroke were related to stroke survivors reporting the depressive symptoms to a health care provider. High functioning, older stroke survivors may benefit from strategies to help them identify when they experience depressive symptoms, in order to be able to play an active role in their recovery by appropriately discussing their symptoms with a health care provider. (c) 2013 APA, all rights reserved.

  18. Effectiveness of air purifier on health outcomes and indoor particles in homes of children with allergic diseases in Fresno, California: A pilot study. (United States)

    Park, Hye-Kyung; Cheng, Kai-Chung; Tetteh, Afua O; Hildemann, Lynn M; Nadeau, Kari C


    Epidemiologic studies indicate that indoor air pollution is correlated with morbidity caused by allergic diseases. We evaluated the effectiveness of reducing the levels of indoor fine particulate matter air purifiers on health outcomes in children with asthma and/or allergic rhinitis. The active group (with air purifiers) and the control group consisted of eight houses each. Air purifiers were installed in the living rooms and bedrooms of the subjects in the active group during the entire 12-week study duration. Childhood asthma control test, peak flow rate monitoring, and nasal symptom scores were evaluated at weeks 0, 6, and 12. At 12 weeks, the active group showed a trend toward an improvement of childhood asthma control test scores and mean evening peak flow rates, whereas the control group showed deterioration in the same measures. Total and daytime nasal symptoms scores significantly reduced in the active group (p = 0.001 and p = 0.011, respectively). The average indoor PM 2.5 concentrations reduced by 43% (7.42 to 4.28 μg/m 3 ) in the active group (p = 0.001). Intervention with air purifiers reduces indoor PM 2.5 levels with significant improvements in nasal symptoms in children with allergic rhinitis in Fresno.

  19. Providers' Experiences with a Melanoma Web-Based Course: a Discussion on Barriers and Intentions. (United States)

    Jiang, Angela J; Eide, Melody J; Alexander, Gwen L; Altschuler, Andrea; Asgari, Maryam M; Geller, Alan C; Fletcher, Suzanne W; Halpern, Allan C; Weinstock, Martin A


    Primary care visits provide an opportunity for skin examinations with the potential to reduce melanoma mortality. The INFORMED (INternet curriculum FOR Melanoma Early Detection) Group developed a Web-based curriculum to improve primary care providers' (PCPs') skin cancer detection skills. This study details feedback obtained from participant focus groups, including the feasibility of implementing in other PCP practices. Practicing PCPs at Henry Ford Health System and Kaiser Permanente Northern California completed the curriculum. Feedback sessions were conducted with standardized questions focusing on four domains: (1) overall impressions of the curriculum, (2) recommendations for improvement, (3) current skin examination practices, and (4) suggestions for increasing skin screening by PCPs. Discussions at each site were audio recorded, transcribed verbatim, and de-identified. Providers (N = 54) had a positive impression of the Web-based curriculum, with suggestions to provide offline teaching aids and request assistance. Despite having improved confidence in diagnosing malignant lesions, many providers felt a lack of confidence in performing the screening and time constraints affected their current practices, as did institutional constraints. Providers intended to increase discussion with patients about skin cancer. The accessibility, effectiveness, and popularity of the curriculum indicate potential for implementation in the primary care setting. Participating providers noted that institutional barriers remain which must be addressed for successful dissemination and implementation.

  20. Swedish District Nurses’ Attitudes to Implement Information and Communication Technology in Home Nursing (United States)

    Nilsson, Carina; Skär, Lisa; Söderberg, Siv


    The use of information and communication technology has increased in the society, and can be useful in nursing care. The aim of this study was to describe district nurses’ attitudes regarding the implementation of information and communication technology in home nursing. The first and third authors performed five focus group discussions with 19 district nurses’ from five primary healthcare centres in northern Sweden. During the focus group discussions, the following topics were discussed: the current and future use of information and communication technology in home nursing; expectations, advantages, disadvantages and hindrances in the use of information and communication technology in home nursing; and the use of information and communication technology from an ethical perspective. The transcribed focus group discussions were analysed using qualitative content analysis. The results showed that district nurses’ attitudes were positive regarding the use of information and communication technology in their work. They also asked for possibilities to influence the design and its introduction. However, the use of information and communication technology in home nursing can be described as a complement to communication that could not replace human physical encounters. Improvements and risks, as well as the importance of physical presence in home nursing were considered vital. The results revealed that the use of information and communication technology requires changes in the district nurses’ work situation. PMID:19319223

  1. Does recent contact with a health care provider make a difference in malaria knowledge? (United States)

    Yamamoto, S S; Souares, A; Sié, A; Sauerborn, R


    Knowledge and practices with respect to malaria are aspects that need to be considered as part of effective malaria programs. We assessed and compared malaria practices and knowledge among those who had recently visited a health care provider and those who had not. A matched, population-based case-control study was conducted among 338 women between 15 and 45 years of age and caretakers of children ≤ 9 years of age in Nouna, Burkina Faso. Little difference was found in the reported responses between the cases and controls, which indicates that recent visits to health care providers may not have an effect on malaria risk or knowledge. Differences were noted in malaria practices, which could suggest that health care providers are consulted only after home treatments fail. Therefore, programs and policies targeted to health care providers aimed at improving the dissemination of information may be of some benefit.

  2. A world-wide databridge supported by a commercial cloud provider (United States)

    Tat Cheung, Kwong; Field, Laurence; Furano, Fabrizio


    Volunteer computing has the potential to provide significant additional computing capacity for the LHC experiments. One of the challenges with exploiting volunteer computing is to support a global community of volunteers that provides heterogeneous resources. However, high energy physics applications require more data input and output than the CPU intensive applications that are typically used by other volunteer computing projects. While the so-called databridge has already been successfully proposed as a method to span the untrusted and trusted domains of volunteer computing and Grid computing respective, globally transferring data between potentially poor-performing residential networks and CERN could be unreliable, leading to wasted resources usage. The expectation is that by placing a storage endpoint that is part of a wider, flexible geographical databridge deployment closer to the volunteers, the transfer success rate and the overall performance can be improved. This contribution investigates the provision of a globally distributed databridge implemented upon a commercial cloud provider.

  3. Performance Measurement for a Logistics Services Provider to the Polymer Industry


    Tok, King Lai


    This management project discusses the form of performance measurement system suitable for a logistics services provider who focuses on providing its services to large multinational petrochemical companies in the polymer industry

  4. 42 CFR 136a.12 - Persons to whom health services will be provided. (United States)


    ... and Who Is Eligible To Receive Care? § 136a.12 Persons to whom health services will be provided. (a... where the woman is not married to the eligible Indian under applicable state or tribal law, paternity... Service funded facilities are available to provide the needed care. When funds are insufficient to provide...

  5. [The anxiety and influence factors of care managers who provide a home palliative care for terminal cancer patients--a comparison between nursing staffs and others]. (United States)

    Furumoto, Naoko; Hirose, Kyoko; Shobatake, Tadataka; Yano, Hidemi; Okazaki, Noriko


    In home palliative care, care managers play an important part. But we suspect that care managers, who don't have a medical license, may feel an anxiety. So, we investigated if these care managers felt an anxiety, and would like to report a role of nursing staffs in home palliative care. We surveyed care managers who were working in the western part of Hiroshima. The number of care managers was 199. And 129 of them(86.9%)filled out the questionnaire. We used c 2 -test and analyzed the difference of an anxiety between nursing staffs and the others. The care managers felt an anxiety about the patient's condition and the therapy rather than nursing staffs. Nursing staffs play an important role by doing a therapeutic management for terminal cancer patients, an explanation for the family of patients, and a cooperation with other staffs.

  6. System and Method for Providing a Climate Data Analytic Services Application Programming Interface Distribution Package (United States)

    Schnase, John L. (Inventor); Duffy, Daniel Q. (Inventor); Tamkin, Glenn S. (Inventor)


    A system, method and computer-readable storage devices for providing a climate data analytic services application programming interface distribution package. The example system can provide various components. The system provides a climate data analytic services application programming interface library that enables software applications running on a client device to invoke the capabilities of a climate data analytic service. The system provides a command-line interface that provides a means of interacting with a climate data analytic service by issuing commands directly to the system's server interface. The system provides sample programs that call on the capabilities of the application programming interface library and can be used as templates for the construction of new client applications. The system can also provide test utilities, build utilities, service integration utilities, and documentation.

  7. Increasing ventilation as an intervention in homes of asthmatic children

    DEFF Research Database (Denmark)

    Hogaard, Nina Viskum; Rubak, Sune Leisgaard Mørck; Halken, Susanne


    In children asthma is the most frequent chronic disease and house dust mite (HDM) allergy the most frequent cause of allergic asthma. Indoors most of the time, children are exposed to many indoor air pollutants that may act as asthma triggers. Reducing this exposure may improve asthma control...... in children. We conducted a double-blind, placebo-controlled intervention study with 46 asthmatic, house dust mite allergic children. The aim was to investigate the association between indoor air quality in homes and severity of asthma, in particular the effect of increased ventilation rate and expected lower...... exposure to HDM on medication intake among these children. As a result of the intervention, the ventilation rate increased and the CO2 concentration fell significantly compared to baseline in the intervention group. The analyses of the effect of ventilation on health outcomes are being processed...

  8. Postdischarge community pharmacist-provided home services for patients after hospitalization for heart failure. (United States)

    Kalista, Tom; Lemay, Virginia; Cohen, Lisa


    To establish a community pharmacist-provided home health service to improve medication adherence and reduce 30-day heart failure-related hospital readmissions. Visiting Nurse Services of Newport and Bristol Counties located in Portsmouth, RI, from December 2013 to April 2014. Each patient received one in-home visit provided by a Postgraduate Year 1 community pharmacy resident within 1 week of admission to visiting nurse services followed by two follow-up telephone calls, 1 week and 4 weeks after the visit. The in-home visit consisted of a baseline assessment of medication adherence using the Morisky 8-Item Medication Adherence Questionnaire as well as pharmacist-provided education regarding chronic heart failure management. The follow-up telephone calls were used to reassess patient adherence and to monitor for hospital readmission within 30 days of the initial in-home visit. Community pharmacist-provided in-home medication reconciliation and medication teaching has not been described in the literature previously. In addition, pharmacists are often not included on home health care teams placing patients undergoing transitions in care at risk for potential medication-related errors. Improvement in medication adherence and reduction in 30-day heart failure-related hospital readmission rates. Ten patients were enrolled from December 2013 through April 2014. Following intervention, all patients saw improvements in adherence questionnaire scores during follow-up. Hospital readmission rates for patients seen by the pharmacist were lower compared with agencywide figures over a similar time period. A community pharmacist-provided in-home medication teaching service for patients following recent hospital discharge helps facilitate successful transitions of care from an inpatient to outpatient setting, improves medication adherence and has produced lower observed 30-day heart failure-related hospital readmission rates. Expansion of this or a similar service within the

  9. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study). (United States)

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise


    To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

  10. k-MED - from a local project to a service provider for eLearning

    Directory of Open Access Journals (Sweden)

    Wagner, Richard


    Full Text Available k-MED evolved from a single medical subject project in 1999 to a provider of comprehensive technology, infrastructure and content for authors and learners. It currently offers about 170 courses covering 16 medical subjects. The k-MED community consists of medical authors and experts for technology, graphical and instructional design. It has its proprietary authoring tools and an internet based learning management system, both being continually improved corresponding to service experiences. k-MED aims at ongoing development as a service provider for educational institutions for undergraduate or continuing medical education. For further information see

  11. Parental involvement in home visiting: Interpersonal predictors and correlates. (United States)

    Sierau, Susan; Brand, Tilman; Jungmann, Tanja


    Parents' commitment to and usage of early intervention are key variables in understanding discrepancies in families' susceptibility to these services. Although the important role of fathers in infant development is widely recognized, early interpersonal predictors of paternal involvement in home-visiting programs have been understudied. This article aims to fill this gap by regressing parents' postnatal involvement on prenatal partnership satisfaction and quality of the helping relationship in a sample of 124 socially and financially disadvantaged families. Paternal program engagement was predicted by partnership satisfaction whereas the perceived quality of the helping relationship best predicted maternal program engagement, with demographical characteristics controlled. Maternal program engagement also mediated the relationship between partnership satisfaction and paternal program engagement. The results are discussed against the theoretical background. Copyright © 2012 Michigan Association for Infant Mental Health.

  12. Data as a service a framework for providing reusable enterprise data services

    CERN Document Server

    Sarkar, Pushpak


    Data as a Service shows how organizations can leverage "data as a service" by providing real-life case studies on the various and innovative architectures and related patterns. Comprehensive approach to introducing data as a service in any organization. A re-usable and flexible SOA based architecture framework. Roadmap to introduce 'big data as a service' for potential clients. Presents a thorough description of each component in the DaaS reference architecture so readers can implement solutions.

