Psychological adaptation after peripartum cardiomyopathy

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de Wolff, Mie; Ersbøll, Anne Schjødt; Hegaard, Hanne

2018-01-01

of regaining psychological balance and wellbeing (i.e. psychological adaptation) after having experienced severe peripartum morbidity. DESIGN: A qualitative exploratory research design was applied to guide the study. Data was collected through in-depth, semi-structured, face-toface telephone and e...

EMERGENCY PERIPARTUM HYSTERECTOMY IN THE LAKES REGION OF TURKEY: INCIDENCE AND MATERNAL MORBIDITY

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Mehmet Güney

2006-06-01

Full Text Available OBJECTIVE: To estimate the incidence, indications, risk factors, and complications of peripartum hysterectomy in a university clinic and a state hospital in the Lakes region of Anatolia.\tDesign: Retrospective clinical study.\tSetting: This retrospective study was conducted between December 1996 and December 2005 at the Süleyman Demirel University, Faculty of Medicine, Department of Obstetrics and Gynecology and Isparta Women’s and Children’s Hospital.\tPatients: Twenty-eight patients who underwent emergency peripartum hysterectomy.\tMain Outcome Measures: Twenty-eight patients with emergency peripartum hysterectomy were evaluated with respect to the demographic characteristics, clinical manifestation, state of parity and type of hysterectomy.\tRESULTS: In the study period, the incidence of emergency peripartum hysterectomy was 0.8 per 1000 deliveries. The main indications for emergency hysterectomy were uterine atony in 18 cases (64 %, rupture of uterus in 6 cases (21 % and placenta accreta in 4 cases (14 %. There were 20 (71 % multiparaous and 8 (28 % primiparaous women. There were 4 total abdominal hysterectomies and 24 subtotal hysterectomies.The rate of maternal mortality was 4% (1 cases.\tCONCLUSION: Our incidence of emergent peripartum hysterectomy was low when compared with most of the studies and uterine atony was the most common indication for emergent peripartum hysterectomy.

Peripartum hysterectomy: an evolving picture.

LENUS (Irish Health Repository)

Turner, Michael J

2012-02-01

Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study.

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Engjom, Hilde M; Morken, Nils-Halvdan; Høydahl, Even; Norheim, Ole F; Klungsøyr, Kari

2017-08-01

Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5-4.9) and contributed 2% (95% confidence interval, 1.2-3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time 2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have

Potentially avoidable peripartum hysterectomies in Denmark

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Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

2016-01-01

to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations...

A case of peripartum heart failure

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Annalisa Vinci

2008-03-01

Full Text Available A 32-year-old woman was admitted in congestive heart failure (CHF 3 days after delivery. She had no history of cardiovascular disease and impaired left ventricular Ejection Fraction (EF 35%. She underwent complete heart catheterisation, selective coronary angiography and right ventricular endomyocardial biopsy (EMB.Coronary arteries were normal and EMB revealed active virus negative myocarditis. Serum was positive for anti-heart autoantibodies (AHA. Thus myocarditis was classified as autoimmune and the patient was treated with immunosuppressive therapy, with clinical and hemodynamic improvement. At 27 months follow-up EMB showed healed myocarditis. Peripartum cardiomyopathy (PPCM is a rare disorder in which left ventricular dysfunction and heart failure occur in the peripartum period in previously healthy women. The etiology is still unknown but a sizable proportion of patients may have an underlying organ-specific autoimmune myocarditis.

Peripartum cardiomeyopathy in a pakistani cohort

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Munir, R.; Hussain, S.; Kayani, A.M.

2016-01-01

Objective: To describe the demographics, risk factors, and clinical presentation in Pakistani patients with peripartum cardiomyopathy. Study Design: A descriptive observational study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi, from June 2014 to June 2015. Methodology: Seventy patients meeting criteria of peripartum cardiomyopathy were included in the study. Adetailed history, physical examination and investigations were done. Epidemiologic data, risk factors, New York Heart Association (NYHA) class and echocardiographic findings were recorded. Statistical analyses were done using SPSS version 19. Result: The mean age was 28.66 ±4.57 years. Mean parity and weight was 3.04 ±1.7 and 60.97 ±12.40 Kg, respectively. Fifty-five (78.6 percent) cases were diagnosed in the postpartum period. Thirty-three (50.8 percent) and 31 patients (44.7 percent) presented in NYHA- III and IV classes, respectively. Pregnancy-induced hypertension was seen in 16 (22.9 percent) cases, diabetes in 6 (8.6 percent), and twin pregnancy in 2 (2.9 percent) cases. The mean hemoglobin and brain natriuretic peptide (BNP) was 11.26 ±1.61 gm/dl and 1583.70 ±1237.65 pg/ml, respectively. Echocardiography showed mean ejection fraction of 21.74 ±7.45 percent. Left ventricle systolic and diastolic diameters were 53.71 ±9.74 mm and 63.37 ±8.48 mm, respectively. Conclusion: Peripartum cardiomyopathy was seen in younger women with higher parity and pregnancy induced hypertension, often manifesting in the postpartum period with NHYAclass III and IV status. (author)

Emergency peripartum hysterectomy: an experience at a tertiary care hospital of mardan, pakistan

International Nuclear Information System (INIS)

Qadir, M.

2017-01-01

To study the incidence, demographic characteristics, indications, complications, associated maternal and perinatal outcome in patients with emergency peripartum hysterectomy (EPH). Methodology: This prospective cross sectional study was performed at Department of Gynecology and Obstetrics, Mardan Medical Complex, Mardan from February 2017 to July 2017. All women of any age, parity and booking status, who underwent emergency peripartum hysterectomy within 24 hours of delivery through any mode were included in the study. Results: Incidence of EPH was 0.1%. Most common age group was more than 35 years where 12(57%) women, majority (76%) were multiparous, 17(81%) were non booked and 15(71.4%) were delivered through cesarean section. Indication for EPH was uterine rupture in 10(47.6%), followed by uterine atony and abruption placentae in 4(19%) each and placenta previa in 2(9.5%) cases. Main intraoperative complications were hemorrhage in 13(62%) and shock in 9(42.8%) patients. Postoperative complications were anemia in 15(71.4%), wound sepsis in 8(38%) and paralytic ileus in 7(33%) cases. Maternal mortality was 3(14.3%) and perinatal mortality rate was 52%, including 9(43%) stillbirths and 2(9.5%) early neonatal deaths. Subtotal hysterectomy was performed in 16(76%) and total hysterectomy in 5(24%) cases. Conclusion: The incidence of EPH and associated rates of maternal and perinatal morbidity and mortality were high in our hospital, with most common indication being uterine rupture followed by atonic uterus. Important risk factors were multiparity, age >35 years, non booked status, rural residence and delivery by cesarean section. (author)

Mental Illness in the Peripartum Period

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Ostler, Teresa

2009-01-01

Women are particularly vulnerable in the peripartum period for either developing a mental illness or suffering symptom exacerbation. These illnesses are often experienced covertly, however, and women may not seek out professional help, even though their symptoms may be seriously affecting their well-being and parenting. This article provides an…

Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS).

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Jakobsson, Maija; Tapper, Anna-Maija; Colmorn, Lotte Berdiin; Lindqvist, Pelle G; Klungsøyr, Kari; Krebs, Lone; Børdahl, Per E; Gottvall, Karin; Källén, Karin; Bjarnadóttir, Ragnheiður I; Langhoff-Roos, Jens; Gissler, Mika

2015-07-01

To assess the prevalence and risk factors of emergency peripartum hysterectomy. Nordic collaborative study. 605 362 deliveries across the five Nordic countries. We collected data prospectively from patients undergoing emergency peripartum hysterectomy within 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period. Emergency peripartum hysterectomy rate. The total number of emergency peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10 000 (95% confidence interval 3.0-4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta (n = 91, 43.1%), atonic bleeding (n = 69, 32.7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post-term birth increased the risk for emergency peripartum hysterectomy. The number of stillbirths was substantially high (70/1000), but the case fatality rate stood at 0.47% (one death, maternal mortality rate 0.17/100 000 deliveries). A combination of prospective data collected from clinicians and information gathered from register-based databases can yield valuable data, improving the registration accuracy for rare, near-miss cases. However, proper and uniform clinical guidelines for the use of well-defined international diagnostic codes are still needed. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome.

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Melo, Maria Adélia Medeiros E; Carvalho, Jordão Sousa; Feitosa, Francisco Edson de Lucena; Araujo Júnior, Edward; Peixoto, Alberto Borges; Costa Carvalho, Francisco Herlânio; Carvalho, Regina Coeli Marques

2016-06-01

Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Peripartum cardiomyopathy in the Hospital Albert Schweitzer District of Haiti.

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Fett, James D; Carraway, Robert D; Dowell, Duane L; King, Mary Etta; Pierre, Ronald

2002-05-01

This report details current epidemiologic information on peripartum cardiomyopathy in 1 district of Haiti and represents the initial report of an ongoing investigation that addresses potential etiologic and prognostic factors. Another goal is to alert the medical community of what appears to be a high-incidence area. A detailed peripartum cardiomyopathy registry has been implemented to include a review of case records from 1994 to 2000 and subsequently to identify new cases from February 1, 2000, to July 1, 2001. The Hospital Albert Schweitzer District of Haiti is a 600-square mile area with approximately 258,000 population served by a hospital, an associated clinic, and outlying health centers. There are approximately 7740 live births annually. This report details epidemiologic information on the HAS District peripartum cardiomyopathy patients including incidence, mortality rate, complications, and prognostic factors. There were 47 confirmed patients (retrospective cohort, 20 patients; prospective cohort, 27 patients), which was approximately 1 case per 400 live births (compared with an incidence of 1 case per 3000 to 4000 live births in the United States). There were 4 deaths (14% of 29 patients with follow-up), and 7 complications (pulmonary embolism, 1 case; hemiplegia, 1 case; subsequent deterioration of heart function, 5 cases). The prognosis for subsequent pregnancy was 4 of 5 cases (80%) of recurrent congestive heart failure. Peripartum cardiomyopathy appears to be relatively common in the Hospital Albert Schweitzer District of Haiti. A core group of patients is identified for ongoing epidemiologic and immunohematologic investigation of risk factors and potential etiologic factors.

High-fat diet prevents adaptive peripartum-associated adrenal gland plasticity and anxiolysis.

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Perani, Clara V; Neumann, Inga D; Reber, Stefan O; Slattery, David A

2015-10-07

Maternal obesity is associated with lower basal plasma cortisol levels and increased risk of postpartum psychiatric disorders. Given that both obesity and the peripartum period are characterized by an imbalance between adrenocorticotropic hormone (ACTH) and cortisol, we hypothesized that the adrenal glands undergo peripartum-associated plasticity and that such changes would be prevented by a high-fat diet (HFD). Here, we demonstrate substantial peripartum adrenal gland plasticity in the pathways involved in cholesterol supply for steroidogenesis in female rats. In detail, the receptors involved in plasma lipid uptake, low density lipoprotein (LDL) receptor (LDLR) and scavenger receptor class B type 1 (SRB1), are elevated, intra-adrenal cholesterol stores are depleted, and a key enzyme in de novo cholesterol synthesis, hydroxymethylglutaryl coenzyme A reductase (HMGCR), is downregulated; particularly at mid-lactation. HFD prevented the lactation-associated anxiolysis, basal hypercorticism, and exaggerated the corticosterone response to ACTH. Moreover, we show that HFD prevented the downregulation of adrenal cholesterol stores and HMGCR expression, and LDLR upregulation at mid-lactation. These findings show that the adrenal gland is an important regulator of peripartum-associated HPA axis plasticity and that HFD has maladaptive consequences for the mother, partly by preventing these neuroendocrine and also behavioural changes.

Bromocriptine treatment associated with recovery from peripartum cardiomyopathy in siblings: two case reports

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Drexler Helmut

2010-03-01

Full Text Available Abstract Introduction Peripartum cardiomyopathy is a rare form of cardiomyopathy, with heterogeneous presentation occurring in women between one-month antepartum and six months postpartum. It carries a poor prognosis and a high risk of mortality. Case presentation We report the development of peripartum cardiomyopathy in two sisters, 27- and 35-year-old African women, one of whom presented with a large left ventricular thrombus. Subsequently, both patients were treated with bromocriptine, heparin and standard therapy for heart failure (angiotensin converting enzyme inhibitors, beta-blockers and diuretics. During follow-up, the left ventricular thrombus observed in one patient degraded. Neither patient experienced a thrombotic event, and both experienced continuous improvements in cardiac function and New York Heart Association stage. Conclusion The development of peripartum cardiomyopathy in two sisters indicates that there may be a genetic basis for this type of cardiomyopathy, and that women with a positive family history for peripartum cardiomyopathy may have an increased risk of developing the disease. This is also the first report of a patient experiencing degradation of a large left ventricular thrombus under standard therapy for heart failure with bromocriptine. It suggests that the use of bromocriptine in association with adequate anti-coagulation and heart failure therapy may be beneficial and safe.

Peripartum back fat thickness of multiparous Holstein-Friesian cows with displacement of the abomasum or ketosis.

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Yamakawa, Kazuhiro; Aoki, Takahiro; Matsui, Motozumi; Yamada, Kazutaka; Ishii, Mitsuo

2012-05-01

To establish a method to predict postpartum diseases using prepartum back fat thickness (BFT), the peripartum BFTs of 54 healthy multiparous cows before calving, which were diagnosed with postpartum displacement of the abomasum (DA), clinical ketosis or subclinical ketosis were compared with those of healthy cows from 8 weeks before the expected calving date to 8 weeks after calving. The peripartum BFTs of the cows with DA or clinical ketosis were significantly higher than those of healthy cows. The peripartum BFTs of the cows with subclinical ketosis were not significantly higher than those of the healthy cows.

Peripartum depression and anxiety as an integrative cross domain target for psychiatric preventative measures.

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Babb, Jessica A; Deligiannidis, Kristina M; Murgatroyd, Christopher A; Nephew, Benjamin C

2015-01-01

Exposure to high levels of early life stress has been identified as a potent risk factor for neurodevelopmental delays in infants, behavioral problems and autism in children, but also for several psychiatric illnesses in adulthood, such as depression, anxiety, autism, and posttraumatic stress disorder. Despite having robust adverse effects on both mother and infant, the pathophysiology of peripartum depression and anxiety are poorly understood. The objective of this review is to highlight the advantages of using an integrated approach addressing several behavioral domains in both animal and clinical studies of peripartum depression and anxiety. It is postulated that a greater focus on integrated cross domain studies will lead to advances in treatments and preventative measures for several disorders associated with peripartum depression and anxiety. Copyright © 2014 Elsevier B.V. All rights reserved.

Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association

DEFF Research Database (Denmark)

Bock, J.; Christoffersen, J.K.; Hedegaard, M.

2008-01-01

: The authors retrospectively investigated peripartum hypoxic brain injuries registered by the Danish Patient Insurance Association. RESULTS: From 1992 to 2004, 127 approved claims concerning peripartum hypoxic brain injuries were registered and subsequently analysed. Thirty-eight newborns died, and a majority...

Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy

NARCIS (Netherlands)

K.Y. van Spaendonck-Zwarts (Karin); J.P. van Tintelen (Peter); D.J. van Veldhuisen (Dirk); R. van der Werf (Rik); J.D.H. Jongbloed (Jan); W.J. Paulus (Walter); D. Dooijes (Dennis); M.P. van den Berg (Maarten)

2010-01-01

textabstractBACKGROUND-: Anecdotal cases of familial clustering of peripartum cardiomyopathy (PPCM) and familial occurrences of PPCM and idiopathic dilated cardiomyopathy (DCM) together have been observed, suggesting that genetic factors play a role in the pathogenesis of PPCM. We hypothesized that

Peripartum cardiomyopathy: A contemporary review

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Akshai Bhandary

2018-01-01

Full Text Available Peripartum cardiomyopathy (PPCM is a rare, potentially life-threatening disorder affecting women in late pregnancy and the postpartum period. Historically, PPCM was not recognized as a separate disease entity until the 1930s. Further research has since led to the identification of at-risk demographics, theories on etiology, and new targets of therapy. Management to date has largely been focused on guideline-based treatment for heart failure with reduced ejection fraction. However, newer studies have shown the efficacy of novel therapies. In this article, we will review the pathogenesis and diagnosis of PPCM and conclude with some of the newest therapies being offered.

Peripartum Cardiomyopathy: A Current Review

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Katie M. Twomley

2010-01-01

Full Text Available Peripartum cardiomyopathy (PPCM is a rare but potentially lethal complication of pregnancy occurring in approximately 1 : 3,000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options.

Peripartum events and molar-incisor hypomineralisation (MIH) amongst young patients in southwest France.

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Garot, E; Manton, D; Rouas, P

2016-08-01

This was to investigate the association of peripartum events with the occurrence of MIH. This study, carried out between 2010 and 2011, was based on objective information noted in child health booklets on putative risk factors for MIH during the Peripartum period, aged between 6 to 28 years. The target population consisted of patients with MIH and a control group. Among the 849 patients examined by two calibrated paediatric dentists, 75 patients with MIH were recorded. These patients attended for consultation either at the teaching dental hospital of Bordeaux (France) or at a private dental practice (Bordeaux, France). Pearson's Chi-squared test was used and Odds ratios (OR) with 95 % test-based confidence intervals (CI) were calculated. Correlations were observed between hypoxia during delivery and occurrence of MIH (OR = 6.1; CI = 1.7-21.85), and also between birth by caesarean section and MIH (OR = 2.9; CI = 1.2-6.9). There was no association between prematurity and MIH. Peripartum events such as hypoxia during birth or delivery by caesarean section are suggested to be risk factors for the occurrence of MIH in this population.

Cardiac angiogenic imbalance leads to peripartum cardiomyopathy.

Science.gov (United States)

Patten, Ian S; Rana, Sarosh; Shahul, Sajid; Rowe, Glenn C; Jang, Cholsoon; Liu, Laura; Hacker, Michele R; Rhee, Julie S; Mitchell, John; Mahmood, Feroze; Hess, Philip; Farrell, Caitlin; Koulisis, Nicole; Khankin, Eliyahu V; Burke, Suzanne D; Tudorache, Igor; Bauersachs, Johann; del Monte, Federica; Hilfiker-Kleiner, Denise; Karumanchi, S Ananth; Arany, Zoltan

2012-05-09

Peripartum cardiomyopathy (PPCM) is an often fatal disease that affects pregnant women who are near delivery, and it occurs more frequently in women with pre-eclampsia and/or multiple gestation. The aetiology of PPCM, and why it is associated with pre-eclampsia, remain unknown. Here we show that PPCM is associated with a systemic angiogenic imbalance, accentuated by pre-eclampsia. Mice that lack cardiac PGC-1α, a powerful regulator of angiogenesis, develop profound PPCM. Importantly, the PPCM is entirely rescued by pro-angiogenic therapies. In humans, the placenta in late gestation secretes VEGF inhibitors like soluble FLT1 (sFLT1), and this is accentuated by multiple gestation and pre-eclampsia. This anti-angiogenic environment is accompanied by subclinical cardiac dysfunction, the extent of which correlates with circulating levels of sFLT1. Exogenous sFLT1 alone caused diastolic dysfunction in wild-type mice, and profound systolic dysfunction in mice lacking cardiac PGC-1α. Finally, plasma samples from women with PPCM contained abnormally high levels of sFLT1. These data indicate that PPCM is mainly a vascular disease, caused by excess anti-angiogenic signalling in the peripartum period. The data also explain how late pregnancy poses a threat to cardiac homeostasis, and why pre-eclampsia and multiple gestation are important risk factors for the development of PPCM.

Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.

LENUS (Irish Health Repository)

O'Brien, D

2010-12-01

The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).

Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM)

NARCIS (Netherlands)

Sliwa, Karen; Mebazaa, Alexandre; Hilfiker-Kleiner, Denise; Petrie, Mark C.; Maggioni, Aldo P.; Laroche, Cecile; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van der Meer, Peter; Roos-Hesselink, JolienW.; Seferovic, Petar; van Spandonck-Zwarts, Karin; Mbakwem, Amam; Boehm, Michael; Mouquet, Frederic; Pieske, Burkert; Hall, Roger; Ponikowski, Piotre; Bauersachs, Johann

Aims: The purpose of this study is to describe disease presentation, co-morbidities, diagnosis and initial therapeutic management of patients with peripartum cardiomyopathy (PPCM) living in countries belonging to the European Society of Cardiology (ESC) vs. non-ESC countries. Methods and results:

Quality of Life in Survivors of Peripartum Cardiomyopathy.

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Koutrolou-Sotiropoulou, Paraskevi; Lima, Fabio Vasconcelos; Stergiopoulos, Kathleen

2016-07-15

Little data exist with regard to the effect of peripartum cardiomyopathy (PPCM) on quality of life. The aim of this study was to determine the impact of PPCM on quality of life and emotional well-being. We sought to determine the feasibility of using social media to perform quality of life research. We conducted a study using a survey distributed to established members of "Peripartum Cardiomyopathy Survivors" support group on the social networking site Facebook. A total of 116 women completed the survey (age 36 ± 6.4 years; 91% white, 75% married, 46% college educated), with 4.9 ± 0.5 years (range 0.02 to 24 years) since the initial diagnosis. Most women (41%) never returned to their baseline level of activity, and 28% discontinued their job because of the diagnosis. Most respondents (56%) were not limited or only slightly limited by heart failure symptoms over the past 2 months. Most respondents (56%) never returned to their baseline emotionally after the diagnosis of PPCM, and most patients (73%) were dissatisfied with their current level of heart failure symptoms. Most patients (67%) felt discouraged frequently (more than several times per month) because of heart failure. Only 26% of women were satisfied with the counseling they received from their providers. The emotional and physical burden of PPCM on young mothers with PPCM years after the diagnosis is striking. Identifying strategies that promote better emotional health and potential treatment strategies may be required. Copyright © 2016. Published by Elsevier Inc.

Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy

NARCIS (Netherlands)

van Spaendonck-Zwarts, Karin Y.; Posafalvi, Anna; van den Berg, Maarten P.; Hilfiker-Kleiner, Denise; Bollen, Ilse A. E.; Sliwa, Karen; Alders, Mariëlle; Almomani, Rowida; van Langen, Irene M.; van der Meer, Peter; Sinke, Richard J.; van der Velden, Jolanda; van Veldhuisen, Dirk J.; van Tintelen, J. Peter; Jongbloed, Jan D. H.

2014-01-01

Peripartum cardiomyopathy (PPCM) can be an initial manifestation of familial dilated cardiomyopathy (DCM). We aimed to identify mutations in families that could underlie their PPCM and DCM. We collected 18 families with PPCM and DCM cases from various countries. We studied the clinical

Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy

NARCIS (Netherlands)

van Spaendonck-Zwarts, Karin Y.; Posafalvi, Anna; van den Berg, Maarten P.; Hilfiker-Kleiner, Denise; Bollen, Ilse A. E.; Sliwa, Karen; Alders, Marielle; AlMomani, Rowida; van Langen, Irene M.; van der Meer, Peter; Sinke, Richard J.; van der Velden, Jolanda; Van Veldhuisen, Dirk J.; van Tintelen, J. Peter; Jongbloed, Jan D. H.

2014-01-01

Aim Peripartum cardiomyopathy (PPCM) can be an initial manifestation of familial dilated cardiomyopathy (DCM). We aimed to identify mutations in families that could underlie their PPCM and DCM. Methods and results We collected 18 families with PPCM and DCM cases from various countries. We studied

Challenges in managing a mother with a dual diagnosis of peripartum cardiomyopathy and paranoid schizophrenia - a case report.

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Weerasundera, Rajiv; Yogaratnam, Jegan

2013-01-01

Psychotic illness has a low incidence in the puerperal period. Peripartum cardiomyopathy as a complication of pregnancy is also rare. We report a case where the above two conditions occurred simultaneously in a patient and posed significant difficulties in the clinical management. She was diagnosed as having paranoid schizophrenia and peripartum cardiomyopathy. Many of the antipsychotics were contraindicated, and electroconvulsive therapy could not be administered due to the added risks involved with regard to anesthesia. She was therefore managed with clonazepam and olanzapine. This case highlights the challenges in a patient with a psychiatric illness presenting with comorbid physical illness. Copyright © 2013 Elsevier Inc. All rights reserved.

Peripartum Depression, Traditional Culture, and Israeli Society.

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Dekel, Sharon; Stanger, Varda; Georgakopoulos, Emily R; Stuebe, Caren M; Dishy, Gabriella A

2016-08-01

Although it is known that culture affects psychopathology, the nature of the relationship between culture and peripartum depression (PPD) is not fully understood. Here we report on 2 cases of Israeli women who are affiliated with traditional cultural groups that emphasize reproduction but developed PPD after childbirth. The first woman is an ultra-Orthodox Israeli Jew and the second is an Israeli Arab. The 2 cases illustrate the effect of cultural beliefs and rituals on the conceptualization, treatment, and trajectory of PPD. The cases suggest a complex relationship between traditional cultures and PPD, including the possibility that cultural factors may have both adaptive and maladaptive consequences. Future qualitative and quantitative studies are needed to further clarify this relationship. © 2016 Wiley Periodicals, Inc.

Emergency peripartum hysterectomy in the Dubai health system: A fifteen year experience.

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Tahlak, Muna Abdulrazzaq; Abdulrahman, Mahera; Hubaishi, Nawal Mahmood; Omar, Mushtaq; Cherifi, Fatima; Magray, Shazia; Carrick, Frederick Robert

2018-03-01

To determine the incidence, demographic data, risk factors, indications, outcome and complications of emergency peripartum hysterectomy (EPH) performed in two major tertiary care hospitals in Dubai, and to compare the results with the literature. The records of all women who underwent EPH from January 2000 to December 2015 in two major tertiary care hospitals in Dubai were accessed and reviewed. Maternal characteristics, hysterectomy indications, outcomes, and postoperative complications were recorded using descriptive statistics to describe the cohort. There were 79 EPH out of 168.293 deliveries, a rate of 0.47/1000 deliveries. The most common indications for hysterectomy were abnormal placentation (previa and/or accreta) and uterine atony. The majority of hysterectomies were subtotal (70%). The complications were dominated by massive transfusion, urinary tract injuries, one case of maternal death, and one case of neonatal death. The main indication for EPH was abnormal placentation in scarred uterus and uterine atony. The major method of prevention of EPH is to assess women's risks and to reduce the number of cesarean section deliveries, by limiting the rate of primary cesareans. This is challenging in the United Arab Emirates (UAE) where the culture is for high gravidity and high parity. Recommendations to act to reduce primary and repeated cesareans should be included on the national agenda in UAE.

The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review

OpenAIRE

Olieman, Renske M; Siemonsma, Femke; Bartens, Margaux A; Niegel, Susan; Scheele, Fedde; Honig, Adriaan

2017-01-01

Background Obstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression. ...

Prolactin fragmentation by trophoblastic matrix metalloproteinases as a possible contributor to peripartum cardiomyopathy and pre-eclampsia

NARCIS (Netherlands)

Reuwer, Anne Q.; Reuwer, Paul J. H. M.; van der Post, Joris A.; Cramer, Maarten J.; Kastelein, John J. P.; Twickler, Marcel Th B.

2010-01-01

Although peripartum cardiomyopathy (PPCM) is a rare disease, it has very serious consequences for both mother and child. No single cause has been held responsible for the pathogenesis. Recent studies have indicated that increased proteolytic cathepsin D activity in cardiomyocytes results in 16 kDa

A 35-year-old pregnant woman presenting with sudden cardiac arrest secondary to peripartum cardiomyopathy.

Science.gov (United States)

Nelson, Matthew; Moorhead, Amy; Yost, Dana; Whorton, Adrian

2012-01-01

We present a case of successful resuscitation from cardiac arrest after 25 minutes of ventricular fibrillation (VF) secondary to peripartum cardiomyopathy. This case highlights a rare disease, but also, more importantly, the successful use of the five links of survival: early access to 9-1-1, early cardiopulmonary resuscitation (CPR), early defibrillation, early advanced life support, and postresuscitative care. We also demonstrate the importance of high-quality resuscitation practices in order to achieve a successful outcome. Manual compressions can be performed at a guidelines-compliant rate. With training, users are able to achieve high compression fractions. Pre/post shock delays can be minimized to further increase compression fraction. Nationally, CPR interruptions are often long. We recommend closer attention to uninterrupted 2-minute cycles of CPR, minimizing delays in CPR through training, and a focus on a closely choreographed approach. User review of transthoracic impedance feedback data should play a vital role in a cardiac arrest quality-improvement program.

Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management.

Science.gov (United States)

Garg, Jalaj; Palaniswamy, Chandrasekar; Lanier, Gregg M

2015-01-01

Peripartum cardiomyopathy (PPCM) is a serious pregnancy-associated disorder of unknown etiology. The precise cellular and molecular mechanisms underlying PPCM are unclear. A heightened awareness among health care providers can result in early diagnosis of heart failure in late pregnancy and the early postpartum period. Though the symptoms of dyspnea and fatigue can result from normal physiologic changes during pregnancy, an electrocardiogram and brain natriuretic peptide level should be obtained in these patients, in addition to baseline laboratory tests such as a complete blood count, and basic metabolic and hepatic function panels. If the electrocardiogram and brain natriuretic peptide level are abnormal, an echocardiogram should be obtained. The role of endomyocardial biopsy for the diagnosis of PPCM is controversial. Patients should be started on diuretics if volume overloaded, and beta-blockers (preferably metoprolol) if no contraindications exist; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy or lactation. There are no standard, universally accepted guidelines for the management of PPCM. Although experimental therapies like bromocriptine, pentoxifylline and immunoglobulins have shown promising results, large double-blind randomized trials are essential to confirm the results of smaller studies. In patients with persistent severe left ventricular (LV) dysfunction, advanced therapies like mechanical circulatory support and heart transplantation should be considered. Owing to recent data demonstrating deterioration of LV systolic function after initial recovery, it is essential to maintain long-term follow up of these patients regardless of initial recovery of LV function. We present a comprehensive review of the literature etiopathogenesis, diagnosis, and management of PPCM.

Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT).

Science.gov (United States)

Hoertel, Nicolas; López, Saioa; Peyre, Hugo; Wall, Melanie M; González-Pinto, Ana; Limosin, Frédéric; Blanco, Carlos

2015-02-01

Whether there are systematic differences in depression symptom expression during pregnancy, the postpartum period and outside these periods (i.e., outside the peripartum period) remains debated. The aim of this study was to use methods based on item response theory (IRT) to examine, after equating for depression severity, differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) in women of childbearing age (i.e., aged 18-50) during pregnancy, the postpartum period and outside the peripartum period. We conducted these analyses using a large, nationally representative sample of women of childbearing age from the United States (n = 11,256) who participated in the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The overall 12-month prevalence of all depressive criteria (except for worthlessness/guilt) was significantly lower in pregnant women than in women of childbearing age outside the peripartum period, whereas the prevalence of all symptoms (except for "psychomotor symptoms") was not significantly different between the postpartum and the nonperipartum group. There were no clinically significant differences in the endorsement rates of symptoms of MDE by pregnancy status when equating for levels of depression severity. This study suggests that the clinical presentation of depressive symptoms in women of childbearing age does not differ during pregnancy, the postpartum period and outside the peripartum period. These findings do not provide psychometric support for the inclusion of the peripartum onset specifier for major depressive disorder in the DSM-5. © 2014 Wiley Periodicals, Inc.

Superior vena thrombosis with peripartum dilated cardiomyopathy

International Nuclear Information System (INIS)

Munir, R.; Hussain, S.; Kayani, A.M.

2014-01-01

A 30 years multiparous female with history of emergency caesarean section 10 days back was referred to us with cough, severe breathlessness at rest, orthopnea with pain in neck and arms. Clinical examination revealed signs of heart failure. Echocardiography showed ejection fraction of 15%, with no right ventricular strain. A diagnosis of peripartum cardiomyopathy was made. Doppler ultrasound of neck veins showed bilateral internal jugular vein thrombosis. Subsequent multislice CT examination showed thrombosis of superior vena cava and both internal jugular veins (with collateral formation) and pulmonary embolism. There were no mediastinal abnormalities on the CT scan. Her thrombophilia screen and CT scan brain was normal. She was managed in collaboration with cardiologist. Following treatment with subcutaneous enoxaparin therapy and warfarin her symptoms of upper limb pain improved. She responded very well to medical therapy for heart failure with marked improvement of NYHA functional class. (author)

Peripartum cardiomyopathy is associated with increased uric acid concentrations: A population based study.