  13. A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial. (United States)

    Allen, Kelli D; Yancy, William S; Bosworth, Hayden B; Coffman, Cynthia J; Jeffreys, Amy S; Datta, Santanu K; McDuffie, Jennifer; Strauss, Jennifer L; Oddone, Eugene Z


    Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused. To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes. Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. ( NCT01130740). Department of Veterans Affairs Medical Center in Durham, North Carolina. 30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record. The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes. At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ. The study was conducted in a single Veterans Affairs medical center. The combined patient and provider intervention resulted in

  14. Preliminary Construction of a Service Provider-Informed Domestic Violence Research Agenda (United States)

    Murray, Christine E.; Welch, Metoka L.


    This article presents the results of a statewide survey of domestic violence (DV) service providers that focused on the needs, background characteristics, and opinions of service providers related to research. The survey included an examination of service providers' motivation for working in the field, research background and training, and…

  15. In this article we provide a solution to a problem in the famous ...

    Indian Academy of Sciences (India)

    Triloki Nath and S R Singh. Department of Mathematics,. Banaras Hindu University. Varanasi 221005, India. Email: Email: In this article we provide a solution to a problem in the famous analysis book [1] by Rudin. It does not use trans- finite induction, and readers may ...

  16. Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol. (United States)

    Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta


    To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

  17. Creation of a Collaborative Disaster Preparedness Video for Daycare Providers: Use of the Delphi Model for the Creation of a Comprehensive Disaster Preparedness Video for Daycare Providers. (United States)

    Mar, Pamela; Spears, Robert; Reeb, Jeffrey; Thompson, Sarah B; Myers, Paul; Burke, Rita V


    Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios. Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension. A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%. Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2018;page 1 of 5).

  18. Patient safety in home hemodialysis: quality assurance and serious adverse events in the home setting. (United States)

    Pauly, Robert P; Eastwood, Deborah O; Marshall, Mark R


    Interest in home hemodialysis (HD) is high because of the reported benefits and its excellent safety record. However, the potential for serious adverse events (AEs) exists when patients perform HD in their homes without supervision. We review the epidemiology of dialysis-related emergencies during home HD, and present a conceptual and practical framework for the prevention and management of serious AEs for those patients performing home HD. In addition, we describe a formal monitored and iterative quality assurance program, and make suggestions for the future development of safety strategies to mitigate the risk of AEs in home HD. © 2015 International Society for Hemodialysis.

  19. Telecommunication technology used in home healthcare. (United States)

    Mishra, Sumant; Nayak, C G; Shet, K C; George, V I


    Current telemedicine applications are usually developed for doctors to do consultation and case study between several hospitals. Patients see doctor at home via Internet becomes possible and it might be a part of lifestyle in the future. Telemedicine has been an active area of research for over 30 years. In the past, several telemedicine applications using wired EPABX telecommunications equipment were provided whereas now-a-days the evolution of wireless communication means enabling telemedicine systems to operate everywhere in the world, thus expanding telemedicine benefits, services and applications. How these applications are used in healthcare delivery and what are the technologies used in this system are explained in this paper.

  20. Using quality improvement to promote implementation and increase well child visits in home visiting. (United States)

    Goyal, Neera K; Ammerman, Robert T; Massie, Julie A; Clark, Margaret; Van Ginkel, Judith B


    A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. (United States)

    Yin, H Shonna; Gupta, Ruchi S; Tomopoulos, Suzy; Mendelsohn, Alan L; Egan, Maureen; van Schaick, Linda; Wolf, Michael S; Sanchez, Dayana C; Warren, Christopher; Encalada, Karen; Dreyer, Benard P


    The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles. Copyright © 2016 by the American Academy of Pediatrics.

  2. A network of experimental forests and ranges: Providing soil solutions for a changing world (United States)

    Mary Beth. Adams


    The network of experimental forests and ranges of the USDA Forest Service represents significant opportunities to provide soil solutions to critical issues of a changing world. This network of 81 experimental forests and ranges encompasses broad geographic, biological, climatic and physical scales, and includes long-term data sets, and long-term experimental...

  3. The Role of ICT in Home Care. (United States)

    Wass, Sofie; Vimarlund, Vivian


    With an ageing population and limited resources, ICT is often mentioned as a solution to support elderly people in maintaining an independent and healthy lifestyle. In this paper, we describe how ICT can support access to information and rationalization of work processes in a home care context. We do this by modelling the workflow and identifying the possible impact of ICT. The results show a complex process and indicate that the available resources are not used in the best possible way. The introduction of ICT could increase patient safety by reducing the risk of misplacing information about the care recipients and at the same time provide real time information about the care recipients' needs and health at the point of care. However, to rationalize the work processes there is a need to combine ICT with a changed procedure for handling keys.

  4. A mobile communication device adapted to provide a dynamic display arrangement

    DEFF Research Database (Denmark)


    The invention relates to a mobile communication device comprising a light projector adapted to project a multi-coloured image onto a surface; a hinged mirror comprising a first mirror part adapted to be tilted around the hinge into the light path of the light projector; wherein the first mirror...... part comprises means for correcting a skew angle in the multi-coloured image projected onto a surface. Thereby is achieved that the mobile communication device is able to provide RGB full colour dynamic image projection which is preferred over monochromatic laser projection because it is a speckle free...... and eye-friendly projection....

  5. Inside the ordering room: characteristics of women's in-home sex toy parties, facilitators and sexual communication. (United States)

    Herbenick, Debra; Reece, Michael; Hollub, Ariane


    Previous research suggests that adult bookstores are a unique way through which individuals may learn about sexuality or practice sexual communication. Recently, the woman-oriented in-home sex toy party industry has rapidly expanded in several countries. The purpose of this study was to document the characteristics of the parties, the women who run the parties ('facilitators') and facilitator-consumer communication about sexual health topics. Female facilitators for a large in-home sex toy party company in the USA were invited to participate in an anonymous, cross-sectional online survey. A total of 1197 completed surveys were received. Most respondents were white (85.2%), heterosexual (91.6%), had at least some college education (76.3%) and were married (59.4%). Most parties were held in another woman's home (88.3%), lasted 1-2 h (72.2%) and had 10 or fewer women in attendance (65.1%). At their most recent party facilitated, most respondents were asked questions about increasing desire/arousal (75.3%), orgasm (57.8%), desire discrepancy (56.4%), erection and ejaculation (73.8%), and vaginal dryness and lubrication (64.5%). Respondents who encountered sexual health questions or disclosures by consumers (those that were more 'askable') scored significantly higher on the Sexual Opinion Survey, indicating greater erotophilia. Results suggest that female in-home sex toy party facilitators have the potential to provide a diverse group of women with opportunities to access sexuality information, products and communication and that facilitators' 'askability' is related to erotophilia. Implications for sexual health professionals are discussed.

  6. Home Care Providers to the Rescue: A Novel First-Responder Programme.

    Directory of Open Access Journals (Sweden)

    Steen M Hansen

    Full Text Available To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA.We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark.Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED.Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.

  7. Healthcare providers' perceptions of a situational awareness display for emergency department resuscitation: a simulation qualitative study. (United States)

    Calder, Lisa A; Bhandari, Abhi; Mastoras, George; Day, Kathleen; Momtahan, Kathryn; Falconer, Matthew; Weitzman, Brian; Sohmer, Benjamin; Cwinn, A Adam; Hamstra, Stanley J; Parush, Avi


    Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants. Dual site tertiary care level 1 trauma centre in Ottawa, Canada. We recruited by email physicians, nurses and respiratory therapist. Situational Awareness Display, a visual cognitive aid that provides key clinical information to enhance resuscitation team communication and situational awareness. Themes emerging from focus groups and simulation debriefs. Three reviewers independently coded and analysed transcripts using content qualitative analysis. We recruited a total of 33 participants in two focus groups (n = 20) and six simulation debriefs with three 4-5 member teams (n = 13). Majority of participants (10/13) strongly endorsed the Situational Awareness Display's utility in simulation (very or extremely useful). Focus groups and debrief themes included improved perception of patient data, comprehension of context and ability to project to future decisions. Participants described potentially positive and negative impacts on patient safety and positive impacts on provider performance and team communication. Participants expressed a need for easy data entry incorporated into clinical workflow and training on how to use the display. Emergency resuscitation team participants felt the Situational Awareness Display has potential to improve provider performance, team communication and situational awareness, ultimately enhancing quality of care.

  8. A method for analyzing the business case for provider participation in the National Cancer Institute's Community Clinical Oncology Program and similar federally funded, provider-based research networks. (United States)

    Reiter, Kristin L; Song, Paula H; Minasian, Lori; Good, Marjorie; Weiner, Bryan J; McAlearney, Ann Scheck


    The Community Clinical Oncology Program (CCOP) plays an essential role in the efforts of the National Cancer Institute (NCI) to increase enrollment in clinical trials. Currently, there is little practical guidance in the literature to assist provider organizations in analyzing the return on investment (ROI), or business case, for establishing and operating a provider-based research network (PBRN) such as the CCOP. In this article, the authors present a conceptual model of the business case for PBRN participation, a spreadsheet-based tool and advice for evaluating the business case for provider participation in a CCOP organization. A comparative, case-study approach was used to identify key components of the business case for hospitals attempting to support a CCOP research infrastructure. Semistructured interviews were conducted with providers and administrators. Key themes were identified and used to develop the financial analysis tool. Key components of the business case included CCOP start-up costs, direct revenue from the NCI CCOP grant, direct expenses required to maintain the CCOP research infrastructure, and incidental benefits, most notably downstream revenues from CCOP patients. The authors recognized the value of incidental benefits as an important contributor to the business case for CCOP participation; however, currently, this component is not calculated. The current results indicated that providing a method for documenting the business case for CCOP or other PBRN involvement will contribute to the long-term sustainability and expansion of these programs by improving providers' understanding of the financial implications of participation. Copyright © 2011 American Cancer Society.

  9. A mixed methods study of patient-provider communication about opioid analgesics. (United States)

    Hughes, Helen Kinsman; Korthuis, Philip Todd; Saha, Somnath; Eggly, Susan; Sharp, Victoria; Cohn, Jonathan; Moore, Richard; Beach, Mary Catherine


    To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients. We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients. 48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n=28, 58%) and ended by the providers (n=36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n=13) of encounters, no decision was made. Fewer than half of providers (n=20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR=0.51, 95% CI: 0.27-0.95) when opioids were discussed. Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients. Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. 12 CFR 9.101 - Providing investment advice for a fee. (United States)


    ... (including acting as investment adviser to a mutual fund). Additionally, the qualifying phrase “if the bank... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Providing investment advice for a fee. 9.101... ACTIVITIES OF NATIONAL BANKS Interpretations § 9.101 Providing investment advice for a fee. (a) In general...

  11. The evolving role of the personal support worker in home care in Ontario, Canada. (United States)

    Saari, Margaret; Patterson, Erin; Kelly, Shawna; Tourangeau, Ann E


    To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills. © 2017 John Wiley & Sons Ltd.

  12. How can a modular Master Program in Hydrology provide a framework for future education challenges? (United States)

    Weiler, Markus; Lange, Jens


    A new Master program in Hydrology started at the University of Freiburg in 2008 as a continuation of the Diploma program in Hydrology due to the proposed changes according to the Bologna ac-cord. This imposed formation provided a perfect opportunity to develop a new program that is able to meet the challenges of future hydrology students to work in a nonstationary world due to climate and land use change. A modular program with individual three week hydrological courses was es-tablished, which builds on a general bachelor knowledge in natural sciences. Besides broad theory, students are taught in all relevant methods of hydrological field data collection and laboratory analy-sis. Recurrently, practical data analysis is carried out using freeware software tools. Examples in-clude time series analysis, (geo-)statistics and independently programmed water balance models including uncertainty assessments. Students work on data sets of different climatic zones and are made aware of hydrological problem areas around the globe. Hence, graduates know how to collect, analyse and evaluate hydrological information and may prepare their own, independent tools to pre-dict future changes. In addition, the new modular program includes instructors from the industry and public authorities to provide the students a broad perspective of their future profession. Finally, the new program allows directly to teach university students and practicing hydrologists together to provide evolving methods in hydrology to the practitioners and to allow contacts to professional for the university students.

  13. An Experimental Analysis of Children's Ability to Provide a False Report about a Crime. (United States)

    Wyman, Joshua; Foster, Ida; Talwar, Victoria


    A considerable amount of research has evaluated children's lie-telling behaviors and skills(1-2); however, limitations with the tasks used for eliciting false testimonies and interviewing children have restricted the generalizability of the findings. The primary aim of the current study is to provide an easy-to-administer and ecologically valid method for measuring the veracity and quality of school-aged children's (ages 6-11) testimonies when they are asked to provide different types of true and false reports. Moreover, the methodology enables researchers to examine the social and developmental factors that could influence the credibility of a child's testimony. In the current study, children will witness a theft, and are then asked to either falsely deny the transgression, falsely accuse a researcher of the theft, or tell the truth. Afterwards, children are to be interviewed by a second researcher using a thorough and ecologically valid interview protocol that requires children to provide closed-ended and free-recall responses about the events with the instigator (E1). Coders then evaluate the length and number of theft-related details the children give throughout the interview, as well as their ability to maintain their true and false reports. The representative results indicate that the truth and lie-telling conditions elicit the intended behaviors from the children. The open-ended interview questions encouraged children to provide free-recall information about their experiences with E1. Moreover, findings from the closed-ended questions suggest that children are significantly better at maintaining their lies with age, and when producing a false denial compared to a false accusation. Results from the current study can be used to develop a greater understanding of the characteristics of children's true and false testimonies about crime, which can potentially benefit law enforcement, legal staff and professionals who interview children.

  14. PTSD among Bosnian refugees: a survey of providers' knowledge, attitudes and service patterns. (United States)

    Weine, S M; Kuc, G; Dzudza, E; Razzano, L; Pavkovic, I


    The objective of this study was to investigate providers' knowledge, attitudes and service provision patterns for Bosnian refugees with PTSD and to consider the overall implications for trauma-related mental health services. A survey instrument was developed and administered to 30 randomly selected service providers working with Bosnian refugees in Chicago. This sample includes primary medical care providers (n = 7), community social service providers (n = 12), and mental health service providers (n = 11). Results showed that knowledge about PTSD is highest in mental health service providers, as is amount of previous training and education about PTSD. Less than half of all providers systematically assess for PTSD, and standardized instruments for PTSD are rarely used. The top three overall recommendations for services were ranked as: 1. Psychotherapy; 2. No intervention; 3. Psychiatric evaluation. In general, less than half of providers hold attitudes toward refugees as suffering from illnesses or mental disorders, or that "something" is wrong with them. Likewise, only half of the providers reported providing education to refugees and their families about the possible mental health consequences of trauma. In conclusion, assessment, intervention and educational activities of providers are not consistent with literature documenting that PTSD is highly prevalent in refugee populations. New training programs, model development, and research initiatives are needed to address the needs of refugees.

  15. The experience of providing end of life care at a children's hospice: a qualitative study. (United States)

    McConnell, Tracey; Porter, Sam


    More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children's hospice. Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children's hospice offering palliative and specialist care to life-limited children and young people. The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children's palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children's palliative care specialists within the acute setting. Service and policy initiatives should encourage open, informal peer/organisational support among the wider children's palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children's hospices and hospital settings.

  16. 42 CFR 51.46 - Disclosing information obtained from a provider of mental health services. (United States)


    ... mental health services. 51.46 Section 51.46 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... a provider of mental health services. (a) Except as provided in paragraph (b) of this section, if a... of mental health services, it may not disclose information from such records to the individual who is...

  17. An observational study of providing structure as a psychiatric nursing intervention

    NARCIS (Netherlands)

    Voogt, L.A.; Goossens, P.J.J.; Nugter, A.; Achterberg, T. van


    PURPOSE: To observe the actions of psychiatric nurses when providing structure and identify results in order to better understand providing structure as a complex nursing intervention. DESIGN AND METHOD: Participant observation data were collected on a dual diagnosis ward and a crisis intervention

  18. 34 CFR 646.4 - What activities and services may a project provide? (United States)


    ...) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION STUDENT SUPPORT SERVICES PROGRAM General § 646.4 What activities and services may a project provide? A Student Support Services project may provide services such as: (a) Instruction in reading, writing, study skills, mathematics, and other subjects...

  19. A Mid-Level Dental Provider in Oregon: Dental hygienists' perceptions. (United States)

    Coplen, Amy E; Bell, Kathryn; Aamodt, Gail L; Ironside, Lynn


    Purpose: Many states are exploring alternative provider models and examining the role of the dental hygienist to address access to care challenges as the United States continues to face increasing demands for oral healthcare services. The purpose of this study was to assess dental hygienists' opinions in the state of Oregon regarding the current limitations of dental hygienists' scope of practice, perceived need for a mid-level provider in Oregon, and personal interest in becoming a mid-level provider.Methods: In December 2013 a survey was mailed to a sample of 1,231 dental hygienists registered in Oregon representing 30% of the licentiates. All licentiates holding expanded practice permits (EPP) were included in the sample (n=351). The following categories were included in the 32-question survey: scope of practice, mid-level provider, current practice, and demographics.Results: A total of 440 surveys were returned for a response rate of 36%. Of the EPP holders, 51% responded to the survey. Over half of respondents (59%) believe that a mid-level provider is needed in the state. Respondents holding membership in the American Dental Hygienists' Association, as well as EPP holders, were significantly more likely to respond that a mid-level dental provider was needed in the state (p<0.0001). Ninety-one percent (n=400) of respondents agreed or strongly agreed that if a mid-level provider was introduced in Oregon, the new provider should be a registered dental hygienist model. Forty-three percent (n=186) of respondents were interested in becoming mid-level providers and 47% (n=203) of respondents believed that the minimum education for a mid-level provider should be a bachelor's degree. The majority, 74% (n=137), of those interested in becoming a mid-level provider indicated a preference in completing their education through online teaching combined with a clinical internship.Conclusion: There is strong support from dental hygienists in Oregon that a need exists for a

  20. Tri-Band PCB Antenna for Wireless Sensor Network Transceivers in Home Automation Applications

    DEFF Research Database (Denmark)

    Rohde, John; Toftegaard, Thomas Skjødeberg


    A novel tri-band antenna design for wireless sensor network devices in home automation applications is proposed. The design is based on a combination of a conventional monopole wire antenna and discrete distributed load impedances. The load impedances are employed to ensure the degrees of freedom...

  1. Embodied Germ Cell at Work: Building an Expansive Concept of Physical Mobility in Home Care (United States)

    Engestrom, Yrjo; Nummijoki, Jaana; Sannino, Annalisa


    This article presents a process of collective formation of a new concept of mobility between home care workers and their elderly clients, who are at risk of losing physical mobility and functional capacity. A new tool called mobility agreement was introduced to facilitate the inclusion of regular mobility exercises in home care visits and in the…

  2. Incorporating a pharmacist into an interprofessional team providing transgender care under a medical home model. (United States)

    Newsome, Cheyenne; Colip, Leslie; Sharon, Nathaniel; Conklin, Jessica


    A pharmacist's role in providing care to transgender and gender-nonconforming (TGNC) patients within a medical home model of care is described. A comprehensive transgender services clinic was established in February 2015 in New Mexico. Clinic services are provided under an "informed consent" model of care, as opposed to the traditional "gatekeeper" approach. The clinic's interprofessional team consists of a clinical pharmacist, a psychiatrist, a nurse practitioner, an endocrinologist, a diabetes educator, a massage therapist, a nurse, a nutritionist, and medical assistants. The clinical pharmacist has served in the following roles: (1) assessing health literacy and tailoring the consent process to the patient's literacy level, (2) initiating in-depth discussion of the medical risks and benefits of cross-sex hormone therapy (HT), as well as HT alternatives, (3) discussing typical timelines for physical outcomes of HT, (4) discussing a patient's expectations and goals for csHT, (5) discussing the different HT formulations and helping to determine which formulation is best suited to meeting patient's goals, (6) helping the team obtain prior authorizations for csHT, and (7) managing risk reduction strategies such as smoking cessation and weight loss. Involvement of a pharmacist in the clinic has improved care access and quality for TGNC patients in the southwestern United States. A pharmacist in an interprofessional team staffing a clinic for TGNC people has assumed multiple responsibilities and helped improve patient care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  3. Integrating Palliative Care in Oncology: The Oncologist as a Primary Palliative Care Provider


    Rangachari, Deepa; Smith, Thomas J.


    The provision of comprehensive cancer care in an increasingly complex landscape necessitates that oncology providers familiarize themselves with the application of palliative care. Palliative care is a learnable skill. Recent endeavors in this arena have demonstrated that providing palliative care is part and parcel with providing compassionate and high-quality cancer care, specifically as it pertains to physical and emotional outcomes for patients and their caregivers alike. The basic tenets...

  4. Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale. (United States)

    Dhiliwal, Sunil; Salins, Naveen; Deodhar, Jayitha; Rao, Raghavendra; Muckaden, Mary Ann


    Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale. Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4-6), and low (Group 3 - ESAS scores 0-3) priority based on ESAS scores. In high priority group, patients received home visit in 0-3 working days; medium priority group, patients received home visit in 0-10 working days; and low priority group, patients received home visit in 0-15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care. "High priority" patients were visited in 2.63 ± 0.75 days; "medium priority" patients were visited in 7.00 ± 1.5 days, and "low priority" patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (χ (2) = 27.3, P home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group, and (d) time taken for intervention

  5. Provider diversity in the English NHS: a study of recent developments in four local health economies. (United States)

    Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda


    To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

  6. Provider perspectives on barriers to family planning quality in Uganda: a qualitative study. (United States)

    Mugisha, John Frank; Reynolds, Heidi


    Provider perspectives on the quality of family planning services have been overlooked in quality of care research and interventions. This qualitative study was carried out in four districts in Uganda, a country where lack of access to quality family planning services remains a challenge. Using four focus group discussions, 16 provider in-depth interviews and nine manager in-depth interviews, this study documented providers' perceptions of quality of care and of barriers to quality services at the organisational and societal levels. To guide study development, analysis and interpretation, the authors relied on an ecological framework where providers' abilities are shaped by the larger organisational and societal environments in which providers live and work. Providers felt that organisational factors, such as supply availability, workload and their own knowledge and skills, affected their abilities to offer quality care. At the same time, providers were challenged by societal factors such as male partner participation, financial constraints, misconceptions and leadership support. While making changes to the elements of quality care that clients experience is important, it is not sufficient in view of the organisational and social barriers. Across the different levels of the ecological framework, providers face barriers to providing quality family planning services that are synergistic. Solutions to improve quality of care must address also limitations at the organisational and societal levels since efforts to overcome a particular constraint are less likely to be successful if this interdependence is not taken into account.

  7. Impact of continuous in-home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year. (United States)

    Imanishi, Miyuki; Tomohisa, Hisao; Higaki, Kazuo


    To verify the effect of in-home rehabilitation on quality of life and activities of daily living in elderly clients. In this non-randomized controlled intervention trial, elderly participants were separated into a rehabilitation or a non-rehabilitation group (n = 100 each). The non-rehabilitation group received basic in-home nursing care, including assistance with cooking, cleaning, toileting, meals and medication. The rehabilitation group received a physical treatment program provided by a licensed professional once a week and basic nursing care in the home. For each group, quality of life and activities of daily living were assessed approximately every 3 months over a 1-year period. Quality of life was evaluated using the Philadelphia Geriatric Center Morale Scale, and activities of daily living were evaluated based on the Functional Independence Measure. The rehabilitation group showed statistically significant improvements in both quality of life and activities of daily living. In contrast, the non-rehabilitation group, although showing slight improvement in quality of life at 9 months, showed almost no effects at the other time-points and no significant changes in activities of daily living over the course of the study. The results of the present study suggest that long-term continuous in-home rehabilitation might improve quality of life and activities of daily living in elderly clients. Geriatr Gerontol Int 2017; 17: 1866-1872. © 2017 Japan Geriatrics Society.

  8. Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis. (United States)

    Gauthier, Lynne V; Kane, Chelsea; Borstad, Alexandra; Strahl, Nancy; Uswatte, Gitendra; Taub, Edward; Morris, David; Hall, Alli; Arakelian, Melissa; Mark, Victor


    Neurological Disorders (NeuroQOL). This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation., NCT02631850 .