Science.gov (United States)

Sagy, Iftach; Salman, Amjad Abu; Kezerle, Louise; Erez, Offer; Yoel, Idan; Barski, Leonid

Peri-partum cardiomyopathy (PPCM) is a clinical heart failure that usually develops during the final stage of pregnancy or the first months following delivery. High maternal serum uric acid concentrations have been previous associated with heart failure and preeclampsia. 1) To explored the clinical characteristics of PPCM patients; and 2) to determine the association between maternal serum uric acid concentrations and PPCM. This is a retrospective population based case control study. Cases and controls were matched 1:4 (for gestational age, medical history of cardiac conditions and creatinine); conditional logistic regression was used to identify clinical parameters that were associated with PPCM. The prevalence of peripartum cardiomyopathy at our institution was 1-3832 deliveries (42/160,964). In a matched multivariate analysis high maternal serum uric acid concentrations were associated with PPCM (O.R 1.336, 95% C.I 1.003-1.778). Uric acid concentrations were higher within the Non-Jewish patients and mothers of male infant with PPCM in compare to those without PPCM (p value 0.003 and 0.01 respectively). PPCM patients had increased maternal serum uric acid concentrations. This observation aligns with previous report regarding the increased uric acid concentration in women with preeclampsia and congestive heart failure, suggestive of a common underlying mechanism that mediates the myocardial damage. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of dietary energy levels using calcium salts of fatty acids on nutritive value of diets and milk quality in peripartum dairy goats

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Rodrigo de Souza

2014-06-01

Full Text Available Peripartum is a critical period for dairy goats, as dry matter intake (DMI is not enough to supply the energy requirement for foetal growth and subsequent lactation. The objective of this study was to evaluate the use of calcium salts of fatty acids (CSFA to increase dietary energy level of peripartum dairy goats and its effects on nutritive value of diets and milk quality. Twenty multiparous Saanen goats (body weight 63.5±10.3 kg were distributed in a completely randomised design in four treatments at the following dietary energy levels: 2.6 Mcal of metabolisable energy per kg of dry matter (Mcal ME/kg DM - control diet; and 2.7, 2.8, and 2.9 Mcal/kg DM - with added CSFA. Goats were housed in individual stalls and evaluated in the peripartum period, by measuring body weight (BW, DMI, dry matter and nutrient digestibility of diets, blood composition, and milk quality and yield. Increasing dietary energy level to 2.9 Mcal ME/kg DM had no effect on BW and did not limit DMI. CSFA supplementation increased intake of total digestible nutrients and did not affect fibre digestion. Blood triglycerides and cholesterol concentration increased with CSFA addition. The treatments had no effect on milk yield and composition; however, CSFA supplementation changed the fatty acid concentration of milk fat, increasing levels of polyunsaturated and essential fatty acids. In conclusion, peripartum dairy goats supplemented with CSFA to increase dietary energy level up to 2.9 Mcal ME/kg DM had a greater supply of total digestible nutrients and showed altered fatty acid concentration of milk fat.

Metabolic profile of santa inês ewes whith low body condition score during peripartum

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Nayara Resende Nasciutti

2012-02-01

Full Text Available The objective of this study was to analyse the variations in the metabolic profile of protein, energy enzyme and mineral of Santa Inês ewes with low body condition score (BCS during peripartum. Blood samples were collected from 12 animals by jugular venipuncture to determine the serum biochemical profiles of protein, energy, mineral and enzyme metabolisms. Samples were collected on the following days: days 28, 21, 14, and 7 before lambing, at birth and, at days 2, 4, 7, 14, 21, and 28 postpartum (dpp. The samples were centrifuged and the serum analysed by Automated-Analyser. There was no alteration of the BCS during the 28 dpp, between 0.6 and 2.1 ± 2.4 ± 0.5, and was considered, as lean. The values of the total serum protein, globulin, albumin, and albumin/globulin ratio were reduced effective from the period before birth until 28dpp. The values of beta-hydroxybutyrate, calcium, phosphorus and magnesium remained below those of reference values. The concentrations of alanin aminotransferase (ALT were decreased particularly during the weeks before delivery. It was concluded that Santa Inês sheep with low body condition score demonstrated a reduction in the metabolism of proteins, energy, mineral and enzyme during peripartum.

Peripartum Antibiotics Promote Gut Dysbiosis, Loss of Immune Tolerance, and Inflammatory Bowel Disease in Genetically Prone Offspring.

Science.gov (United States)

Miyoshi, Jun; Bobe, Alexandria M; Miyoshi, Sawako; Huang, Yong; Hubert, Nathaniel; Delmont, Tom O; Eren, A Murat; Leone, Vanessa; Chang, Eugene B

2017-07-11

Factors affecting the developing neonatal gut microbiome and immune networks may increase the risk of developing complex immune disorders such as inflammatory bowel diseases (IBD). In particular, peripartum antibiotics have been suggested as risk factors for human IBD, although direct evidence is lacking. Therefore, we examined the temporal impact of the commonly used antibiotic cefoperazone on both maternal and offspring microbiota when administered to dams during the peripartum period in the IL-10-deficient murine colitis model. By rigorously controlling for cage, gender, generational, and murine pathobiont confounders, we observed that offspring from cefoperazone-exposed dams develop a persistent gut dysbiosis into adulthood associated with skewing of the host immune system and increased susceptibility to spontaneous and chemically dextran sodium sulfate (DSS)-induced colitis. Thus, early life exposure to antibiotic-induced maternal dysbiosis during a critical developmental window for gut microbial assemblage and immune programming elicits a lasting impact of increased IBD risk on genetically susceptible offspring. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Recruiting and consenting into a peripartum trial in an emergency setting: a qualitative study of the experiences and views of women and healthcare professionals.

Science.gov (United States)

Lawton, Julia; Snowdon, Claire; Morrow, Susan; Norman, Jane E; Denison, Fiona C; Hallowell, Nina

2016-04-11

Recruiting and consenting women to peripartum trials can be challenging as the women concerned may be anxious, in pain, and exhausted; there may also be limited time for discussion and decision-making to occur. To address these potential difficulties, we undertook a qualitative evaluation of the internal pilot of a trial (Got-it) involving women who had a retained placenta (RP). We explored the experiences and views of women and staff about the information and consent pathway used within the pilot, in order to provide recommendations for use in future peripartum trials involving recruitment in emergency situations. In-depth interviews were undertaken with staff (n = 27) and participating women (n = 22). Interviews were analysed thematically. The accounts of women and staff were compared to identify differences and similarities in their views about recruitment and consent procedures. Women and staff regarded recruitment as having been straightforward and facilitated by the use of simplified (verbal and written) summaries of trial information. Both parties, however, conveyed discordant views about whether fully informed consent had been obtained. These differences in perspectives appeared to arise from the different factors and considerations impinging on women and staff at the time of recruitment. While staff placed emphasis on promoting understanding in the emergency situation of RP by imparting information in clear and succinct ways, women highlighted the experiential realities of their pre- and post-birthing situations, and how these had led to quick decisions being made without full engagement with the potential risks of trial participation. To facilitate informed consent, women suggested that trial information should be given during the antenatal period, and, in doing so, articulated a rights-based discourse. Staff, however, voiced opposition to this approach by emphasising a duty of care to all pregnant women, and raising concerns about causing undue

Prenatal and Postpartum Evening Salivary Cortisol Levels in Association with Peripartum Depressive Symptoms

Science.gov (United States)

Iliadis, Stavros I.; Comasco, Erika; Sylvén, Sara; Hellgren, Charlotte; Sundström Poromaa, Inger; Skalkidou, Alkistis

2015-01-01

Background The biology of peripartum depression remains unclear, with altered stress and the Hypothalamus-Pituitary-Adrenal axis response having been implicated in its pathophysiology. Methods The current study was undertaken as a part of the BASIC project (Biology, Affect, Stress, Imaging, Cognition), a population-based longitudinal study of psychological wellbeing during pregnancy and the postpartum period in Uppsala County, Sweden, in order to assess the association between evening salivary cortisol levels and depressive symptoms in the peripartum period. Three hundred and sixty-five pregnant women from the BASIC cohort were recruited at pregnancy week 18 and instructed to complete a Swedish validated version of the Edinburgh Postnatal Depression Scale at the 36th week of pregnancy as well as the sixth week after delivery. At both times, they were also asked to provide evening salivary samples for cortisol analysis. A comprehensive review of the relevant literature is also provided. Results Women with postpartum EPDS score ≥ 10 had higher salivary evening cortisol at six weeks postpartum compared to healthy controls (median cortisol 1.19 vs 0.89 nmol/L). A logistic regression model showed a positive association between cortisol levels and depressive symptoms postpartum (OR = 4.1; 95% CI 1.7–9.7). This association remained significant even after controlling for history of depression, use of tobacco, partner support, breastfeeding, stressful life events, and sleep problems, as possible confounders (aOR = 4.5; 95% CI 1.5–14.1). Additionally, women with postpartum depressive symptoms had higher postpartum cortisol levels compared to both women with depressive symptoms antenatally and controls (p = 0.019 and p = 0.004, respectively). Conclusions Women with depressive symptoms postpartum had higher postpartum cortisol levels, indicating an altered response of the HPA-axis in postpartum depression. PMID:26322643

Cardiomiopatía periparto Peripartum cardiomyopathy

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Jorge E Velásquez V

2008-02-01

Full Text Available La cardiomiopatía periparto es una entidad clínica con una frecuencia variable de acuerdo con la zona en estudio. Se caracteriza por disfunción sistólica del ventrículo izquierdo y posterior aparición de síntomas de falla cardiaca, los cuales ocurren durante el último mes de gestación y los primeros meses post- parto. Su etiología aún no es clara, pero se plantean diferentes teorías, las cuales se basan en fenómenos inflamatorios, infecciosos y auto-inmunes. Recientemente, se describieron alteraciones relacionadas con el estrés oxidativo, que podrían explicar en gran medida esta patología. Su presentación clínica guarda gran similitud con las demás causas de falla cardíaca, aunque se han descrito presentaciones atípicas. Su diagnóstico requiere alto nivel de sospecha y debe considerarse en toda mujer con síntomas de falla cardíaca durante el periparto. El tratamiento convencional de la falla cardiaca crónica que incluye beta-bloqueadores, inhibidores de la enzima convertidora de angiotensina y diuréticos, además de los adelantos en el diagnóstico y manejo de la falla cardiaca aguda, permitió cambiar la historia de la enfermedad al disminuir la mortalidad y recuperar la función sistólica del ventrículo izquierdo. Las gestaciones posteriores al desarrollo de esta entidad, dependerán de la recuperación completa de la función cardíaca, sin disminuir el riesgo de recurrencia. Todavía existen múltiples preguntas por responder en áreas como etiología, factores de riesgo, tratamiento y marcadores pronósticos que permitan prevenir y manejar en forma oportuna y segura tanto a la madre como a su hijo.Peripartum cardiomyopathy is a clinical entity with a variable frequency according to the zone of the study. It is characterized by a systolic dysfunction of the left ventricle and posterior appearance of heart failure symptoms that occur during the last month of pregnancy and the first post-partum months. Its etiology

Peripartum Cardiomyopathy: Moving Towards a More Central Role of Genetics#

Science.gov (United States)

Cemin, Roberto; Janardhanan, Rajesh; Donazzan, Luca; Daves, Massimo

2013-01-01

Peripartum cardiomyopathy (PCM) is a relatively rare disease with potentially devasting consequences requiring prompt identification and correct treatment. Overall prognosis is good in majority of the cases, although some patients may progress to irreversible heart failure. Early diagnosis is important and effective treatment reduces mortality rates and increases the chance of complete recovery of ventricular systolic function. The aetiology and pathogenesis seems to be multifactorial and poorly understood, with the available literature rather conflicting. In recent years, there has been increased interest in the role played by genetic predisposition in the development of PCM. It probably develops as a result of a complex interaction of pregnancy-associated factors and genetic factors and recently there have been many observations pointing out the central role played by a genetic predisposition. The direct and indirect observations on genetic susceptibility may offer new insights into the pathogenesis of PCM. However, larger studies are needed before advising routine genetic testing in these patients. PMID:23909634

Metabolic predictors of peri-partum diseases and their association with parity in dairy cows.

Science.gov (United States)

Ruprechter, Gretel; Adrien, Maria de Lourdes; Larriestra, Alejandro; Meotti, Otavio; Batista, Chester; Meikle, Ana; Noro, Mirela

2018-02-19

The predictive values of plasma non-esterified fatty acid (NEFA), beta-hydroxybutyrate (BHB), cholesterol, albumin and calcium to predict risk of peripartum diseases in primiparous (PP) and multiparous (MP) Holstein cows was investigated. Besides it was assessed if the health status interacted with parity on body condition score and metabolic profiles during the transition period. Dairy cows (126 PP and 182 MP) from a commercial dairy free stall herd (loose-housing system) were weekly body condition scored and tail bled for metabolites determination from -3 to +4 weeks relative to calving. Peripartum diseases were diagnosed by a single trained veterinarian, while subclinical diseases (ketosis and hypocalcemia) were diagnosed at the laboratory. Cows were classified as healthy cows, cows with one event, or cows with two clinical events following a prospective observational cohort study, with only healthy cows enrolled at the beginning of the study. The largest incidence was for metritis (26.6%) followed by retained placenta (17.2%) and mastitis (15.2%) with no effect of parity, while subclinical hypocalcemia incidence was greater in MP than PP cows (43% vs 9.5%) respectively. In MP cows albumin concentrations were predictive for metritis at week -2 and for retained placenta at weeks -2 and -1, while cholesterol was predictive for mastitis at week -2, -1 and at calving. The interaction between health status and parity affected all metabolites during the transition period. This study showed a different evolution of metabolic profiles in healthy and sick cows during the transition according to parity, pointing out albumin and cholesterol as diseases predictors before calving. Copyright © 2018 Elsevier Ltd. All rights reserved.

Fetal placental prostaglandin metabolism in the peripartum cow

International Nuclear Information System (INIS)

Gross, T.S.; Williams, W.F.; Lewis, G.S.

1986-01-01

Previous results demonstrate that fetal placental tissue synthesizes prostaglandin E (PGE) prior to parturition. When placental membranes do not separate postpartum, PGE synthesis is maintained, while prostaglandin F (PGF) synthesis predominates when the membranes separate. Concurrent with separation is a decline in fetal placental binucleate cell (BNC) numbers. These data suggest a fetal placental conversion of PGE to PGF. For this experiment, placentomes were collected at ten days prepartum (PRE, n=12) and within 1 hr postpartum. Nine of the postpartum animals had fetal membrane separation within 12 hr postpartum (S) and eight did not exhibit membrane separation (NS). For each placentome, fetal (villi) components were manually isolated and examined for the ability to interconvert 3 H labeled PGE 2 and PGF 2 . All villi were unable to convert PGE 2 to PGF 2 (P > .05). The PRE and NS villi were able to convert PGF 2 to PGE 2 (P 2 to PGE 2 (P 2 to PGE 2 also declines (P < .05). These data suggest that peripartum fetal placental tissue might synthesize PGF which is then converted to PGE. It is possible that the BNC are directly converting PGF to PGE or that they are modulating this conversion. Therefore, with a decline in BNC numbers, PGF synthesis would predominate

Defining the Adipose Tissue Proteome of Dairy Cows to Reveal Biomarkers Related to Peripartum Insulin Resistance and Metabolic Status.

Science.gov (United States)

Zachut, Maya

2015-07-02

Adipose tissue is a central regulator of metabolism in dairy cows; however, little is known about the association between various proteins in adipose tissue and the metabolic status of peripartum cows. Therefore, the objectives were to (1) examine total protein expression in adipose tissue of dairy cows and (2) identify biomarkers in adipose that are linked to insulin resistance and to cows' metabolic status. Adipose tissue biopsies were obtained from eight multiparous cows at -17 and +4 days relative to parturition. Proteins were analyzed by intensity-based, label-free, quantitative shotgun proteomics (nanoLC-MS/MS). Cows were divided into groups with insulin-resistant (IR) and insulin-sensitive (IS) adipose according to protein kinase B phosphorylation following insulin stimulation. Cows with IR adipose lost more body weight postpartum compared with IS cows. Differential expression of 143 out of 586 proteins was detected in prepartum versus postpartum adipose. Comparing IR to IS adipose revealed differential expression of 18.9% of the proteins; those related to lipolysis (hormone-sensitive lipase, perilipin, monoglycerol lipase) were increased in IR adipose. In conclusion, we found novel biomarkers related to IR in adipose and to metabolic status that could be used to characterize high-yielding dairy cows that are better adapted to peripartum metabolic stress.

Peripartum cardiomyopathy: risk factors, hospital course and prognosis; experiences at lady reading hospital Peshawar

International Nuclear Information System (INIS)

Shah, I.; Shahzeb, A.; Shah, S.T.; Faheem, M.; Rafiullah, A.; Hafizullah, M.

2012-01-01

Objective: To study the so-called risk factors associated with peripartum cardiomyopathy (PPCM), its hospital course, short and long term mortality and outcome of subsequent pregnancies. Methodology: A total of 61 patients diagnosed with PPCM were enrolled in the study. Data regarding risk factors, presenting complaints, complications, pregnancy outcomes, therapeutics used and outcome at 3, 6 and 12 months were recorded. Results: The incidence was estimated to be 1 per 933 deliveries. Mean age +- SD was 30.94+-6.63 years. Majority of patients 33(54.1%) were obese. The mean parity was 3.66 +- 1.41. Other risk factors were chronic hypertension 19 (31.1%), pre-eclampsia 12 (19.7%) and multiple pregnancies 5(8.2%). Forty-three patients 43(70.5%) presented in post partum period while 18 (29.5%) in antepartum period. All patients presented with dyspnea. Main ECG findings were sinus tachycardia 39 (63.9%), LV hypertrophy 42 (68.9%) and T wave inversion 28(45.9%). Ejection fraction was universally reduced on echocardiography. There were 50(82%) live births and 11(18%) perinatal deaths. Main complications were pulmonary edema 7(11.5%), cardiogenic shock 8(13.1%) and thromboembolism 13(21.3%). At hospital discharge, 9 (14.8%) patients were dead and 52(85.2%) were discharged with stable heart failure. At 12 month follow up, a total of 20(32.8%) were dead while 32(52.5%) had recovered fully and 9(14.75%) were still suffering from heart failure. During follow up, only 8(19.5%) pregnancies were detected. Five (62.5%) patients had uneventful course while 3(37.5%) developed heart failure again. Conclusion: Peripartum cardiomyopathy is associated with multiple risk factors and carries high morbidity and mortality. (author)

A Change of Heart: Case Series of Peripartum Cardiomyopathy

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Sean Martin

2013-01-01

Full Text Available Peripartum cardiomyopathy (PPCM is an uncommon disease of pregnancy, occurring in about 1 in 2000 live births, and is characterized by the development of heart failure, due to left ventricular systolic dysfunction. It is associated with high rates of maternal and neonatal mortality. Cardiac disease is the leading cause of maternal death in the UK: PPCM accounts for about 17% of these. Clinical findings of decompensated heart failure (HF are often masked by the normal physiological changes seen in pregnancy making the diagnosis challenging. A high index of suspicion is essential—prompting referral for echocardiogram, which is crucial for diagnosis. Favourable prognosis is dependent on the early initiation of HF medications. Although full recovery occurs in around half of cases, left ventricular systolic dysfunction persists in a significant proportion of patients with PPCM and the risk of recurrence in subsequent pregnancies is high. The pathophysiology of PPCM is under intense research. We present four patients with PPCM and a review of the literature. Owing to the diagnostic challenge of PPCM and decompensated HF in pregnant mothers and its high mortality rate without treatment, prompt investigation and referral are key to improving maternal survival.

Research gaps in neonatal HIV-related care

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Mary-Ann Davies

2015-05-01

Full Text Available The South African prevention of mother to child transmission programme has made excellentprogress in reducing vertical HIV transmission, and paediatric antiretroviral therapyprogrammes have demonstrated good outcomes with increasing treatment initiation inyounger children and infants. However, both in South Africa and across sub-Saharan African,lack of boosted peri-partum prophylaxis for high-risk vertical transmission, loss to followup,and failure to initiate HIV-infected infants on antiretroviral therapy (ART before diseaseprogression are key remaining gaps in neonatal HIV-related care. In this issue of the Southern African Journal of HIV Medicine, experts provide valuable recommendations for addressingthese gaps. The present article highlights a number of areas where evidence is lacking toinform guidelines and programme development for optimal neonatal HIV-related care.

Antenatal Deworming and Materno-Perinatal Outcomes in Calabar, Nigeria

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Ubong Bassey Akpan

2018-05-01

CONCLUSION: Presumptive deworming during the antenatal period can significantly reduce the incidence of peripartum anaemia. However, more studies may be needed to prove any positive perinatal outcome.

Usefulness of vessel-sealing devices for peripartum hysterectomy: a retrospective cohort study.

Science.gov (United States)

Rossetti, Diego; Vitale, Salvatore Giovanni; Bogani, Giorgio; Rapisarda, Agnese Maria Chiara; Gulino, Ferdinando Antonio; Frigerio, Luigi

2015-09-01

To evaluate the feasibility to perform peripartum hysterectomy (PH) with the introduction of LigaSure™ vessels-sealing device (LVSD) and how it influenced the surgical outcomes. We retrospectively evaluated procedures and outcome of women undergoing PH during the period between January 2001 and October 2013. Perioperative surgical results of patients undergoing PH using LVSD were compared to patients undergoing PH without LVSD. Forty-nine subjects had PH during the study period. Twenty (41%) hysterectomies were performed for placenta accreta, 8 (16%) for placenta previa, 21 (43%) for atony. Twenty-three subjects had PH using LVSD and 26 subjects had hysterectomy without the use of this device. We observe significant differences in estimated blood loss (p = 0.001), massive blood transfusions (>10 units RBC) (p = 0.025), operative time (p = 0.06). No difference in term of hospital stay and complications were observed (p = 0.78 and p = 0.35). One patient for each group had intraoperative complication (p = 0.9). The use of LVSD during PH does not increase operative complications, blood loss, and operative time in comparison to standard procedure.

The Effect of Race on Provider Decisions to Test for Illicit Drug Use in the Peripartum Setting

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KUNINS, HILLARY VEDA; BELLIN, ERAN; CHAZOTTE, CYNTHIA; DU, EVELYN; ARNSTEN, JULIA HOPE

2010-01-01

Background Testing for illicit drugs may expose women who test positive to severe legal and social consequences. It is unknown whether racial disparities in drug testing practices underlie observed disparities in legal and social consequences of positive tests. Methods Using administrative hospital and birth certificate data, we analyzed factors associated with both receipt and results of illicit drug testing among women with live births during 2002–2003. We assessed the independent association of race and other sociodemographic factors with both receipt of a drug test by the mother or her newborn infant and positive maternal or neonatal toxicology results, after controlling for obstetrical conditions and birth outcomes associated with maternal substance abuse. Results Of the 8487 women with live births, 244 mother-newborn pairs (3%) were tested for illicit drug use. Black women and their newborns were 1.5 times more likely to be tested for illicit drugs as nonblack women in multivariable analysis. However, race was not independently associated with a positive result. Conclusions We identified racial differences in rates of testing for illicit drug use between black and nonblack women. We found equivalent positivity rates among tested black and nonblack women. The prevalence of drug use among untested women is unknown, however, so although tested women had equivalent rates of substance use detected, whether black and nonblack substance users are equally likely to be identified in the course of peripartum care remains uncertain. PMID:17388741

Changing trends in peripartum hysterectomy over the last 4 decades.

LENUS (Irish Health Repository)

Flood, Karen M

2012-02-01

OBJECTIVE: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years. STUDY DESIGN: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital. RESULTS: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4\\/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001). CONCLUSION: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.

Peripartum hysterectomy in the first decade of the 21st century.

LENUS (Irish Health Repository)

Tadesse, W

2012-02-01

We reviewed the role of peripartum hysterectomy (PH) in the first decade of the 21st century. The study was confined to women who delivered a baby weighing 500 g or more between 2000 and 2009, and who required a hysterectomy within 72 h of delivery for obstetric reasons. Individual case records were reviewed. There were 19 cases of PH in 78,961 deliveries giving an incidence of 1 in 4,156 (0.02%). Of the 19 cases, 95% were delivered by caesarean section and 89% had one or more prior sections. The indications were placental bed pathology (79%), uterine atony (16%) and uterine trauma (5%). Of the 19 hysterectomies, 16 (84%) were total and a gynaecological oncologist was involved in nine (56%) of these cases. There were no maternal or fetal deaths, but a mother required an average blood transfusion of 10 units. The overall rate of PH was remarkably low compared with other studies but it is likely to increase in the future because of the strong association between increasing caesarean section rates and placental bed pathology. The potential involvement of the cervix and other pelvic structures by placental pathology means that PH in the future will be more challenging, and the hysterectomy will need to be total rather than subtotal.

Transient peripartum osteoporosis of the femoral head in first and third pregnancy.

Science.gov (United States)

Truszczyńska, Aleksandra; Walczak, Piotr; Rapała, Kazimierz

2012-01-01

The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient-a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3 wk each. She breastfed her second baby for 4 mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7 yr. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Dyspnoea at Term in an Obese Mother

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Vicky O'Dwyer

2011-01-01

Full Text Available Peripartum cardiomyopathy is a serious, potentially life-threatening heart disease of uncertain aetiology in previously healthy women. We report a morbidly obese woman who presented with peripartum shortness of breath. We discuss the differential diagnosis of dyspnoea in pregnancy and highlight the complexity of care of the morbidly obese woman.

Perturbation of neonatal microbial gut community by peripartum antibiotics in wistar rats lead to decreased weight gain

DEFF Research Database (Denmark)

Tulstrup, Monica Vera-Lise; Bahl, Martin Iain; Roager, Henrik Munch

2016-01-01

orally to either mothers or young children to treat or prevent bacterial infections not necessarily related to the gastrointestinal system. This has adverse effects on the commensal gut microbial community, as it disrupts the intricate balance between specific bacterial groups within this ecosystem......, potentially leading to dysbiosis. We hypothesized that modulation of community composition and function induced by peripartum antibiotics affects intestinal microbial composition and general health of the offspring. To address this, 33 pregnant Wistar rats were dosed by oral gavage with either amoxicillin......H as well as spleen size than control animals. Offspring were dissected at different time points and significant changes in liver, spleen and epididymal fat were measured between groups. Composition of the gut microbiota, alpha diversity, caecum short chain fatty acid levels, caloric contents of faeces...

The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery.

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Colmorn, Lotte B; Petersen, Kathrine B; Jakobsson, Maija; Lindqvist, Pelle G; Klungsoyr, Kari; Källen, Karin; Bjarnadottir, Ragnheidur I; Tapper, Anna-Maija; Børdahl, Per E; Gottvall, Karin; Thurn, Lars; Gissler, Mika; Krebs, Lone; Langhoff-Roos, Jens

2015-07-01

To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. Prospective, Nordic collaboration. The Nordic Obstetric Surveillance Study (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases by using International Classification of Diseases, 10th revision codes on diagnoses and the Nordic Medico-Statistical Committee Classification of Surgical Procedure codes. Rates of the studied complications and possible risk factors among parturients in the Nordic countries. The studied complications were reported in 1019 instances among 605 362 deliveries during the study period. The reported rate of severe blood loss at delivery was 11.6/10 000 deliveries, complete uterine rupture was 5.6/10 000 deliveries, abnormally invasive placenta was 4.6/10 000 deliveries, and peripartum hysterectomy was 3.5/10 000 deliveries. Of the women, 25% had two or more complications. Women with complications were more often >35 years old, overweight, with a higher parity, and a history of cesarean delivery compared with the total population. The studied obstetric complications are rare. Uniform definitions and valid reporting are essential for international comparisons. The main risk factors include previous cesarean section. The detailed information collected in the NOSS database provides a basis for epidemiologic studies, audits, and educational activities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Case study of first episode schizophrenia in pregnancy and postpartum.

Science.gov (United States)

Kast, Kristopher A; Agarkar, Smita

2017-08-01

Patients with first-episode psychosis of peripartum onset commonly prove to have a mood-disorder diathesis; however, a proportion of cases represent first-episode schizophrenia. We present such a case and discuss the clinical relevance of recognizing this small but important population of new mothers. These patients are at considerable risk of misdiagnosis, resulting in ineffective maintenance therapy, poorer recovery of function, and development of treatment resistance. Accurate diagnosis in the peripartum period will impact treatment decisions and long-term therapy. Clinicians need to be vigilant, especially during maintenance therapy, to identify these patients and ensure appropriate antipsychotic therapy is provided.

The significance of peripartum fever in women undergoing vaginal deliveries.

Science.gov (United States)

Bensal, Adi; Weintraub, Adi Y; Levy, Amalia; Holcberg, Gershon; Sheiner, Eyal

2008-10-01

We investigated whether patients undergoing vaginal delivery who developed peripartum fever (PPF) had increased rates of other gestational complications. A retrospective study was undertaken comparing pregnancy complications of patients who developed PPF with those who did not. A multivariable logistic regression model was constructed to control for confounders. To avoid ascertainment bias, the year of birth was included in the model. Women who underwent cesarean delivery and those with multiple pregnancies were excluded from the study. During the study period, there were 169,738 singleton vaginal deliveries, and 0.4% of the women suffered from PPF. Hypertensive disorders, induction of labor, dystocia of labor in the second stage, suspected fetal distress, meconium-stained amniotic fluid, postpartum hemorrhage, manual lysis of a retained placenta, and revision of the uterine cavity and cervix were found to be independently associated with PPF by multivariable analysis. Year of birth was found to be a risk factor for fever. Apgar scores lower than 7 at 1 but not 5 minutes were significantly higher in the PPF group. Perinatal mortality rates were significantly higher among women with PPF (6.7% versus 1.3%, odds ratio [OR] = 5.4; 95% confidence interval [CI] 3.9 to 7.3; P < 0.001). Using another multivariable analysis, with perinatal mortality as the outcome variable, PPF was found as an independent risk factor for perinatal mortality (OR = 2.9; 95% CI 1.9 to 4.6; P < 0.001). PPF in women undergoing vaginal deliveries is associated with adverse perinatal outcomes and specifically is an independent risk factor for perinatal mortality.

Association of a patent foramen ovale with myocardial infarction and pulmonary emboli in a peripartum woman.

Science.gov (United States)

Ramineni, Rajesh; Daniel, George K

2010-10-01

Peripartum myocardial infarction is uncommon but devastating in young women. Although it is generally associated with arterial dissection, pregnancy-induced hypercoagulable state can also be a major contributor. Association of patent foramen ovale (PFO) adds to this potential risk. A 29-year-old postpartum female presented with worsening chest pressure, shortness of breath and syncope. She was hypotensive and tachycardic. A ventilation perfusion imaging displayed high probability for pulmonary emboli. With elevated cardiac enzymes and echocardiogram showing wall motion abnormalities, patient underwent percutaneous coronary angioplasty for a midvessel thrombus in the left anterior descending artery. Further workup showed a thrombus straddling into the left atrium via a PFO and a deep venous thrombus in the right iliac vein. Hormonal changes in pregnancy are noted to place young women in a hypercoagulable state. Screening for PFO in this group of patients with timely intervention might prevent a major systemic event caused by paradoxical embolus.

The Medical Treatment of New-Onset Peripartum Cardiomyopathy: A Systematic Review of Prospective Studies.

Science.gov (United States)

Desplantie, Olivier; Tremblay-Gravel, Maxime; Avram, Robert; Marquis-Gravel, Guillaume; Ducharme, Anique; Jolicoeur, E Marc

2015-12-01

Peripartum cardiomyopathy (PPCM) is a rare disorder with potentially fatal consequences, which occurs mainly in previously healthy women. The aetiology of PPCM remains unknown and various pathologic mechanisms have been proposed, including immune-mediated injuries and impaired response to oxidative stress and inflammatory cytokines. Several therapies have been studied, but few have been validated in a well-designed randomized controlled trial. In the present study we sought to review the medical treatment intended for acute PPCM. To this end, we performed a systematic review of the literature of randomized and nonrandomized prospective clinical studies. We identified 2 randomized controlled trials that evaluated the dopamine agonist bromocriptine and the inotrope levosimendan, respectively, and 1 nonrandomized study that evaluated the nonselective phosphodiesterase inhibitor pentoxifylline. We reviewed the pathophysiological, pharmacological, and clinical properties for each treatment option identified. Bromocriptine and pentoxifylline both improved left ventricular systolic function and patient-oriented clinical end points and levosimendan did not improve mortality or echocardiographic findings of PPCM. In this review we identified bromocriptine and pentoxifylline, but not levosimendan, as potentially useful agents to improve left ventricle function and outcomes in PPCM. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review.

Science.gov (United States)

Olieman, Renske M; Siemonsma, Femke; Bartens, Margaux A; Garthus-Niegel, Susan; Scheele, Fedde; Honig, Adriaan

2017-06-19

Obstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression. We searched on PubMed, PsychoInfo and Embase. Studies were included with primary data on anxiety and/or depression postpartum in women with childbirth fear who had requested an ECS. After full-text evaluation of 65 papers and quality analysis of four papers, three papers were included. Of one paper additional and yet unpublished data were provided. Studies varied in outcome measures, hence no meta-analysis was performed. Women who requested an ECS had higher antepartum depression and anxiety levels but no different postpartum depression levels than women who delivered vaginally. One study of good quality examined the effect of vaginal delivery in women preferring ECS: These women had significantly higher symptom levels of post-traumatic stress disorder (PTSD) and depression than women with normal vaginal delivery. The prospect of an ECS does not lower antepartum anxiety and/or depression levels in women requesting an ECS. If women resolutely persist in wishing an ECS despite adequate counselling and/or psychiatric treatment, the risk of developing depressive and PTSD symptoms in case of vaginal delivery should be taken into account, and an ECS may be considered as a valid alternative.

Symbolic logic and mechanical theorem proving

CERN Document Server

Chang, Chin-Liang

1969-01-01

This book contains an introduction to symbolic logic and a thorough discussion of mechanical theorem proving and its applications. The book consists of three major parts. Chapters 2 and 3 constitute an introduction to symbolic logic. Chapters 4-9 introduce several techniques in mechanical theorem proving, and Chapters 10 an 11 show how theorem proving can be applied to various areas such as question answering, problem solving, program analysis, and program synthesis.

Clinical Risk Factors Associated With Peripartum Maternal Bacteremia.

Science.gov (United States)

Easter, Sarah Rae; Molina, Rose L; Venkatesh, Kartik K; Kaimal, Anjali; Tuomala, Ruth; Riley, Laura E

2017-10-01

To evaluate risk factors associated with maternal bacteremia in febrile peripartum women. We performed a case-control study of women with fevers occurring between 7 days before and up to 42 days after delivery of viable neonates at two academic hospitals. Women with positive blood cultures were matched with the next two febrile women meeting inclusion criteria with negative blood cultures in the microbiology data without other matching parameters. We compared maternal and neonatal characteristics and outcomes between women in the case group and those in the control group with univariate analysis. We then used logistic regression to examine the association between clinical characteristics and maternal bacteremia. After excluding blood cultures positive only for contaminants, we compared 115 women in the case group with 285 in the control group. Bacteremic women were more likely to experience their initial fever during labor (40.9% compared with 22.8%, P<.01) and more likely to have fever at or above 102°F (62.6% compared with 31.6%, P<.01). These associations persisted in the adjusted analysis: multiparity (adjusted odds ratio [OR] 1.75, 95% CI 1.07-2.87), initial fever during labor (adjusted OR 2.82, 95% CI 1.70-4.70), and fever at or above 102°F (adjusted OR 3.83, 95% CI 2.37-6.19). In an analysis restricted to neonates whose mothers had initial fevers before or in the immediate 24 hours after delivery, neonates born to women in the case group had higher rates of bacteremia compared with those born to women in the control group (9.0% compared with 1.3%, P<.01). Eight of the nine bacteremic neonates born to bacteremic mothers (89%) grew the same organism as his or her mother in blood culture. Maternal bacteremia is associated with multiparity, initial fever during labor, and fever at or above 102°F; however, 37.5% of cases of bacteremia occurred in women with maximum fevers below this threshold. Obstetricians should maintain a heightened suspicion for an

Proving productivity in infinite data structures

NARCIS (Netherlands)

Zantema, H.; Raffelsieper, M.; Lynch, C.

2010-01-01

For a general class of infinite data structures including streams, binary trees, and the combination of finite and infinite lists, we investigate the notion of productivity. This generalizes stream productivity. We develop a general technique to prove productivity based on proving context-sensitive

Emergency peripartum hysterectomy, physical and mental consequences: a 6-year study

Directory of Open Access Journals (Sweden)

Denisa-Oana Bălălău

2016-04-01

Full Text Available Emergency peripartum hysterectomy (EPH is performed for massive postpartum hemorrhage following a cesarean delivery or vaginal delivery, in order to save the patient’s life. The current study was performed on a sample of 13.162 patients, which underwent cesarean or vaginal delivery during a period of 6 years, from 2010 to 2015, in Bucur Maternity Hospital. There were two subsequential groups consisting in: 6593 patients with cesarean operations and 6569 patients with vaginal delivery. In 12 cases occurred one or more of the risk factors that lead to EPH, divided equally across the two groups above. The main two types of surgery are a more frequent subtotal hysterectomy, which is the preferred type of EPH as it takes less time and is associated with fewer complications, and a total hysterectomy. The majority of procedures were performed at patients over 35 years old (9 of 12, with a median age of 31,16 (ranging from 21 to 44 years old. The most important risk factor present across the lot was multiparity (11 from 12, with cicatricial uterus being the second one (4 of 12. ICU median time was 4,5 days (ranging from 3 to 15 days, with a median blood transfusion necessity of around 2,4 I.U per patient. There were no mother or newborn reported deaths, neither PTSD following EPH.EPH is a procedure performed as last-resort, life-saving surgery, leaving no time for mental preparation of the patients. This may predispose to negative psychological outcomes, especially because they are not part of decision-making process due to the emergency character of hysterectomy.

Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE Registry

Directory of Open Access Journals (Sweden)

Kamilu M Karaye

2017-01-01

Full Text Available Background Nigeria probably has the highest burden of Peripartum Cardiomyopathy (PPCM in the world. The primary objective of this study is to describe the burden, ventricular remodelling and survival of PPCM in Nigeria. In the sub-studies, we aim to describe the relationship between selenium deficiency, oxidative stress and PPCM, the impact of sodium selenite supplementation on left ventricular reverse remodelling, change in New York Heart Association functional class and survival in PPCM, and the prevalence of selenium deficiency and its relationship with cardiac function in apparently healthy pregnant women. Methods The main registry and the first sub-study are prospective longitudinal studies, while the second sub-study is an open-label randomised trial. 36 study centres across Nigeria have been registered and 14 of them are already recruiting subjects. Patients will be recruited from June to December 2017 and followed up till December 2018. Serum selenium and glutathione peroxidase will be assayed at recruitment for consecutive PPCM patients with LV ejection fraction (LVEF <45% at 6 months postpartum. 200 subjects with selenium deficiency will be randomised into treatment (Selenium Selenite 200μg tablets daily for 3 months and no-treatment arms. In the second sub-study, 120 apparently healthy pregnant women (Controls will be recruited at 28-38 weeks of gestation and reviewed at 6-8 weeks postpartum, and their serum selenium and GPO levels will be measured at recruitment. Conclusions This will be the largest systematic evaluation of PPCM in Nigeria, and it is hoped that the information will assist in understanding the disease better and developing locally applicable interventions for the disease. ClinicalTrials.gov Identifier: NCT03081949

Proving relations between modular graph functions

International Nuclear Information System (INIS)

Basu, Anirban

2016-01-01

We consider modular graph functions that arise in the low energy expansion of the four graviton amplitude in type II string theory. The vertices of these graphs are the positions of insertions of vertex operators on the toroidal worldsheet, while the links are the scalar Green functions connecting the vertices. Graphs with four and five links satisfy several non-trivial relations, which have been proved recently. We prove these relations by using elementary properties of Green functions and the details of the graphs. We also prove a relation between modular graph functions with six links. (paper)

The role of therapeutic optimism in recruitment to a clinical trial in a peripartum setting: balancing hope and uncertainty.

Science.gov (United States)

Hallowell, Nina; Snowdon, Claire; Morrow, Susan; Norman, Jane E; Denison, Fiona C; Lawton, Julia

2016-06-01

Hope has therapeutic value because it enables people to cope with uncertainty about their future health. Indeed, hope, or therapeutic optimism (TO), is seen as an essential aspect of the provision and experience of medical care. The role of TO in clinical research has been briefly discussed, but the concept, and whether it can be transferred from care to research and from patients to clinicians, has not been fully investigated. The role played by TO in research emerged during interviews with staff involved in a peripartum trial. This paper unpacks the concept of TO in this setting and considers the role it may play in the wider delivery of clinical trials. The Got-it trial is a UK-based, randomised placebo-controlled trial that investigates the use of sublingual glyceryl trinitrate (GTN) spray to treat retained placenta. Qualitative data were collected in open-ended interviews with obstetricians, research and clinical midwives (n =27) involved in trial recruitment. Data were analysed using the method of constant comparison. TO influenced staff engagement with Got-it at different points in the trial and in different ways. Prior knowledge of, and familiarity with, GTN meant that from the outset staff perceived the trial as low risk. TO facilitated staff involvement in the trial; staff who already understood GTN's effects were optimistic that it would work, and staff collaborated because they hoped that the trial would address what they identified as an important clinical need. TO could fluctuate over the course of the trial, and was sustained or undermined by unofficial observation of clinical outcomes and speculations about treatment allocation. Thus, TO appeared to be influenced by key situational factors: prior knowledge and experience, clinical need and observed participant outcomes. Situational TO plays a role in facilitating staff engagement with clinical research. TO may affect trial recruitment by enabling staff to sustain the levels of uncertainty, or

Supplemental fish oil does not alter immune competence or the pathophysiological response to an intramammary infusion of endotoxin in peri-partum multiparous Holstein cows.

Science.gov (United States)

Ballou, Michael A; Gomes, Rodrigo C; DePeters, Edward J

2009-05-01

The objective was to determine the effects of supplementing the diet with fish oil during the peri-partum period on the immune competence and the pathophysiological response to a lipopolysaccharide-induced mastitis challenge. Multiparous Holstein cows (n=30) were completely randomized to one of two treatments at 3 weeks pre-partum. Treatments differed only in the source of supplemental lipid and included either Energy Booster or fish oil. Treatment diets were fed from -21 d relative to expected date of parturition until 10 d post partum. Treatments were fed as a bolus prior to the a.m. feeding. The dose of lipid during the pre-partum period was 250 g/d, whereas the amount of lipid supplemented post partum was adjusted to the level of intake, approximately 0.92% of the previous day's dry matter intake. Ex-vivo analyses of immune competence were measured including the antimicrobial activity of whole blood against Escherichia coli, Salmonella typhimurium and Candida albicans as well as the production of interferon-gamma by peripheral blood mononuclear cultures. At 7 days in milk cows were infused with 100 microg of Esch. coli lipopolysaccharide into one rear quarter. Supplementing fish oil increased plasma concentrations of eicosapentaenoic and docosahexaenoic acids, but had no affect on the proportions of arachidonic acid at calving. Fish oil did not influence the production of interferon-gamma or the antimicrobial activity of whole blood against any of the microorganisms. Furthermore, fish oil had no ameliorative effect on either the local or the systemic acute phase response following an intramammary lipopolysaccharide challenge in early lactating Holstein cows. Supplementing fish oil in the diet of peri-partum cows will not protect them from deleterious effects of an excessive acute phase response.

Rate-difference method proved satisfactory in estimating the influenza burden in primary care visits

NARCIS (Netherlands)

Jansen, Angelique G S C; Sanders, Elisabeth A M; Wallinga, Jacco; Groen, Eelke J; van Loon, Anton M; Hoes, Arno W; Hak, Eelko

OBJECTIVE: To compare different methods to estimate the disease burden of influenza, using influenza and respiratory syncytial virus-(RSV) associated primary care data as an example. STUDY DESIGN AND SETTING: In a retrospective study in the Netherlands over 1997-2003, primary care attended

Automated theorem proving theory and practice

CERN Document Server

Newborn, Monty

2001-01-01

As the 21st century begins, the power of our magical new tool and partner, the computer, is increasing at an astonishing rate. Computers that perform billions of operations per second are now commonplace. Multiprocessors with thousands of little computers - relatively little! -can now carry out parallel computations and solve problems in seconds that only a few years ago took days or months. Chess-playing programs are on an even footing with the world's best players. IBM's Deep Blue defeated world champion Garry Kasparov in a match several years ago. Increasingly computers are expected to be more intelligent, to reason, to be able to draw conclusions from given facts, or abstractly, to prove theorems-the subject of this book. Specifically, this book is about two theorem-proving programs, THEO and HERBY. The first four chapters contain introductory material about automated theorem proving and the two programs. This includes material on the language used to express theorems, predicate calculus, and the rules of...

Theorem Proving In Higher Order Logics

Science.gov (United States)

Carreno, Victor A. (Editor); Munoz, Cesar A.; Tahar, Sofiene

2002-01-01

The TPHOLs International Conference serves as a venue for the presentation of work in theorem proving in higher-order logics and related areas in deduction, formal specification, software and hardware verification, and other applications. Fourteen papers were submitted to Track B (Work in Progress), which are included in this volume. Authors of Track B papers gave short introductory talks that were followed by an open poster session. The FCM 2002 Workshop aimed to bring together researchers working on the formalisation of continuous mathematics in theorem proving systems with those needing such libraries for their applications. Many of the major higher order theorem proving systems now have a formalisation of the real numbers and various levels of real analysis support. This work is of interest in a number of application areas, such as formal methods development for hardware and software application and computer supported mathematics. The FCM 2002 consisted of three papers, presented by their authors at the workshop venue, and one invited talk.

An extra X does not prevent acquired hemophilia - Pregnancy-associated acquired hemophilia A.

Science.gov (United States)

Barg, Assaf A; Livnat, Tami; Kenet, Gili

2017-03-01

Acquired hemophilia A (AHA) is a severe bleeding disorder caused by autoantibodies against clotting factor VIII (FVIII). With an estimated annual incidence of 1.3 to 1.5 per million, AHA is a rare disease. An extremely rare form of AHA has been described among women in the peripartum period, and may present with peripartum hemorrhage. Notably, although hemorrhagic symptoms commonly present 1-4 months around delivery, they may occur up to 1 year after parturition. When caring for a mother with AHA it is important to note that Factor VIII inhibitor may be transferred via the placenta from the mother to the fetus. Hence the newborn may also be affected. It is important to increase the awareness of Gynecologists for clinical symptoms and laboratory signs of AHA in order to avoid delayed diagnosis. Treatment may involve use of bypass agents to control hemorrhage, despite the risk of thrombosis, while immunomodulation (with increasing role for Rituximab) may be required to eradicate the inhibiting antibodies. Our review will evaluate the epidemiology, diagnosis, clinical course and treatment of peripartum AHA, focusing upon mother and infant care. © 2017 Elsevier Ltd. All rights reserved.

[Neuroradiological pattern of peripartum cerebro vascular disease medicating transfer to determine care unit].

Science.gov (United States)

Lakhdar, Rim; Baffoun, Nader; Hammami, Nadia; Nagi, Sonia; Baccar, Kamel; Drissi, Syrine; Kaddour, Chokri

2012-03-01

Pregnancy and puerperium are considered a period of a high risk of stroke responsible in a part of the morbidity and mortality in women. Imaging is the pivotal tool to diagnostics and care. To investigate the clinical and imaging features cerebrovascular complications during pregnancy and in post partum period. We report a retrospective analysis of forty four patients (November 2002 - October 2010) admitted in the intensive car department of the national institute of neurology for cerebro-vascular complications during pregnancy and in post partum period. Cerebro-vascular imaging modalities included cerebral computed tomography (CCT) with and without contrast in 94% of cases, magnetic resonance imaging (MRI) in 30.6% of cases completed by venous angiography MRI in 27.2% of cases and angiography MRI of Willis polygon in 11.3% of cases and by cerebral angiography in 13.6% of cases. Posterior reversible encephalopathy syndrome (PRES) is diagnosed in 61.4 % of cases followed by meningo-cerebral haemorrhage (MCH) in 29.5% and finally cerebral venous thrombosis (CVT) and arterial ischemia in 4.5% of cases each one. The cerebro-vascular complications are revelled in 86.3 % of the cases during the postpartum and were associated with the eclampsia or preeclampsia in 90.9 % of the cases (n=40). CCT showed typical lesions of PRES in 23 patients. It confirms the presence of hematoma in the 13 patients with MCH and find hypodense lesion in one case with ischemic stroke. CCT show direct (delta sign) and indirect signs of CVT. MRI confirms the diagnostic of PRES, when done (11 of 12 cases) and show cortical sub cortical hyper signal on T2 and FLAIR and hypo signal on T1 sequences. MRI was normal in one case. It shows hemorrhagic lesion in the 2 cases of MCH, thrombosis in the cases of CVT and ischemic lesion in the cases of ischemic stroke. CCT and MRI done within 48 hours from admission were decisive for early diagnostic and for fast and adequate care. Early recognition of stroke

Valutazione economica dello studio PROVE-IT

Directory of Open Access Journals (Sweden)

Lorenzo G. Mantovani

2007-10-01

Full Text Available Introduction: the PROVE-IT (“Intensive versus moderate lipid lowering with statins after acute coronary syndromes” was a comparison of pravastatin 40 mg/die versus atorvastatin 80 mg/die in patients with an acute coronary syndrome (ACS. Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of pravastatin in Italian patients with a history of acute coronary syndrome. Methods: the analysis is conducted on the basis of clinical outcomes of the PROVE-IT study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die versus usual-dose of pravastatin (40 mg/die in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006. Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations. We considered an observation period of 24 months. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. Results: the cost of pravastatin or atorvastatin therapy over the 2 years period amounted to approximately 1.3 millions euro and 870,000 euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to pravastatin and the overall cost of care per 1,000 patients over 24 months of follow-up was estimated at 3.2 millions euro in the pravastatin and 2.5 millions euro in the atorvastatin group, resulting into a cost saving of about 700,000 euro that is 27% of total costs occurred in the pravastatin group. Discussion: this study demonstrates that high does atorvastatin treatment leads to a reduction of direct costs for the National Health System

Models and Techniques for Proving Data Structure Lower Bounds

DEFF Research Database (Denmark)

Larsen, Kasper Green

In this dissertation, we present a number of new techniques and tools for proving lower bounds on the operational time of data structures. These techniques provide new lines of attack for proving lower bounds in both the cell probe model, the group model, the pointer machine model and the I...... bound of tutq = (lgd􀀀1 n). For ball range searching, we get a lower bound of tutq = (n1􀀀1=d). The highest previous lower bound proved in the group model does not exceed ((lg n= lg lg n)2) on the maximum of tu and tq. Finally, we present a new technique for proving lower bounds....../O-model. In all cases, we push the frontiers further by proving lower bounds higher than what could possibly be proved using previously known techniques. For the cell probe model, our results have the following consequences: The rst (lg n) query time lower bound for linear space static data structures...

Proving termination of logic programs with delay declarations

NARCIS (Netherlands)

E. Marchiori; F. Teusink (Frank)

1996-01-01

textabstractIn this paper we propose a method for proving termination of logic programs with delay declarations. The method is based on the notion of recurrent logic program, which is used to prove programs terminating wrt an arbitrary selection rule. Most importantly, we use the notion of bound

Impact of Preeclampsia on Clinical and Functional Outcomes in Women With Peripartum Cardiomyopathy.

Science.gov (United States)

Lindley, Kathryn J; Conner, Shayna N; Cahill, Alison G; Novak, Eric; Mann, Douglas L

2017-06-01

Preeclampsia is a risk factor for the development of peripartum cardiomyopathy (PPCM), but it is unknown whether preeclampsia impacts clinical or left ventricular (LV) functional outcomes. This study sought to assess clinical and functional outcomes in women with PPCM complicated by preeclampsia. This retrospective cohort study included women diagnosed with PPCM delivering at Barnes-Jewish Hospital between 2004 to 2014. The primary outcome was one-year event-free survival rate for the combined end point of death and hospital readmission. The secondary outcome was recovery of LV ejection fraction. Seventeen of 39 women (44%) with PPCM had preeclampsia. The groups had similar mean LV ejection fraction at diagnosis (29.6 with versus 27.3 without preeclampsia; P =0.5). Women with preeclampsia had smaller mean LV end-diastolic diameters (5.2 versus 6.0 cm; P =0.001), greater relative wall thickness (0.41 versus 0.35 mm Hg; P =0.009), and lower incidence of eccentric remodeling (12% versus 48%; P =0.03). Clinical follow-up was available for 32 women; 5 died of cardiovascular complications within 1 year of diagnosis (4/15 with versus 1/17 without preeclampsia; P =0.16). In time to event analysis, patients with preeclampsia had worse event-free survival during 1-year follow-up ( P =0.047). Echocardiographic follow-up was available in 10 survivors with and 16 without preeclampsia. LV ejection fraction recovered in 80% of survivors with versus 25% without preeclampsia ( P =0.014). PPCM with concomitant preeclampsia is associated with increased morbidity and mortality and different patterns of LV remodeling and recovery of LV function when compared with patients with PPCM that is not complicated by preeclampsia. © 2017 American Heart Association, Inc.

Proving Non-Deterministic Computations in Agda

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Sergio Antoy

2017-01-01

Full Text Available We investigate proving properties of Curry programs using Agda. First, we address the functional correctness of Curry functions that, apart from some syntactic and semantic differences, are in the intersection of the two languages. Second, we use Agda to model non-deterministic functions with two distinct and competitive approaches incorporating the non-determinism. The first approach eliminates non-determinism by considering the set of all non-deterministic values produced by an application. The second approach encodes every non-deterministic choice that the application could perform. We consider our initial experiment a success. Although proving properties of programs is a notoriously difficult task, the functional logic paradigm does not seem to add any significant layer of difficulty or complexity to the task.

20 CFR 219.23 - Evidence to prove death.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Evidence to prove death. 219.23 Section 219... EVIDENCE REQUIRED FOR PAYMENT Evidence of Age and Death § 219.23 Evidence to prove death. (a) Preferred evidence of death. The best evidence of a person's death is— (1) A certified copy of or extract from the...

Elliptic curves and primality proving

Science.gov (United States)

Atkin, A. O. L.; Morain, F.

1993-07-01

The aim of this paper is to describe the theory and implementation of the Elliptic Curve Primality Proving algorithm. Problema, numeros primos a compositis dignoscendi, hosque in factores suos primos resolvendi, ad gravissima ac utilissima totius arithmeticae pertinere, et geometrarum tum veterum tum recentiorum industriam ac sagacitatem occupavisse, tam notum est, ut de hac re copiose loqui superfluum foret.

Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?

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Hironori Takahashi

2016-01-01

Full Text Available Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy. Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique. Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919. Of the 18, 14 (78% had a prior cesarean section (CS history and the other 4 (22% were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%, with the remaining 6 (33% undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67% patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%. Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon (4,448±1,948 versus 8,861±3,988 mL, planned hysterectomy (5,003±2,057 versus 9,957±4,485 mL, and prior CS (5,706±2,727 versus 9,975±5,532 mL. Patients with prior CS (− bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation. Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.

Seismic proving test of PWR reactor containment vessel

International Nuclear Information System (INIS)

Akiyama, H.; Yoshikawa, T.; Tokumaru, Y.

1987-01-01

The seismic reliability proving tests of nuclear power plant facilities are carried out by Nuclear Power Engineering Test Center (NUPEC), using the large-scale, high-performance vibration of Tadotsu Engineering Laboratory, and sponsored by the Ministry of International Trade and Industry (MITI). In 1982, the seismic reliability proving test of PWR containment vessel started using the test component of reduced scale 1/3.7 and the test component proved to have structural soundness against earthquakes. Subsequently, the detailed analysis and evaluation of these test results were carried out, and the analysis methods for evaluating strength against earthquakes were established. Whereupon, the seismic analysis and evaluation on the actual containment vessel were performed by these analysis methods, and the safety and reliability of the PWR reactor containment vessel were confirmed

Preservice Mathematics Teachers' Metaphorical Perceptions towards Proof and Proving

Science.gov (United States)

Ersen, Zeynep Bahar

2016-01-01

Since mathematical proof and proving are in the center of mathematics; preservice mathematics teachers' perceptions against these concepts have a great importance. Therefore, the study aimed to determine preservice mathematics teachers' perceptions towards proof and proving through metaphors. The participants consisted of 192 preservice…

Proving test on the reliability for nuclear valves

International Nuclear Information System (INIS)

Kajiyama, Yasuo; Tashiro, Hisao; Uga, Takeo; Maeda, Shunichi.

1986-01-01

Since valves are the most common components, they could be the most frequent causes of troubles in nuclear power plants. This proving test, therefore, has an important meaning to examine and verify the reliability of various valves under simulating conditions of abnormal and transient operations of the nuclear power plant. The test was performed mainly for the various types and pressure ratings of valves which were used in the primary and secondary systems in BWR and PWR nuclear power plants and which had major operating or safety related functions in those nuclear power plants. The results of the proving test, confirmed for more than four years, showed relatively favourable performance of the tested valves. It is concluded that performances of valves including operability, seat sealing and structural integrity were proved under the thermal cycling, vibration and pipe reaction load conditions. Operating functions during and after accident such as loss of coolant accident were satisfactory. From these results, it was considered that the purpose of this proving test was satisfactorily fulfilled. Several data accumulated by the test would be useful to get better reliability if it was evaluated with the actually experienced data of valves in the nuclear power plants. (Nogami, K.)

Responsibility for proving and defining in abstract algebra class

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Fukawa-Connelly, Timothy

2016-07-01

There is considerable variety in inquiry-oriented instruction, but what is common is that students assume roles in mathematical activity that in a traditional, lecture-based class are either assumed by the teacher (or text) or are not visible at all in traditional math classrooms. This paper is a case study of the teaching of an inquiry-based undergraduate abstract algebra course. In particular, gives a theoretical account of the defining and proving processes. The study examines the intellectual responsibility for the processes of defining and proving that the professor devolved to the students. While the professor wanted the students to engage in all aspects of defining and proving, he was only successful at devolving responsibility for certain aspects and much more successful at devolving responsibility for proving than conjecturing or defining. This study suggests that even a well-intentioned instructor may not be able to devolve responsibility to students for some aspects of mathematical practice without using a research-based curriculum or further professional development.

Changes in the expression of α-tocopherol-related genes in liver and mammary gland biopsy specimens of peripartum dairy cows.

Science.gov (United States)

Haga, S; Miyaji, M; Nakano, M; Ishizaki, H; Matsuyama, H; Katoh, K; Roh, S G

2018-03-28

Blood α-tocopherol (α-Toc) concentrations decline gradually throughout the prepartum period, reaching the nadir after calving in dairy cows. The 6 α-Toc-related molecules [α-Toc transfer protein (TTPA); afamin; scavenger receptor class B, Type I; ATP-binding cassette transporter A1; tocopherol-associated protein (SEC14L2); and cytochrome P450 family 4, subfamily F, polypeptide 2 (CYP4F2)] are expressed in liver and other peripheral tissues. These molecules could regulate α-Toc transport, blood concentrations, and metabolism of α-Toc. Therefore, the aim of this study was to evaluate the changes in the expression of α-Toc-related genes in liver and mammary gland tissues of dairy cows around calving, which have remained elusive until now. In experiment (Exp.) 1, 28 multiparous Holstein cows were used (from -5 to 6 wk relative to parturition) to monitor the changes in dietary α-Toc intake, blood concentrations of α-Toc, and lipoproteins; in Exp. 2, 7 peripartum Holstein cows were used (from -4 to 4 wk relative to parturition) for liver tissue biopsy; and in Exp. 3, 10 peripartum Holstein cows were used (from -8 to 6 wk relative to parturition) to carry out the mammary gland tissue biopsy and milk sampling. In Exp. 1, the serum α-Toc concentrations declined gradually with decreasing amount of α-Toc intake and plasma high-density lipoprotein concentrations toward calving time. However, in the early lactation period after calving, serum α-Toc concentrations remained at a lower concentration despite the recovery of α-Toc intake and plasma high-density lipoprotein concentrations. In Exp. 2, just after calving, the TTPA, SEC14L2, afamin, and albumin mRNA expression levels in the liver were temporarily downregulated, and the hepatic mRNA levels of endoplasmic reticulum stress-induced unfolded protein response markers and acute-phase response marker increased at calving. In Exp. 3, the concentrations of α-Toc in colostrum were greater than those in precolostrum

Geometric inequalities methods of proving

CERN Document Server

Sedrakyan, Hayk

2017-01-01

This unique collection of new and classical problems provides full coverage of geometric inequalities. Many of the 1,000 exercises are presented with detailed author-prepared-solutions, developing creativity and an arsenal of new approaches for solving mathematical problems. This book can serve teachers, high-school students, and mathematical competitors. It may also be used as supplemental reading, providing readers with new and classical methods for proving geometric inequalities. .

Reasoning and Proving Opportunities in Textbooks: A Comparative Analysis

Science.gov (United States)

Hong, Dae S.; Choi, Kyong Mi

2018-01-01

In this study, we analyzed and compared reasoning and proving opportunities in geometry lessons from American standard-based textbooks and Korean textbooks to understand how these textbooks provide student opportunities to engage in reasoning and proving activities. Overall, around 40% of exercise problems in Core Plus Mathematics Project (CPMP)…

Insertion/deletion polymorphism of ACE gene in females with peripartum cardiomyopathy: A case-control study.

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Yaqoob, Irfan; Tramboo, Nisar A; Bhat, Irfan A; Pandith, Arshad; Beig, Jahangir R; Hafeez, Imran; Lone, Aijaz A; Shah, Tariq R; Samreen, Sumera

The role of polymorphism of Angiotensin converting enzyme (ACE) gene and ACE activity in etiopathogenesis, prognosis, and many other clinical parameters in the various form of the cardiovascular disease has been established to some degree of certainty. The pathophysiology of Peripartum cardiomyopathy (PPCM) remains an area of active research. The main aim of our study was to see pattern of ACE- Insertion/Deletion (I/D) allele in PPCM and its implications on left ventricular performance indices. This single-center case-control study included 45 cases and 70 controls. The diagnosis of PPCM was established clinically and echocardiographically. ACE genotyping was done by polymerase chain reaction (PCR) method in all subjects. The II, ID, and DD genotype was present in 16, 18 and 11 of subjects with PPCM and 48, 19 and 3 of controls respectively. The odds ratio for ACE-II genotype in cases vs. controls was 0.253 (95% CI=0.114-0.558; p=0.007), for that of II genotype was 1.93 (95% CI=0.86-4.3; p=0.107) and for DD genotype was 7.225 (95% CI; 1.88-27.6; p=0.0039). Overall frequency of D allele in cases was significantly higher than controls (odds=4.25; 95% CI=2.01-6.7; p=0.0001). Moreover, ejection fraction, left ventricular volume and linear dimensions were worse in patients with DD genotype. ACE DD genotype and overall frequency of D allele is significantly higher in patients with PPCM. Also, the presence of DD genotype is associated with worse systolic performance indices measured echocardiographically. Copyright © 2017. Published by Elsevier B.V.

A New Approach for Proving or Generating Combinatorial Identities

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Gonzalez, Luis

2010-01-01

A new method for proving, in an immediate way, many combinatorial identities is presented. The method is based on a simple recursive combinatorial formula involving n + 1 arbitrary real parameters. Moreover, this formula enables one not only to prove, but also generate many different combinatorial identities (not being required to know them "a…

Generic Example Proving Criteria for All

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Yopp, David; Ely, Rob; Johnson­-Leung, Jennifer

2015-01-01

We review literature that discusses generic example proving and highlight ambiguities that pervade our research community's discourse about generic example arguments. We distinguish between pedagogical advice for choosing good examples that can serve as generic examples when teaching and advice for developing generic example arguments. We provide…

SARS – Koch´Postulates proved.

Indian Academy of Sciences (India)

SARS – Koch´Postulates proved. Novel coronavirus identified from fluids of patients. Virus cultured in Vero cell line. Sera of patients have antibodies to virus. Cultured virus produces disease in Macaque monkeys. -produces specific immune response; -isolated virus is SARS CoV; -pathology similar to human.

WA42 Proving its worth - changing public policy for palliative care, end of life care and bereavement through advocacy and communications.

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Edghill, Angela; Donohoe, Miriam

2015-04-01

The 2015 palliative care budget is €72 million (Euros) but up to €1.3 billion spent on end of life care annually - much of this larger figure unplanned and uncoordinated. Geographic and other inequities evident in palliative care provision. Build support for the development and implementation of a National Strategy on Palliative Care, End of Life and Bereavement. Multi-layered approach to raising awareness and building consensus: Targeting the correct audience who can make change happen Presenting robust evidence including costs justifying reform and investment Demonstrating that issues affect a significant number of people Sharing experience and knowledge Knowing their policy priorities Staying resilient - advancing and introducing new angles to argument Engaging directly as advocates within the political system at all political levels - developing relationships with politicians Identifying advocates in the public service to promote policy change Using a variety of new and existing projects and programmes Encouraging patients and families to be self-advocates - using a novel project for discussing and recording future care preferences Supporting healthcare professionals to become effective advocates for patients Creating alliances to lobby for policy development Using media opportunities to sell the message The recognition of the importance of a strategic approach to palliative and end of life care acknowledged in Parliamentary Committee Report affords an opportunity to develop further policy and practice. This a long - term exercise, dependent on supporting the implementation plan, building momentum and promoting a public dialogue on sensitive issues around dying, death and bereavement. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Earth is Flat, and I Can Prove It!

Science.gov (United States)

Klinger, Art

1998-01-01

Describes an educational program that asks students to attempt to prove that the earth is spherical and that it rotates. Presents tips to pique student interest and charts related to sensing the spin, nonrotation notions, flat earth fallacies, evidence that the earth is spherical and rotates, and the role of watersheds in proving that the earth…

Effect of Moxidectin Treatment at Peripartum on Gastrointestinal Parasite Infections in Ewes Raised under Tropical Andes High Altitude Conditions

Science.gov (United States)

Vargas-Duarte, J. J.; Lozano-Márquez, H.; Grajales-Lombana, H. A.; Manrique-Perdomo, C.; Martínez-Bello, D. A.; Saegerman, C.; Raes, M.; Kirschvink, N.