  9. Medical abortion service in rural areas of Henan Province, China: a provider survey. (United States)

    Ji, Ning; Zhou, You; Zhang, Ying; He, Dian; Pang, Cheng; Xi, Maomao; Cheng, Yimin


    The aim of this study was to explore the knowledge, attitudes and practices on medical abortion of abortion service providers in rural areas of China. A cross-sectional study via self-administered questionnaire was conducted among 362 abortion service providers from family planning service centers (FPSC) and hospitals in rural areas of Henan Province, China, between November 2009 and May 2010. Most of the providers were female (99.4%) and obstetricians/gynecologists (63.3%). The knowledge score achieved ranged from 9.4 to 78.1 points, with both the median and the mode of 56.3 points. Of the 52.2% (189/362) of providers having a preference on abortion method, 30.2% (57/189) preferred medical abortion, while 69.8% (132/189) preferred surgical abortion. In total, 50.7% (174/343) of the providers indicated the provision of medical abortion should be expanded, with the three biggest challenges in its further expansion being increased complications/failures, poor client knowledge/awareness, and problems with drug/equipment supplies. Of all the providers, 81.7% and 92.2% reported they had experience in providing medical abortion and surgical abortion, respectively. Medical abortion providers were mainly experienced in misoprostol with oral (81.8%)/vaginal (79.6%) prostaglandin (misoprostol/gemeprost). Knowledge on medical abortion of providers working in rural China was at a moderate level. Providers preferred surgical abortion to medical abortion. Providers have more experience in providing surgical abortion than medical abortion. Efforts should be made to overcome the perceived challenges in future expansion of medical abortion. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  10. Association of provider opioid prescribing practices and the Centers for Medicare and Medicaid Services hierarchical condition category score: A retrospective examination of correlation between the volume of provider-prescribed opioid medications and provider panel complexity

    Directory of Open Access Journals (Sweden)

    Frederick North


    Full Text Available Objective: Opioids are being prescribed at increasing rates in primary care practices, and among individual providers there is significant variability in opioid prescribing. Primary care practices also vary significantly in complexity of their patients, ranging from healthy patients to those with multiple comorbidities. Our objective was to examine individual primary care providers for an association between their opioid prescribing and the complexity/risk of their panel of patients (a panel of patients is a group of patients whose medical care is the responsibility of a specific healthcare provider or care team. Methods: We retrospectively examined 12 months of opioid prescription data from a primary care practice. We obtained counts of opioids prescribed by providers in the Mayo Clinic, Rochester, Minnesota primary care practice. For patients paneled (assigned to family medicine and internal medicine, we used the Centers for Medicare and Medicaid Services hierarchical condition category patient risk score as a measure of patient complexity. After adjusting the opioid counts for panel patient count (to get opioid counts per patient, we used linear regression analysis to determine the correlation between the hierarchical condition category risk and the amount of opioid prescribed by individual providers. Results: Among our combined 103 primary care providers, opioid unit counts prescribed per patient were highly correlated with the providers’ hierarchical condition category panel risk score (r2 = 0.54. After excluding three outliers, r2 was 0.74. With and without the outliers, the correlation was very significant (p  0.45 showed significant correlation with hierarchical condition category (r2 = 0.26; p = 0.001. Conclusion: When examining differences in primary care providers’ opioid prescribing practices, the Centers for Medicare and Medicaid Services endorsed risk score (the hierarchical condition category score can help

  11. Randomized Controlled Trial of Problem-Solving Therapy for Minor Depression in Home Care (United States)

    Gellis, Zvi D.; McGinty, Jean; Tierney, Lynda; Jordan, Cindy; Burton, Jean; Misener, Elizabeth


    Objective: Data are presented from a pilot research program initiated to develop, refine, and test the outcomes of problem-solving therapy that targets the needs of older adults with minor depression in home care settings. Method: A pilot randomized clinical trial compares the impact of problem-solving therapy for home care to treatment as usual…

  12. Predictors of change and continuity in home care for dementia patients

    NARCIS (Netherlands)

    Vernooy-Dassen, M.J.F.J.; Felling, A.J.A.; Persoon, J.M.G.


    Objective. To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients. Design. A prospective longitudinal study with a follow-up period of 10 months. Setting. Dementia patients living in the community selected by Dutch

  13. Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey. (United States)

    Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos


    Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

  14. Providing written information increases patient satisfaction: a web-based questionnaire survey of Japanese cancer survivors. (United States)

    Sakai, Hitomi; Katsumata, Noriyuki; Takahashi, Miyako


    The Institute of Medicine (IOM) of the United States recommends that all cancer survivors be provided with a survivorship care plan (SCP), which includes a patient treatment summary and a follow-up care plan. However, SCPs have not been widely adopted in Japan. To provide basic data necessary for implementing SCPs in Japan, we aimed to investigate the forms of clinical and survivorship-related information that Japanese cancer survivors receive from their healthcare providers, and to examine whether written information increases their satisfaction. We performed a cross-sectional online survey of cancer survivors who underwent acute cancer treatment and had at least one follow-up with a physician in the past year. Cancer survivors provided the elements and forms (verbally and/or written) of information they received, as well as the degree of satisfaction with the information provided. Responses were obtained from 545 cancer survivors. Information elements such as surgical procedure (98.3%), surgical outcome (98.1%), and names of administered chemotherapy agents (97.8%) were commonly provided, whereas mental care resources and providers (29.7%), effects on marital relationship and sexual health (35.7%), and effects on fertility (43.4%) were less common. A large proportion of cancer survivors received verbal information only. For 18 of 20 elements, except for effects on fertility and duration of hormonal therapy, satisfaction was significantly higher when both forms of information were provided (P information can better meet the needs of Japanese cancer survivors.

  15. Providing Students with Foundational Field Instruction within a 50 Minute Class Period: A Practical Example (United States)

    Percy, M.


    There is a growing recognition among secondary educators and administrators that students need to have a science education that provides connections between familiar classes like biology, chemistry, and physics. Because of this waxing interest in an integrative approach to the sciences, there is a broader push for school districts to offer classes geared towards the earth sciences, a field that incorporates knowledge and skills gleaned from the three core science subjects. Within the contexts of a regular secondary school day on a traditional schedule (45- to 50-minute long classes), it is challenging to engage students in rigorous field-based learning, critical for students to develop a deeper understanding of geosciences content, without requiring extra time outside of the regular schedule. We suggest instruction using common, manmade features like drainage retention ponds to model good field practices and provide students with the opportunity to calculate basic hydrologic budgets, take pH readings, and, if in an area with seasonal rainfall, make observations regarding soils by way of trenching, and near-surface processes, including mass wasting and the effects of vegetation on geomorphology. Gains in student understanding are discussed by analyzing the difference in test scores between exams provided to the students after they had received only in-class instruction, and after they had received field instruction in addition to the in-class lectures. In an advanced setting, students made measurements regarding ion contents and pollution that allowed the classes to practice lab skills while developing a data set that was analyzed after field work was completed. It is posited that similar fieldwork could be an effective approach at an introductory level in post-secondary institutions.

  16. A systematic analysis of online marketing materials used by providers of expanded carrier screening. (United States)

    Chokoshvili, Davit; Borry, Pascal; Vears, Danya F


    PurposeExpanded carrier screening (ECS) for a large number of recessive disorders is available to prospective parents through commercial providers. This study aimed to analyze the content of marketing materials on ECS providers' websites.MethodsTo identify providers of ECS tests, we undertook a comprehensive online search, reviewed recent academic literature on commercial carrier screening, and consulted with colleagues familiar with the current ECS landscape. The identified websites were archived in April 2017, and inductive content analysis was performed on website text, brochures and educational materials, and video transcripts.ResultsWe identified 18 ECS providers, including 16 commercial genetic testing companies. Providers typically described ECS as an important family planning tool. The content differed in both the tone used to promote ECS and the accuracy and completeness of the test information provided. We found that most providers offered complimentary genetic counseling to their consumers, although this was often optional, limited to the posttest context, and, in some cases, appeared to be available only to test-positive individuals.ConclusionThe quality of ECS providers' websites could be improved by offering more complete and accurate information about ECS and their tests. Providers should also ensure that all carrier couples receive posttest genetic counseling to inform their subsequent reproductive decision making.Genet Med advance online publication, 14 December 2017; doi:10.1038/gim.2017.222.

  17. Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines. (United States)

    Kennedy, C E; Yeh, P T; Johnson, C; Baggaley, R


    New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (≥98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.

  18. A lightweight augmented virtuality system for providing a faithful and spatially manipulable visual hand representation. (United States)

    Pusch, Andreas; Martin, Olivier; Coquillart, Sabine


    This paper introduces the technical foundations of a system designed to embed a lightweight, faithful and spatially manipulable representation of the user's hand into an otherwise virtual world - Augmented Virtuality (AV). A highly intuitive control during pointing-like near space interaction can be provided to the user, as well as a very flexible means to experimenters, in a variety of non-medical and medical contexts. Our approach essentially relies on stereoscopic video see-through Augmented Reality (AR) technology and a generic, extendible framework for managing 3-D visual hand displacements. Research from human-computer interaction, perception and motor control has contributed to the elaboration of our proposal which combines a) acting in co-location, b) avoiding occlusion violations by assuring a correct scene depth ordering and c) providing a convincing visual feedback of the user's hand. We further present two cases in which this system has already successfully been used and then outline some other applications that we think are promising, for instance, in the fields of neuromotor rehabilitation and experimental neuroscience.

  19. Effects of librarian-provided services in healthcare settings: a systematic review. (United States)

    Perrier, Laure; Farrell, Ann; Ayala, A Patricia; Lightfoot, David; Kenny, Tim; Aaronson, Ellen; Allee, Nancy; Brigham, Tara; Connor, Elizabeth; Constantinescu, Teodora; Muellenbach, Joanne; Epstein, Helen-Ann Brown; Weiss, Ardis


    To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. The meaning of providing caring to obese patients to a group of nurses

    Directory of Open Access Journals (Sweden)

    Emilly Souza Marques


    Full Text Available This qualitative study was performed with six nurses of a public hospital, with the objective to describe their view of the meaning of providing care to obese patients. Interviews were conducted using a semi-structured script. The data were organized under themes extracted from the subjects’ statements, after being thoroughly read. Symbolic Interactionism was adopted to interpret the findings. The results from the analysis were organized under the following themes: Being obese is excessive, it is not healthy; Providing care to the obese is a structural issue; Obese patients are troublesome, they require care, no big deal; Providing care to the obese requires teamwork. The grasped meanings can interfere in the care provided. The nurses, however, recognize the need to work as a team to deliver comprehensive care. Making positive changes to the meanings found in this study is possible, thus, contributing to providing prejudice-free nursing care to obese patients. Descriptors: Obesity; Nursing Care; Hospital Care.

  1. Creating a smart application system to provide a beneficial maintenance service for elderly drivers

    Directory of Open Access Journals (Sweden)

    Jung Sebin


    Full Text Available As overall population ages, elderly drivers have become a larger percentage of the driving population. With this trend, a lot of vehicle systems have been improved for elderly’s safety and convenience using different advanced technologies. However, elderly drivers have often paid more money than other drivers in a car-repair shop due to their lack of knowledge about vehicle systems with modern technologies. Given this fact, developing a tool to diminish this disadvantage and to help elderly drivers maintain their cars with confidence and with minimal cost is necessary. Therefore, this research work mainly focuses on suggesting a system concept on user-interface application, which is connected to a smart phone or a tablet to provide beneficial services anywhere. For the research outcome, diverse research activities – surveys, interviews with small focus groups, observations of the focus groups, and discussions – has been conducted to understand the elderly driver’s difficulties and behaviours regarding vehicle maintenance, to investigate what specific problems make them uncomfortable in repair shops, and to demonstrate how new system-concepts could be developed for the elderly. Furthermore, we conclude that adequate system-concepts for the elderly would offer elderly drivers convenient vehicle repair and maintenance and provide them a confident driving experience.

  2. Pneumatic compression devices for in-home management of lymphedema: two case reports


    Cannon, Samantha


    The two patients in this case series had experienced long-term difficulty controlling lymphedema at home. Both patients had used numerous home therapies, including older-generation intermittent pneumatic compression devices, without success. The Flexitouch? system, an advanced pneumatic device, was prescribed to assist them with in-home efforts by providing therapy to their affected limbs in addition to the lower trunk area for the patient with lymphedema of the lower extremity; and the trunk...

  3. Non-contact versus contact-based sensing methodologies for in-home upper arm robotic rehabilitation. (United States)

    Howard, Ayanna; Brooks, Douglas; Brown, Edward; Gebregiorgis, Adey; Chen, Yu-Ping


    In recent years, robot-assisted rehabilitation has gained momentum as a viable means for improving outcomes for therapeutic interventions. Such therapy experiences allow controlled and repeatable trials and quantitative evaluation of mobility metrics. Typically though these robotic devices have been focused on rehabilitation within a clinical setting. In these traditional robot-assisted rehabilitation studies, participants are required to perform goal-directed movements with the robot during a therapy session. This requires physical contact between the participant and the robot to enable precise control of the task, as well as a means to collect relevant performance data. On the other hand, non-contact means of robot interaction can provide a safe methodology for extracting the control data needed for in-home rehabilitation. As such, in this paper we discuss a contact and non-contact based method for upper-arm rehabilitation exercises that enables quantification of upper-arm movements. We evaluate our methodology on upper-arm abduction/adduction movements and discuss the advantages and limitations of each approach as applied to an in-home rehabilitation scenario.