2015-01-01

This study tested the impact of moxidectin at peripartum on nematode fecal egg count (FEC) and clinical parameters on ewes in the high altitude tropical Andes of Colombia. FEC and clinical evaluations were performed on 9 occasions in 43 naturally infected ewes before and during gestation and after lambing. Moxidectin (Mox, 200 µg kg−1) was applied at late pregnancy (T 1, n = 15) or 48 hours after parturition (T 2, n = 14). 14 untreated ewes served as controls (C). Suckling lambs (n = 58) remained untreated and underwent four clinical and parasitological evaluations until 8 weeks after birth. Mox efficacy equaled 99.3% (T 1) and 96.9% (T 2). Highest mean FEC value reflecting periparturient nematode egg rise (PPER) was recorded in C ewes at 4–6 weeks after lambing. Significant FEC reductions were found in T 1 (94.8%) and T 2 (96.7%) ewes (p ewes-group independent increase in FEC before weaning (p < 0.05). Clinical parameters (anemia and diarrhea) showed time- and treatment-related differences (p < 0.05). Monitoring of FEC and clinical parameters linked to gastrointestinal parasite infections allowed demonstrating that postpartum or preweaning are two critical periods to nematode infection for sheep raised under tropical Andes high altitude conditions. Use of Mox as anthelmintic treatment prevented PPER. PMID:26078913

Pengembangan Perangkat Pembelajaran Geometri Ruang dengan Model Proving Theorem

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Bambang Eko Susilo

2016-03-01

Full Text Available Kemampuan berpikir kritis dan kreatif mahasiswa masih lemah. Hal ini ditemukan pada mahasiswa yang mengambil mata kuliah Geometri Ruang yaitu dalam membuktikan soal-soal pembuktian (problem to proof. Mahasiswa masih menyelesaikan secara algoritmik atau prosedural sehingga diperlukan pengembangan perangkat pembelajaran Geometri Ruang berbasis kompetensi dan konservasi dengan model Proving Theorem. Dalam penelitian ini perangkat perkuliahan yang dikembangkan yaitu Silabus, Satuan Acara Perkuliahan (SAP, Kontrak Perkuliahan, Media Pembelajaran, Bahan Ajar, Tes UTS dan UAS serta Angket Karakter Konservasi telah dilaksanakan dengan baik dengan kriteria (1 validasi perangkat pembelajaran mata kuliah Geometri ruang berbasis kompetensi dan konservasi dengan model proving theorem berkategori baik dan layak digunakan dan (2 keterlaksanaan RPP pada pembelajaran yang dikembangkan secara keseluruhan berkategori baik.Critical and creative thinking abilities of students still weak. It is found in students who take Space Geometry subjects that is in solving problems to to prove. Students still finish in algorithmic or procedural so that the required the development of Space Geometry learning tools based on competency and conservation with Proving Theorem models. This is a research development which refers to the 4-D models that have been modified for the Space Geometry learning tools, second semester academic year 2014/2015. Instruments used include validation sheet, learning tools and character assessment questionnaire. In this research, the learning tools are developed, namely Syllabus, Lesson Plan, Lecture Contract, Learning Media, Teaching Material, Tests, and Character Conservation Questionnaire had been properly implemented with the criteria (1 validation of Space Geometry learning tools based on competency and conservation with Proving Theorem models categorized good and feasible to use, and (2 the implementation of Lesson Plan on learning categorized

Myofilament Remodeling and Function Is More Impaired in Peripartum Cardiomyopathy Compared with Dilated Cardiomyopathy and Ischemic Heart Disease.

Science.gov (United States)

Bollen, Ilse A E; Ehler, Elisabeth; Fleischanderl, Karin; Bouwman, Floor; Kempers, Lanette; Ricke-Hoch, Melanie; Hilfiker-Kleiner, Denise; Dos Remedios, Cristobal G; Krüger, Martina; Vink, Aryan; Asselbergs, Folkert W; van Spaendonck-Zwarts, Karin Y; Pinto, Yigal M; Kuster, Diederik W D; van der Velden, Jolanda

2017-12-01

Peripartum cardiomyopathy (PPCM) and dilated cardiomyopathy (DCM) show similarities in clinical presentation. However, although DCM patients do not recover and slowly deteriorate further, PPCM patients show either a fast cardiac deterioration or complete recovery. The aim of this study was to assess if underlying cellular changes can explain the clinical similarities and differences in the two diseases. We, therefore, assessed sarcomeric protein expression, modification, titin isoform shift, and contractile behavior of cardiomyocytes in heart tissue of PPCM and DCM patients and compared these with nonfailing controls. Heart samples from ischemic heart disease (ISHD) patients served as heart failure control samples. Passive force was only increased in PPCM samples compared with controls, whereas PPCM, DCM, and ISHD samples all showed increased myofilament Ca 2+ sensitivity. Length-dependent activation was significantly impaired in PPCM compared with controls, no impairment was observed in ISHD samples, and DCM samples showed an intermediate response. Contractile impairments were caused by impaired protein kinase A (PKA)-mediated phosphorylation because exogenous PKA restored all parameters to control levels. Although DCM samples showed reexpression of EH-myomesin, an isoform usually only expressed in the heart before birth, PPCM and ISHD did not. The lack of EH-myomesin, combined with low PKA-mediated phosphorylation of myofilament proteins and increased compliant titin isoform, may explain the increase in passive force and blunted length-dependent activation of myofilaments in PPCM samples. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

Science.gov (United States)

Goodwin, N

2001-01-01

This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

Directory of Open Access Journals (Sweden)

Nick Goodwin

2001-03-01

Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B

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Jodie Dionne-Odom

2016-01-01

Full Text Available Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60% or shortly afterwards (24.4% by 12 months. Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4–3.8 was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed.

Overcoming the Obstacle of Poor Knowledge in Proving Geometry Tasks

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Zlatan Magajna

2013-12-01

Full Text Available Proving in school geometry is not just about validating the truth of a claim. In the school setting, the main function of the proof is to convince someone that a claim is true by providing an explanation. Students consider proving to be difficult; in fact, they find the very concept of proof demanding. Proving a claim in planar geometry involves several processes, the most salient being visual observation and deductive argumentation. These two processes are interwoven, but often poor observation hinders deductive argumentation. In the present article, we consider the possibility of overcoming the obstacle of a student’s poor observation by making use of computer-aided observation with appropriate software. We present the results of two small-scale research projects, both of which indicate that students are able to work out considerably more deductions if computer-aided observation is used. Not all students use computer-aided observation effectively in proving tasks: some find an exhaustive computer-provided list of properties confusing and are not able to choose the properties that are relevant to the task.

On proving syntactic properties of CPS programs

DEFF Research Database (Denmark)

Danvy, Olivier; Dzafic, Belmina; Pfenning, Frank

1999-01-01

Higher-order program transformations raise new challenges for proving properties of their output, since they resist traditional, first-order proof techniques. In this work, we consider (1) the “one-pass” continuation-passing style (CPS) transformation, which is second-order, and (2) the occurrences...

Inhibition of Progenitor Dendritic Cell Maturation by Plasma from Patients with Peripartum Cardiomyopathy: Role in Pregnancy-associated Heart Disease

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Jane E. Ellis

2005-01-01

Full Text Available Dendritic cells (DCs play dual roles in innate and adaptive immunity based on their functional maturity, and both innate and adaptive immune responses have been implicated in myocardial tissue remodeling associated with cardiomyopathies. Peripartum cardiomyopathy (PPCM is a rare disorder which affects women within one month antepartum to five months postpartum. A high occurrence of PPCM in central Haiti (1 in 300 live births provided the unique opportunity to study the relationship of immune activation and DC maturation to the etiology of this disorder. Plasma samples from two groups (n = 12 of age- and parity-matched Haitian women with or without evidence of PPCM were tested for levels of biomarkers of cardiac tissue remodeling and immune activation. Significantly elevated levels of GM-CSF, endothelin-1, proBNP and CRP and decreased levels of TGF- were measured in PPCM subjects relative to controls. Yet despite these findings, in vitro maturation of normal human cord blood derived progenitor dendritic cells (CBDCs was significantly reduced (p < 0.001 in the presence of plasma from PPCM patients relative to plasma from post-partum control subjects as determined by expression of CD80, CD86, CD83, CCR7, MHC class II and the ability of these matured CBDCs to induce allo-responses in PBMCs. These results represent the first findings linking inhibition of DC maturation to the dysregulation of normal physiologic cardiac tissue remodeling during pregnancy and the pathogenesis of PPCM.

Communication-related allegations against physicians caring for premature infants.

Science.gov (United States)

Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R

2017-10-01

Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

Proving the correctness of unfold/fold program transformations using bisimulation

DEFF Research Database (Denmark)

Hamilton, Geoff W.; Jones, Neil

2011-01-01

by a labelled transition system whose bisimilarity relation is a congruence that coincides with contextual equivalence. Labelled transition systems are well-suited to represent global program behaviour. On the other hand, unfold/fold program transformations use generalization and folding, and neither is easy......This paper shows that a bisimulation approach can be used to prove the correctness of unfold/fold program transformation algorithms. As an illustration, we show how our approach can be use to prove the correctness of positive supercompilation (due to Sørensen et al). Traditional program equivalence...... to describe contextually, due to use of non-local information. We show that weak bisimulation on labelled transition systems gives an elegant framework to prove contextual equivalence of original and transformed programs. One reason is that folds can be seen in the context of corresponding unfolds....

Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy.

Science.gov (United States)

Haghikia, A; Podewski, E; Libhaber, E; Labidi, S; Fischer, D; Roentgen, P; Tsikas, D; Jordan, J; Lichtinghagen, R; von Kaisenberg, C S; Struman, I; Bovy, N; Sliwa, K; Bauersachs, J; Hilfiker-Kleiner, Denise

2013-07-01

Peripartum cardiomyopathy (PPCM) is a life-threatening heart disease developing towards the end of pregnancy or in the months following delivery in previously healthy women in terms of cardiac disease. Enhanced oxidative stress and the subsequent cleavage of the nursing hormone Prolactin into an anti-angiogenic 16 kDa subfragment emerged as a potential causal factor of the disease. We established a prospective registry with confirmed PPCM present in 115 patients (mean baseline left ventricular ejection fraction, LVEF: 27 ± 9 %). Follow-up data (6 ± 3 months) showed LVEF improvement in 85 % and full recovery in 47 % while 15 % failed to recover with death in 2 % of patients. A positive family history of cardiomyopathy was present in 16.5 %. Pregnancy-associated hypertension was associated with a better outcome while a baseline LVEF ≤ 25 % was associated with a worse outcome. A high recovery rate (96 %) was observed in patients obtaining combination therapy with beta-blocker, angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor-blockers (ARBs) and bromocriptine. Increased serum levels of Cathepsin D, the enzyme that generates 16 kDa Prolactin, miR-146a, a direct target of 16 kDa Prolactin, N-terminal-pro-brain-natriuretic peptide (NT-proBNP) and asymmetric dimethylarginine (ADMA) emerged as biomarkers for PPCM. In conclusion, low baseline LVEF is a predictor for poor outcome while pregnancy-induced hypertensive disorders are associated with a better outcome in this European PPCM cohort. The high recovery rate in this collective is associated with a treatment concept using beta-blockers, ACE inhibitors/ARBs and bromocriptine. Increased levels of Cathepsin D activity, miR-146a and ADMA in serum of PPCM patients support the pathophysiological role of 16 kDa Prolactin for PPCM and may be used as a specific diagnostic marker profile.

Seismic proving test of BWR primary loop recirculation system

International Nuclear Information System (INIS)

Sato, H.; Shigeta, M.; Karasawa, Y.

1987-01-01

The seismic proving test of BWR Primary Loop Recirculation system is the second test to use the large-scale, high-performance vibration table of Tadotsu Engineering Laboratory. The purpose of this test is to prove the seismic reliability of the primary loop recirculation system (PLR), one of the most important safety components in the BWR nuclear plants, and also to confirm the adequacy of seismic analysis method used in the current seismic design. To achieve the purpose, the test was conducted under conditions and scale as near as possible to actual systems. The strength proving test was carried out with the test model mounted on the vibration table in consideration of basic design earthquake ground motions and other conditions to confirm the soundness of structure and the strength against earthquakes. Detailed analysis and analytic evaluation of the data obtained from the test was conducted to confirm the adequacy of the seismic analysis method and earthquake response analysis method used in the current seismic design. Then, on the basis of the results obtained, the seismic safety and reliability of BWR primary loop recirculation of the actual plants was fully evaluated

Collaborative networks in the internet of services: 13th IFIP WG 5.5 working conference on virtual enterprises, PRO-VE 2012, Bournemouth, UK, October 2012: proceedings

NARCIS (Netherlands)

Camarinha-Matos, L.M.; Xu, L.; Afsarmanesh, H.

2012-01-01

This book constitutes the refereed proceedings of the 13th IFIP WG 5.5 Working Conference on Virtual Enterprises, PRO-VE 2012, held in Bournemouth, UK, in October 2012. The 61 revised papers presented were carefully selected from numerous submissions. They provide a comprehensive overview of

Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM.

Science.gov (United States)

Sliwa, Karen; Mebazaa, Alexandre; Hilfiker-Kleiner, Denise; Petrie, Mark C; Maggioni, Aldo P; Laroche, Cecile; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van der Meer, Peter; Roos-Hesselink, Jolien W; Seferovic, Petar; van Spandonck-Zwarts, Karin; Mbakwem, Amam; Böhm, Michael; Mouquet, Frederic; Pieske, Burkert; Hall, Roger; Ponikowski, Piotre; Bauersachs, Johann

2017-09-01

The purpose of this study is to describe disease presentation, co-morbidities, diagnosis and initial therapeutic management of patients with peripartum cardiomyopathy (PPCM) living in countries belonging to the European Society of Cardiology (ESC) vs. non-ESC countries. Out of 500 patients with PPCM entered by 31 March 2016, we report on data of the first 411 patients with completed case record forms (from 43 countries) entered into this ongoing registry. There were marked differences in socio-demographic parameters such as Human Development Index, GINI index on inequality, and Health Expenditure in PPCM patients from ESC vs. non-ESC countries (P heart failure after 1 month (92.3% vs. 81.3%, P heart failure were common within 1 month post-diagnosis and required intensive, multidisciplinary management. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

On proving syntactic properties of CPS programs

DEFF Research Database (Denmark)

Danvy, Olivier; Dzafic, Belmina; Pfenning, Frank

1999-01-01

Higher-order program transformations raise new challenges for proving properties of their output, since they resist traditional, first-order proof techniques. In this work, we consider (1) the “one-pass” continuation-passing style (CPS) transformation, which is second-order, and (2) the occurrences...... of parameters of continuations in its output. To this end, we specify the one-pass CPS transformation relationally and we use the proof technique of logical relations....

Preparing for Mars: The Evolvable Mars Campaign 'Proving Ground' Approach

Science.gov (United States)

Bobskill, Marianne R.; Lupisella, Mark L.; Mueller, Rob P.; Sibille, Laurent; Vangen, Scott; Williams-Byrd, Julie

2015-01-01

As the National Aeronautics and Space Administration (NASA) prepares to extend human presence beyond Low Earth Orbit, we are in the early stages of planning missions within the framework of an Evolvable Mars Campaign. Initial missions would be conducted in near-Earth cis-lunar space and would eventually culminate in extended duration crewed missions on the surface of Mars. To enable such exploration missions, critical technologies and capabilities must be identified, developed, and tested. NASA has followed a principled approach to identify critical capabilities and a "Proving Ground" approach is emerging to address testing needs. The Proving Ground is a period subsequent to current International Space Station activities wherein exploration-enabling capabilities and technologies are developed and the foundation is laid for sustained human presence in space. The Proving Ground domain essentially includes missions beyond Low Earth Orbit that will provide increasing mission capability while reducing technical risks. Proving Ground missions also provide valuable experience with deep space operations and support the transition from "Earth-dependence" to "Earth-independence" required for sustainable space exploration. A Technology Development Assessment Team identified a suite of critical technologies needed to support the cadence of exploration missions. Discussions among mission planners, vehicle developers, subject-matter-experts, and technologists were used to identify a minimum but sufficient set of required technologies and capabilities. Within System Maturation Teams, known challenges were identified and expressed as specific performance gaps in critical capabilities, which were then refined and activities required to close these critical gaps were identified. Analysis was performed to identify test and demonstration opportunities for critical technical capabilities across the Proving Ground spectrum of missions. This suite of critical capabilities is expected to

Unexploded ordnance issues at Aberdeen Proving Ground: Background information

Energy Technology Data Exchange (ETDEWEB)

Rosenblatt, D.H.

1996-11-01

This document summarizes currently available information about the presence and significance of unexploded ordnance (UXO) in the two main areas of Aberdeen Proving Ground: Aberdeen Area and Edgewood Area. Known UXO in the land ranges of the Aberdeen Area consists entirely of conventional munitions. The Edgewood Area contains, in addition to conventional munitions, a significant quantity of chemical-munition UXO, which is reflected in the presence of chemical agent decomposition products in Edgewood Area ground-water samples. It may be concluded from current information that the UXO at Aberdeen Proving Ground has not adversely affected the environment through release of toxic substances to the public domain, especially not by water pathways, and is not likely to do so in the near future. Nevertheless, modest but periodic monitoring of groundwater and nearby surface waters would be a prudent policy.

Classificació de proves no paramètriques. Com aplicar-les en SPSS

Directory of Open Access Journals (Sweden)

Vanesa Berlanga-Silvente

2012-07-01

Full Text Available Les proves no paramètriques engloben una sèrie de proves estadístiques, que tenen com a denominador comú l'absència de assumpcions sobre la llei de probabilitat que segueix la població de la qual ha estat extreta la mostra. Per aquesta raó és comú referir-s'hi com a proves de distribució lliure. A l'article es descriuen i treballen les proves no paramètriques ressaltant el seu fonament i les indicacions per al seu ús quan es tracta d'una sola mostra (Chi-quadrat, de dues mostres amb dades independents (U de Mann-Whitney, de dues mostres amb dades relacionades (T de Wilcoxon, de diverses mostres amb dades independents (H de Kruskal-Wallis i de diverses mostres amb dades relacionades (Friedman.

Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

International Nuclear Information System (INIS)

Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G.

1995-01-01

This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys

Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

Energy Technology Data Exchange (ETDEWEB)

Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G. [Colorado State Univ., Fort Collins, CO (United States). Dept. of Fishery and Wildlife Biology

1995-01-01

This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys.

Theorem Proving in Intel Hardware Design

Science.gov (United States)

O'Leary, John

2009-01-01

For the past decade, a framework combining model checking (symbolic trajectory evaluation) and higher-order logic theorem proving has been in production use at Intel. Our tools and methodology have been used to formally verify execution cluster functionality (including floating-point operations) for a number of Intel products, including the Pentium(Registered TradeMark)4 and Core(TradeMark)i7 processors. Hardware verification in 2009 is much more challenging than it was in 1999 - today s CPU chip designs contain many processor cores and significant firmware content. This talk will attempt to distill the lessons learned over the past ten years, discuss how they apply to today s problems, outline some future directions.

Formalizing and proving a typing result for security protocols in Isabelle/HOL

DEFF Research Database (Denmark)

Hess, Andreas Viktor; Modersheim, Sebastian

2017-01-01

or the positive output of a verification tool. However several of these works have used a typed model, where the intruder is restricted to "well-typed" attacks. There also have been several works that show that this is actually not a restriction for a large class of protocols, but all these results so far...... are again pen-and-paper proofs. In this work we present a formalization of such a typing result in Isabelle/HOL. We formalize a constraint-based approach that is used in the proof argument of such typing results, and prove its soundness, completeness and termination. We then formalize and prove the typing...... result itself in Isabelle. Finally, to illustrate the real-world feasibility, we prove that the standard Transport Layer Security (TLS) handshake satisfies the main condition of the typing result....

IHSI [Induction Heating Stress Improvement] proves its worth

International Nuclear Information System (INIS)

Froehlich, C.H.; Cofie, N.G.; Sheffield, J.R.

1988-01-01

Based upon the wealth of experimental test data, extensive and successful in-plant application, and the decreasing cost of applying the process, IHSI is proving itself an important part of overall IGSCC mitigation programmes. Work is ongoing on the development of new temperature sensing systems, more efficient equipment immobilization/demobilization hardware configurations, and craft support management practices to further enhance the cost-effectiveness of IHSI. (author)

SPoRT's Participation in the GOES-R Proving Ground Activity

Science.gov (United States)

Jedlovec, Gary; Fuell, Kevin; Smith, Matthew; Stano, Geoffrey; Molthan, Andrew

2011-01-01

The next generation geostationary satellite, GOES-R, will carry two new instruments with unique atmospheric and surface observing capabilities, the Advanced Baseline Imager (ABI) and the Geostationary Lightning Mapper (GLM), to study short-term weather processes. The ABI will bring enhanced multispectral observing capabilities with frequent refresh rates for regional and full disk coverage to geostationary orbit to address many existing and new forecast challenges. The GLM will, for the first time, provide the continuous monitoring of total lightning flashes over a hemispherical region from space. NOAA established the GOES-R Proving Ground activity several years ago to demonstrate the new capabilities of these instruments and to prepare forecasters for their day one use. Proving Ground partners work closely with algorithm developers and the end user community to develop and transition proxy data sets representing GOES-R observing capabilities. This close collaboration helps to maximize refine algorithms leading to the delivery of a product that effectively address a forecast challenge. The NASA Short-term Prediction Research and Transition (SPoRT) program has been a participant in the NOAA GOES-R Proving Ground activity by developing and disseminating selected GOES-R proxy products to collaborating WFOs and National Centers. Established in 2002 to demonstrate the weather and forecasting application of real-time EOS measurements, the SPoRT program has grown to be an end-to-end research to operations activity focused on the use of advanced NASA modeling and data assimilation approaches, nowcasting techniques, and unique high-resolution multispectral data from EOS satellites to improve short-term weather forecasts on a regional and local scale. Participation in the Proving Ground activities extends SPoRT s activities and taps its experience and expertise in diagnostic weather analysis, short-term weather forecasting, and the transition of research and experimental

Renewable Energy Opportunties at Dugway Proving Ground, Utah

Energy Technology Data Exchange (ETDEWEB)

Orrell, Alice C.; Kora, Angela R.; Russo, Bryan J.; Horner, Jacob A.; Williamson, Jennifer L.; Weimar, Mark R.; Gorrissen, Willy J.; Nesse, Ronald J.; Dixon, Douglas R.

2010-05-31

This document provides an overview of renewable resource potential at Dugway Proving Ground, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and ground source heat pumps (GSHPs). The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment.

Reproductive health experiences of women with cardiovascular disease.

Science.gov (United States)

Chor, Julie; Oswald, Lora; Briller, Joan; Cowett, Allison; Peacock, Nadine; Harwood, Bryna

2012-11-01

Limited research exists exploring contraceptive and pregnancy experiences of women with cardiovascular diseases. We conducted semistructured interviews with reproductive-age women with chronic hypertension or peripartum cardiomyopathy exploring thoughts and behaviors regarding future fertility. Transcribed interviews were coded and analyzed identifying salient themes. We interviewed 20 women with chronic hypertension and 10 women with peripartum cardiomyopathy. Women described a spectrum of perspectives regarding the relationship between disease and fertility: from complete disconnect to full integration of diagnosis and future fertility plans. Integration of reproductive and cardiovascular health was influenced by and reflected in circumstances of diagnosis, pregnancy-related experiences, contraception-related experiences and conceptualization of disease risk related to reproductive health. Providers must better understand how women perceive and consider their reproductive and cardiovascular health in order to optimize contraceptive care of women with cardiovascular disease and help them make safe, informed decisions about future fertility. Copyright © 2012 Elsevier Inc. All rights reserved.

Unicorns do exist: a tutorial on "proving" the null hypothesis.

Science.gov (United States)

Streiner, David L

2003-12-01

Introductory statistics classes teach us that we can never prove the null hypothesis; all we can do is reject or fail to reject it. However, there are times when it is necessary to try to prove the nonexistence of a difference between groups. This most often happens within the context of comparing a new treatment against an established one and showing that the new intervention is not inferior to the standard. This article first outlines the logic of "noninferiority" testing by differentiating between the null hypothesis (that which we are trying to nullify) and the "nill" hypothesis (there is no difference), reversing the role of the null and alternate hypotheses, and defining an interval within which groups are said to be equivalent. We then work through an example and show how to calculate sample sizes for noninferiority studies.

Emotional changes occurring in women in pregnancy, parturition and lying-in period according to factors exerting an effect on a woman during the peripartum period.

Science.gov (United States)

Pięta, Beata; Jurczyk, Mieczysława Urszula; Wszołek, Katarzyna; Opala, Tomasz

2014-01-01

Pregnancy, parturition and childcare, which are important moments in a woman's life, are connected with many emotional states of a future mother, a pregnant woman and a lying-in woman. The perinatal period is the time when the risk of psychological disorders in a pregnant woman may increase by even several times. Objective. The objective of the study was recognition of the main emotional and psychological changes in pregnant women, those in labour and lying-in, according to the factors occurring during the peripartum period. The study was conducted in the form of a survey and covered a group of 108 mothers who were hospitalized in gynaecological-obstetric and obstetric wards in the Karol Marcinkowski Gynaecological-Obstetric University Hospital in Poznań. There are a number of factors which may exert a negative effect on the emotions of women in pregnancy, parturition, and during lying-in. The study showed that there is a close relationship between the occurrence of these factors and emotional states of the mothers after giving birth. Special attention should be given to women in whom already during pregnancy factors arise which may have a negative impact on their mental state. Emotions during pregnancy, parturition and lying-in are often quite extreme, and achieve a high intensity, as well being very variable within a short period of time.

On the problem of proving the existence of ''charmed'' particles

International Nuclear Information System (INIS)

Tyapkin, A.A.

1975-01-01

In order to search for ''charmed'' particles a possibility of performing an experiment is discussed in which one could observe a new particle and prove a necessity of introducting for this particle a new quantum number conserved in strong interactions

Nursing Care and Parents Contribution in the Care of their Childern with Hypospadias

Directory of Open Access Journals (Sweden)

Marianna Orfanidou

2010-01-01

Full Text Available The term hypospadias is derived from the Greek language and refers to the pathological condition of urethra, which the vestibule, by the time of embryology is imperfect. Approximately 1 to 300 male births appear this problem. The aim of this study is the best quality of nursing management. It is proved that the child recover earlier when the parents involved in care, so it is important to explain the procedure, educate parents about the care after leaving the hospital and to make sure that there are no questions unanswered. The new techniques, the nursing management and the parents’ contribution in care promote to reduce hypospadias hospitalization and so, the less suffering.

Searching for fixed point combinators by using automated theorem proving: A preliminary report

International Nuclear Information System (INIS)

Wos, L.; McCune, W.

1988-09-01

In this report, we establish that the use of an automated theorem- proving program to study deep questions from mathematics and logic is indeed an excellent move. Among such problems, we focus mainly on that concerning the construction of fixed point combinators---a problem considered by logicians to be significant and difficult to solve, and often computationally intensive and arduous. To be a fixed point combinator, Θ must satisfy the equation Θx = x(Θx) for all combinators x. The specific questions on which we focus most heavily ask, for each chosen set of combinators, whether a fixed point combinator can be constructed from the members of that set. For answering questions of this type, we present a new, sound, and efficient method, called the kernel method, which can be applied quite easily by hand and very easily by an automated theorem-proving program. For the application of the kernel method by a theorem-proving program, we illustrate the vital role that is played by both paramodulation and demodulation---two of the powerful features frequently offered by an automated theorem-proving program for treating equality as if it is ''understood.'' We also state a conjecture that, if proved, establishes the completeness of the kernel method. From what we can ascertain, this method---which relies on the introduced concepts of kernel and superkernel---offers the first systematic approach for searching for fixed point combinators. We successfully apply the new kernel method to various sets of combinators and, for the set consisting of the combinators B and W, construct an infinite set of fixed point combinators such that no two of the combinators are equal even in the presence of extensionality---a law that asserts that two combinators are equal if they behave the same. 18 refs

Searching for fixed point combinators by using automated theorem proving: A preliminary report

Energy Technology Data Exchange (ETDEWEB)

Wos, L.; McCune, W.

1988-09-01

In this report, we establish that the use of an automated theorem- proving program to study deep questions from mathematics and logic is indeed an excellent move. Among such problems, we focus mainly on that concerning the construction of fixed point combinators---a problem considered by logicians to be significant and difficult to solve, and often computationally intensive and arduous. To be a fixed point combinator, THETA must satisfy the equation THETAx = x(THETAx) for all combinators x. The specific questions on which we focus most heavily ask, for each chosen set of combinators, whether a fixed point combinator can be constructed from the members of that set. For answering questions of this type, we present a new, sound, and efficient method, called the kernel method, which can be applied quite easily by hand and very easily by an automated theorem-proving program. For the application of the kernel method by a theorem-proving program, we illustrate the vital role that is played by both paramodulation and demodulation---two of the powerful features frequently offered by an automated theorem-proving program for treating equality as if it is ''understood.'' We also state a conjecture that, if proved, establishes the completeness of the kernel method. From what we can ascertain, this method---which relies on the introduced concepts of kernel and superkernel---offers the first systematic approach for searching for fixed point combinators. We successfully apply the new kernel method to various sets of combinators and, for the set consisting of the combinators B and W, construct an infinite set of fixed point combinators such that no two of the combinators are equal even in the presence of extensionality---a law that asserts that two combinators are equal if they behave the same. 18 refs.

The in-pile proving test for fuel assembly of Qinshan nuclear power plant

International Nuclear Information System (INIS)

Chen Dianshan; Zhang Shucheng; Kang Rixin; Wang Huarong; Chen Guanghan

1989-10-01

The in-pile proving test for fuel assembly of Qinshan nuclear power plant had been conducted in the experimental loop of HWRR at IAE (Institute of Atomic Energy) in Beijing, China, from January 1985 to December 1986. Average burnup of 27000 MWd/tU and peak burnup of 34000 MWd/tU of fuel rod had already been reached. The basic status of the experiment are described, emphasis is placed on the discussion of proving test parameters and analysis of experiment results

Peripartum dynamics of Coxiella burnetii infections in intensively managed dairy goats associated with a Q fever outbreak in Australia.

Science.gov (United States)

Muleme, Michael; Stenos, John; Vincent, Gemma; Wilks, Colin R; Devlin, Joanne M; Campbell, Angus; Cameron, Alexander; Stevenson, Mark A; Graves, Stephen; Firestone, Simon M

2017-04-01

Coxiella burnetii may cause reproduction disorders in pregnant animals but subclinical infection in other animals. Unrecognised disease may delay implementation of control interventions, resulting in transmission of infection to other livestock and to humans. Seroreactivity to C. burnetii phase-specific antigens, is routinely used to interpret the course of human Q fever. This approach could be similarly useful in identifying new and existing infections in livestock herds to help describe risk factors or production losses associated with the infections and the implementation of disease-control interventions. This study aimed to elucidate the dynamics of C. burnetii infections using seroreactivity to phase-specific antigens and to examine the impact of infection on milk yield in goats in an endemically-infected farm that was associated with a Q fever outbreak in Australia. Seroreactivity pre- and post-partum and milk yield were studied in 164 goats (86 nulliparous and 78 parous). Post-partum, the seroprevalence of antibodies to C. burnetti increased from 4.7% to 31.4% throughout goats' first kiddings and from 47.4% to 55.1% in goats kidding for the second or greater time. Of 123 goats that were seronegative pre-partum, 26.8% seroconverted over the three-month peri-partum period, highlighting the importance of controlling infection throughout this time. The risk of seroconversion was comparable in first or later kidders, suggesting constant risk irrespective of parity. No loss in milk production associated with seroconversion to phase 2 was observed within the first nine weeks of lactation. However, seroconversion to only phase 1 was associated with extra 0.276L of milk per day (95% Confidence Interval: 0.010, 0.543; P=0.042), which warrants further investigation to ascertain whether or not the association is causal. Further studies on seroreactivity and milk production over longer periods are required, as milk production loss caused by C. burnetti may be an

“Deliberate distortion of facts” and the problem of proving bias:

African Journals Online (AJOL)

user

informed observer would reasonably perceive bias on the part of the officer .... represent an excellent illustration of what an Australian Chief Justice once .... the appellants prove that the Justice of Appeal who had no financial or other.

Performance and burnout in intensive care units

NARCIS (Netherlands)

Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

1995-01-01

The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit

Emotional changes occurring in women in pregnancy, parturition and lying-in period according to factors exerting an effect on a woman during the peripartum period

Directory of Open Access Journals (Sweden)

Beata Pięta

2014-09-01

Full Text Available [b]Introduction[/b]. Pregnancy, parturition and childcare, which are important moments in a woman’s life, are connected with many emotional states of a future mother, a pregnant woman and a lying-in woman. The perinatal period is the time when the risk of psychological disorders in a pregnant woman may increase by even several times. [b]Objective.[/b] The objective of the study was recognition of the main emotional and psychological changes in pregnant women, those in labour and lying-in, according to the factors occurring during the peripartum period. [b]Material and method[/b]. The study was conducted in the form of a survey and covered a group of 108 mothers who were hospitalized in gynaecological-obstetric and obstetric wards in the Karol Marcinkowski Gynaecological-Obstetric University Hospital in Poznań. [b]Results[/b]. There are a number of factors which may exert a negative effect on the emotions of women in pregnancy, parturition, and during lying-in. The study showed that there is a close relationship between the occurrence of these factors and emotional states of the mothers after giving birth. [b]Conclusion[/b]. Special attention should be given to women in whom already during pregnancy factors arise which may have a negative impact on their mental state. Emotions during pregnancy, parturition and lying-in are often quite extreme, and achieve a high intensity, as well being very variable within a short period of time.