  4. Family carers providing support to a person dying in the home setting: A narrative literature review. (United States)

    Morris, Sara M; King, Claire; Turner, Mary; Payne, Sheila


    This study is based on people dying at home relying on the care of unpaid family carers. There is growing recognition of the central role that family carers play and the burdens that they bear, but knowledge gaps remain around how to best support them. The aim of this study is to review the literature relating to the perspectives of family carers providing support to a person dying at home. A narrative literature review was chosen to provide an overview and synthesis of findings. The following search terms were used: caregiver, carer, 'terminal care', 'supportive care', 'end of life care', 'palliative care', 'domiciliary care' AND home AND death OR dying. During April-May 2013, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Pubmed, Cochrane Reviews and Citation Indexes were searched. Inclusion criteria were as follows: English language, empirical studies and literature reviews, adult carers, perspectives of family carers, articles focusing on family carers providing end-of-life care in the home and those published between 2000 and 2013. A total of 28 studies were included. The overarching themes were family carers' views on the impact of the home as a setting for end-of-life care, support that made a home death possible, family carer's views on deficits and gaps in support and transformations to the social and emotional space of the home. Many studies focus on the support needs of people caring for a dying family member at home, but few studies have considered how the home space is affected. Given the increasing tendency for home deaths, greater understanding of the interplay of factors affecting family carers may help improve community services. © The Author(s) 2015.

  5. Engineering practice variation through provider agreement: a cluster-randomized feasibility trial

    Directory of Open Access Journals (Sweden)

    McCarren M


    Full Text Available Madeline McCarren,1 Elaine L Twedt,1 Faizmohamed M Mansuri,2 Philip R Nelson,3 Brian T Peek3 1Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, IL, 2Wilkes-Barre VA Medical Center, Wilkes-Barre, PA, 3Charles George VA Medical Center, Asheville, NC, USA Purpose: Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters (eg, providers to “favor” a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design.Subjects and methods: Agreeable providers were randomized to “favor” either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate.Results: All four institutional review boards waived documentation of patient consent. Providers (n=18 followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients. In the “favor hydrochlorothiazide” group, there was 99% adherence to that strategy. In the “favor chlorthalidone” group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25–50 mg/day and 100% for chlorthalidone (12.5–25.0 mg/day. Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information

  6. Keeping Kids Safe: A Guide for Safe Food Handling & Sanitation for Child Care Providers. (United States)

    Food Safety and Inspection Service (USDA), Washington, DC.

    Because children under age 5 are susceptible to food-borne illnesses and children in diapers present special sanitation and health problems, food safety and sanitation are emerging as important issues for child care providers. This booklet is designed to give providers and parents a quick and easy reference for food safety and sanitation. The…

  7. Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs (United States)

    Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol


    The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

  8. 33 CFR 169.225 - Which Application Service Providers may a ship use? (United States)


    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Which Application Service Providers may a ship use? 169.225 Section 169.225 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... Providers may also serve as an ASP. ...

  9. Child Care Providers' Strategies for Supporting Healthy Eating: A Qualitative Approach (United States)

    Lynch, Meghan; Batal, Malek


    Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the…

  10. Integrating palliative care in oncology: the oncologist as a primary palliative care provider. (United States)

    Rangachari, Deepa; Smith, Thomas J


    The provision of comprehensive cancer care in an increasingly complex landscape necessitates that oncology providers familiarize themselves with the application of palliative care. Palliative care is a learnable skill. Recent endeavors in this arena have demonstrated that providing palliative care is part and parcel with providing compassionate and high-quality cancer care, specifically as it pertains to physical and emotional outcomes for patients and their caregivers alike. The basic tenets of providing palliative care emphasize: frequent and honest communication, routine and systematic symptom assessment, integration of spiritual assessments, and early integration of specialized hospice and palliative care resources as a patient's circumstances evolve. This article will endeavor to review and synthesize recent developments in the palliative care literature, specifically as they pertain to the oncologist as a primary palliative care provider.

  11. Health organizations providing and seeking social support: a Twitter-based content analysis. (United States)

    Rui, Jian Raymond; Chen, Yixin; Damiano, Amanda


    Providing and seeking social support are important aspects of social exchange. New communication technologies, especially social network sites (SNSs), facilitate the process of support exchange. An increasing number of health organizations are using SNSs. However, how they provide and seek social support via SNSs has yet to garner academic attention. This study examined the types of social support provided and sought by health organizations on Twitter. A content analysis was conducted on 1,500 tweets sent by a random sample of 58 health organizations within 2 months. Findings indicate that providing informational and emotional support, as well as seeking instrumental support, were the main types of social support exchanged by health organizations through Twitter. This study provides a typology for studying social support exchanges by health organizations, and recommends strategies for health organizations regarding the effective use of Twitter.

  12. Providing affinity

    DEFF Research Database (Denmark)

    Guglielmi, Michel; Johannesen, Hl


    This paper will introduce a project sourced by an ideas competition called Landmark East England. It was open to anyone with the ability to develop and deliver a visionary idea for a landmark. A sustainable icon representing a new region in England, which comprises Bedfordshire, Cambridgeshire, E...

  13. A Compact, Wide Area Surveillance 3D Imaging LIDAR Providing UAS Sense and Avoid Capabilities Project (United States)

    National Aeronautics and Space Administration — Eye safe 3D Imaging LIDARS when combined with advanced very high sensitivity, large format receivers can provide a robust wide area search capability in a very...

  14. Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study. (United States)

    Reese, Jennifer Barsky; Beach, Mary Catherine; Smith, Katherine Clegg; Bantug, Elissa T; Casale, Kristen E; Porter, Laura S; Bober, Sharon L; Tulsky, James A; Daly, Mary B; Lepore, Stephen J


    Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development. Patient data (n = 28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n = 11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis. Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication, and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions. Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.

  15. Promoting gynecologic cancer awareness at a critical juncture--where women and providers meet. (United States)

    Cooper, Crystale Purvis; Gelb, Cynthia A; Rodriguez, Juan; Hawkins, Nikki A


    Given the absence of effective population-based screening tests for ovarian, uterine, vaginal, and vulvar cancers, early detection can depend on women and health care providers recognizing the potential significance of symptoms. In 2008, the Centers for Disease Control and Prevention's (CDC) Inside Knowledge campaign began distributing consumer education materials promoting awareness of gynecologic cancer symptoms. We investigated providers' in-office use of CDC gynecologic cancer materials and their recognition of the symptoms highlighted in the materials. We analyzed data from a national 2012 survey of US primary care physicians, nurse practitioners, and gynecologists (N = 1,380). Less than a quarter of providers (19.4%) reported using CDC gynecologic cancer education materials in their offices. The provider characteristics associated with the use of CDC materials were not consistent across specialties. However, recognition of symptoms associated with gynecologic cancers was consistently higher among providers who reported using CDC materials. The possibility that providers were educated about gynecologic cancer symptoms through the dissemination of materials intended for their patients is intriguing and warrants further investigation. Distributing consumer education materials in health care provider offices remains a priority for the Inside Knowledge campaign, as the setting where women and health care providers interact is one of the most crucial venues to promote awareness of gynecologic cancer symptoms.

  16. Energy Provider: Delivered Energy Efficiency: A global stock-taking based on case studies

    Energy Technology Data Exchange (ETDEWEB)



    In 2011 the IEA and the Regulatory Assistance Project (RAP) took on a work programme focused on the role of energy providers in delivering energy efficiency to end-users. This work was part of the IEA’s contribution to the PEPDEE Task Group, which falls under the umbrella of the International Partnership on Energy Efficiency Cooperation (IPEEC). In addition to organizing regional dialogues between governments, regulators, and energy providers, the PEPDEE work stream conducted global stock-takings of regulatory mechanisms adopted by governments to obligate or encourage energy providers to delivery energy savings and the energy savings activities of energy providers. For its part the IEA conducted a global review of energy provider-delivered energy savings programmes. The IEA reached out to energy providers to identify the energy savings activities they engaged in. Some 250 energy saving activities were considered, and 41 detailed case studies spanning 18 countries were developed. Geographic balance was a major consideration, and much effort was expended identifying energy provider-delivered energy savings case studies from around the world. Taken together these case studies represent over USD 1 billion in annual spending, or about 8% of estimated energy provider spending on energy efficiency.

  17. Physical Activity and Beverages in Home- and Center-Based Child Care Programs (United States)

    Tandon, Pooja S.; Garrison, Michelle M.; Christakis, Dimitri A.


    Objective: To describe and compare obesity prevention practices related to physical activity and beverages in home- and center-based child care programs. Methods: A telephone survey of licensed home- and center-based child care programs in Florida, Massachusetts, Michigan, and Washington between October and December 2008. Results: Most programs…

  18. Performance in Home Schooling: An Argument against Compulsory Schooling in the Netherlands (United States)

    Blok, Henk


    Although home education is a growing phenomenon in many Western countries, it is almost non-existent in the Netherlands. Under Dutch educational law, children must be educated in the school system. Home schooling is thought to endanger children's development. This study examines--primarily American--analyses of performance in home schooling. Its…

  19. socio-cultural factors influencing male involvement in home-based

    African Journals Online (AJOL)


    Aug 8, 2011 ... in home-based care variables were negatively correlated with socio-cultural variables. For example, there was a significant strong negative relationship between taboo for married man to cook with men cook and feed HIV patients (r =- 0.69, P=0.01). Conclusion: Full participation of males' in HIV home care ...

  20. The Psychological Effects of Providing Personal Care to a Partner: A Multidimensional Perspective. (United States)

    Hansen, Thomas; Slagsvold, Britt


    The expected increasing demand for informal care in aging societies underscores the importance of understanding the psychological implications of caregiving. This study explores the effect of providing regular help with personal care to a partner on different aspects of psychological well-being. We use cross-sectional data from the Norwegian Life Course, Ageing and Generation study (n. ~15,000; age 40-84) and two-wave panel data from the Norwegian study on Life Course, Ageing and Generation (n. ~3000; age 40-84). To separate the effects of providing care from those of the partner's disability, caregivers are contrasted with non-caregivers with both disabled and nondisabled partners. We separate outcomes into cognitive well-being (life satisfaction), psychological functioning (self-esteem, mastery), and affective well-being (happiness, depression, loneliness). Findings show that caregiving has important cross-sectional and longitudinal detrimental psychological effects. These effects are fairly consistent across all aspects of well-being, demonstrating that caregiving has a broad-based negative impact. Among women, however, these effects are similar to if not weaker than the effects of a partner's disability. Caregiving effects are constant by age, education, and employment status, but stronger among caregivers with health problems. Providing personal care to a partner is associated with marked adverse psychological effects for men and women irrespective of age and socio-economic status. Hence, no sociodemographic group is immune from caregiving stress, so programs should be targeted generally. The results also suggest that the health needs of caregivers demand more attention.

  1. The psychological effects of providing personal care to a partner: a multidimensional perspective

    Directory of Open Access Journals (Sweden)

    Thomas Hansen


    Full Text Available The expected increasing demand for informal care in aging societies underscores the importance of understanding the psychological implications of caregiving. This study explores the effect of providing regular help with personal care to a partner on different aspects of psychological well-being. We use cross-sectional data from the Norwegian Life Course, Ageing and Generation study (n. ~15,000; age 40-84 and two-wave panel data from the Norwegian study on Life Course, Ageing and Generation (n. ~3000; age 40-84. To separate the effects of providing care from those of the partner’s disability, caregivers are contrasted with non-caregivers with both disabled and nondisabled partners. We separate outcomes into cognitive well-being (life satisfaction, psychological functioning (self-esteem, mastery, and affective well-being (happiness, depression, loneliness. Findings show that caregiving has important cross-sectional and longitudinal detrimental psychological effects. These effects are fairly consistent across all aspects of well-being, demonstrating that caregiving has a broad-based negative impact. Among women, however, these effects are similar to if not weaker than the effects of a partner’s disability. Caregiving effects are constant by age, education, and employment status, but stronger among caregivers with health problems. Providing personal care to a partner is associated with marked adverse psychological effects for men and women irrespective of age and socio-economic status. Hence, no socio-demographic group is immune from caregiving stress, so programs should be targeted generally. The results also suggest that the health needs of caregivers demand more attention.