Proving test on the performance of a Multiple-Excitation Simulator

International Nuclear Information System (INIS)

Fujita, Katsuhisa; Ito, Tomohiro; Kojima, Nobuyuki; Sasaki, Yoichi; Abe, Hiroshi; Kuroda, Katsuhiko

1995-01-01

Seismic excitation test on large scale piping systems is scheduled to be carried out by the Nuclear power Engineering Corporation (NUPEC) using the large-scale, high-performance vibration table at the Tadotsu Engineering Laboratory, under the sponsorship of the Ministry of International Trade and Industry (MITI). In the test, the piping systems simulate the main steam piping system and the main feed water piping system in the nuclear power plants. In this study, a fundamental test was carried out to prove the performance of the Multiple Excitation Simulator which consists of the hydraulic actuator and the control system. An L-shaped piping system and a hydraulic actuator were installed on the shaking table. Acceleration and displacement generated by the actuator were measured. The performance of the actuator and the control system was discussed comparing the measured values and the target values on the time histories and the response spectrum of the acceleration. As a result, it was proved that the actuator and the control system have good performance and will be applicable to the verification test

Proving the AGT relation for N f = 0, 1, 2 antifundamentals

Science.gov (United States)

Hadasz, Leszek; Jaskólski, Zbigniew; Suchanek, Paulina

2010-06-01

Using recursive relations satisfied by Nekrasov partition functions and by irregular conformal blocks we prove the AGT correspondence in the case of mathcal{N} = 2 superconformal SU(2) quiver gauge theories with N f = 0, 1, 2 antifundamental hypermultiplets.

Logic for computer science foundations of automatic theorem proving

CERN Document Server

Gallier, Jean H

2015-01-01

This advanced text for undergraduate and graduate students introduces mathematical logic with an emphasis on proof theory and procedures for algorithmic construction of formal proofs. The self-contained treatment is also useful for computer scientists and mathematically inclined readers interested in the formalization of proofs and basics of automatic theorem proving. Topics include propositional logic and its resolution, first-order logic, Gentzen's cut elimination theorem and applications, and Gentzen's sharpened Hauptsatz and Herbrand's theorem. Additional subjects include resolution in fir

E-squared nine do-it-yourself energy experiments that prove your thoughts create your reality

CERN Document Server

Grout, Pam

2013-01-01

E-Squared is a lab manual with simple experiments to prove once and for all that there really is a good, loving, totally hip force in the universe. Rather than take it on faith, you are invited to conduct ten 48-hour experiments to prove each of the principles in this book. Yes, you read that right. It says prove. The experiments, each of which can be conducted with absolutely no money and very little time expenditure, demonstrate that spiritual principles are as dependable as gravity, as consistent as Newton's 2nd law of motion. For years, you've been hoping and praying that spiritual principles are true. Now, you can know.

Using eternity variables to specify and prove a serializable database interface

NARCIS (Netherlands)

Hesselink, Wim H.

Eternity variables are introduced to specify and verify serializability of transactions of a distributed database. Eternity variables are a new kind of auxiliary variables. They do not occur in the implementation but are used in specification and verification. Elsewhere it has been proved that

Automatically Proving Termination and Memory Safety for Programs with Pointer Arithmetic

DEFF Research Database (Denmark)

Ströder, Thomas; Giesl, Jürgen; Brockschmidt, Marc

2017-01-01

While automated verification of imperative programs has been studied intensively, proving termination of programs with explicit pointer arithmetic fully automatically was still an open problem. To close this gap, we introduce a novel abstract domain that can track allocated memory in detail. We use...

Technical report on the Piping Reliability Proving Tests at the Japan Atomic Energy Research Institute

International Nuclear Information System (INIS)

1993-05-01

Japan Atomic Energy Research Institute (JAERI) conducts Piping Reliability Proving Tests from 1975 to 1992 based upon the contracts between JAERI and Science and Technology Agency of Japan (STA) under the auspices of the special account law for electric power development promotion. The purpose of these tests are to prove the structural reliability of the primary cooling piping constituting a part of the pressure boundary in the light water reactor power plants. The tests with large experimental facilities had ended already in 1990. Presently piping reliability analysis by the probabilistic fracture mechanics method is being done. Until now annual reports concerning the proving tests were produced and submitted to STA, whereas this report summarizes the test results done during these 16 years. Objectives of the piping reliability proving tests are to prove that the primary piping of the light water reactor (1) be reliable throughout the service period, (2) have no possibility of rupture, (3) bring no detrimental influence on the surrounding instrumentations or equipments near the break location even if it ruptured suddenly. To attain these objectives (i) pipe fatigue tests, (ii) unstable pipe fracture tests, (iii) pipe rupture tests and also the analyses by computer codes were done. After carrying out these tests, it is verified that the piping is reliable throughout the service period. The authors of this report are T. Isozaki, K. Shibata, S. Ueda, R. Kurihara, K. Onizawa and A. Kohsaka. The parts they wrote are shown in contents. (author)

76 FR 50771 - Submission for Review: RI 25-37, Evidence To Prove Dependency of a Child, 3206-0206

Science.gov (United States)

2011-08-16

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: RI 25-37, Evidence To Prove Dependency of a...) 3206-0206, Evidence to Prove Dependency of a Child. As required by the Paperwork Reduction Act of 1995... or faxed to (202) 395-6974. SUPPLEMENTARY INFORMATION: Evidence to Prove Dependency of a Child is...

Origin of choriocarcinoma in previous molar pregnancy proved by DNA analysis

International Nuclear Information System (INIS)

Vojtassak, J.; Repiska, V.; Konecna, B.; Zajac, V.; Korbel, M.; Danihel, L.

1996-01-01

A 17-year old woman had in a short time period (seven months) a very exciting reproduction history. Molar pregnancy in December 1993, choriocarcinoma in January 1994 and induced abortion in June 1994. DNA analysis proved the origin of the choriocarcinoma in the previous molar pregnancy. (author)

Peripartum Cardiomyopathy

African Journals Online (AJOL)

disease has multifactorial origin.[6] In acute ... devices, and extracorporeal membrane oxygenation. In severe ... In this article, we reviewed the current status of PPCM. Materials .... concentration of plasma inflammatory cytokines such as tumor.

Peripartum cardiomyopathy

Science.gov (United States)

... sounds. The liver may be enlarged and neck veins may be swollen. Blood pressure may be low or may drop when standing up. Heart enlargement, congestion of the lungs or the veins in the lungs, decreased cardiac output, decreased movement ...

Peripartum cardiomyopathy

DEFF Research Database (Denmark)

Ersboll, Anne S.; Damm, Peter; Gustafsson, Finn

2016-01-01

. The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis....... Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy. CONCLUSIONS: PPCM has a huge impact...... of pathophysiology, diagnostics and clinical management. MATERIAL AND METHODS: Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews...

Characterization of peripartum rumination and activity of cows diagnosed with metabolic and uterine diseases.

Science.gov (United States)

Liboreiro, Daniela N; Machado, Karine S; Silva, Paula R B; Maturana, Milton M; Nishimura, Thiago K; Brandão, Alice P; Endres, Márcia I; Chebel, Ricardo C

2015-10-01

The objectives of the current experiment were to characterize the correlation among total serum Ca, nonesterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), and haptoglobin concentrations and daily rumination time (DRT) and activity of periparturient cows and to determine the association between periparturient events and peripartum DRT and activity. Holstein animals (nulliparous = 77, parous = 219) were enrolled in the experiment approximately 21 d before expected calving date. Cows were fitted with individual Heat Rumination Long Distance collars (HRLD, SCR Engineers Ltd., Netanya, Israel) from enrollment until approximately 21 ± 3 d postpartum. Blood samples collected weekly from enrollment to 21 d postpartum were used to determine concentrations of NEFA, BHBA, and haptoglobin. Blood samples collected within 72 h after calving were used to determine total serum Ca concentration. Subclinical ketosis was characterized by BHBA > 1,000 µmol/L in any sample, and subclinical hypocalcemia was characterized by Ca Cows were examined 1, 7 ± 3, and 14 ± 3 d postpartum for diagnosis of retained fetal membrane and metritis. Total Ca (r = 0.15), NEFA (r = -0.27), and haptoglobin (r = -0.18) concentrations were weakly correlated with DRT. Concentration of BHBA (r = -0.14) was weakly correlated with activity. Postpartum DRT was reduced among cows that delivered twins compared with cows that delivered singletons (437.9 ± 4.8 vs. 385.9 ± 17.1 min/d). Prepartum (465.8 ± 4.1 vs 430.8 ± 14.9 arbitrary units) and postpartum (536.5 ± 5.5 vs. 480.3 ± 19.4 arbitrary units) activity were reduced among cows that delivered twins compared with cows that delivered singletons. Delivery of stillborn calves was associated with reduced DRT prepartum (478.0 ± 5.9 vs. 417.0 ± 23.4 min/d) and postpartum (437.2 ± 4.8 vs. 386.5 ± 19.3 min/d). On the other hand, cows delivering stillborn calves had increased activity prepartum compared with cows delivering live calves (499.3 ± 16

Mathematical Understanding and Proving Abilities: Experiment With Undergraduate Student By Using Modified Moore Learning Approach

Directory of Open Access Journals (Sweden)

Rippi Maya

2011-07-01

Full Text Available This paper reports findings of  a  post test experimental control group design conducted to investigate the role of modified Moore learning approach  on improving students’ mathematical understanding and proving abilities. Subject of study were 56 undergradute students of one state university in Bandung, who took advanced abstract algebra course. Instrument of study were a set test of mathematical understanding ability, a set test of mathematical proving ability, and a set of students’ opinion scale on modified Moore learning approach. Data were analyzed by using two path ANOVA. The study found that proof construction process was more difficult than mathematical understanding  task  for all students, and students still posed some difficulties on constructing mathematical proof task.  The study also found there were not differences  between students’  abilities on mathematical understanding and on proving abilities of  the both classes, and both abilities were classified as mediocre. However, in modified Moore learning approach class there were more students who got above average grades on mathematical understanding than those of conventional class. Moreover, students performed positive  opinion toward  modified Moore learning approach. They  were  active in questioning and solving problems, and in explaining their works in front of class as well, while students of conventional teaching prefered to listen to lecturer’s explanation. The study also found that there was no interaction between learning approach and students’ prior mathematics ability on mathematical understanding and proving abilities,  but  there were  quite strong  association between students’ mathematical understanding and proving abilities.Keywords:  modified Moore learning approach, mathematical understanding ability, mathematical proving ability. DOI: http://dx.doi.org/10.22342/jme.2.2.751.231-250

Amnioinfusion for meconium-stained liquor in labour.

Science.gov (United States)

Hofmeyr, G Justus; Xu, Hairong; Eke, Ahizechukwu C

2014-01-23

Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid. Three review authors independently assessed eligibility and trial quality, and extracted data. Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium

Placenta accreta and anesthesia: A multidisciplinary approach

OpenAIRE

R S Khokhar; J Baaj; M U Khan; F A Dammas; N Rashid

2016-01-01

Placenta accreta (an abnormally adherent placenta) is one of the two leading causes of peripartum hemorrhage and the most common indication for peripartum hysterectomy. Placenta accreta may be associated with significant maternal hemorrhage at delivery owing to the incomplete placental separation. When placenta accreta is diagnosed before delivery, a multidisciplinary approach may improve patient outcome.

Written versus verbal consent: a qualitative study of stakeholder views of consent procedures used at the time of recruitment into a peripartum trial conducted in an emergency setting.

Science.gov (United States)

Lawton, J; Hallowell, N; Snowdon, C; Norman, J E; Carruthers, K; Denison, F C

2017-05-24

Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women's and staff views about the consent procedures used during the internal pilot of a trial (GOT-IT), where the protocol permitted staff to gain verbal consent at recruitment. Interviews with staff (n = 27) and participating women (n = 22). Data were analysed thematically and interviews were cross-compared to identify differences and similarities in participants' views about the consent procedures used. Women and some staff highlighted benefits to obtaining verbal consent at trial enrolment, including expediting recruitment and reducing the burden on those left exhausted by their births. However, most staff with direct responsibility for taking consent expressed extreme reluctance to proceed with enrolment until they had obtained written consent, despite being comfortable using verbal procedures in their clinical practice. To account for this resistance, staff drew a strong distinction between research and clinical care and suggested that a higher level of consent was needed when recruiting into trials. In doing so, staff emphasised the need to engage women in reflexive decision-making and highlighted the role that completing the consent form could play in enabling and evidencing this process. While most staff cited their ethical responsibilities to women, they also voiced concerns that the absence of a signed consent form at recruitment could expose them to greater risk of litigation were an individual to experience a complication during the trial. Inexperience of recruiting into peripartum trials and limited availability of staff trained to take consent also reinforced preferences for

Proof and Proving: Logic, Impasses, and the Relationship to Problem Solving

Science.gov (United States)

Savic, Milos

2012-01-01

Becoming a skillful prover is critical for success in advanced undergraduate and graduate mathematics courses. In this dissertation, I report my investigations of proof and the proving process in three separate studies. In the first study, I examined the amount of logic used in student-constructed proofs to help in the design of…

76 FR 22938 - Submission for Review: RI 25-37, Evidence To Prove Dependency of a Child

Science.gov (United States)

2011-04-25

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: RI 25-37, Evidence To Prove Dependency of a..., Evidence to Prove Dependency of a Child. As required by the Paperwork Reduction Act of 1995 (Pub. L. 104-13... Dependency of a Child, is designed to collect sufficient information for the Office of Personnel Management...

Formal Analysis of Soft Errors using Theorem Proving

Directory of Open Access Journals (Sweden)

Sofiène Tahar

2013-07-01

Full Text Available Modeling and analysis of soft errors in electronic circuits has traditionally been done using computer simulations. Computer simulations cannot guarantee correctness of analysis because they utilize approximate real number representations and pseudo random numbers in the analysis and thus are not well suited for analyzing safety-critical applications. In this paper, we present a higher-order logic theorem proving based method for modeling and analysis of soft errors in electronic circuits. Our developed infrastructure includes formalized continuous random variable pairs, their Cumulative Distribution Function (CDF properties and independent standard uniform and Gaussian random variables. We illustrate the usefulness of our approach by modeling and analyzing soft errors in commonly used dynamic random access memory sense amplifier circuits.

An Endocrine Cause of Acute Post-partum Hypertension

OpenAIRE

Bretherton, Ingrid; Pattison, David; Pattison, Sarah; Varadarajan, Suresh

2013-01-01

This is a case of acute peri-partum hypertension secondary to Conn's syndrome. The timing of presentation offers a rare insight into the hormonal physiology of pregnancy and its impact on blood pressure regulation. This case highlights the challenges of diagnosing primary hyperaldosteronism in the peripartum period and the high index of suspicion required by the obstetric physician.

An Endocrine Cause of Acute Post-partum Hypertension.

Science.gov (United States)

Bretherton, Ingrid; Pattison, David; Pattison, Sarah; Varadarajan, Suresh

2013-03-01

This is a case of acute peri-partum hypertension secondary to Conn's syndrome. The timing of presentation offers a rare insight into the hormonal physiology of pregnancy and its impact on blood pressure regulation. This case highlights the challenges of diagnosing primary hyperaldosteronism in the peripartum period and the high index of suspicion required by the obstetric physician.

Placenta accreta and anesthesia: A multidisciplinary approach

Directory of Open Access Journals (Sweden)

R S Khokhar

2016-01-01

Full Text Available Placenta accreta (an abnormally adherent placenta is one of the two leading causes of peripartum hemorrhage and the most common indication for peripartum hysterectomy. Placenta accreta may be associated with significant maternal hemorrhage at delivery owing to the incomplete placental separation. When placenta accreta is diagnosed before delivery, a multidisciplinary approach may improve patient outcome.

Proving Test on the Reliability for Reactor Containment Vessel

International Nuclear Information System (INIS)

Takumi, K.; Nonaka, A.

1988-01-01

NUPEC (Nuclear Power Engineering Test Center) has started an eight-year project of Proving Test on the Reliability for Reactor Containment Vessel since June 1987. The objective of this project is to confirm the integrity of containment vessels under severe accident conditions. This paper shows the outline of this project. The test Items are (1) Hydrogen mixing and distribution test, (2) Hydrogen burning test, (3) Iodine trapping characteristics test, and (4) Structural behavior test. Based on the test results, computer codes are verified and as the results of analysis and evaluation by the computer codes, containment integrity is to be confirmed

On proving confluence modulo equivalence for Constraint Handling Rules

DEFF Research Database (Denmark)

Christiansen, Henning; Kirkeby, Maja Hanne

2017-01-01

-logical built-in predicates such as var/1 and incomplete ones such as is/2, that are ignored in previous work on confluence. To this end, a new operational semantics for CHR is developed which includes such predicates. In addition, this semantics differs from earlier approaches by its simplicity without loss......Previous results on proving confluence for Constraint Handling Rules are extended in two ways in order to allow a larger and more realistic class of CHR programs to be considered confluent. Firstly, we introduce the relaxed notion of confluence modulo equivalence into the context of CHR: while...

PROVE Land Cover and Leaf Area of Jornada Experimental Range, New Mexico, 1997

Data.gov (United States)

National Aeronautics and Space Administration — ABSTRACT: Field measurement of shrubland ecological properties is important for both site monitoring and validation of remote-sensing information. During the PROVE...

The role of radiotherapy in hospice care

International Nuclear Information System (INIS)

Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.

1989-01-01

The aim of palliative radiotherapy for the terminally ill is to improve the quality of the remaining span of life. From November 1982 to September 1987, 69 patients in the Seirei Hospice have been treated with such radiotherapy, and symptomatic relief was obtained in 64% of these patients. Radiotherapy also proved useful in achieving an improvement in their performance status. While the aim of hospice care is not directed towards treatment of the underlying disease, the use of radiotherapy is considered to have an important role in hospice care. (author)

PROVE Land Cover and Leaf Area of Jornada Experimental Range, New Mexico, 1997

Data.gov (United States)

National Aeronautics and Space Administration — Field measurement of shrubland ecological properties is important for both site monitoring and validation of remote-sensing information. During the PROVE exercise on...

Clinical and echocardiographic characteristics and outcomes in congestive heart failure at the Hospital of The State University of Haiti.

Science.gov (United States)

Malebranche, Rodolphe; Tabou Moyo, Christian; Morisset, Paul-Henry; Raphael, Nernst-Atwood; Wilentz, James Robert

2016-08-01

This study aimed to evaluate the clinical and epidemiologic profile of congestive heart failure at the principal free-care hospital in Haiti. Cardiovascular disease represents the most prevalent cause of admissions to the medical service of the University Hospital of the State of Haiti. No previous study has examined the demographics of congestive heart failure in urban Haiti. Two hundred forty-seven patients presented to the inpatient service between May 2011 and May 2013. Evaluation included history and physical, CBC, renal/metabolic profile, serum glucose, anti-HIV antibody, ECG, chest radiograph and echocardiogram. Treatment included angiotensin converting enzyme inhibitors, furosemide and spironolactone, carvedilol, digoxin and anticoagulation. Women (62.4%) outnumbered men; patients were relatively young (mean age 50.1) and from the lowest socio-economic levels of the population. Nearly all (98.8%) presented with NYHA III-IV status, with correspondingly high mortality (23.3%). Echocardiography showed 73% dilated cardiomyopathy; 83% showed moderate to severe LV systolic dysfunction (mean EF 36.5 +/- 15%) and 17% preserved LV systolic function. The three principal etiologies were dilated cardiomyopathy (29%) hypertensive cardiomyopathy (27%) and peripartum cardiomyopathy (20%). Ischemic cardiomyopathy was rare (3.4%). At 27 months follow-up, 76.7% of the patients were alive and well. Among those who died, mean survival time was 113 days. Readmission carried a poor prognosis. This congestive heart failure study from Haiti shows an unusually high proportion of young women, primarily due to peripartum cardiomyopathy. Ischemic cardiomyopathy is rare, as in Africa. Further study is warranted to address the particular problem of the high frequency of peripartum cardiomyopathy in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa.

Science.gov (United States)

Bloch, Evan M; Crookes, Robert L; Hull, Jennifer; Fawcus, Sue; Gangaram, Rajesh; Anthony, John; Ingram, Charlotte; Ngcobo, Solomuzi; Croxford, Julie; Creel, Darryl V; Murphy, Edward L

2015-07-01

Globally, as in South Africa, obstetric hemorrhage (OH) remains a leading cause of maternal mortality and morbidity. Although blood transfusion is critical to OH management, the incidence and predictors of transfusion as well as their relation to human immunodeficiency virus (HIV) infection are poorly described. A cross-sectional study was conducted of all peripartum patients at four major hospitals in South Africa (April to July 2012). Comprehensive clinical data were collected on patients who sustained OH and/or were transfused. Logistic regression was used to model risk factors for OH and transfusion. A total of 15,725 peripartum women were evaluated, of whom 3969 (25.2%) were HIV positive. Overall, 387 (2.5%) women sustained OH and 438 (2.8%) received transfusions, including 213 (1.4%) women with both OH and transfusion. There was no significant difference in OH incidence between HIV-positive (2.8%) and HIV-negative (2.3%) patients (adjusted odds ratio [OR], 0.95; 95% confidence interval [CI], 0.72-1.25). In contrast, the incidence of blood transfusion was significantly higher in HIV-positive (3.7%) than in HIV-negative (2.4%) patients (adjusted OR, 1.52; 95% CI, 1.14-2.03). Other risk factors for transfusion included OH, low prenatal hemoglobin, the treating hospital, lack of prenatal care, and gestational age of not more than 34 weeks. In the South African obstetric setting, the incidence of peripartum blood transfusion is significantly higher than in the United States and other high-income countries while OH incidence is similar. While OH and prenatal anemia are major predictors of transfusion, HIV infection is a common and independent contributing factor. © 2015 AABB.

Proving termination of graph transformation systems using weighted type graphs over semirings

NARCIS (Netherlands)

Bruggink, H.J.S.; König, B.; Nolte, D.; Zantema, H.; Parisi-Presicce, F.; Westfechtel, B.

2015-01-01

We introduce techniques for proving uniform termination of graph transformation systems, based on matrix interpretations for string rewriting. We generalize this technique by adapting it to graph rewriting instead of string rewriting and by generalizing to ordered semirings. In this way we obtain a

Users manual on database of the Piping Reliability Proving Tests at the Japan Atomic Energy Research Institute

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-09-01

Japan Atomic Energy Research Institute(JAERI) conducted Piping Reliability Proving Tests from 1975 to 1992 based upon the contracts between JAERI and Science and Technology Agency of Japan under the auspices of the special account law for electric power development promotion. The purposes of those tests are to prove the structural reliability of the primary cooling piping constituting a part of the pressure boundary in the water reactor power plants. The tests with large experimental facilities had ended already in 1990. After that piping reliability analysis by the probabilistic method followed until 1992. This report describes the users manual on databases about the test results using the large experimental facilities. Objectives of the piping reliability proving tests are to prove that the primary piping of the water reactor (1) be reliable throughout the service period, (2) have no possibility of rupture, (3) bring no detrimental influence on the surrounding instrumentations or equipments near the break location. The research activities using large scale piping test facilities are described. The present report does the database about the test results pairing the former report. With these two reports, all the feature of Piping Reliability Proving Tests is made clear. Briefings of the tests are described also written in Japanese or English. (author)

Case report 486: Spondyloepiphyseal dysplasia tarda (SDT) (presumptively proved)

International Nuclear Information System (INIS)

Brown, D.D.; Childress, M.H.

1988-01-01

A 51 year old man with severe degenerative joint disease, short stature, barrel chest deformity, platyspondyly, a narrow pelvis, small iliac bones, dysplastic femoral heads and necks, notching of the patellae and flattening of the femoral intercondylar notches has been described as an example of Spondyloepiphyseal dysplasia tarda SDT. The entity was discussed in detail. The notching of the patellae has not been reported in association with SDT to the authors' knowledge. Characteristic features of SDT allow it to be differentiated from other arthropathies and dysplasias and these distinctions have been emphasized in the discussion. The diagnosis in this case can only be considered presumptively proved. (orig./MG)

Ecological survey of M-Field, Edgewood Area Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Downs, J.L.; Eberhardt, L.E.; Fitzner, R.E.; Rogers, L.E.

1991-12-01

An ecological survey was conducted on M-Field, at the Edgewood Area, Aberdeen Proving Ground, Maryland. M-Field is used routinely to test army smokes and obscurants, including brass flakes, carbon fibers, and fog oils. The field has been used for testing purposes for the past 40 years, but little documented history is available. Under current environmental regulations, the test field must be assessed periodically to document the presence or potential use of the area by threatened and endangered species. The M-Field area is approximately 370 acres and is part of the US Army's Edgewood Area at Aberdeen Proving Ground in Harford County, Maryland. The grass-covered field is primarily lowlands with elevations from about 1.0 to 8 m above sea level, and several buildings and structures are present on the field. The ecological assessment of M-Field was conducted in three stages, beginning with a preliminary site visit in May to assess sampling requirements. Two field site visits were made June 3--7, and August 12--15, 1991, to identify the biota existing on the site. Data were gathered on vegetation, small mammals, invertebrates, birds, large mammals, amphibians, and reptiles.

Ecological survey of M-Field, Edgewood Area Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Downs, J.L.; Eberhardt, L.E.; Fitzner, R.E.; Rogers, L.E.

1991-12-01

An ecological survey was conducted on M-Field, at the Edgewood Area, Aberdeen Proving Ground, Maryland. M-Field is used routinely to test army smokes and obscurants, including brass flakes, carbon fibers, and fog oils. The field has been used for testing purposes for the past 40 years, but little documented history is available. Under current environmental regulations, the test field must be assessed periodically to document the presence or potential use of the area by threatened and endangered species. The M-Field area is approximately 370 acres and is part of the US Army`s Edgewood Area at Aberdeen Proving Ground in Harford County, Maryland. The grass-covered field is primarily lowlands with elevations from about 1.0 to 8 m above sea level, and several buildings and structures are present on the field. The ecological assessment of M-Field was conducted in three stages, beginning with a preliminary site visit in May to assess sampling requirements. Two field site visits were made June 3--7, and August 12--15, 1991, to identify the biota existing on the site. Data were gathered on vegetation, small mammals, invertebrates, birds, large mammals, amphibians, and reptiles.

Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

Science.gov (United States)

Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

2017-10-01

To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

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

Science.gov (United States)

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

2008-08-01

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

The GOES-R Proving Ground: 2012 Update

Science.gov (United States)

Gurka, J.; Goodman, S. J.; Schmit, T.; Demaria, M.; Mostek, A.; Siewert, C.; Reed, B.

2011-12-01

The Geostationary Operational Environmental Satellite (GOES)-R will provide a great leap forward in observing capabilities, but will also offer a significant challenge to ensure that users are ready to exploit the vast improvements in spatial, spectral, and temporal resolutions. To ensure user readiness, forecasters and other users must have access to prototype advanced products well before launch, and have the opportunity to provide feedback to product developers and computing and communications managers. The operational assessment is critical to ensure that the end products and NOAA's computing and communications systems truly meet their needs in a rapidly evolving environment. The GOES-R Proving Ground (PG) engages the National Weather Service (NWS) forecast, watch and warning community and other agency users in pre-operational demonstrations of select products with GOES-R attributes (enhanced spectral, spatial, and temporal resolution). In the PG, developers and forecasters test and apply algorithms for new GOES-R satellite data and products using proxy and simulated data sets, including observations from current and future satellite instruments (MODIS, AIRS, IASI, SEVIRI, NAST-I, NPP/VIIRS/CrIS, LIS), lightning networks, and computer simulated products. The complete list of products to be evaluated in 2012 will be determined after evaluating results from experiments in 2011 at the NWS' Storm Prediction Center, National Hurricane Center, Aviation Weather Center, Ocean Prediction Center, Hydrometeorological Prediction Center, and from the six NWS regions. In 2012 and beyond, the PG will test and validate data processing and distribution systems and the applications of these products in operational settings. Additionally developers and forecasters will test and apply display techniques and decision aid tools in operational environments. The PG is both a recipient and a source of training. Training materials are developed using various distance training tools in

Com aplicar les proves paramètriques bivariades t de Student i ANOVA en SPSS. Cas pràctic

Directory of Open Access Journals (Sweden)

María-José Rubio-Hurtado

2012-07-01

Full Text Available Les proves paramètriques són un tipus de proves de significació estadística que quantifiquen l'associació o independència entre una variable quantitativa i una categòrica. Les proves paramètriques són exigents amb certs requisits previs per a la seva aplicació: la distribució Normal de la variable quantitativa en els grups que es comparen, l'homogeneïtat de variàncies en les poblacions de les quals procedeixen els grups i una n mostral no inferior a 30. El seu no compliment comporta la necessitat de recórrer a proves estadístiques no paramètriques. Les proves paramètriques es classifiquen en dos: prova t (per a una mostra o per a dues mostres relacionades o independents i prova ANOVA (per a més de dues mostres independents.

An Archeological Overview and Management Plan for the Dugway Proving Ground.

Science.gov (United States)

1984-03-29

niches, particulary the lacustrine environment of the Great Basin (Baumhoff and Heizer 1965, Butler 1978, Heizer and Krieger 1956, Heizer and Harper...power that would capture the animals souls, rendering them docile and stupid (Steward 1970:34). Other large game was present, but were not numerous...uni versity. Baum, Bernard. 1947. Dugway Proving Ground. Aberdeen: U.S. Army Chemical Corps.* Bailmhoff, W.A. and R.F. Heizer . 1965. Postglacial

Developing a decision support system for tobacco use counselling using primary care physicians

Directory of Open Access Journals (Sweden)

Theodore Marcy

2008-07-01

Conclusions A multi-method evaluation process utilising primary care physicians proved useful for developing a CDSS that was acceptable to physicians and patients, and feasible to use in their clinical environment.

L’Inquisizione, gli indizi, le prove

Directory of Open Access Journals (Sweden)

Guido Dall’Olio

2012-11-01

Full Text Available This essay focuses on some characteristics of the inquisitorial trial, comparing it with the accusatory procedure. The inquisitorial trial, which resulted in almost inevitable torture of the accused, is certainly in our eyes an injustice and a violation of the legal rights that are essential for us in a proper procedure. However, the care with which the evidence was produced and examined by the institutions that adopted the inquisitorial procedure deserves to be emphasized, especially for the consequences it had in certain types of imaginary crime such as witchcraft.

Achondroplasia: anaesthetic challenges for caesarean section.

Science.gov (United States)

Dubiel, L; Scott, G A; Agaram, R; McGrady, E; Duncan, A; Litchfield, K N

2014-08-01

Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Differential susceptibility to parenting and quality child care.

Science.gov (United States)

Pluess, Michael; Belsky, Jay

2010-03-01

Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from reasonably diverse backgrounds were followed from 1 month to 11 years with repeated observational assessments of parenting and child care quality, as well as teacher report and standardized assessments of children's cognitive-academic and social functioning, to determine whether those with histories of difficult temperament proved more susceptible to early rearing effects at ages 10 and 11. Evidence for such differential susceptibility emerges in the case of both parenting and child care quality and with respect to both cognitive-academic and social functioning. Differential susceptibility to parenting and child care quality extends to late middle childhood. J. Belsky, D. L. Vandell, et al.'s (2007) failure to consider such temperament-moderated rearing effects in their evaluation of long-term child care effects misestimates effects of child care quality on social adjustment.

A Hybrid Approach to Proving Memory Reference Monotonicity

KAUST Repository

Oancea, Cosmin E.

2013-01-01

Array references indexed by non-linear expressions or subscript arrays represent a major obstacle to compiler analysis and to automatic parallelization. Most previous proposed solutions either enhance the static analysis repertoire to recognize more patterns, to infer array-value properties, and to refine the mathematical support, or apply expensive run time analysis of memory reference traces to disambiguate these accesses. This paper presents an automated solution based on static construction of access summaries, in which the reference non-linearity problem can be solved for a large number of reference patterns by extracting arbitrarily-shaped predicates that can (in)validate the reference monotonicity property and thus (dis)prove loop independence. Experiments on six benchmarks show that our general technique for dynamic validation of the monotonicity property can cover a large class of codes, incurs minimal run-time overhead and obtains good speedups. © 2013 Springer-Verlag.

[Internal audit--the foundation of healthcare quality management in health care].

Science.gov (United States)

Smiianov, V A

2014-01-01

The paper proved the need for internal audit as the basis for quality control of medical care in a health facility, developed the project milestones and explains what needs to be taken into account at every stage during its implementation.

Research Objectives for Human Missions in the Proving Ground of Cis-Lunar Space

Science.gov (United States)

Spann, James; Niles, Paul; Eppler, Dean; Kennedy, Kriss; Lewis, Ruthan; Sullivan, Thomas

2016-07-01

Introduction: This talk will introduce the preliminary findings in support of NASA's Future Capabilities Team. In support of the ongoing studies conducted by NASA's Future Capabilities Team, we are tasked with collecting re-search objectives for the Proving Ground activities. The objectives could include but are certainly not limited to: demonstrating crew well being and performance over long duration missions, characterizing lunar volatiles, Earth monitoring, near Earth object search and identification, support of a far-side radio telescope, and measuring impact of deep space environment on biological systems. Beginning in as early as 2023, crewed missions beyond low Earth orbit will be enabled by the new capabilities of the SLS and Orion vehicles. This will initiate the "Proving Ground" phase of human exploration with Mars as an ultimate destination. The primary goal of the Proving Ground is to demonstrate the capability of suitably long dura-tion spaceflight without need of continuous support from Earth, i.e. become Earth Independent. A major component of the Proving Ground phase is to conduct research activities aimed at accomplishing major objectives selected from a wide variety of disciplines including but not limited to: Astronomy, Heliophysics, Fun-damental Physics, Planetary Science, Earth Science, Human Systems, Fundamental Space Biology, Microgravity, and In Situ Resource Utilization. Mapping and prioritizing the most important objectives from these disciplines will provide a strong foundation for establishing the architecture to be utilized in the Proving Ground. Possible Architectures: Activities and objectives will be accomplished during the Proving Ground phase using a deep space habitat. This habitat will potentially be accompanied by a power/propulsion bus capable of moving the habitat to accomplish different objectives within cis-lunar space. This architecture can also potentially support stag-ing of robotic and tele-robotic assets as well as

Radiation protection medical care of radiation workers

International Nuclear Information System (INIS)

Walt, H.

1988-01-01

Radiation protection medical care for radiation workers is part of the extensive programme protecting people against dangers emanating from the peaceful application of ionizing radiation. Thus it is a special field of occupational health care and emergency medicine in case of radiation accidents. It has proved helpful in preventing radiation damage as well as in early detection, treatment, after-care, and expert assessment. The medical checks include pre-employment and follow-up examinations, continued long-range medical care as well as specific monitoring of individuals and defined groups of workers. Three levels of action are involved: works medical officers specialized in radiation protection, the Institute of Medicine at the National Board for Atomic Safety and Radiation Protection, and a network of clinical departments specialized in handling cases of acute radiation damage. An account is given of categories, types, and methods of examinations for radiation workers and operators. (author)

Reasoning by analogy as an aid to heuristic theorem proving.

Science.gov (United States)

Kling, R. E.

1972-01-01

When heuristic problem-solving programs are faced with large data bases that contain numbers of facts far in excess of those needed to solve any particular problem, their performance rapidly deteriorates. In this paper, the correspondence between a new unsolved problem and a previously solved analogous problem is computed and invoked to tailor large data bases to manageable sizes. This paper outlines the design of an algorithm for generating and exploiting analogies between theorems posed to a resolution-logic system. These algorithms are believed to be the first computationally feasible development of reasoning by analogy to be applied to heuristic theorem proving.

[Quality assurance concepts in intensive care medicine].

Science.gov (United States)

Brinkmann, A; Braun, J P; Riessen, R; Dubb, R; Kaltwasser, A; Bingold, T M

2015-11-01

Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved.

[Assessment, delivery and peripartum care in the case of a uterine rupture during labor of a woman with a previous C-section].

Science.gov (United States)

Parrilla-Fernández, Alberto; Manrique-Tejedor, Javier; Figuerol-Calderó, M Inmaculada; García-Romero, Verónica

Uterine rupture is a rare but severe complication in obstetrics. A previous C-section is the most important risk factor. Its incidence during labor in women with a previous C-section is of approximately 0.3-0.47%, being potentially severe. We present the case of a pregnant women with a previous C-section who suffered uterine rupture during labor. The rapid assessment and action of the midwife and obstetric team was essential to obtain a successful obstetric outcome, avoiding maternal and fetal mortality; and nursing care given to the mother and the newborn after birth contributed to achieving a normal postpartum. It is necessary to have specific knowledge about this condition that, despite rare, can present insidiously with a potential risk for the mother and the fetus. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Anna Bryndis Blondal

2017-04-01

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

Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

Science.gov (United States)

Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano

2015-11-14

Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

Intrapartum amnioinfusion for meconium-stained amniotic fluid: a systematic review of randomised controlled trials.

Science.gov (United States)

Xu, H; Hofmeyr, J; Roy, C; Fraser, W D

2007-04-01

Amnioinfusion (AI) is thought to dilute meconium when present in the amniotic fluid and so reduces the risk of meconium aspiration. To evaluate if AI reduces meconium aspiration syndrome (MAS) and other indicators of morbidity in babies born to women with meconium-stained amniotic fluid (MSAF). PubMed, Medline, EMBASE, and the Cochrane Controlled Trials Register from January 1980 to May 30, 2005, using the keywords 'amnioinfusion' and 'meconium'. Randomised trials comparing AI with no AI for women in labour with MSAF. Trial quality was evaluated using pre-established criteria. The following morbidity indicators were assessed: MAS, 5-minute Apgar score < 7, arterial cord pH < 7.2, and caesarean section. Studies were stratified according to the level of peripartum surveillance (standard versus limited). Typical relative risks (RRs) with their 95% confidence intervals were calculated for each outcome using a random effects model. In clinical settings with standard peripartum surveillance, we found no evidence that AI reduced the risk of MAS (RR 0.59, 95% CI 0.28-1.25), 5-minute Apgar score < 7 (RR 0.90, 95% CI 0.58-1.41), or caesarean delivery (RR 0.89, 95% CI 0.73-1.10). In clinical settings with limited peripartum surveillance, AI appeared to reduce the risk of MAS (RR 0.25, 95% CI 0.13-0.47). In clinical settings with standard peripartum surveillance, the evidence does not support the use of AI for MSAF. In settings with limited peripartum surveillance, where complications of MSAF are common, AI appears to reduce the risk of MAS. However, this finding requires confirmation by further studies.

RFID Continuance Usage Intention in Health Care Industry.

Science.gov (United States)

Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud

Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.

Workplace Financial Wellness Programs Help Employees Manage Health Care Changes.

Science.gov (United States)

Meyer, Cynthia; Smith, Michael C

Employers and employees are navigating major changes in health insurance benefits, including the move to high-deductible health plans in conjunction with health savings accounts (HSAs). The HSA offers unique benefits that could prove instrumental in helping workers both navigate current health care expenses and build a nest egg for much larger health care costs in retirement. Yet employees often don't understand the HSA and how to best use it. How can employers help employees make wise benefits choices that work for their personal financial circumstances?

GOES-R Proving Ground Activities at the NASA Short-Term Prediction Research and Transition (SPoRT) Center

Science.gov (United States)

Molthan, Andrew

2011-01-01

SPoRT is actively involved in GOES-R Proving Ground activities in a number of ways: (1) Applying the paradigm of product development, user training, and interaction to foster interaction with end users at NOAA forecast offices national centers. (2) Providing unique capabilities in collaboration with other GOES-R Proving Ground partners (a) Hybrid GOES-MODIS imagery (b) Pseudo-GLM via regional lightning mapping arrays (c) Developing new RGB imagery from EUMETSAT guidelines

Palliative care in Africa: a global challenge.

Science.gov (United States)

Ntizimira, Christian R; Nkurikiyimfura, Jean Luc; Mukeshimana, Olive; Ngizwenayo, Scholastique; Mukasahaha, Diane; Clancy, Clare

2014-01-01

We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said 'in the middle of difficulty lies opportunity' and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.

Depleted uranium risk assessment at Aberdeen Proving Ground

International Nuclear Information System (INIS)

Ebinger, M.H.; Myers, O.B.; Kennedy, P.L.; Clements, W.H.

1993-01-01

The Environmental Science Group at Los Alamos and the Test and Evaluation Command (TECOM) are assessing the risk of depleted uranium (DU) testing at Aberdeen Proving Ground (APG). Conceptual and mathematical models of DU transfer through the APG ecosystem have been developed in order to show the mechanisms by which DU migrates or remains unavailable to different flora and fauna and to humans. The models incorporate actual rates of DU transfer between different ecosystem components as much as possible. Availability of data on DU transport through different pathways is scarce and constrains some of the transfer rates that can be used. Estimates of transfer rates were derived from literature sources and used in the mass-transfer models when actual transfer rates were unavailable. Objectives for this risk assessment are (1) to assess if DU transports away from impact areas; (2) to estimate how much, if any, DU migrates into Chesapeake Bay; (3) to determine if there are appreciable risks to the ecosystems due to DU testing; (4) to estimate the risk to human health as a result of DU testing

Specialized traumatological and orthopedic care for children through public-private partnership programs in the Novosibirsk region

Directory of Open Access Journals (Sweden)

Tamara A Mylnikova

2016-03-01

Conclusions: Implementation of an organizational model of specialized traumatological and orthopedic care for children in the Novosibirsk region using mechanisms associated with public–private partnerships has proved to be very positive. Application of the model allowed improvements in the availability of specialized traumatological and orthopedic care for children to ensure succession in the stages of medical care and to increase the number of cases entering rehabilitation. Therefore, this model demonstrates the viability of providing medical care to the population through the mechanisms of public–private partnership.

Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care

DEFF Research Database (Denmark)

Hertel-Joergensen, Michala; Abrahamsen, Charlotte; Jensen, Carsten

2018-01-01

patients were screened for eligibility; 215 were included. The full-scale model fit estimates were moderate. Factor loadings typically ranged from 0.65 to 0.97, except for the questions concerning Technical Skills (0.38-0.63) and Nursing Process (0.28). The Cronbach's alpha value for the total scale score......AIM: To test the psychometric validity of the Good Perioperative Nursing Care Scale (GPNCS), a self-administered questionnaire, following translation and adaptation. INTRODUCTION: Patients' satisfaction with and experience of nursing care in orthopaedic or perioperative settings are currently...... was 0.92, with subfactors ranging from 0.72 to 0.87. CONCLUSION: Providing evidence for quality, or lack thereof, the Danish version of the GPNCS is a valid tool for measuring surgical patients' experiences with perioperative nursing care. The electronic version proved practical. RELEVANCE TO CLINICAL...

a Test to Prove Cloud Whitening THEORY!

Science.gov (United States)

Buttram, J. W.

2011-12-01

Climate science researchers believe our planet can possibly tolerate twice the present carbon dioxide levels with no upwards temperature change, IF we could increase the amount of energy reflected back out into space by about 2.0%. (c)Cloudtec basically alters a blend of seawater and applies heat derived from magma to it at a temperature exceeding 2,000 degrees F. The interaction of seawater and magma displaces the oxygen, causing the volume of water to vaporize and expand over 4,000 times - transforming billions of tons of seawater into thousands of cubic miles of white, maritime, stratocumulus clouds to reflect the incident Sun's rays back out into space. A 6 month test to prove Cloud Whitening Theory will cost 6 million dollars. (No profit added.) This study will enable everyone on the planet with a computer the transparency to use satellite imagery and check out for themselves - if and when Cloud Whitening is occurring. If Cloud Whitening Theory is validated, (c)Cloudtec's innovation can strategically create the clouds we need to reflect the Sun's rays back out into space and help neutralize the projected 3.6 degrees F rise in temperature. Based on reasonable calculations of anthropogenic global warming: this one move alone would be comparable to slashing global carbon dioxide emissions by over 60% over the next 40 years.

NASA SPoRT GOES-R Proving Ground Activities

Science.gov (United States)

Stano, Geoffrey T.; Fuell, Kevin K.; Jedloec, Gary J.

2010-01-01

The NASA Short-term Prediction Research and Transition (SPoRT) program is a partner with the GOES-R Proving Ground (PG) helping prepare forecasters understand the unique products to come from the GOES-R instrument suite. SPoRT is working collaboratively with other members of the GOES-R PG team and Algorithm Working Group (AWG) scientists to develop and disseminate a suite of proxy products that address specific forecast problems for the WFOs, Regional and National Support Centers, and other NOAA users. These products draw on SPoRT s expertise with the transition and evaluation of products into operations from the MODIS instrument and the North Alabama Lightning Mapping Array (NALMA). The MODIS instrument serves as an excellent proxy for the Advanced Baseline Imager (ABI) that will be aboard GOES-R. SPoRT has transitioned and evaluated several multi-channel MODIS products. The true and false color products are being used in natural hazard detection by several SPoRT partners to provide better observation of land features, such as fires, smoke plumes, and snow cover. Additionally, many of SPoRT s partners are coastal offices and already benefit from the MODIS sea surface temperature composite. This, along with other surface feature observations will be developed into ABI proxy products for diagnostic use in the forecast process as well as assimilation into forecast models. In addition to the MODIS instrument, the NALMA has proven very valuable to WFOs with access to these total lightning data. These data provide situational awareness and enhanced warning decision making to improve lead times for severe thunderstorm and tornado warnings. One effort by SPoRT scientists includes a lightning threat product to create short-term model forecasts of lightning activity. Additionally, SPoRT is working with the AWG to create GLM proxy data from several of the ground based total lightning networks, such as the NALMA. The evaluation will focus on the vastly improved spatial

The Secret Prover : Proving Possession of Arbitrary Files While not Giving Them Away

NARCIS (Netherlands)

Teepe, Wouter

2005-01-01

The Secret Prover is a Java application which allows a user (A) to prove to another user (B), that A possesses a file. If B also possesses this file B will get convinced, and if B does not possess this file B will gain no information on (the contents of) this file. This is the first implementation

Impact of cooking, proving, and baking on the (poly)phenol content of wild blueberry.

Science.gov (United States)

Rodriguez-Mateos, Ana; Cifuentes-Gomez, Tania; George, Trevor W; Spencer, Jeremy P E

2014-05-07

Accumulating evidence suggests that diets rich in (poly)phenols may have positive effects on human health. Currently there is limited information regarding the effects of processing on the (poly)phenolic content of berries, in particular in processes related to the baking industry. This study investigated the impact of cooking, proving, and baking on the anthocyanin, procyanidin, flavonol, and phenolic acid contents of wild blueberry using HPLC with UV and fluorescence detection. Anthocyanin levels decreased during cooking, proving, and baking, whereas no significant changes were observed for total procyanidins. However, lower molecular weight procyanidins increased and high molecular weight oligomers decreased during the process. Quercetin and ferulic and caffeic acid levels remained constant, whereas increases were found for chlorogenic acid. Due to their possible health benefits, a better understanding of the impact of processing is important to maximize the retention of these phytochemicals in berry-containing products.

Conceptualizing reasoning-and-proving opportunities in textbook expositions : Cases from secondary calculus

OpenAIRE

Bergwall, Andreas

2017-01-01

Several recent textbook studies focus on opportunities to learn reasoning-and-proving. They typically investigate the extent to which justifications are general proofs and what opportunities exist for learning important elements of mathematical reasoning. In this paper, I discuss how a particular analytical framework for this might be refined. Based on an in-depth analysis of certain textbook passages in upper secondary calculus textbooks, I make an account for analytical issues encountered d...

The effects of GeoGebra software on pre-service mathematics teachers' attitudes and views toward proof and proving

Science.gov (United States)

Zengin, Yılmaz

2017-11-01

The purpose of this study is to determine the effect of GeoGebra software on pre-service mathematics teachers' attitudes towards proof and proving and to determine pre-service teachers' pre- and post-views regarding proof. The study lasted nine weeks and the participants of the study consisted of 24 pre-service mathematics teachers. The study used the 'Attitude Scale Towards Proof and Proving' and an open-ended questionnaire that were administered before and after the intervention as data collection tools. Paired samples t-test analysis was used for the analysis of quantitative data and content and descriptive analyses were utilized for the analysis of qualitative data. As a result of the data analysis, it was determined that GeoGebra software was an effective tool in increasing pre-service teachers' attitudes towards proof and proving.

Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children's critical care unit.

Science.gov (United States)

Hill, Charlotte

2016-05-09

Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role.

Palliative care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care.

Science.gov (United States)

Klop, Hanna T; de Veer, Anke J E; van Dongen, Sophie I; Francke, Anneke L; Rietjens, Judith A C; Onwuteaka-Philipsen, Bregje D

2018-04-24

Homeless people often suffer from complex and chronic comorbidities, have high rates of morbidity and die at much younger ages than the general population. Due to a complex combination of physical, psychosocial and addiction problems at the end of life, they often have limited access to palliative care. Both the homeless and healthcare providers experience a lot of barriers. Therefore, providing palliative care that fits the needs and concerns of the homeless is a challenge to healthcare providers. This systematic review aims to summarize evidence about the concerns, palliative care needs and preferences of homeless people, as well as barriers and facilitators for delivering high quality palliative care. PubMed, Embase, PsycINFO, CINAHL and Web of Science were searched up to 10 May 2016. Included were studies about homeless people with a short life expectancy, their palliative care needs and the palliative care provided, that were conducted in Western countries. Data were independently extracted by two researchers using a predefined extraction form. Quality was assessed using a Critical Appraisal instrument. The systematic literature review was based on the PRISMA statement. Twenty-seven publications from 23 different studies met the inclusion criteria; 15 studies were qualitative and eight were quantitative. Concerns of the homeless often related to end-of-life care not being a priority, drug dependence hindering adequate care, limited insight into their condition and little support from family and relatives. Barriers and facilitators often concerned the attitude of healthcare professionals towards homeless people. A respectful approach and respect for dignity proved to be important in good quality palliative care. A patient-centred, flexible and low-threshold approach embodying awareness of the concerns of homeless people is needed so that appropriate palliative care can be provided timely. Training, education and experience of professionals can help to

Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment.

Science.gov (United States)

H Bjørk, Marte; Veiby, Gyri; A Engelsen, Bernt; Gilhus, Nils Erik

2015-05-01

To review available data and provide treatment recommendations concerning peripartum depression, anxiety and fear of birth in women with epilepsy (WWE). The PubMed, the LactMed, the DART and the Cochrane database were searched for original articles concerning psychiatric disease in the peripartum period in WWE. Point prevalence of depression from 2nd trimester to 6 months postpartum ranged from 16 to 35% in women with epilepsy compared to 9-12% in controls. The highest estimates were found early in pregnancy and in the perinatal period. Anxiety symptoms 6 months postpartum were reported by 10 and 5%, respectively. Fear of birth symptoms were increased in primiparous WWE compared to controls. Previous psychiatric disease, sexual/physical abuse, antiepileptic drug (AED) polytherapy, and high seizure frequency emerged as strong risk factors. Depressed WWE rarely used antidepressive medication during pregnancy. No evidence was available concerning treatment effects or impact on the developing child. Peripartum depression is frequent in WWE and seldom medically treated. Health personnel should screen WWE for psychiatric disease and risk factors during pre-pregnancy planning, pregnancy and postpartum follow up. Treatment decisions should rely on efficacy and safety data in peripartum patients without epilepsy and non-pregnant people with epilepsy. Consequences of in utero exposure to AED therapy in combination with antidepressants are not known, and non-pharmacological treatment should be tried first. Copyright © 2015. Published by Elsevier Ltd.

[3D printing in health care facilities: What legislation in France?].

Science.gov (United States)

Montmartin, M; Meyer, C; Euvrard, E; Pazart, L; Weber, E; Benassarou, M

2015-11-01

Health care facilities more and more use 3D printing, including making their own medical devices (MDs). However, production and marketing of MDs are regulated. The goal of our work was to clarify what is the current French regulation that should be applied concerning the production of custom-made MDs produced by 3D printing in a health care facility. MDs consist of all devices used for diagnosis, prevention, or treatment of diseases in patients. Prototypes and anatomic models are not considered as MDs and no specific laws apply to them. Cutting guides, splints, osteosynthesis plates or prosthesis are MDs. In order to become a MD manufacturer in France, a health care facility has to follow the requirements of the 93/42/CEE directive. In addition, custom-made 3D-printed MDs must follow the annex VIII of the directive. This needs the writing of a declaration of conformity and the respect of the essential requirements (proving that a MD is secure and conform to what is expected), the procedure has to be qualified, a risk analysis and a control of the biocompatibility of the material have to be fulfilled. The documents proving that these rules have been respected have to be available. Becoming a regulatory manufacturer of MD in France is possible for a health care facility but the specifications have to be respected. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Geophysics: Building E5481 decommissioning, Aberdeen Proving Ground

International Nuclear Information System (INIS)

Thompson, M.D.; McGinnis, M.G.; McGinnis, L.D.; Miller, S.F.

1992-11-01

Building E5481 is one of ten potentially contaminated sites in the Canal Creek and Westwood areas of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May of 1992. Noninvasive geophysical surveys, including magnetics, electrical resistivity, and ground-penetrating radar, were conducted around the perimeter of the building to guide a sampling program prior to decommissioning and dismantling. The building is located on the northern margin of a landfill that was sited in a wetland. The large number of magnetic sources surrounding the building are believed to be contained in construction fill that had been used to raise the grade. The smaller anomalies, for the most part, are not imaged with ground radar or by electrical profiling. A conductive zone trending northwest to southeast across the site is spatially related to an old roadbed. Higher resistivity areas in the northeast and east are probably representive of background values. Three high-amplitude, positive, rectangular magnetic anomalies have unknown sources. The features do not have equivalent electrical signatures, nor are they seen with radar imaging

Geophysics: Building E5375 decommissioning, Aberdeen Proving Ground

International Nuclear Information System (INIS)

McGinnis, M.G.; McGinnis, L.D.; Miller, S.F.; Thompson, M.D.

1992-08-01

Building E5375 was one of ten potentially contaminated sites in the Canal Creek area of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May 1992. Noninvasive geophysical surveys, including magnetics, electrical resistivity, and ground-penetrating radar (GPR), were conducted around the perimeter of the building to guide a sampling program prior to decommissioning and dismantling. Several anomalies wear, noted: (1) An underground storage tank located 25 ft east of Building E5375 was identified with magnetic, resistivity, and GPR profiling. (2) A three-point resistivity anomaly, 12 ft east of the northeast comer of Building E5374 (which borders Building E5375) and 5 ft south of the area surveyed with the magnetometer, may be caused by another underground storage tank. (3) A 2,500-gamma magnetic anomaly near the northeast corner of the site has no equivalent resistivity anomaly, although disruption in GPR reflectors was observed. (4) A one-point magnetic anomaly was located at the northeast comer, but its source cannot be resolved. A chaotic reflective zone to the east represents the radar signature of Building E5375 construction fill

A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care

DEFF Research Database (Denmark)

Thomsen, Kia Toft; Guldin, Mai-Britt; Nielsen, Mette Kjærgaard

2017-01-01

the feasibility of an intervention based on key elements of the "Bereavement support standards for specialist palliative care services" in a Danish specialised palliative home care team. We followed the UK Medical Research Council's guidelines for the process evaluation of complex interventions. The intervention...... was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable. CONCLUSION: The intervention proved feasible and useful. Still, we identified barriers...

The active straight leg raising test and mobility of the pelvic joints

OpenAIRE

Mens, J. M. A.; Vleeming, Andry; Snijders, Chris J.; Stam, Henk J.; Ginai, Abida Z.

1999-01-01

Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) mot...

The effect of herbal formula PROVE 1 and Stevia levels in diets on diet utilization of growing pigs

Directory of Open Access Journals (Sweden)

Kooprasert, S.

2007-05-01

Full Text Available The objective of this experiment was to study the effect of 0.2% antibiotic (ascomix-s®, one kilogram of which contains lincomycin hydrochloride 44 g and sulfamethazine 110 g or 0.25% herbal formulaPROVE 1, combined with five levels of Stevia supplementation in the diets on digestibility of pigs. Two factors; 1 type of drug (0.2% antibiotic and 0.25% herbal formula PROVE 1 and 2 five Stevia levels (0,0.2, 0.4, 0.6 and 0.8% were investigated and 10 dietary treatments were used in this study. Ten related growing crossbred (Large White x Landrace barrow pigs (30±1.5 kg body weight were raised in individualmetabolism cages for three collecting periods (30, 40 and 50 kg body weight, each pig was fed one experimental diet throughout the collecting period.The results showed that pigs fed diet with either 0.2% antibiotic or 0.25% herbal formula PROVE 1 had similar digestibility of diet, crude protein (CP, fiber, ash and nitrogen free extract (NFE (89.01 vs 87.83,94.96 vs 94.23, 60.73 vs 59.03, 61.22 vs 60.44 and 93.28 vs 92.03%, respectively. Negligible differences were observed between 0 and 0.4% Stevia supplementation in diet, but levels showed better digestibility than the other levels of Stevia supplementation, and the diet with 0.4% Stevia supplementation had the highestdigestibility of diet, CP, fiber, ash and NFE (91.04, 96.43, 69.48, 70.47 and 94.07%, respectively. The diet with antibiotic combined with 0.4% Stevia had digestibility of diet, CP, fat and fiber better than the otherlevels of Stevia supplementation, especially digestibility of ash, which was significantly higher than that of diet with 0.2% Stevia, but not significantly different from the other levels of Stevia supplementation. A partof herbal formula PROVE1 combined with 0% Stevia had the highest digestibility of ash (72.90%, significantly higher than the other levels of Stevia supplementation, except the diet with herbal formula PROVE 1combined with 0.4% Stevia supplementation

Safety objectives for next generation reactors: proving their achievement

International Nuclear Information System (INIS)

Tanguy, P.Y.

1996-01-01

Assuming that there is a consensus between regulatory bodies and nuclear operating organizations on safety objectives for future plants, how are we going to demonstrate that they have been achieved, with a reasonable certainty? Right from the beginning, I would like to underline the importance of convincing the public that high level safety objectives will be effectively achieved in future nuclear power plants. The mere fulfillment of administrative requirements might not be sufficient to obtain public acceptance. One has to take into account the changes that have occurred in the public preception of nuclear risks in the wake of the Chernobyl accident. Today public opinion rules out the possibility not only that such a catastrophic accident could recur, but also that any accident with detrimental health consequences off-site could occur. The nuclear industry has to reflect this concern in its safety demonstration, independently of proving the achievement of technical safety goals. The public opinion issue will be readdressed at the end of this paper. (orig.)

Why prove it again? alternative proofs in mathematical practice

CERN Document Server

Dawson, Jr , John W

2015-01-01

This monograph considers several well-known mathematical theorems and asks the question, “Why prove it again?” while examining alternative proofs.   It  explores the different rationales mathematicians may have for pursuing and presenting new proofs of previously established results, as well as how they judge whether two proofs of a given result are different.  While a number of books have examined alternative proofs of individual theorems, this is the first that presents comparative case studies of other methods for a variety of different theorems. The author begins by laying out the criteria for distinguishing among proofs and enumerates reasons why new proofs have, for so long, played a prominent role in mathematical practice.  He then outlines various purposes that alternative proofs may serve.  Each chapter that follows provides a detailed case study of alternative proofs for particular theorems, including the Pythagorean Theorem, the Fundamental Theorem of Arithmetic, Desargues’ Theorem, the...

Initial building investigations at Aberdeen Proving Ground, Maryland: Objectives and methodology

Energy Technology Data Exchange (ETDEWEB)

Brubaker, K.L.; Dougherty, J.M.; McGinnis, L.D.

1994-12-01

As part of an environmental-contamination source-definition program at Aberdeen Proving Ground, detailed internal and external inspections of 23 potentially contaminated buildings are being conducted to describe and characterize the state of each building as it currently exists and to identify areas potentially contaminated with toxic or other hazardous substances. In addition, a detailed geophysical investigation is being conducted in the vicinity of each target building to locate and identify subsurface structures, associated with former building operations, that are potential sources of contamination. This report describes the objectives of the initial building inspections, including the geophysical investigations, and discusses the methodology that has been developed to achieve these objectives.

Divide and conquer method for proving gaps of frustration free Hamiltonians

DEFF Research Database (Denmark)

Kastoryano, Michael J.; Lucia, Angelo

2018-01-01

Providing system-size independent lower bounds on the spectral gap of local Hamiltonian is in general a hard problem. For the case of finite-range, frustration free Hamiltonians on a spin lattice of arbitrary dimension, we show that a property of the ground state space is sufficient to obtain...... such a bound. We furthermore show that such a condition is necessary and equivalent to a constant spectral gap. Thanks to this equivalence, we can prove that for gapless models in any dimension, the spectral gap on regions of diameter $n$ is at most $o\\left(\\frac{\\log(n)^{2+\\epsilon}}{n}\\right)$ for any...... positive $\\epsilon$....

Bronco Junction Proves Asthmatic Kids Can Live Active Lives.

Science.gov (United States)

Foster, Scarlett Lee

1980-01-01

Camp Bronco Junction combines physical development, medical self-care knowledge, and fun in its eight-week program for asthmatic youngsters. In this environment, children are able to undertake activities that were formerly thought beyond their physical or emotional capabilities. (CJ)

The effects of hospice-shared care for gastric cancer patients.

Science.gov (United States)

Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao

2017-01-01

Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, pgastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

The Economics of Medicare Accountable Care Organizations

Science.gov (United States)

Blackstone, Erwin A.; Fuhr, Joseph P.

2016-01-01

Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

A tool for assessing continuity of care across care levels: an extended psychometric validation of the CCAENA questionnaire

Directory of Open Access Journals (Sweden)

Marta Beatriz Aller

2013-12-01

Full Text Available Background: The CCAENA questionnaire was developed to assess care continuity across levels from the patients’ perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire. Methods: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three healthcare areas of the Catalan healthcare system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity and the item-rest correlations and Cronbach’s alpha were calculated (internal consistency. Spearman correlation coefficients were calculated (multidimensionality and the ability to discriminate between groups was tested. Results: The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient-secondary care provider relationship and continuity across care levels. Cronbach’s alpha indicated good internal consistency (0.97, 0.93, 0.80 and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to healthcare area, age and educational level. Conclusion: The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients’ perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for healthcare improvement.

Everyday ethical problems in dementia care: a teleological model.

Science.gov (United States)

Bolmsjö, Ingrid Agren; Edberg, Anna-Karin; Sandman, Lars

2006-07-01

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses' ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses' everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

Reconciliation of work and care among lone mothers of adults with intellectual disabilities: the role and limits of care capital.

Science.gov (United States)

Chou, Yueh-Ching; Kröger, Teppo

2014-07-01

In this study, the concept of social capital is applied to an exploration of Guanxi (social networking to create good relationships) among working lone mothers of adults with intellectual disabilities (ID) in Taiwan. Using in-depth interviews, this study explores the role of social capital, here referred to as 'care capital', in making it possible for working lone mothers to combine their roles as family carers and workers. Eleven divorced or widowed mothers combining their paid work with long-term care responsibilities were recruited from a survey or through NGOs and were interviewed at their home between October 2008 and July 2010. An interpretative phenomenological approach was adopted for data analysis. The findings revealed that the mothers' care capital was extremely limited and was lost, gained and lost again during their life-cycles of long-term care-giving. Guanxi, especially in relation to their employers, proved to be the sole source of care capital for these mothers, making reconciliation between work and care responsibilities possible. In the absence of formal or informal support, religion and the mother-child relationship seemed also to become a kind of care capital for these lone mothers, helping them to get by with their life-long care responsibilities. For formal social and healthcare services, not just in Taiwan but in every country, it is important to develop support for lone mothers of adults with ID who have long-term care responsibilities and low levels of care capital and thus face care poverty. © 2014 John Wiley & Sons Ltd.

JPSS Preparations at the Satellite Proving Ground for Marine, Precipitation, and Satellite Analysis

Science.gov (United States)

Folmer, Michael J.; Berndt, E.; Clark, J.; Orrison, A.; Kibler, J.; Sienkiewicz, J.; Nelson, J.; Goldberg, M.; Sjoberg, W.

2016-01-01

The ocean prediction center at the national hurricane center's tropical analysis and forecast Branch, the Weather Prediction center and the Satellite analysis branch of NESDIS make up the Satellite Proving Ground for Marine, Precipitation and Satellite Analysis. These centers had early exposure to JPSS products using the S-NPP Satellite that was launched in 2011. Forecasters continue to evaluate new products in anticipation for the launch of JPSS-1 sometime in 2017.

Research in advanced formal theorem-proving techniques. [design and implementation of computer languages

Science.gov (United States)

Raphael, B.; Fikes, R.; Waldinger, R.

1973-01-01

The results are summarised of a project aimed at the design and implementation of computer languages to aid in expressing problem solving procedures in several areas of artificial intelligence including automatic programming, theorem proving, and robot planning. The principal results of the project were the design and implementation of two complete systems, QA4 and QLISP, and their preliminary experimental use. The various applications of both QA4 and QLISP are given.

Proving Continuity of Coinductive Global Bisimulation Distances: A Never Ending Story

Directory of Open Access Journals (Sweden)

David Romero-Hernández

2015-12-01

Full Text Available We have developed a notion of global bisimulation distance between processes which goes somehow beyond the notions of bisimulation distance already existing in the literature, mainly based on bisimulation games. Our proposal is based on the cost of transformations: how much we need to modify one of the compared processes to obtain the other. Our original definition only covered finite processes, but a coinductive approach allows us to extend it to cover infinite but finitary trees. After having shown many interesting properties of our distance, it was our intention to prove continuity with respect to projections, but unfortunately the issue remains open. Nonetheless, we have obtained several partial results that are presented in this paper.

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center.

Science.gov (United States)

Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

2016-01-01

Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada

OpenAIRE

Romain, Sandra J.

2013-01-01

Background. Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requ...

NIDCAP and developmental care

Directory of Open Access Journals (Sweden)

Dominique Haumont

2014-06-01

Full Text Available Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC, emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs. The Neonatal Individualized Developmental Care Assessment Program (NIDCAP is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

Proving the Efficiency of Placental Transfer of Maternal Measles

African Journals Online (AJOL)

are immunoglobulins, which makeup about 20% of plasma proteins.[1] The antibody ... Annals of Medical and Health Sciences Research | Sep-Oct 2014 | Vol 4 | Special Issue 3 |. 299. UMTH is a ... bio-data, pregnancy history and antenatal care history. The .... [12] this could have been responsible for the negative effect of.