  2. Holding health providers in developing countries accountable to consumers: a synthesis of relevant scholarship. (United States)

    Berlan, David; Shiffman, Jeremy


    Health care providers in low-income countries often treat consumers poorly. Many providers do not consider it their responsibility to listen carefully to consumer preferences, to facilitate access to care, to offer detailed information, or to treat patients with respect. A lack of provider accountability to health consumers may have adverse effects on the quality of health care they provide, and ultimately on health outcomes. This paper synthesizes relevant research on health provision in low-, middle- and high-income countries with the aim of identifying factors that shape health provider accountability to consumers, and discerning promising interventions to enhance responsiveness. Drawing on this scholarship, we develop a framework that classifies factors into two categories: those concerning the health system and those that pertain to social influences. Among the health systems factors that may shape provider accountability are oversight mechanisms, revenue sources, and the nature of competition in the health sector-all influences that may lead providers to be accountable to entities other than consumers, such as governments and donors. Among the social factors we explore are consumer power, especially information levels, and provider beliefs surrounding accountability. Evidence on factors and interventions shaping health provider accountability is thin. For this reason, it is not possible to draw firm conclusions on what works to enhance accountability. This being said, research does suggest four mechanisms that may improve provider responsiveness: 1. Creating official community participation mechanisms in the context of health service decentralization; 2. Enhancing the quality of health information that consumers receive; 3. Establishing community groups that empower consumers to take action; 4. Including non-governmental organizations in efforts to expand access to care. This synthesis reviews evidence on these and other interventions, and points to future

  3. A Conserved Motif Provides Binding Specificity to the PP2A-B56 Phosphatase

    DEFF Research Database (Denmark)

    Hertz, Emil Peter Thrane; Kruse, Thomas; Davey, Norman E


    -exposed pocket on PP2A regulatory B56 subunits binds to a consensus sequence on interacting proteins, which we term the LxxIxE motif. The composition of the motif modulates the affinity for B56, which in turn determines the phosphorylation status of associated substrates. Phosphorylation of amino acid residues......Dynamic protein phosphorylation is a fundamental mechanism regulating biological processes in all organisms. Protein phosphatase 2A (PP2A) is the main source of phosphatase activity in the cell, but the molecular details of substrate recognition are unknown. Here, we report that a conserved surface...... within the motif increases B56 binding, allowing integration of kinase and phosphatase activity. We identify conserved LxxIxE motifs in essential proteins throughout the eukaryotic domain of life and in human viruses, suggesting that the motifs are required for basic cellular function. Our study provides...

  4. Evaluation of poison information services provided by a new poison information center. (United States)

    Churi, Shobha; Abraham, Lovin; Ramesh, M; Narahari, M G


    The aim of this study is to assess the nature and quality of services provided by poison information center established at a tertiary-care teaching hospital, Mysore. This was a prospective observational study. The poison information center was officially established in September 2010 and began its functioning thereafter. The center is equipped with required resources and facility (e.g., text books, Poisindex, Drugdex, toll free telephone service, internet and online services) to provide poison information services. The poison information services provided by the center were recorded in documentation forms. The documentation form consists of numerous sections to collect information on: (a) Type of population (children, adult, elderly or pregnant) (b) poisoning agents (c) route of exposure (d) type of poisoning (intentional, accidental or environmental) (e) demographic details of patient (age, gender and bodyweight) (f) enquirer details (background, place of call and mode of request) (g) category and purpose of query and (h) details of provided service (information provided, mode of provision, time taken to provide information and references consulted). The nature and quality of poison information services provided was assessed using a quality assessment checklist developed in accordance with DSE/World Health Organization guidelines. Chi-Square test (χ(2)). A total of 419 queries were received by the center. A majority (n = 333; 79.5%) of the queries were asked by the doctors to provide optimal care (n = 400; 95.5%). Most of the queries were received during ward rounds (n = 201; 48.0%), followed by direct access (n = 147; 35.1%). The poison information services were predominantly provided through verbal communication (n = 352; 84.0%). Upon receipt of queries, the required service was provided immediately (n = 103; 24.6%) or within 10-20 min (n = 296; 70.6%). The queries were mainly related to intentional poisoning (n = 258; 64.5%), followed by accidental poisoning

  5. Child Maltreatment History and Response to CBT Treatment in Depressed Mothers Participating in Home Visiting. (United States)

    Ammerman, Robert T; Peugh, James L; Teeters, Angelique R; Putnam, Frank W; Van Ginkel, Judith B


    Child maltreatment contributes to depression in adults. Evidence indicates that such experiences are associated with poorer outcomes in treatment. Mothers in home visiting programs display high rates of depression and child maltreatment histories. In-Home Cognitive Behavioral Therapy (IH-CBT) was developed to treat maternal depression in home visiting. The purpose of this study was to examine the moderating effects of child maltreatment history on depression, social functioning, and parenting in mothers participating in a clinical trial of IH-CBT. Ninety-three depressed mothers in home visiting between 2 and 10 months postpartum were randomly assigned to IH-CBT (n = 47) plus home visiting or standard home visiting (SHV; n = 46). Mothers were identified via screening and then confirmation of major depressive disorder diagnosis. Measures of child maltreatment history, depression, social functioning, and parenting were administered at pre-treatment, post-treatment, and 3-month follow-up. Results indicated high rates of maltreatment in both conditions relative to the general population. Mixed model analyses found a number of main effects in which experiences of different types of trauma were associated with poorer functioning regardless of treatment condition. Evidence of a moderating effect of maltreatment on treatment outcomes was found for physical abuse and parenting and emotional abuse and social network size. Future research should focus on increasing the effectiveness of IH-CBT with depressed mothers who have experienced child maltreatment. © The Author(s) 2014.

  6. Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study. (United States)

    Brown, Seth A; Hayden, Theresa C; Randell, Kimberly A; Rappaport, Lara; Stevenson, Michelle D; Kim, In K


    Previous studies have illustrated pediatric knowledge deficits among Emergency Medical Services (EMS) providers. The purpose of this study was to identify perspectives of a diverse group of EMS providers regarding pediatric prehospital care educational deficits and proposed methods of training improvements. Purposive sampling was used to recruit EMS providers in diverse settings for study participation. Two separate focus groups of EMS providers (administrative and non-administrative personnel) were held in three locations (urban, suburban, and rural). A professional moderator facilitated focus group discussion using a guide developed by the study team. A grounded theory approach was used to analyze data. Forty-two participants provided data. Four major themes were identified: (1) suboptimal previous pediatric training and training gaps in continuing pediatric education; (2) opportunities for improved interactions with emergency department (ED) staff, including case-based feedback on patient care; (3) barriers to optimal pediatric prehospital care; and (4) proposed pediatric training improvements. Focus groups identified four themes surrounding preparation of EMS personnel for providing care to pediatric patients. These themes can guide future educational interventions for EMS to improve pediatric prehospital care. Brown SA , Hayden TC , Randell KA , Rappaport L , Stevenson MD , Kim IK . Improving pediatric education for Emergency Medical Services providers: a qualitative study. Prehosp Disaster Med. 2017;32(1):20-26.

  7. A Process Framework for Designing Software Reference Architectures for Providing Tools as a Service

    DEFF Research Database (Denmark)

    Chauhan, Muhammad Aufeef; Babar, Muhammad Ali; Probst, Christian W.


    to be provisioned and underlying cloud platforms to be used while designing SRA. The framework recommends adoption of the multi-faceted approach for evaluation of SRA and quantifiable measurement scheme to evaluate quality of the SRA. We foresee that RADeF can facilitate software architects and researchers during...... of software systems need customized and systematic SRA design and evaluation methods. In this paper, we present a software Reference Architecture Design process Framework (RADeF) that can be used for analysis, design and evaluation of the SRA for provisioning of Tools as a Service as part of a cloud......Software Reference Architecture (SRA), which is a generic architecture solution for a specific type of software systems, provides foundation for the design of concrete architectures in terms of architecture design guidelines and architecture elements. The complexity and size of certain types...

  8. A Process Framework for Designing Software Reference Architectures for Providing Tools as a Service

    DEFF Research Database (Denmark)

    Chauhan, Muhammad Aufeef; Babar, Muhammad Ali; Probst, Christian W.


    Software Reference Architecture (SRA), which is a generic architecture solution for a specific type of software systems, provides foundation for the design of concrete architectures in terms of architecture design guidelines and architecture elements. The complexity and size of certain types...... of software systems need customized and systematic SRA design and evaluation methods. In this paper, we present a software Reference Architecture Design process Framework (RADeF) that can be used for analysis, design and evaluation of the SRA for provisioning of Tools as a Service as part of a cloud......-enabled workSPACE (TSPACE). The framework is based on the state of the art results from literature and our experiences with designing software architectures for cloud-based systems. We have applied RADeF SRA design two types of TSPACE: software architecting TSPACE and software implementation TSPACE...

  9. Gender differences in patient-provider symptom agreement in reporting respiratory complaints on a questionnaire. (United States)

    Canaris, Gay J; Tape, Thomas G; Smith, Lynette M; Nickol, Devin R; Wigton, Robert S


    Men and women communicate differently, but it is unclear whether this influences health care outcomes. Because women patients frequently choose women health care providers, we examined whether this preference was affected by communication styles. We focused on communication of disease-specific symptoms, hypothesizing that symptom agreement between women patients and women health care providers would be greater than between other patient-provider gender combinations. Patients attending outpatient clinics were recruited as part of a study of respiratory illness at 7 university-affiliated sites during 3 consecutive influenza seasons (2000-2003). Individuals aged > or = 19 years were offered enrollment if they sought care for cold or flu symptoms at a participating study site. Patients were eligible to participate in the study if they reported any 1 of 6 symptoms: cough, runny nose, fever (subjective), muscle aches, sore throat, and/or exhaustion. Using separate questionnaires, patients and their health care providers recorded the patients' respiratory symptoms (as present or absent). Patients recorded their symptoms before visiting their health care provider, and providers recorded patient symptoms after the visit. Symptom agreement was compared using general estimating equations across all gender combinations. A total of 327 patients (220 women, 107 men) and 84 health care providers (37 women, 47 men) participated in the study. Overall symptom agreement for all patient-provider gender combinations was 81.9% (95% CI, 79.6%-84.2%). For each symptom, the observed agreement significantly exceeded the agreement expected by chance alone (P difference in symptom agreement for most symptoms between the male-male and female-female patient-provider combinations. Based on these findings, symptom agreement alone does not explain why women patients select women health care providers.

  10. Teaching astronomy for the blind: Providing a lecture and laboratory experience (United States)

    Spagna, George F.


    A general education course in astronomy was successfully adapted to provide a meaningful laboratory science experience for a visually-impaired student. Minor alterations to the style of lecture, coupled with an edition of the text on audio cassette tapes, allowed the student to keep pace with the theory component of the course. Laboratory equipment was modified to provide tactile measuring apparatus, which allowed the student to perform all the same processes of data acquisition and analysis required of sighted students.


    Adekoya, B J; Adepoju, F G; Moshood, K F; Balarabe, A H


    Glaucoma management is challenging to patients as well as to the eye care providers. The study is aimed at describing the challenges faced by providers using qualitative methods. In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative methods. This was done using semi-structured, open ended questions to explore the providers' perspective on glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients, and recommendations for improving glaucoma services. The discussions were recorded with the aid of a micro-cassette recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes were identified. Quotes that reflect the themes and sub-themes were then identified in the data. In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority were of the opinion that glaucoma is a significant burden constituting about 35% of outpatient visits. Identified patient related challenges include; late presentation, lack of glaucoma awareness, delay in referral from optometrists, and poor compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and counterfeiting of drugs were the major challenges related to medical treatment. Majority of the participants agreed that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced the patients will be compliant. Some respondents considered the current number of glaucoma surgeries as adequate, while some think otherwise. Reasons put forward for reluctance to offer glaucoma surgery include; late presentation, lack

  12. Contraception services for incarcerated women: a national survey of correctional health providers. (United States)

    Sufrin, Carolyn B; Creinin, Mitchell D; Chang, Judy C


    Incarcerated women have had limited access to health care prior to their arrest. Although their incarceration presents an opportunity to provide them with health care, their reproductive health needs have been overlooked. We performed a cross-sectional study of a nationally representative sample of 950 correctional health providers who are members of the Academy of Correctional Health Providers. A total of 405 surveys (43%) were returned, and 286 (30%) were eligible for analysis. Most ineligible surveys were from clinicians at male-only facilities. Of eligible respondents, 70% reported some degree of contraception counseling for women at their facilities. Only 11% provided routine counseling prior to release. Seventy percent said that their institution had no formal policy on contraception. Thirty-eight percent of clinicians provided birth control methods at their facilities. Although the most frequently counseled and prescribed method was oral contraceptive pills, only 50% of providers rated their oral contraceptive counseling ability as good or very good. Contraception counseling was associated with working at a juvenile facility, and with screening for sexually transmitted infections. Contraception does not appear to be integrated into the routine delivery of clinical services to incarcerated women. Because the correctional health care system can provide important clinical and public health interventions to traditionally marginalized populations, services for incarcerated women should include access to contraception.

  13. What is a good health check? An interview study of health check providers' views and practices. (United States)

    Stol, Yrrah H; Asscher, Eva C A; Schermer, Maartje H N


    Health checks identify (risk factors for) disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as 'personal health checks'. Health check providers' perspective of 'good' health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for 'good' health checks, and the role these criteria play in their practices. Providers unanimously formulate a number of minimal criteria: Checks must focus on (risk factors for) treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of (potential) users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any (risk factor for) disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the (Dutch) organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health

  14. [Providing grief counseling to a major depressive elderly widower: a nurse's experience]. (United States)

    Chu, Hsiu-Ching; Chow, Philip C


    The death of a spouse is both a major loss and a tremendous life stressor for the partner left behind. Such has been shown to be particularly hard on the elderly. This article describes a nurse's experience caring for an elderly patient suffering from major depression resulting from the death of his wife. While providing nursing care to the client, the author, employing holistic nursing assessment, identified a reciprocal influence between his depressive symptoms and grief reaction. In applying the Inventory of Complicated Grief to ascertain grief reaction intensity to help the client discern between major depressive symptoms and grief reaction, the author found that the client (1) could not accept the loss of his wife, (2) had difficulty adjusting to life after his wife's death, and (3) faced a tense and distant relationship with his son. Such resulted in suicidal ideation and planning and feelings of loneliness, helplessness, hopelessness and incapability, which triggered major depression and a complicated grief reaction. Therefore, the author applied grief counseling to help the client accept the loss of his spouse, communicate his grief, overcome the difficult adjustment to life after his spouse's death, bid farewell to his wife, and establish new relationships. Such counseling gradually helped the client accept the inevitability of death and his wife's passing. To help the client establish new relationships under existing circumstances of negligible external support systems, the author encouraged the client to establish a new relationship with himself and integrate the old-age stage of life cycle naturally into his daily routine. Based on this care experience, we recommend psychiatric nurses assess cautiously the loss experience and grief reaction in elderly widowers under their care in order to provide timely grief counseling intervention to help the client pass quickly through the grieving phase and free him or her from the haze of depression.

  15. Evaluation of a Sickle Cell Disease Educational Website for Emergency Providers. (United States)

    Kayle, Mariam; Brennan-Cook, Jill; Carter, Brigit M; Derouin, Anne L; Silva, Susan G; Tanabe, Paula


    Sickle cell disease (SCD) is a complex multisystem debilitating disease. Despite its complexity, health care providers who are not SCD experts receive little formal education on SCD. An open-access, educational website, "Emergency Department Sickle Cell Disease: Crisis Management and Beyond," was created to provide education about SCD to emergency department (ED) providers who are not SCD experts but who provide care for patients with SCD. Electronic surveys were used to conduct a formal evaluation of the accuracy and relevance of the website's content, as well as the effectiveness of the education modules in improving knowledge among health care providers. The evaluation consisted of (1) individual module pre- and post-knowledge assessment, (2) content validity assessment of educational modules, (3) overall website content assessment, and (4) overall website assessment (Health on the Net core principles). A convenient sample of ED providers, accelerated bachelor of science in nursing students, SCD experts, and website experts completed the anonymous surveys. Descriptive statistics and paired t tests were used to compare mean difference in post- minus pre-knowledge test scores. Knowledge scores statistically improved for nursing students (p value less than 0.0001). Emergency department providers showed a mean improvement of 3.2 points on the eight-item knowledge assessment. Both SCD experts and ED providers agreed that the module content was clear and easy to understand, accurate, comprehensive, relevant, and met module objectives. Participants agreed that the website was clear, easy to navigate, and visually appealing. Website experts stated that the website met much of the Health on the Net criteria. The website is a useful resource for providers and nursing students, especially those who serve or plan to serve in EDs.

  16. New consumer services provided by smart metering

    Directory of Open Access Journals (Sweden)

    Daminov Ildar


    Full Text Available This paper focuses on the issues of smart metering market and considers different services provided by smart metering from consumer point of view. Firstly, smart metering deployment challenges emerging and conventional tariffs, which modify a consumer behavior and thus, the entire electric energy market can be optimized since the customer is motivated to consume less energy. Secondly, the authors illustrate changes in electricity quality, which have an impact on consumer relations with utility. Additionally, two main indices of grid resilience – SAIDI and SAIFI – are exemplified to reveal the improvement potential of smart metering implementation in certain regions of Russia that also influence the consumer. Finally, in-home display and privacy problem directly reflect the consumer’s behavior, thus the private life rights should not be violated as they are guaranteed by law.

  17. Providing health services during a civil war: the experience of a garrison town in South Sudan. (United States)

    Kevlihan, Rob


    The impact of conflict, particularly conflict arising during civil wars, on the provision of healthcare is a subject that has not been widely considered in conflict-related research. Combatants often target health services to weaken or to defeat the enemy, while attempts to maintain or improve health systems also can comprise part of counter-insurgency 'hearts-and-minds' strategies. This paper describes the dynamics associated with the provision of health services in Malakal, an important garrison town in South Sudan, during the second Sudanese civil war (1983-2005). Drawing on the concepts of opportunity hoarding and exploitation, it explores the social and political dynamics of service provision in and around the town during the war. These concepts provide a useful lens with which to understand better how health services are affected by conflict, while the empirical case study presented in the paper illustrates dynamics that may be repeated in other contexts. The concepts and case study set out in this paper should prove useful to healthcare providers working in conflict zones, including humanitarian aid agencies and their employees, increasing their understanding of the social and political dynamics that they are likely to face during future conflict-related complex emergencies. © 2013 The Author(s). Disasters © Overseas Development Institute, 2013.

  18. "I understand just a little…" Perspectives of HIV/AIDS service providers in South Africa of providing mental health care for people living with HIV/AIDS. (United States)

    Mall, Sumaya; Sorsdahl, Katherine; Swartz, Leslie; Joska, John


    Research conducted in South Africa and other parts of the world has revealed that people living with HIV/AIDS (PLWHA) are more at risk of developing a mental disorder than the general population. It makes sense to explore means of integrating HIV/AIDS and mental health care thereby facilitating access of PLWHA to prompt mental health care. We conducted qualitative interviews with 22 HIV/AIDS service providers of three occupational categories (10 nurses, six adherence counsellors and six patient advocates) at three primary health care clinics in the Western Cape, South Africa. We explored the issues of knowledge and practice in mental health care as well as the role of nurses and lay health workers in providing mental health care to PLWHA thereby attempting to integrate mental health and HIV/AIDS care. Although the majority of participants were in favour of mental health screening for PLWHA, they lacked confidence to conduct the screening themselves. Most participants displayed poor knowledge of mental disorders and reported that they referred to colleagues or to an external mental health service if they suspected a possible mental disorder in a patient. Integration of mental health and HIV/AIDS care has potential benefit to the public HIV/AIDS care system. Mental health training should be provided to HIV/AIDS service providers in this regard.

  19. Experience in implementing inpatient clinical note capture via a provider order entry system. (United States)

    Rosenbloom, S Trent; Grande, Jonathan; Geissbuhler, Antoine; Miller, Randolph A


    Care providers' adoption of computer-based health-related documentation ("note capture") tools has been limited, even though such tools have the potential to facilitate information gathering and to promote efficiency of clinical charting. The authors have developed and deployed a computerized note-capture tool that has been made available to end users through a care provider order entry (CPOE) system already in wide use at Vanderbilt. Overall note-capture tool usage between January 1, 1999, and December 31, 2001, increased substantially, both in the number of users and in their frequency of use. This case report is provided as an example of how an existing care provider order entry environment can facilitate clinical end-user adoption of a computer-assisted documentation tool-a concept that may seem counterintuitive to some.

  20. Knowledge, attitude & practice on human papillomavirus vaccination: A cross-sectional study among healthcare providers

    Directory of Open Access Journals (Sweden)

    P Cheena Chawla


    Interpretation & conclusions: The findings reinforce continued medical education of healthcare providers, particularly those from the government sector on HPV vaccination for cervical cancer prevention. Public education is also pertinent for a successful HPV vaccination programme in the country.

  1. Auroral Electrojet Index Designed to Provide a Global Measure, Hourly Intervals, of Auroral Zone Magnetic Activity (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Auroral Electrojet (AE) index is designed to provide a global quantitative measure of auroral zone magnetic activity produced by enhanced ionospheric currents...

  2. Providing Dental Care to Pregnant Patients: A Survey of Oregon General Dentists

    National Research Council Canada - National Science Library

    Huebner, Colleen E; Milgrom, Peter; Conrad, Douglas; Lee, Rosanna Shuk Yin


    A growing number of studies and reports indicate preventive, routine and emergency dental procedures can be provided safely to pregnant patients to alleviate dental problems and promote oral health...

  3. A grey DEMATEL approach to develop third-party logistics provider selection criteria

    DEFF Research Database (Denmark)

    Govindan, Kannan; Khodaverdi, Roohollah; Vafadarnikjoo, Amin


    criteria and identified the main criteria for 3PL provider selection. The most important criteria for 3PL provider selection are on time delivery performance, technological capability, financial stability, human resource policies, service quality, and customer service, respectively. Practical implications......Purpose - Third-party logistics (3PL) plays a main role in supply chain management and, as a result, has experienced remarkable growth. The demand for 3PL providers has become a main approach for companies to offer better customer service, reduce costs, and gain competitive advantage. This paper...... - The paper's results help managers of automotive industries, particularly in developing countries, to outsource logistics activities to 3PL providers effectively and to create a significant competitive advantage. Originality/value - The main contributions of this paper are twofold. First, this paper proposes...

  4. Stigmatized Attitude of Healthcare Providers: A Barrier for Delivering Health Services to HIV Positive Patients

    Directory of Open Access Journals (Sweden)

    Nooshin Zarei


    Full Text Available Abstract Background: Despite the success of developed countries in preventing the spread of HIV/AIDS, the disease is expanding in developing countries where an unfavorable attitude exists among people, health professionals and employees. This study aimed to assess the stigmatized attitude among health care providers toward people living with HIV (PLWHA. Methods: The study is a cross-sectional survey. The data were gathered using a structured questionnaire. The study sample included 575 health care providers of public and private hospitals in Shiraz. The data were gathered using a structured questionnaire in spring 2014. Data analysis was carried out using the Statistical Package for Social Sciences, version 21. Results: The most dominant attitude of the health care providers toward HIV/AIDS patients was related to fear (42.42%. According to the results of this study, there was a significant relationship between stigmatized attitude of the health care providers and their religious beliefs, society stigmatized attitude, and knowledge of transmission routes. The relationship between social stigmatized attitude of health care providers and their knowledge of transmission routes, with their willingness to provide services to patients is significant, as well (P<0.05. 39.6% and 46.2% of the respondents preferred not to provide services to the prostitutes and homosexual patients. Conclusion: Fear of contamination and social stigmatized attitude are the main impediments to dealing with patients and providing services to them. Hence, it seems that creating an effective knowledge about transmission and correcting the socio-cultural beliefs of health providers are two key strategies to tackle this problem.

  5. [Influence of in-home nursing care on the weight of the early discharged preterm newborn]. (United States)

    Alvarez Miró, R; Lluch Canut, M T; Figueras Aloy, J; Esqué Ruiz, M T; Arroyo Gili, L; Bella Rodríguez, J; Carbonell Estrany, X


    In-Home nursing care of the preterm newborn helps to bring the family situation to normal, promotes breastfeeding and development of the newborn, and enables the reorganization of health care resources. The purpose of this paper is to demonstrate that in-home nursing care of the preterm newborn leads to an increase in weight and a similar morbidity. A total of 65 cases and 65 controls (matched by weight, age and sex) were studied, all of them preterm newborns born in hospital and weighing less than 2100 g at discharge. In-home nursing care was carried out by a pediatrician neonatologist, as well as two nurses specialized in neonatology who made several visits to the home. Weight gain was calculated as g/day and g/Kg/day, comparing the first week of the study with the week prior to the beginning of the study. The groups were comparable. Weight gain in the group with home nursing care was 38 g per day, significantly higher than the weight gain in the control group (31 g/day). The independent predictive variables of the increase in g/Kg/day during the study were in-home nursing care, male gender, breastfeeding less, and not having suffered from a peri-intraventricular hemorrhage. Neonatal morbidity was similar in both groups. In-home care was associated with a greater weight gain of the newborn at home than during their stay in the hospital, and can be considered safe because neonatal morbidity was not increased. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  6. "Providing structure" as a psychiatric nursing intervention: a review of the literature. (United States)

    Voogt, L Amar; Nugter, Annet; Goossens, Peter J J; van Achterberg, Theo


    The focus is on a nursing intervention called "providing structure" (PS). This label does not exist in the Nursing Interventions Classification. The following three questions were asked: (a) How is PS defined? (b) What are the goals of PS? and (c) What is the evidence regarding the effectiveness of PS? A systematic literature review. Forty articles, predominantly qualitative studies of PS, were selected for review. Regarding PS, three elements were mentioned: to impose and maintain rules and limits; to assess the condition of the patient; and to interact with the patient. The goals for PS related to patient security, making expectations explicit, and recovering from illness. Major findings were reviewed, but little was found about the effectiveness of PS. © 2013 Wiley Periodicals, Inc.