Using wound care algorithms: a content validation study.

Science.gov (United States)

Beitz, J M; van Rijswijk, L

1999-09-01

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

Basal transethmoidal encephalocele and malignant hypertension in a parturient with a seizure disorder. A case report.

Science.gov (United States)

Yee, Lynn M; Kacmar, Rachel M; Bolden, Janelle R

2015-01-01

Nasal encephaloceles are uncommon in North America and may be diagnosed only as incidental findings. The presence of an encephalocele and malignant hypertension in the parturient requires complex coordination of care. We present a case of severe chronic hypertension in a pregnant patient with a seizure disorder and new finding of a basal transethmoidal encephalocele. She required 5 antihypertensive agents and cesarean delivery at 34 weeks' gestation under general anesthesia. The obstetric and anesthetic management of encephalocele are reviewed. Nasal encephaloceles are rarely reported in pregnancy and present additional peripartum obstetric and anesthetic considerations that require multidisciplinary planning for optimization of maternal and fetal outcomes.

Geophysics: Building E5476 decommissiong, Aberdeen Proving Ground

International Nuclear Information System (INIS)

Miller, S.F.; Thompson, M.D.; McGinnis, M.G.; McGinnis, L.D.

1992-11-01

Building E5476 was one of ten potentially contaminated sites in the Canal Creek and Westwood areas of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May of 1992. Noninvasive geophysical surveys, including magnetics, electrical resistivity, and ground-penetrating radar, were conducted around the perimeter of the building to guide a sampling program prior to decommissioning and dismantling. The large number of magnetic sources surrounding the building are believed to be contained in construction fill. The smaller anomalies, for the most part, were not imaged with ground radar or by electrical profiling. Large magnetic anomalies near the southwest comer of the building are due to aboveground standpipes and steel-reinforced concrete. Two high-resistivity areas, one projecting northeast from the building and another south of the original structure, may indicate the presence of organic pore fluids in the subsurface. A conductive lineament protruding from the south wall that is enclosed by the southem, high-resistivity feature is not associated with an equivalent magnetic anomaly. Magnetic and electrical anomalies south of the old landfill boundary are probably not associated with the building. The boundary is marked by a band of magnetic anomalies and a conductive zone trending northwest to southeast. The cause of high resistivities in a semicircular area in the southwest comer, within the landfill area, is unexplained

Strategies to reduce blood product utilization in obstetric practice.

Science.gov (United States)

Neb, Holger; Zacharowski, Kai; Meybohm, Patrick

2017-06-01

Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.

Valuing narrative in the care of older people: a framework of narrative practice for older adult residential care settings.

Science.gov (United States)

Buckley, Catherine; McCormack, Brendan; Ryan, Assumpta

2014-09-01

To report on the development of a framework of narrative practice, in residential care settings for older people. Residential care settings for older people provide care for people who are no longer able to live in their own home. To date, the impact and structure of nursing practice on care provision in these settings has proved difficult to conceptualise within a specific nursing theory framework. A hermeneutic approach incorporating narrative methods was used. Forty-six narrative interviews with older people in residential care were secondary-analysed for key themes through a three-stage process: by the first author, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Finally, the combined findings were used to derive a single set of themes. The secondary data analysis process led to the development of a framework of narrative practice for the care of older people in residential settings. The framework is influenced by narrative enquiry, person-centred practice and practice development. It has four pillars, prerequisites, care processes, care environment and narrative aspects of care. To operationalise the framework of narrative practice, three narrative elements, narrative knowing, narrative being and narrative doing, need to be considered. Working with the foundational pillars and the narrative elements would enable staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults in residential care. This framework provides nurses with a template that confirms the identity of the older person taking account of their biography. The framework outlines an approach that provides staff with a template on how to provide person-centred care in a narrative way. © 2013 John Wiley & Sons Ltd.

20 CFR 416.1603 - How to prove you are a resident of the United States.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How to prove you are a resident of the United States. 416.1603 Section 416.1603 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... as— (1) Property, income, or other tax forms or receipts; (2) Utility bills, leases or rent payment...

Using aetnanova to formally prove that the Davis-Putnam satisfiability test is correct

Directory of Open Access Journals (Sweden)

Eugenio G. Omodeo

2008-05-01

Full Text Available This paper reports on using the ÆtnaNova/Referee proof-verification system to formalize issues regarding the satisfiability of CNF-formulae of propositional logic. We specify an “archetype” version of the Davis-Putnam-Logemann-Loveland algorithm through the THEORY of recursive functions based on a well-founded relation, and prove it to be correct.Within the same framework, and by resorting to the Zorn lemma, we develop a straightforward proof of the compactness theorem.

Lessons from the implementation of a near patient anticoagulant monitoring service in primary care

Directory of Open Access Journals (Sweden)

Simon DeLusignan

2004-02-01

Conclusions The group, by sharing their experiences through a structured series of workshops, developed an understanding of when it might be appropriate to vary from the decision support software’s recommendations and how this could be audited. The technological solution modelled on hospital practice proved hard to implement in primary care.

The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

Science.gov (United States)

Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

2017-03-15

's profile has been drafted on the basis of the comparative analysis conducted. It has been noted how the Case/Care Manager's professional profile can really improve relationships and communications between medical staff and patients, promoting a major unity among the working team. According to the present research, the Case/Care Manager's profile has been proved helpful in positively influencing the team activity and to elicit major satisfaction both in patients and their family.

Orthogeriatric care: improving patient outcomes

Directory of Open Access Journals (Sweden)

Tarazona-Santabalbina FJ

2016-06-01

Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

Potential Cislunar and Interplanetary Proving Ground Excursion Trajectory Concepts

Science.gov (United States)

McGuire, Melissa L.; Strange, Nathan J.; Burke, Laura M.; MacDonald, Mark A.; McElrath, Timothy P.; Landau, Damon F.; Lantoine, Gregory; Hack, Kurt J.; Lopez, Pedro

2016-01-01

NASA has been investigating potential translunar excursion concepts to take place in the 2020s that would be used to test and demonstrate long duration life support and other systems needed for eventual Mars missions in the 2030s. These potential trajectory concepts could be conducted in the proving ground, a region of cislunar and near-Earth interplanetary space where international space agencies could cooperate to develop the technologies needed for interplanetary spaceflight. Enabled by high power Solar Electric Propulsion (SEP) technologies, the excursion trajectory concepts studied are grouped into three classes of increasing distance from the Earth and increasing technical difficulty: the first class of excursion trajectory concepts would represent a 90-120 day round trip trajectory with abort to Earth options throughout the entire length, the second class would be a 180-210 day round trip trajectory with periods in which aborts would not be available, and the third would be a 300-400 day round trip trajectory without aborts for most of the length of the trip. This paper provides a top-level summary of the trajectory and mission design of representative example missions of these three classes of excursion trajectory concepts.

Fractal geometry as a new approach for proving nanosimilarity: a reflection note.

Science.gov (United States)

Demetzos, Costas; Pippa, Natassa

2015-04-10

Nanosimilars are considered as new medicinal outcomes combining the generic drugs and the nanocarrier as an innovative excipient, in order to evaluate them as final products. They belong to the grey area - concerning the evaluation process - between generic drugs and biosimilar medicinal products. Generic drugs are well documented and a huge number of them are in market, replacing effectively the off-patent drugs. The scientific approach for releasing them to the market is based on bioequivalence studies, which are well documented and accepted by the regulatory agencies. On the other hand, the structural complexity of biological/biotechnology-derived products demands a new approach for the approval process taking into consideration that bioequivalence studies are not considered as sufficient as in generic drugs, and new clinical trials are needed to support their approval process of the product to the market. In proportion, due to technological complexity of nanomedicines, the approaches for proving the statistical identity or the similarity for generic and biosimilar products, respectively, with those of prototypes, are not considered as effective for nanosimilar products. The aim of this note is to propose a complementary approach which can provide realistic evidences concerning the nanosimilarity, based on fractal analysis. This approach is well fit with the structural complexity of nanomedicines and smooths the difficulties for proving the similarity between off-patent and nanosimilar products. Fractal analysis could be considered as the approach that completely characterizes the physicochemical/morphological characteristics of nanosimilar products and could be proposed as a start point for a deep discussion on nanosimilarity. Copyright © 2015 Elsevier B.V. All rights reserved.

Seismic proving test of ultimate piping strength (current status of preliminary tests)

International Nuclear Information System (INIS)

Suzuki, K.; Namita, Y.; Abe, H.; Ichihashi, I.; Suzuki, K.; Ishiwata, M.; Fujiwaka, T.; Yokota, H.

2001-01-01

In 1998 Fiscal Year, the 6 year program of piping tests was initiated with the following objectives: i) to clarify the elasto-plastic response and ultimate strength of nuclear piping, ii) to ascertain the seismic safety margin of the current seismic design code for piping, and iii) to assess new allowable stress rules. In order to resolve extensive technical issues before proceeding on to the seismic proving test of a large-scale piping system, a series of preliminary tests of materials, piping components and simplified piping systems is intended. In this paper, the current status of the material tests and the piping component tests is reported. (author)

Nonverbal accommodation in health care communication.

Science.gov (United States)

D'Agostino, Thomas A; Bylund, Carma L

2014-01-01

This exploratory study examined patterns of nonverbal accommodation within health care interactions and investigated the impact of communication skills training and gender concordance on nonverbal accommodation behavior. The Nonverbal Accommodation Analysis System (NAAS) was used to code the nonverbal behavior of physicians and patients within 45 oncology consultations. Cases were then placed in one of seven categories based on patterns of accommodation observed across the interaction. Results indicated that across all NAAS behavior categories, physician-patient interactions were most frequently categorized as joint convergence, followed closely by asymmetrical-patient convergence. Among paraverbal behaviors, talk time, interruption, and pausing were most frequently characterized by joint convergence. Among nonverbal behaviors, eye contact, laughing, and gesturing were most frequently categorized as asymmetrical-physician convergence. Differences were predominantly nonsignificant in terms of accommodation behavior between pre- and post-communication skills training interactions. Only gesturing proved significant, with post-communication skills training interactions more likely to be categorized as joint convergence or asymmetrical-physician convergence. No differences in accommodation were noted between gender-concordant and nonconcordant interactions. The importance of accommodation behavior in health care communication is considered from a patient-centered care perspective.

Peripartum cardiomyopathy in Denmark

DEFF Research Database (Denmark)

Ersbøll, Anne S; Johansen, Marianne; Damm, Peter

2017-01-01

equalling 1 in 10 149 deliveries. The majority recovered left ventricular systolic function within one year, but 14.8% suffered a major adverse event with 3.3% mortality, 8.2% mechanical circulatory support requirement and/or heart transplantation and 4.9% persistent severe heart failure. Half of the women...

Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer.

Science.gov (United States)

D'Ambruoso, Sarah F; Coscarelli, Anne; Hurvitz, Sara; Wenger, Neil; Coniglio, David; Donaldson, Dusty; Pietras, Christopher; Walling, Anne M

2016-11-01

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.

Events occurring during the previous lactation, the dry period, and peripartum as risk factors for early lactation mastitis in cows receiving 2 different intramammary dry cow therapies.

Science.gov (United States)

Pinedo, P J; Fleming, C; Risco, C A

2012-12-01

The objective of this study was to investigate the association between mastitis events occurring during the previous lactation, the dry period, and the peripartum period on the incidence of early lactation mastitis in cows receiving ceftiofur hydrochloride or penicillin dihydrostreptomycin as intramammary dry cow antibiotic therapy. Cows (n=402) from 2 large dairy farms in Central Florida were enrolled in the study at the time of dry-off processing and were randomly assigned to 1 of 2 dry cow therapies: ceftiofur hydrochloride or penicillin dihydrostreptomycin. Composite milk samples were collected at dry-off and after calving for bacteriological examination and somatic cell count. Peripartal health disorders were monitored during the first 30 d of lactation and included calving difficulty, metritis, ketosis, and left displaced abomasum. Milk production and individual somatic cell scores (SCS) were recorded monthly by the Dairy Herd Improvement Association. The main outcome variables were the risk of clinical mastitis during the first 30 and 60 d of lactation, and the risk of subclinical mastitis at the first 2 monthly Dairy Herd Improvement Association tests after calving (up to 70 d in milk). Additionally, the SCS and the presence of mastitis pathogens in milk at dry-off and at calving were analyzed. Explanatory variables consisted of events occurring during the previous lactation, at dry-off and during the dry period, at calving, and within the first 30 d after calving. Multiple events occurring during the previous lactation had a significant effect on the incidence of mastitis in the subsequent lactation. These events included low milk yield, intermediate lactation length, clinical mastitis, and lactation SCS average. Similarly, intramammary infections with environmental bacteria at dry-off increased the chances of clinical mastitis the first month after calving. Dry-off therapy had a significant effect on mastitis incidence; cows treated with ceftiofur

Nursing Care Interpersonal Relationship Questionnaire: elaboration and validation.

Science.gov (United States)

Borges, José Wicto Pereira; Moreira, Thereza Maria Magalhães; Andrade, Dalton Franscisco de

2018-01-08

to elaborate an instrument for the measurement of the interpersonal relationship in nursing care through the Item Response Theory, and the validation thereof. methodological study, which followed the three poles of psychometry: theoretical, empirical and analytical. The Nursing Care Interpersonal Relationship Questionnaire was developed in light of the Imogene King's Interpersonal Conceptual Model and the psychometric properties were studied through the Item Response Theory in a sample of 950 patients attended in Primary, Secondary and Tertiary Health Care. the final instrument consisted of 31 items, with Cronbach's alpha of 0.90 and McDonald's Omega of 0.92. The parameters of the Item Response Theory demonstrated high discrimination in 28 items, being developed a five-level interpretive scale. At the first level, the communication process begins, gaining a wealth of interaction. Subsequent levels demonstrate qualitatively the points of effectiveness of the interpersonal relationship with the involvement of behaviors related to the concepts of transaction and interaction, followed by the concept of role. the instrument was created and proved to be consistent to measure interpersonal relationship in nursing care, as it presented adequate reliability and validity parameters.

Nursing Care Interpersonal Relationship Questionnaire: elaboration and validation

Directory of Open Access Journals (Sweden)

José Wicto Pereira Borges

2018-01-01

Full Text Available ABSTRACT Objective: to elaborate an instrument for the measurement of the interpersonal relationship in nursing care through the Item Response Theory, and the validation thereof. Method: methodological study, which followed the three poles of psychometry: theoretical, empirical and analytical. The Nursing Care Interpersonal Relationship Questionnaire was developed in light of the Imogene King’s Interpersonal Conceptual Model and the psychometric properties were studied through the Item Response Theory in a sample of 950 patients attended in Primary, Secondary and Tertiary Health Care. Results: the final instrument consisted of 31 items, with Cronbach’s alpha of 0.90 and McDonald’s Omega of 0.92. The parameters of the Item Response Theory demonstrated high discrimination in 28 items, being developed a five-level interpretive scale. At the first level, the communication process begins, gaining a wealth of interaction. Subsequent levels demonstrate qualitatively the points of effectiveness of the interpersonal relationship with the involvement of behaviors related to the concepts of transaction and interaction, followed by the concept of role. Conclusion: the instrument was created and proved to be consistent to measure interpersonal relationship in nursing care, as it presented adequate reliability and validity parameters.

National audit of continence care: laying the foundation.

Science.gov (United States)

Mian, Sarah; Wagg, Adrian; Irwin, Penny; Lowe, Derek; Potter, Jonathan; Pearson, Michael

2005-12-01

National audit provides a basis for establishing performance against national standards, benchmarking against other service providers and improving standards of care. For effective audit, clinical indicators are required that are valid, feasible to apply and reliable. This study describes the methods used to develop clinical indicators of continence care in preparation for a national audit. To describe the methods used to develop and test clinical indicators of continence care with regard to validity, feasibility and reliability. A multidisciplinary working group developed clinical indicators that measured the structure, process and outcome of care as well as case-mix variables. Literature searching, consensus workshops and a Delphi process were used to develop the indicators. The indicators were tested in 15 secondary care sites, 15 primary care sites and 15 long-term care settings. The process of development produced indicators that received a high degree of consensus within the Delphi process. Testing of the indicators demonstrated an internal reliability of 0.7 and an external reliability of 0.6. Data collection required significant investment in terms of staff time and training. The method used produced indicators that achieved a high degree of acceptance from health care professionals. The reliability of data collection was high for this audit and was similar to the level seen in other successful national audits. Data collection for the indicators was feasible to collect, however, issues of time and staffing were identified as limitations to such data collection. The study has described a systematic method for developing clinical indicators for national audit. The indicators proved robust and reliable in primary and secondary care as well as long-term care settings.

Comparison of peripartum metabolic status and postpartum health of Holstein and Montbéliarde-sired crossbred dairy cows.

Science.gov (United States)

Mendonça, L G D; Abade, C C; da Silva, E M; Litherland, N B; Hansen, L B; Hansen, W P; Chebel, R C

2014-02-01

Objectives of the current experiment were to evaluate plasma concentrations of metabolites and haptoglobin peripartum, uterine health and involution, and follicle growth and resumption of cyclicity of Holstein (HO) and Montbéliarde-sired crossbred cows. Cows (52 HO and 52 crossbred) were enrolled in the study 45 d before expected calving date. Cows had body weight and body condition score recorded on d -45, -14, 0, 1, 28, and 56 relative to calving. Dry matter intake was calculated for a subgroup of cows (25 HO and 38 crossbred) from 6 wk before to 6 wk after calving. Blood was sampled weekly from d -14 to 56 relative to calving for determination of glucose, nonesterified fatty acid, and β-hydroxybutyrate concentrations; from d -7 to 21 relative to calving for determination of haptoglobin concentration; and from d 14 to 56 postpartum for determination of progesterone concentration. Cows were examined at calving and on d 4, 7, 10, and 14 postpartum for diagnosis of postparturient diseases, on d 24 postpartum for diagnosis of purulent vaginal discharge, and on d 42 postpartum for diagnosis of subclinical endometritis. Uteri and ovaries were examined by ultrasonography every 3 d from d 14 to 41 postpartum. Milk yield and composition were measured monthly and yield of milk, fat, protein, and energy-corrected milk were recorded for the first 90 d postpartum. Body weight was not different between Holstein and crossbred cows, but HO cows had reduced body condition score compared with crossbred cows. Even though DMI from 6 wk before to 6 wk after calving tended to be greater for HO cows (16.8 ± 0.7 vs. 15.3 ± 0.5 kg/d), HO cows tended to have more pronounced decline in dry matter intake, expressed in percentage of body weight from d -15 to 0 relative to calving. Energy-corrected milk and nonesterified fatty acid and β-hydroxybutyrate concentrations were not different between breeds. No differences were observed in incidence of retained fetal membranes, metritis, and

Wind tunnel experiments to prove a hydraulic passive torque control concept for variable speed wind turbines

NARCIS (Netherlands)

Diepeveen, N.F.B.; Jarquin-Laguna, A.

2014-01-01

In this paper the results are presented of experiments to prove an innovative concept for passive torque control of variable speed wind turbines using fluid power technology. It is demonstrated that by correctly configuring the hydraulic drive train, the wind turbine rotor operates at or near

20 CFR 1002.33 - Does the employee have to prove that the employer discriminated against him or her in order to be...

Science.gov (United States)

2010-04-01

... employer discriminated against him or her in order to be eligible for reemployment? 1002.33 Section 1002.33... have to prove that the employer discriminated against him or her in order to be eligible for reemployment? No. The employee is not required to prove that the employer discriminated against him or her...

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

Directory of Open Access Journals (Sweden)

Manulik S

2016-08-01

Full Text Available Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.Objectives: The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.Materials and methods: The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.Results: All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.Conclusion: Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. Keywords: health care service quality, patients’ expectations, qualitative priorities, outpatient health care facilities

Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.

Science.gov (United States)

Sawyer, Taylor; White, Marjorie; Zaveri, Pavan; Chang, Todd; Ades, Anne; French, Heather; Anderson, JoDee; Auerbach, Marc; Johnston, Lindsay; Kessler, David

2015-08-01

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

Green Care: A Review of the Benefits and Potential of Animal-Assisted Care Farming Globally and in Rural America

Science.gov (United States)

Artz, Brianna; Bitler Davis, Doris

2017-01-01

Simple Summary The term Green Care encompasses a number of therapeutic strategies that can include farm-animal-assisted therapy, horticultural therapy, and general, farm-based therapy. This review article provides an overview of how Green Care has been used as part of the therapeutic plan for a variety of psychological disorders and related physical disabilities in children, adolescents and adults. While many countries have embraced Green Care, and research-based evidence supports its efficacy in a variety of therapeutic models, it has not yet gained widespread popularity in the United States. We suggest that Green Care could prove to be an effective approach to providing mental health care in the U.S., particularly in rural areas that are typically underserved by more traditional mental health facilities, but have an abundance of farms, livestock, and green spaces where care might be effectively provided. Abstract The term Green Care includes therapeutic, social or educational interventions involving farming; farm animals; gardening or general contact with nature. Although Green Care can occur in any setting in which there is interaction with plants or animals, this review focuses on therapeutic practices occurring on farms. The efficacy of care farming is discussed and the broad utilization of care farming and farm care communities in Europe is reviewed. Though evidence from care farms in the United States is included in this review, the empirical evidence which could determine its efficacy is lacking. For example, the empirical evidence supporting or refuting the efficacy of therapeutic horseback riding in adults is minimal, while there is little non-equine care farming literature with children. The health care systems in Europe are also much different than those in the United States. In order for insurance companies to cover Green Care techniques in the United States, extensive research is necessary. This paper proposes community-based ways that Green Care

Seismic proving tests on the reliability for large components and equipment of nuclear power plants

International Nuclear Information System (INIS)

Ohno, Tokue; Tanaka, Nagatoshi

1988-01-01

Since Japan has destructive earthquakes frequently, the structural reliability for large components and equipment of nuclear power plants are rigorously required. They are designed using sophisticated seismic analyses and have not yet encountered a destructive earthquake. When nuclear power plants are planned, it is very important that the general public understand the structural reliability during and after an earthquake. Seismic Proving Tests have been planned by Ministry of International Trade and Industry (Miti) to comply with public requirement in Japan. A large-scale high-performance vibration table was constructed at Tasted Engineering Laboratory of Nuclear Power Engineering Test Center (NU PEC), in order to prove the structural reliability by vibrating the test model (of full scale or close to the actual size) in the condition of a destructive earthquake. As for the test models, the following four items were selected out of large components and equipment important to the safety: Reactor Containment Vessel; Primary Coolant Loop or Primary Loop Recirculation System; Reactor Pressure Vessel; and Reactor Core Internals. Here is described a brief of the vibration table, the test method and the results of the tests on PWR Reactor Containment Vessel and BWR Primary Loop Recirculation System (author)

Internet of Things Framework for Home Care Systems

Directory of Open Access Journals (Sweden)

Biljana Risteska Stojkoska

2017-01-01

Full Text Available The increasing average age of the population in most industrialized countries imposes a necessity for developing advanced and practical services using state-of-the-art technologies, dedicated to personal living spaces. In this paper, we introduce a hierarchical distributed approach for home care systems based on a new paradigm known as Internet of Things (IoT. The proposed generic framework is supported by a three-level data management model composed of dew computing, fog computing, and cloud computing for efficient data flow in IoT based home care systems. We examine the proposed model through a real case scenario of an early fire detection system using a distributed fuzzy logic approach. The obtained results prove that such implementation of dew and fog computing provides high accuracy in fire detection IoT systems, while achieving minimum data latency.

Mental health care and average happiness: strong effect in developed nations.

Science.gov (United States)

Touburg, Giorgio; Veenhoven, Ruut

2015-07-01

Mental disorder is a main cause of unhappiness in modern society and investment in mental health care is therefore likely to add to average happiness. This prediction was checked in a comparison of 143 nations around 2005. Absolute investment in mental health care was measured using the per capita number of psychiatrists and psychologists working in mental health care. Relative investment was measured using the share of mental health care in the total health budget. Average happiness in nations was measured with responses to survey questions about life-satisfaction. Average happiness appeared to be higher in countries that invest more in mental health care, both absolutely and relative to investment in somatic medicine. A data split by level of development shows that this difference exists only among developed nations. Among these nations the link between mental health care and happiness is quite strong, both in an absolute sense and compared to other known societal determinants of happiness. The correlation between happiness and share of mental health care in the total health budget is twice as strong as the correlation between happiness and size of the health budget. A causal effect is likely, but cannot be proved in this cross-sectional analysis.

HRM and its effect on employee, organizational and financial outcomes in health care organizations.

Science.gov (United States)

Vermeeren, Brenda; Steijn, Bram; Tummers, Lars; Lankhaar, Marcel; Poerstamper, Robbert-Jan; van Beek, Sandra

2014-06-17

One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. This study uses a unique dataset, based on the 'ActiZ Benchmark in Healthcare', a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the 'black box' between HRM and performance. The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM

Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

DEFF Research Database (Denmark)

Frølich, Anne

2012-01-01

are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

Effect of the Economic Recession on Primary Care Access for the Homeless.

Science.gov (United States)

White, Brandi M; Jones, Walter J; Moran, William P; Simpson, Kit N

2016-01-01

Primary care access (PCA) for the homeless can prove challenging, especially during periods of economic distress. In the United States, the most recent recession may have presented additional barriers to accessing care. Limited safety-net resources traditionally used by the homeless may have also been used by the non-homeless, resulting in delays in seeking treatment for the homeless. Using hospitalizations for ambulatory care sensitivity (ACS) conditions as a proxy measure for PCA, this study investigated the recession's impact on PCA for the homeless and non-homeless in four states. The State Inpatient Databases were used to identify ACS admissions. Findings from this study indicate the recession was a barrier to PCA for homeless people who were uninsured. Ensuring that economically-disadvantaged populations have the ability to obtain insurance coverage is crucial to facilitating PCA. With targeted outreach efforts, the Affordable Care Act provides an opportunity for expanding coverage to the homeless.

Mental disorders of pregnant and postpartum women after earthquakes: a systematic review.

Science.gov (United States)

Ren, Jian-Hua; Chiang, Chung-Lim Vico; Jiang, Xiao-Lian; Luo, Bi-Ru; Liu, Xing-Hui; Pang, Mei-Che

2014-08-01

The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action. A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes. Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations. Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.

How cytogenetical methods help victims prove radiation exposure and claim right for social support: NCERM experience

International Nuclear Information System (INIS)

Aleksanin, S.; Slozina, N.; Neronova, E.; Smoliakov, E.

2011-01-01

Russian citizens who were irradiated because of radiation disasters, nuclear weapons testing and some other sources have a right to some social support and financial compensation. In order to get this compensation people have to prove that they were irradiated. As it is, not all victims for a variety of reasons have formal documents. Thus they apply for cytogenetic investigation to prove irradiation months, years and even decades after irradiation. Since 1992 the cytogenetic investigations related to radiation exposure were performed in NRCERM for more than 700 people. At the beginning of this investigation FISH method was not certified as a biodosimenty test in Russia. Only dicentric analysis was approved as a proof of irradiation. It is known that the rate of dicentrics decrease in time, but the residual level of cytogenetical markers could be revealed a long time after a radiation accident. Thus the dicentric analysis was performed for the people who applied for biological indication of radiation exposure at that time. Rates of dicentrics exceeding control levels were revealed in half the people who applied for radiation conformation. Now FISH method is certified in Russia and both cytogenetic tests of biodosimetry (dicentrics and FISH) are available for all comers. Increased levels of translocations were found in 8 cases (the dose rate from 0.16 to 0.64 Gy). On the basis of the results of cytogenetic tests official documents were supplied to these people and they were entitled to apply for radiation exposure compensation. Thus cytogenetic tests are very effective and in some cases the only possible way for the victims to prove irradiation exposure and to apply for radiation exposure compensation a long time after an accident.

How cytogenetical methods help victims prove radiation exposure and claim right for social support: NCERM experience

Energy Technology Data Exchange (ETDEWEB)

Aleksanin, S., E-mail: Aleksanin@arcerm.spb.ru [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation); Slozina, N., E-mail: NataliaSlozina@peterlink.ru [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation); Neronova, E.; Smoliakov, E. [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation)

2011-09-15

Russian citizens who were irradiated because of radiation disasters, nuclear weapons testing and some other sources have a right to some social support and financial compensation. In order to get this compensation people have to prove that they were irradiated. As it is, not all victims for a variety of reasons have formal documents. Thus they apply for cytogenetic investigation to prove irradiation months, years and even decades after irradiation. Since 1992 the cytogenetic investigations related to radiation exposure were performed in NRCERM for more than 700 people. At the beginning of this investigation FISH method was not certified as a biodosimenty test in Russia. Only dicentric analysis was approved as a proof of irradiation. It is known that the rate of dicentrics decrease in time, but the residual level of cytogenetical markers could be revealed a long time after a radiation accident. Thus the dicentric analysis was performed for the people who applied for biological indication of radiation exposure at that time. Rates of dicentrics exceeding control levels were revealed in half the people who applied for radiation conformation. Now FISH method is certified in Russia and both cytogenetic tests of biodosimetry (dicentrics and FISH) are available for all comers. Increased levels of translocations were found in 8 cases (the dose rate from 0.16 to 0.64 Gy). On the basis of the results of cytogenetic tests official documents were supplied to these people and they were entitled to apply for radiation exposure compensation. Thus cytogenetic tests are very effective and in some cases the only possible way for the victims to prove irradiation exposure and to apply for radiation exposure compensation a long time after an accident.

Nursing Care Interpersonal Relationship Questionnaire: elaboration and validation 1

Science.gov (United States)

Borges, José Wicto Pereira; Moreira, Thereza Maria Magalhães; de Andrade, Dalton Franscisco

2018-01-01

ABSTRACT Objective: to elaborate an instrument for the measurement of the interpersonal relationship in nursing care through the Item Response Theory, and the validation thereof. Method: methodological study, which followed the three poles of psychometry: theoretical, empirical and analytical. The Nursing Care Interpersonal Relationship Questionnaire was developed in light of the Imogene King’s Interpersonal Conceptual Model and the psychometric properties were studied through the Item Response Theory in a sample of 950 patients attended in Primary, Secondary and Tertiary Health Care. Results: the final instrument consisted of 31 items, with Cronbach’s alpha of 0.90 and McDonald’s Omega of 0.92. The parameters of the Item Response Theory demonstrated high discrimination in 28 items, being developed a five-level interpretive scale. At the first level, the communication process begins, gaining a wealth of interaction. Subsequent levels demonstrate qualitatively the points of effectiveness of the interpersonal relationship with the involvement of behaviors related to the concepts of transaction and interaction, followed by the concept of role. Conclusion: the instrument was created and proved to be consistent to measure interpersonal relationship in nursing care, as it presented adequate reliability and validity parameters. PMID:29319743

Depleted uranium risk assessment for Jefferson Proving Ground using data from environmental monitoring and site characterization. Final report

International Nuclear Information System (INIS)

Ebinger, M.H.; Hansen, W.R.

1996-10-01

This report documents the third risk assessment completed for the depleted uranium (DU) munitions testing range at Jefferson Proving Ground (JPG), Indiana, for the U.S. Army Test and Evaluation command. Jefferson Proving Ground was closed in 1995 under the Base Realignment and Closure Act and the testing mission was moved to Yuma Proving Ground. As part of the closure of JPG, assessments of potential adverse health effects to humans and the ecosystem were conducted. This report integrates recent information obtained from site characterization surveys at JPG with environmental monitoring data collected from 1983 through 1994 during DU testing. Three exposure scenarios were evaluated for potential adverse effects to human health: an occasional use scenario and two farming scenarios. Human exposure was minimal from occasional use, but significant risk were predicted from the farming scenarios when contaminated groundwater was used by site occupants. The human health risk assessments do not consider the significant risk posed by accidents with unexploded ordnance. Exposures of white-tailed deer to DU were also estimated in this study, and exposure rates result in no significant increase in either toxicological or radiological risks. The results of this study indicate that remediation of the DU impact area would not substantially reduce already low risks to humans and the ecosystem, and that managed access to JPG is a reasonable model for future land use options

The demise of primary care: a diatribe from the trenches.

Science.gov (United States)

Norenberg, David D

2009-05-19

Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence to a standard. Individualized clinical judgment has been devalued; thinking has been replaced by algorithms. Practice guidelines have been usurped by pay-for-performance police, on patrol for deviations--not understanding that knowing and allowing for exceptions is the heart and soul of primary care. The coercive surveillance of "Quality Improvement" has become oppressive, making single organ-system specialties increasingly attractive (or at least more tolerable). Generalists are spending so much time proving they are good doctors, they don't have time to be good doctors. A remedy is suggested: a pilot project of volunteer salaried internists (more trusted, less audited) commissioned to our expandable national health care program, Medicare.

Hermansky-Pudlak syndrome in a pregnant patient: a case report.