  7. Configurable memory system and method for providing atomic counting operations in a memory device (United States)

    Bellofatto, Ralph E.; Gara, Alan G.; Giampapa, Mark E.; Ohmacht, Martin


    A memory system and method for providing atomic memory-based counter operations to operating systems and applications that make most efficient use of counter-backing memory and virtual and physical address space, while simplifying operating system memory management, and enabling the counter-backing memory to be used for purposes other than counter-backing storage when desired. The encoding and address decoding enabled by the invention provides all this functionality through a combination of software and hardware.

  8. Approaches to health-care provider education and professional development in perinatal depression: a systematic review


    Legere, Laura E.; Wallace, Katherine; Bowen, Angela; McQueen, Karen; Montgomery, Phyllis; Evans, Marilyn


    Background Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of...

  9. Communication strategies and accommodations utilized by health care providers with hearing loss: a pilot study. (United States)

    Trotter, Alanna R; Matt, Susan B; Wojnara, Danuta


    Poor communication between health care providers and patients may negatively impact patient outcomes, and enhancing communication is one way to improve outcomes. Effective communication is particularly important for health care providers who have hearing loss. The authors found that a systematic survey of the communication strategies and experiences of health care providers with hearing loss had not yet been conducted. In this pilot study, 32 health care professionals with hearing loss were recruited via the Association of Medical Professionals With Hearing Losses and were asked to complete a 28-question survey. Health care providers with hearing loss already employ strategies that all health care providers are encouraged to use in order to enhance patient–provider communication, and survey participants have found the strategies to be effective. The communication techniques and assistive technologies used by individuals with hearing loss seem to be effective: All participants reported feeling able to communicate effectively with patients at least most of the time. More research is needed to determine if use of these communication techniques has similar results for health care providers without hearing loss.

  10. Caregiver and health care provider preferences of nutritional support in a hematopoietic stem cell transplant unit. (United States)

    Williams-Hooker, Ruth; Adams, Marissa; Havrilla, David A; Leung, Wing; Roach, Robin R; Mosby, Terezie T


    Many pediatric oncology patients undergoing hematopoietic stem cell transplantation (HSCT) require nutritional support (NS) because of their inability to consume adequate caloric intake enough calories orally. Although NS can be provided either enteraly (EN) or parenteraly (PN), EN is the preferred method of NS as long as if the gastrointestinal tract is functioning. In this qualitative study, we determined the type of NS preferences and the reservations of caregivers of pediatric HSCT patients undergoing hematopoietic stem cell transplantation (HSCT) as well as those of health care (HC) providers working on the HSCT unit. A survey was developed and completed anonymously by HC providers and caregivers. The hypothesis was that HC providers and caregivers would prefer PN because it is convenient to use in patients who already have a central line in place. Most caregivers preferred PN to EN, while most HC providers preferred EN to PN. The barrier between EN initiation and caregivers' approval was the caregivers' perception that EN was invasive and painful, most common obstacle for initiation of EN among caregivers was that it hurts/is invasive, while the barrier with HC providers was vomiting and/abdominal pain associated with EN. If caregivers were better educated about NS and the advantages/disadvantages of the different forms of NS, their preferences may change. There have been policy changes at St. Jude have been implemented since this study, and an outpatient dietitian now provides education to caregivers about NS during the pre-evaluation for HSCT. © 2015 Wiley Periodicals, Inc.

  11. Guidance Provided by Teacher and Simulation for Inquiry-Based Learning: a Case Study (United States)

    Lehtinen, Antti; Viiri, Jouni


    Current research indicates that inquiry-based learning should be guided in order to achieve optimal learning outcomes. The need for guidance is even greater when simulations are used because of their high information content and the difficulty of extracting information from them. Previous research on guidance for learning with simulations has concentrated on guidance provided by the simulation. Little research has been done on the role of the teacher in guiding learners with inquiry-based activities using simulations. This descriptive study focuses on guidance provided during small group investigations; pre-service teachers ( n = 8) guided third and fifth graders using a particular simulation. Data was collected using screen capture videos. The data was analyzed using a combination of theory- and data-driven analysis. Forms of guidance provided by the simulation and by the teachers were divided into the same categories. The distribution of the guidance between the teacher and the simulation was also analyzed. The categories for forms of guidance provided by simulations proved to be applicable to guidance provided by the teachers as well. Teachers offered more various forms of guidance than the simulation. The teachers adapted their guidance and used different patterns to complement the guidance provided by the simulation. The results of the study show that guidance provided by teachers and simulations have different affordances, and both should be present in the classroom for optimal support of learning. This has implications for both teaching with simulations and development of new simulations.

  12. Turning Electromyography Reports Upside Down: A Pilot Study Surveying Referring Providers (United States)

    Shenoy, Anant M.; Baquis, Kate G.; Baquis, George D.


    Providers are expressing a desire for more efficient ways to retrieve relevant clinical data from the Electronic Health Record. In an effort to improve our Electromyography and Nerve Conduction Study reports, we surveyed referring providers on the effects of having the IMPRESSION at the start of the report. Our survey respondents felt that using this format for an Electromyography and Nerve Conduction Study report significantly improved the quality of the report while saving them time and/or mouse clicks when interpreting the report. Electro diagnosticians might consider using this format for their Electromyography and Nerve Conduction Study reports to improve referring provider satisfaction. PMID:27708744

  13. Health care providers' and parents' attitudes toward administration of new infant vaccines--a multinational survey. (United States)

    Bakhache, P; Rodrigo, C; Davie, S; Ahuja, A; Sudovar, B; Crudup, T; Rose, M


    The New Vaccinations of Infants in Practice online survey in seven countries evaluated vaccination-related attitudes and concerns of parents of infants and health care providers (HCPs) who provide pediatric medical care. The survey showed that HCPs and parents were open to adding new vaccines to the immunization schedule, even if it requires co-administration with current vaccines or introduction of new office visits. Parental disease awareness campaigns would be helpful to achieve widespread acceptance of changes to vaccination schedules. In addition, HCPs would ideally provide disease education to parents to accompany recommendations for a new vaccine.

  14. Human resources in home care in Europe.

    NARCIS (Netherlands)

    Genet, N.; Lamura, G.; Boerma, W.; Hutchinson, A.; Garms-Homolova, V.; Naiditch, M.; Chlabicz, S.; Ersek, K.; Gulácsi, L.; Fagerstrom, C.; Bolibar, B.


    Introduction: The increasing old-age dependency ratio implies future reduction of human resources available to provide services. Little information is available about the level of qualification, contractual aspects, payment and working conditions of home care workers and the existence of staff

  15. Huperzine A provides robust and sustained protection against induced seizures in Scn1a mutant mice

    Directory of Open Access Journals (Sweden)

    Jennifer C. Wong


    Full Text Available De novo loss-of-function mutations in the voltage-gated sodium channel (VGSC SCN1A (encoding Nav1.1 are the main cause of Dravet syndrome (DS, a catastrophic early-life encephalopathy associated with prolonged and recurrent early-life febrile seizures (FSs, refractory afebrile epilepsy, cognitive and behavioral deficits, and a 15-20% mortality rate. SCN1A mutations also lead to genetic epilepsy with febrile seizures plus (GEFS+, which is an inherited disorder characterized by early-life FSs and the development of a range of adult epilepsy subtypes. Current antiepileptic drugs often fail to protect against the severe seizures and behavioral and cognitive deficits found in patients with SCN1A mutations. To address the need for more efficacious treatments for SCN1A-derived epilepsies, we evaluated the therapeutic potential of Huperzine A, a naturally occurring reversible acetylcholinesterase inhibitor. In CF1 mice, Hup A (0.56 or 1 mg/kg was found to confer protection against 6 Hz-, pentylenetetrazole (PTZ-, and maximal electroshock (MES-induced seizures. Robust protection against 6 Hz-, MES-, and hyperthermia-induced seizures was also achieved following Hup A administration in mouse models of DS (Scn1a+/- and GEFS+ (Scn1aRH/+. Furthermore, Hup A-mediated seizure protection was sustained during 3 weeks of daily injections in Scn1aRH/+ mutants. Finally, we determined that the muscarinic and GABAA receptors play a role in Hup A-mediated seizure protection. These findings indicate that Hup A might provide a novel therapeutic strategy for increasing seizure resistance in DS and GEFS+, and more broadly, in other forms of refractory epilepsy.

  16. Globus Nexus: A Platform-as-a-Service provider of research identity, profile, and group management

    Energy Technology Data Exchange (ETDEWEB)

    Chard, Kyle; Lidman, Mattias; McCollam, Brendan; Bryan, Josh; Ananthakrishnan, Rachana; Tuecke, Steven; Foster, Ian


    Globus Nexus is a professionally hosted Platform-as-a-Service that provides identity, profile and group management functionality for the research community. Many collaborative e-Science applications need to manage large numbers of user identities, profiles, and groups. However, developing and maintaining such capabilities is often challenging given the complexity of modern security protocols and requirements for scalable, robust, and highly available implementations. By outsourcing this functionality to Globus Nexus, developers can leverage best-practice implementations without incurring development and operations overhead. Users benefit from enhanced capabilities such as identity federation, flexible profile management, and user-oriented group management. In this paper we present Globus Nexus, describe its capabilities and architecture, summarize how several e-Science applications leverage these capabilities, and present results that characterize its scalability, reliability, and availability.

  17. Providing a harmonious smile with laminate veneers for a patient with peg-shaped lateral incisors. (United States)

    Alberton, Simone Beatriz; Alberton, Victória; de Carvalho, Rodrigo Varella


    The most common discrepancy concerning tooth size is the presence of peg-shaped lateral incisors, which can cause teeth with reduced size, anterior diastema, and consequently an unpleasant smile. The development of the adhesive dentistry and ceramic veneers allowed all ceramic-bonded restorations to become an esthetic and functional approach to reestablish the smile harmony. The purpose of this clinical report is to describe a conservative treatment approach to recover an esthetic disharmony caused by bilateral peg-shaped lateral incisors. A 30-year-old female patient was seeking treatment to solve an esthetic disharmony of her smile. Lithium disilicate veneers were planned and build-up with the help of diagnostic models, wax-up, mock-up, and silicone guides, to restore the morphology, size, function, and esthetic of upper lateral incisors and smile. The lithium disilicate veneers were able to provide the harmonization of the patient's smile, recovering the teeth size, shape, and anatomic characteristics.

  18. Providing a harmonious smile with laminate veneers for a patient with peg-shaped lateral incisors (United States)

    Alberton, Simone Beatriz; Alberton, Victória; de Carvalho, Rodrigo Varella


    The most common discrepancy concerning tooth size is the presence of peg-shaped lateral incisors, which can cause teeth with reduced size, anterior diastema, and consequently an unpleasant smile. The development of the adhesive dentistry and ceramic veneers allowed all ceramic-bonded restorations to become an esthetic and functional approach to reestablish the smile harmony. The purpose of this clinical report is to describe a conservative treatment approach to recover an esthetic disharmony caused by bilateral peg-shaped lateral incisors. A 30-year-old female patient was seeking treatment to solve an esthetic disharmony of her smile. Lithium disilicate veneers were planned and build-up with the help of diagnostic models, wax-up, mock-up, and silicone guides, to restore the morphology, size, function, and esthetic of upper lateral incisors and smile. The lithium disilicate veneers were able to provide the harmonization of the patient's smile, recovering the teeth size, shape, and anatomic characteristics. PMID:29279628

  19. Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting. (United States)

    Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A


    Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

  20. Googling Concussion Care: A Critical Appraisal of Online Concussion Healthcare Providers and Practices in Canada. (United States)

    Ellis, Michael J; Ritchie, Lesley; Selci, Erin; Chu, Stephanie; McDonald, Patrick; Russell, Kelly


    Concussion is an emerging public health concern, but care of patients with a concussion is presently unregulated in Canada. Independent, blinded Google Internet searches were conducted for the terms "concussion" and "concussion clinic" and each of the Canadian provinces and territories. The first 10 to 15 concussion healthcare providers per province were identified. A critical appraisal of healthcare personnel and services offered on the provider's Web site was conducted. Fifty-eight concussion healthcare providers were identified using this search methodology. Only 40% listed the presence of an on-site medical doctor (M.D.) as a member of the clinical team. Forty-seven percent of concussion healthcare providers advertised access to a concussion clinic, program, or center on their Web site. Professionals designated as team leaders, directors, or presidents among concussion clinics, programs, and centers included a neuropsychologist (15%), sports medicine physician (7%), neurologist (4%), and neurosurgeon (4%). Services offered by providers included baseline testing (67%), physiotherapy (50%), and hyperbaric oxygen therapy (2%). This study indicates that there are numerous concussion healthcare providers in Canada offering diverse services with clinics operated by professionals with varying levels of training in traumatic brain injury. In some cases, the practices of these concussion clinics do not conform to current expert consensus guidelines.