Science.gov (United States)

Harris-Glocker, Miranda; Thornburg, Loralei L; Pressman, Eva K

2013-01-01

Hermansky-Pudlak syndrome (HPS), a rare autosomal-recessive disorder encompassing multiple organs, is characterized by oculocutaneous albinism, platelet storage pool deficiency resulting in bleeding diathesis, and ceroid lipofuscin deposition which can lead to pulmonary fibrosis, colitis, cardiomyopathy and renal failure. Pregnancy in a patient with HPS can produce multiple complications such as peripartum hemorrhage and difficulties with administration of anesthesia, either regional or general. We present the case of a patient with HPS also complicated by spontaneous triplet pregnancy. A multidisciplinary approach, including the involvement of obstetric, anesthesia, and hematology teams, is the ideal for an HPS patient with the potential for multiple complications in the peripartum period.

US military primary care: problems, solutions, and implications for civilian medicine.

Science.gov (United States)

Mundell, Benjamin F; Friedberg, Mark W; Eibner, Christine; Mundell, William C

2013-11-01

The US Military Health System (MHS), which is responsible for providing care to active and retired members of the military and their dependents, faces challenges in delivering cost-effective, high-quality primary care while maintaining a provider workforce capable of meeting both peacetime and wartime needs. The MHS has implemented workforce management strategies to address these challenges, including "medical home" teams for primary care and other strategies that expand the roles of nonphysician providers such as physician assistants, nurse practitioners, and medical technicians. Because these workforce strategies have been implemented relatively recently, there is limited evidence of their effectiveness. If they prove successful, they could serve as a model for the civilian sector. However, because the MHS model features a broad mix of provider types, changes to civilian scope-of-practice regulations for nonphysician providers would be necessary before the civilian provider mix could replicate that of the MHS.

Seeing a Colleague Encourage a Student to Make an Assumption while Proving: What Teachers Put in Play when Casting an Episode of Instruction

Science.gov (United States)

Nachlieli, Talli; Herbst, Patricio

2009-01-01

This article reports on an investigation of how teachers of geometry perceived an episode of instruction presented to them as a case of engaging students in proving. Confirming what was hypothesized, participants found it remarkable that a teacher would allow a student to make an assumption while proving. But they perceived this episode in various…

Seismic test facilities at the ENEA Casaccia Research Center; Prove sismiche con le tavole vibranti al centro ricerche Enea Casaccia

Energy Technology Data Exchange (ETDEWEB)

De Canio, G. [ENEA, Divisione Servizi Tecnologici, Centro Ricerche Casaccia, Rome (Italy)

2000-07-01

The main experimental facilities for seismic tests at the ENEA C.R. Casaccia laboratories consist of two high performance shake table for three axial seismic tests of structures up to 10 ton mass and 3g acceleration applied at the Center of Gravity at 1m from the base table. The activities are principally devoted to the dynamic characterization and vibration tests for mechanical and aero spatial structures, and the experimental analysis of innovative systems for the seismic isolation and retrofitting of civil, industrial, and historical buildings; together with the seismic tests of sub-structures and scaled mock-ups, in order to evaluate the isolation/dissipation performance of the anti-seismic devices, and the failure modes of the structural parts of the building. [Italian] Le principali attrezzature per le prove sismiche presso i laboratori del C.R. Casaccia consistono di due tavole vibranti triassali per prove su strutture fino a 10t di peso con una accelerazione di 3g applicata al centro di gravita' posto ad 1 m di altezza dal piano della tavola. Le principali attivita' riguardano: (a) test di caratterizzazione dinamica e prove di vibrazioni per strutture meccaniche ed aerospaziali; (b) l'analisi sperimentale di sistemi innovativi per l'isolamento sismico ed il consolidamento di strutture civili, industriali e storico monumentali, e le prove sismiche di elementi strutturali e di modelli in scala per la valutazione della capacita' di dissipazione dei dispositivi antisismici e le modalita' di formazione delle fratture.

[Medication errors in Spanish intensive care units].

Science.gov (United States)

Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

2013-01-01

To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Disruptive innovation in academic medical centers: balancing accountable and academic care.

Science.gov (United States)

Stein, Daniel; Chen, Christopher; Ackerly, D Clay

2015-05-01

Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

Machine Learning Takes on Health Care: Leonard D'Avolio's Cyft Employs Big Data to Benefit Patients and Providers.

Science.gov (United States)

Mertz, Leslie

2018-01-01

When Leonard D'Avolio (Figure 1) was working on his Ph.D. degree in biomedical informatics, he saw the power of machine learning in transforming multiple industries; health care, however, was not among them. "The reason that Amazon, Netflix, and Google have transformed their industries is because they have embedded learning throughout every aspect of what they do. If we could prove that is possible in health care too, I thought we would have the potential to have a huge impact," he says.

Remedial investigation report for J-Field, Aberdeen Proving Ground, Maryland. Volume 3: Ecological risk assessment

Energy Technology Data Exchange (ETDEWEB)

Hlohowskyj, I.; Hayse, J.; Kuperman, R.; Van Lonkhuyzen, R.

2000-02-25

The Environmental Management Division of the U.S. Army Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation (RI) and feasibility study (FS) of the J-Field area at APG, pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended. As part of that activity, Argonne National Laboratory (ANL) conducted an ecological risk assessment (ERA) of the J-Field site. This report presents the results of that assessment.

Remedial investigation report for J-Field, Aberdeen Proving Ground, Maryland. Volume 3: Ecological risk assessment

International Nuclear Information System (INIS)

Hlohowskyj, I.; Hayse, J.; Kuperman, R.; Van Lonkhuyzen, R.

2000-01-01

The Environmental Management Division of the U.S. Army Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation (RI) and feasibility study (FS) of the J-Field area at APG, pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended. As part of that activity, Argonne National Laboratory (ANL) conducted an ecological risk assessment (ERA) of the J-Field site. This report presents the results of that assessment

The role of melatonin in anaesthesia and critical care

Directory of Open Access Journals (Sweden)

Madhuri S Kurdi

2013-01-01

Full Text Available Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.

The role of melatonin in anaesthesia and critical care.

Science.gov (United States)

Kurdi, Madhuri S; Patel, Tushar

2013-03-01

Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.

Effect of peripartum dietary energy supplementation on thyroid hormones, insulin-like growth factor-i and its binding proteins in early lactation dairy cows

Directory of Open Access Journals (Sweden)

Kirovski Danijela

2012-01-01

three examined postpartum periods, but the difference was significant only on day 60 after parturition (p<0.01, respectively. Concentrations of total protein and albumin were significantly higher in GLY compared to the control group in all three examined periods after parturition. Based on these results it can be concluded that peripartum dietary energy supplementation prevent cows' exposure to severe negative energy balance, preserves synthetic activity of hepatocytes and consequently has a positive impact on milk production and reproductive performances in dairy cows.

Fake News: A Technological Approach to Proving the Origins of Content, Using Blockchains.

Science.gov (United States)

Huckle, Steve; White, Martin

2017-12-01

In this article, we introduce a prototype of an innovative technology for proving the origins of captured digital media. In an era of fake news, when someone shows us a video or picture of some event, how can we trust its authenticity? It seems that the public no longer believe that traditional media is a reliable reference of fact, perhaps due, in part, to the onset of many diverse sources of conflicting information, via social media. Indeed, the issue of "fake" reached a crescendo during the 2016 U.S. Presidential Election, when the winner, Donald Trump, claimed that The New York Times was trying to discredit him by pushing disinformation. Current research into overcoming the problem of fake news does not focus on establishing the ownership of media resources used in such stories-the blockchain-based application introduced in this article is technology that is capable of indicating the authenticity of digital media. Put simply, using the trust mechanisms of blockchain technology, the tool can show, beyond doubt, the provenance of any source of digital media, including images used out of context in attempts to mislead. Although the application is an early prototype and its capability to find fake resources is somewhat limited, we outline future improvements that would overcome such limitations. Furthermore, we believe that our application (and its use of blockchain technology and standardized metadata) introduces a novel approach to overcoming falsities in news reporting and the provenance of media resources used therein. However, while our application has the potential to be able to verify the originality of media resources, we believe that technology is only capable of providing a partial solution to fake news. That is because it is incapable of proving the authenticity of a news story as a whole. We believe that takes human skills.

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

Science.gov (United States)

Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

The dialogic educational pathway as a strategy of care with elderly women in sexuality

Directory of Open Access Journals (Sweden)

Daysi Mara Murio Ribeiro Rodrigues

2018-03-01

Full Text Available Abstract Objective: Unveiling the critical knowledge mediated by a care-educational dialogic pathway in sexuality with elderly women. Method: Qualitative and participatory study, outlined in educational action research approach, for which it was anchored in the Paulo Freire's Research Itinerary. 15 elderly women from a group of socialization participated in the study. Three ethical precepts were followed. Results: It was evident that the women of this study had difficulty in conceptualizing sexuality, reducing the concept to sex. In addition to diverging sexuality for men and women and configuring it as a practice of the youth. Conclusion and implications for practice: Dialogic educational activity proved to be an important care tool, since it allowed the unleashing of prejudice concerning sexuality in Aging, promoting elderly health and showing new ways of care.

Seismic proving test of process computer systems with a seismic floor isolation system

International Nuclear Information System (INIS)

Fujimoto, S.; Niwa, H.; Kondo, H.

1995-01-01

The authors have carried out seismic proving tests for process computer systems as a Nuclear Power Engineering Corporation (NUPEC) project sponsored by the Ministry of International Trade and Industry (MITI). This paper presents the seismic test results for evaluating functional capabilities of process computer systems with a seismic floor isolation system. The seismic floor isolation system to isolate the horizontal motion was composed of a floor frame (13 m x 13 m), ball bearing units, and spring-damper units. A series of seismic excitation tests was carried out using a large-scale shaking table of NUPEC. From the test results, the functional capabilities during large earthquakes of computer systems with a seismic floor isolation system were verified

Perceived benefits and proposed solutions for teen pregnancy: qualitative interviews with youth care workers.

Science.gov (United States)

Boustani, Maya Mroué; Frazier, Stacy L; Hartley, Chelsey; Meinzer, Michael; Hedemann, Erin

2015-01-01

The purpose of this article is to examine youth care workers' perceptions of the specific and unique sexual health needs of youth at risk for foster care. Semistructured interviews were conducted with youth care workers (N = 10) at a shelter for youth in or at risk for foster care. Youth care workers perceive that youth have unique experiences and needs related to sexual health programming and pregnancy prevention. Reflecting a great deal of family dysfunction, 3 themes emerged that revealed perceived benefits of teen pregnancy: youths' effort to prove themselves as adults, opportunity to secure their relationship with a partner, and desire to create an emotional connection with a baby. Lack of knowledge and accumulation of risk factors were viewed as most problematic. Current pregnancy prevention programs assume teen pregnancies are unwanted and emphasize the costs of sexual risk taking. Current findings suggest that sexual health programming for youth in or at risk for foster care should account for 3 perceived benefits of teen pregnancy. New opportunities for improving the reach and effectiveness of intervention for youth in or at risk for foster care are discussed.

Important questions asked by family members of intensive care unit patients.

Science.gov (United States)

Peigne, Vincent; Chaize, Marine; Falissard, Bruno; Kentish-Barnes, Nancy; Rusinova, Katerina; Megarbane, Bruno; Bele, Nicolas; Cariou, Alain; Fieux, Fabienne; Garrouste-Orgeas, Maite; Georges, Hugues; Jourdain, Merce; Kouatchet, Achille; Lautrette, Alexandre; Legriel, Stephane; Regnier, Bernard; Renault, Anne; Thirion, Marina; Timsit, Jean-Francois; Toledano, Dany; Chevret, Sylvie; Pochard, Frédéric; Schlemmer, Benoît; Azoulay, Elie

2011-06-01

Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit. This was a multicenter study. Questions asked by relatives of intensive care unit patients were collected from five different sources (literature, panel of 28 intensive care unit nurses and physicians, 1-wk survey of nurses and 1-wk survey of physicians in 14 intensive care units, and in-depth interviews with 14 families). After a qualitative analysis (framework approach and thematic analysis), questions were rated by 22 relatives and 14 intensive care unit physicians, and the ratings were analyzed using principal component analysis and hierarchical clustering. The five sources produced 2,135 questions. Removal of duplicates and redundancies left 443 questions, which were distributed among nine predefined domains using a framework approach ("diagnosis," "treatment," "prognosis," "comfort," "interaction," "communication," "family," "end of life," and "postintensive care unit management"). Thematic analysis in each domain led to the identification of 46 themes, which were reworded as 46 different questions. Ratings by relatives and physicians showed that 21 of these questions were particularly important for relatives of intensive care unit patients. This study increases knowledge about the informational needs of relatives of intensive care unit patients. This list of questions may prove valuable for both relatives and intensive care unit physicians as a tool for improving communication in the intensive care unit.

Contributions of ludic care in nursing to chemical detoxification due to the use of crack cocaine

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Paola Aparecida Pavanatto

Full Text Available OBJECTIVE: to understand the contributions of ludic care in nursing by stimulating the acceptance of chemical detoxification from crack on the perception of people in the detoxification process. METHODS: an exploratory, descriptive study with a qualitative approach, performed with five people hospitalized for chemical detoxification from crack, from March to July 2013 in a chemical detox unit of a midsize hospital in the central region of Rio Grande do Sul. Data was collected using a semi-structured interview and was subjected to content analysis. RESULTS: Two categories emerged: Ludic care in nursing as a stimulus to the acceptance of chemical detoxification; Ludic care in nursing in the promotion for healthy living after chemical detoxification. CONCLUSION: ludic care in nursing proved to enhance the acceptance of chemical detoxification from crack in the reality investigated.

Balancing personalized medicine and personalized care.

Science.gov (United States)

Cornetta, Kenneth; Brown, Candy Gunther

2013-03-01

The current description of personalized medicine by the National Institutes of Health is "the science of individualized prevention and therapy." Although physicians are beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act on personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. Because these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care.

Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

Directory of Open Access Journals (Sweden)

Stewart Allison

2008-05-01

design – strengthened by provision of transport for clients to health centres, separate men's and women's clinic rooms, specific roles of primary care team members in relation to chronic illness care, effective teamwork, and functional pathology and pharmacy systems, but weakened by staff shortage (particularly doctors and Aboriginal health workers and high staff turnover; and 6 clinical information systems – facilitated by wide adoption of computerised information systems, but weakened by the systems' complexity and lack of IT maintenance and upgrade support. Conclusion Using concrete examples, this study translates the concept of the Chronic Care Model (and associated systems view into practical application in Australian Indigenous primary care settings. This approach proved to be useful in understanding the quality of primary care systems for prevention and management of chronic illness. Further refinement of the systems should focus on both increasing human and financial resources and improving management practice.

Meeting on Solute/Solvent Interactions Held in Aberdeen Proving Ground, Maryland on May 29-30, 1991

Science.gov (United States)

1992-01-01

the magnitudes of the nuclear charges and therefore cannot be assumed to indicate relative reactivities toward nucleophiles. There is accordingly no...APPENDIX 3 ORGANIZATIONS OF AUTHORS IN THESE PROCEEDINGS Central Michigan University 49 Instituto de Quimica Fisica 33 La Sierra University, Riverside 71...Aberdeen Proving Gd, MD Joxe-Luis Abbud Christopher Cramer Instituto de Quimica Fisica SMCCR-RSP-C "Rocasolano" U.S. Army Chemical RD&E Center Conajo

Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

Science.gov (United States)

Riveros-Perez, Efrain; Hermesch, Amy C; Barbour, Linda A; Hawkins, Joy L

2018-01-01

Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis. PMID:29535558

Environmental geophysics at J-Field, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Daudt, C.R.; McGinnis, L.D.; Miller, S.F.; Thompson, M.D.

1994-11-01

Geophysical data collected at J-Field, Aberdeen Proving Ground, Maryland, were used in the characterization of the natural hydrogeologic framework of the J-Field area and in the identification of buried disturbances (trenches and other evidences of contamination). Seismic refraction and reflection data and electrical resistivity data have aided in the characterization of the leaky confining unit at the base of the surficial aquifer (designated Unit B of the Tertiary Talbot Formation). Excellent reflectors have been observed for both upper and lower surfaces of Unit B that correspond to stratigraphic units observed in boreholes and on gamma logs. Elevation maps of both surfaces and an isopach map of Unit B, created from reflection data at the toxic burning pits site, show a thickening of Unit B to the east. Abnormally low seismic compressional-wave velocities suggest that Unit B consists of gassy sediments whose gases are not being flushed by upward or downward moving groundwater. The presence of gases suggests that Unit B serves as an efficient aquitard that should not be penetrated by drilling or other activities. Electromagnetic, total-intensity magnetic, and ground-penetrating radar surveys have aided in delineating the limits of two buried trenches, the VX burning pit and the liquid smoke disposal pit, both located at the toxic burning pits site. The techniques have also aided in determining the extent of several other disturbed areas where soils and materials were pushed out of disposal pits during trenching activities. Surveys conducted from the Prototype Building west to the Gunpowder River did not reveal any buried trenches.

The Use of a Novel Heart Failure Agent in the Treatment of Pregnancy-Associated Cardiomyopathy

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Vamsi C. Gaddipati

2017-01-01

Full Text Available Peripartum cardiomyopathy is an uncommon, pregnancy-related form of dilated cardiomyopathy that is associated with development of new-onset left ventricular dysfunction. Its etiology is presently unknown, but current standard of care involves the use of typical drug therapy for the treatment of heart failure. Pregnancy-associated cardiomyopathy (PACM is a similar condition that refers to patients who develop such symptoms prior to the last month of pregnancy. We report the case of a nulliparous Caucasian female who develops early, severe PACM during her first pregnancy with postpartum persistence of New York Heart Association class II-III symptoms despite medical therapy. The use of the novel heart failure agent, sacubitril/valsartan (Entresto, is initiated with near-complete resolution of her symptoms.

Quality of care for people with multimorbidity - a case series.

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Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B; Domínguez, Helena; Hamid, Yasmin; Almind, Merete; Sørensen, Kim L; Saxild, Thomas; Holm, Rikke Høgsbro; Frølich, Anne

2017-11-18

Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. The review of the patients' records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment. Our findings reveal quality of care deficiencies for

Automated Theorem Proving in High-Quality Software Design

Science.gov (United States)

Schumann, Johann; Swanson, Keith (Technical Monitor)

2001-01-01

The amount and complexity of software developed during the last few years has increased tremendously. In particular, programs are being used more and more in embedded systems (from car-brakes to plant-control). Many of these applications are safety-relevant, i.e. a malfunction of hardware or software can cause severe damage or loss. Tremendous risks are typically present in the area of aviation, (nuclear) power plants or (chemical) plant control. Here, even small problems can lead to thousands of casualties and huge financial losses. Large financial risks also exist when computer systems are used in the area of telecommunication (telephone, electronic commerce) or space exploration. Computer applications in this area are not only subject to safety considerations, but also security issues are important. All these systems must be designed and developed to guarantee high quality with respect to safety and security. Even in an industrial setting which is (or at least should be) aware of the high requirements in Software Engineering, many incidents occur. For example, the Warshaw Airbus crash, was caused by an incomplete requirements specification. Uncontrolled reuse of an Ariane 4 software module was the reason for the Ariane 5 disaster. Some recent incidents in the telecommunication area, like illegal "cloning" of smart-cards of D2GSM handies, or the extraction of (secret) passwords from German T-online users show that also in this area serious flaws can happen. Due to the inherent complexity of computer systems, most authors claim that only a rigorous application of formal methods in all stages of the software life cycle can ensure high quality of the software and lead to real safe and secure systems. In this paper, we will have a look, in how far automated theorem proving can contribute to a more widespread application of formal methods and their tools, and what automated theorem provers (ATPs) must provide in order to be useful.

Preparing for International Travel and Global Medical Care.

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Mahadevan, Swaminatha V; Strehlow, Matthew C

2017-05-01

Thorough pretravel preparation and medical consultation can mitigate avoidable health and safety risks. A comprehensive pretravel medical consultation should include an individualized risk assessment, immunization review, and discussion of arthropod protective measures, malaria prophylaxis, traveler's diarrhea, and injury prevention. Travel with children and jet lag reduction require additional planning and prevention strategies; travel and evacuation insurance may prove essential when traveling to less resourced countries. Consideration should also be given to other high-risk travel scenarios, including the provision of health care overseas, adventure and extreme sports, water environments and diving, high altitude, and terrorism/unstable political situations. Copyright © 2017 Elsevier Inc. All rights reserved.

Stimulating collaboration between human and veterinary health care professionals.

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Eussen, Björn G M; Schaveling, Jaap; Dragt, Maria J; Blomme, Robert Jan

2017-06-13

Despite the need to control outbreaks of (emerging) zoonotic diseases and the need for added value in comparative/translational medicine, jointly addressed in the One Health approach [One health Initiative (n.d.a). About the One Health Initiative. http://www.onehealthinitiative.com/about.php . Accessed 13 September 2016], collaboration between human and veterinary health care professionals is limited. This study focuses on the social dilemma experienced by health care professionals and ways in which an interdisciplinary approach could be developed. Based on Gaertner and Dovidio's Common Ingroup Identity Model, a number of questionnaires were designed and tested; with PROGRESS, the relation between collaboration and common goal was assessed, mediated by decategorization, recategorization, mutual differentiation and knowledge sharing. This study confirms the Common Ingroup Identity Model stating that common goals stimulate collaboration. Decategorization and mutual differentiation proved to be significant in this relationship; recategorization and knowledge sharing mediate this relation. It can be concluded that the Common Ingroup Identity Model theory helps us to understand how health care professionals perceive the One Health initiative and how they can intervene in this process. In the One Health approach, professional associations could adopt a facilitating role.

Contextualizing Competence: Language and LGBT-Based Competency in Health Care.

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Rossi, Alexis L; Lopez, Eliot J

2017-01-01

Changes in the language and terminology used to refer to individuals identifying as lesbian, gay, bisexual, and transgender (LGBT), as well as how best to discuss issues of sexual and gender identity, can prove challenging for health care providers due to (1) lack of training; (2) interdisciplinary issues; and (3) prejudices on personal and institutional levels. Given the importance of language in the relationship between health care provider and patient as well as the myriad ways in which language can reflect knowledge, skills, and attitudes, we contend that language is both a facilitator and inhibitor of competence. In this article, we discuss language as a means of exhibiting cultural competence as well as the barriers to facilitating this degree of competence. Communicative competence, a concept traditionally used in linguistics, is discussed as a framework for contextualizing LGBT-specific cultural competence in health care. Ideally, a professional will be considered competent once they (1) acquire a foundation in issues associated with LGBT individuals, as well as a basic understanding of appropriate vocabulary' (2) reconcile personal beliefs with their professional role; (3) create an inclusive healthcare environment such that the influence of personal biases does not negatively impact care; and (4) use identifiers suggested by the patient.

Modern community care program

International Nuclear Information System (INIS)

Nordin, Staffan

2000-01-01

Going into the next millennium do we see nuclear energy? Yes we will see an expanding nuclear sector in the modem community. he modem community that cares for people, health and environment needs nuclear. Energy saves lives. Electricity is efficient use of energy. Energy will be the key to a sustainable society, energy is life. Nuclear energy protects the environment. Nuclear is an integral part of the modern community caring for people, health and environment. The dynamics of the public opinion-forming process and its effects on the nuclear industry are a challenge of the global nuclear industry. Current communications strategy and its consequences are on of the key issues. The nuclear industry must be perceived in certain ways in order to move towards achieving the vision and avoiding the harassment scenario. Each perception goal does not bear the same function within the communications process. As the nuclear industry is oe of the keys to a sustainable society, it must achieve legitimacy in its capacity as an interesting agenda-setter for tackling problems and as an expert. We have to build our communication activities on an open and honest attitude and we have to establish trust and confidence. The nuclear industry must also prove its ability and performance. If this could be achieved there will be an option for the future

The existence of propagated sensation along the meridian proved by neuroelectrophysiology

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Xu, Jinsen; Zheng, Shuxia; Pan, Xiaohua; Zhu, Xiaoxiang; Hu, Xianglong

2013-01-01

Propagated sensation along the meridian can occur when acupoints are stimulated by acupuncture or electrical impulses. In this study, participants with notable propagated sensation along the dian were given electro-acupuncture at the Jianyu (LI15) acupoint of the large intestine meridian. When participants stated that the sensation reached the back of their hand, regular nervous system action discharge was examined using a physiological recording electrode placed on the superficial branch of the radial nerve. The topographical maps of brain-evoked potential in the primary cortical somatosensory area were also detected. When Guangming (GB37) acupoint in the lower limb and Hegu (LI4) acupoint in the upper limb were stimulated, subjects without propagated sensation along the meridian exhibited a high potential reaction in the corresponding area of the brain cortical so-matosensory area. For subjects with a notable propagated sensation along the meridian, the tion area was larger and extended into the face representative area. These electrophysiological measures directly prove the existence of propagated sensation along the meridian, and the pheral stimulated site is consistent with the corresponding primary cortical somatosensory area, which presents a high potential reaction. PMID:25206574

Paternity protection can provide a kick-start for the evolution of male-only parental care.

Science.gov (United States)

Kahn, Andrew T; Schwanz, Lisa E; Kokko, Hanna

2013-08-01

Sperm competition and uncertainty of paternity hamper the evolution of male parental care. Thus, maternal care predominates in most taxa. What if males can, however, limit cuckoldry by guarding the eggs postmating? Here, we show that this provides a reason to reconsider an old and nowadays rather discredited hypothesis: that external fertilization is associated with male care because the parent who releases its gametes first can depart leaving the other in a "cruel bind," having to care for the offspring. In our model, protection of paternity provides an additional incentive for the male to stay associated with its young. When we then assume that offspring survive better if guarded, paternity protection proves enough to kick-start the evolution of male-only parental care from a scenario with no care. This fits with data from fishes, where male-only care is associated with external fertilization, whereas female-only care almost always evolves after an initial transition to internal fertilization. Our model unifies disparate hypotheses regarding parental care roles and provides support for the idea that care roles can be influenced by sex differences in selection to be physically close to the offspring, including selection that is initially not based on offspring survival. © 2013 The Author(s). Evolution © 2013 The Society for the Study of Evolution.

The effects of hospice-shared care for gastric cancer patients.

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Kun-Siang Huang

Full Text Available Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients.A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93 and a control group (n = 81.Among the 174 patients, 84% had advanced stage (stage III or stage IV cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001 and those cared by other physicians (63% vs 41%, p = 0.004. Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001, intubation (1% vs 27%, p<0.001, cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001, ventilator use (1% vs 27%, p<0.001, inotropic agent use (8% vs 46%, p<0.001, total or partial parenteral nutrition use (38% vs. 58%, p = 0.029, and blood transfusion (45% vs 74%, p<0.001. Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR orders (95% vs 37%, p<0.001, receiving home hospice care (16% vs 1%, p<0.001, and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001. The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

Yoga into cancer care: A review of the evidence-based research

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Ram P Agarwal

2018-01-01

Full Text Available To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM. Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed, through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.

Intersectoral cooperation in the sphere of public health care: ways of optimization

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Natan G. Korshever

2017-08-01

Material and Methods — There were analyzed the normative legal field of public health care, the results of anonymous survey of 838 physicians – health care organizers including 34 experts, and of 6,106 persons not engaged in medical professions. Results — There were established the list and significance of 37 health determinants; the effect produced on them by 23 state and public sectors engaged in health care; characteristics of these sectors’ interaction. There were substantiated 38 informative vectors for evaluating the effectiveness of intersectoral cooperation in the sphere of public health care – 22 simple (each representing a single informative criterion and 16 complex (consisting of several, from 3 to 12 informative criteria. There was developed an automatic multi-vector method for assessing success in intersectoral cooperation in the sphere of public health care in a territorial formation (formations, and there was designed an appropriate technology of optimization, including the primary multi-vector analysis, purposeful correction and dynamic evaluation. Conclusion — Public health care optimization is a process which should be carried out with regard to hierarchic interaction of the engaged sectors and peculiarities of their influence on health determinants, multi-vector evaluation of intersectoral cooperation efficacy aimed to substantiate and choose such administrative decisions which prove to be the best from the viewpoint of resulting effective achievements. The obtained materials may be realized in everyday practice of public health care.

The heart of Africa: succeeding against the odds.

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Sliwa, Karen

2016-12-17

South Africa and other areas of sub-Saharan Africa have in the past 20 years undergone rapid demographical changes, largely due to urbanisation and changes in lifestyle. This rapid change has led to a marked increase in specific cardiac conditions, such as hypertensive heart disease and coronary artery disease (with the highest prevalence in the middle-aged population), in conjunction with a range of other heart diseases, which are historically common in Africa-eg, rheumatic heart disease, cardiomyopathies, and unoperated congenital heart disease. The short supply of well-equipped screening facilities, late diagnosis, and inadequate care at primary, secondary, and tertiary levels have led to a large burden of patients with poorly treated heart failure. Excellent progress has been made in the understanding of the epidemiology, sociodemographical factors, effect of urbanisation, and pathophysiology of cardiac conditions, such as peripartum cardiomyopathy, rheumatic heart disease, and tuberculous pericarditis, which are common in sub-Saharan Africa. This progress has been achieved largely through several studies, such as the Heart of Soweto, THESUS, REMEDY, BA-HEF, Abeokuta-HF, and the PAPUCO studies. Studies on the suitable therapeutic management of several heart conditions have also been done or are underway. In this Lecture, I provide a personal perspective on the evolving burden of cardiac disease, as witnessed since my appointment at Chris Hani Baragwanath Hospital, in Soweto, South Africa, in 1992, which was also the year that the referendum to end apartheid in South Africa was held. Subsequently, a network of cardiologists was formed under the umbrella of the Heart of Africa Studies and the Pan African Cardiac Society. Furthermore, I summarise the major gaps in the health-care system dealing with the colliding epidemic of communicable and non-communicable heart diseases, including cardiac diseases common in peripartum women. I also touch on the fantastic

Correlation of Fault Size, Moment Magnitude, and Tsunami Height to Proved Paleo-tsunami Data in Sulawesi Indonesia

Science.gov (United States)

Julius, A. M.; Pribadi, S.

2016-02-01

Sulawesi (Indonesia) island is located in the meeting of three large plates i.e. Indo-Australia, Pacific, and Eurasia. This configuration surely make high risk on tsunami by earthquake and by sea floor landslide. NOAA and Russia Tsunami Laboratory show more than 20 tsunami data recorded in Sulawesi since 1820. Based on this data, determine of correlation between all tsunami parameter need to be done to proved all event in the past. Complete data of magnitudes, fault sizes and tsunami heights in this study sourced from NOAA and Russia Tsunami database and completed with Pacific Tsunami Warning Center (PTWC) catalog. This study aims to find correlation between fault area, moment magnitude, and tsunami height by simple regression in Sulawesi. The step of this research are data collect, processing, and regression analysis. Result shows very good correlation, each moment magnitude, tsunami heights, and fault parameter i.e. long, wide, and slip are correlate linier. In increasing of fault area, the tsunami height and moment magnitude value also increase. In increasing of moment magnitude, tsunami height also increase. This analysis is enough to proved all Sulawesi tsunami parameter catalog in NOAA, Russia Tsunami Laboratory and PTWC are correct. Keyword: tsunami, magnitude, height, fault

[Home treatment--a treatment model of integrated care in Hamburg].

Science.gov (United States)

Schöttle, Daniel; Ruppelt, Friederike; Karow, Anne; Lambert, Martin

2015-03-01

Treatment models like "Crisis Resolution and Hometreatment (CRHT)" or "Assertive Community Treatment" (ACT), were found to be effective, enhancing the qualitative level of treatment for patients with severe mental disorders. In Germany, these are implemented only sporadically until today, often as part of a cross-sectoral Integrated Care (IC) treatment system. We will present the implementation of an "Assertive Community Treatment" embedded into an IC-treatment model in Hamburg and discuss the 3-year-outcomes. The IC-treatment model has been designed for severe mentally ill patients with psychotic disorders. Since May 2007 the model is financed by different health insurances as a managed-care "capitation-model" and its effectiveness gets continuously evaluated. The model proved to be effective in earlier studies were compared with standard care low rates of service disengagement were found as well as significantly improved psychopathology, psychosocial functioning, quality of life, satisfaction with care and adherence, while being cost effective. The rates of involuntary admissions declined to 10% in comparison to the years before. In 2011 the model was specified to the indication "first-episode adolescents and young adults in the age of 12-29" in a government-funded study "Integrated Care in Early Psychosis, ICEP Study". In this study an interdisciplinary team of child, adolescent and adult psychiatrists was implemented and since 2012 it is financed by the involved health insurances throughout an expansion of the §140 SGB V agreement. © Georg Thieme Verlag KG Stuttgart · New York.

Risk factors relating to helminth infections in cows during the peripartum Fatores de risco relacionados à infecção por helmintos em vacas durante o periparto

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Jenevaldo Barbosa da Silva

2012-06-01

Full Text Available The aim of this study was to investigate whether season, lactation number, breed standard and milk production were risk factors relating to occurrences of gastrointestinal nematodes in dairy cows during the peripartum period. Eighty-four cows were randomly selected through proportional stratified sampling. In order to analyze the fecal egg per gram (EPG count, the data were subjected to the Spearman test, Kruskal-Wallis test at 5% significance and linear regression. At the time of calving, the cows showed high EPG counts in relation to all variables analyzed. Among the animals studied, we observed that purebred Holstein cows at their first lactation and with high milk production showed high EPG counts (600 and comprised the group most at risk within the herd studied. In this group, the animals showed moderate EPG during the prepartum period (300 and a significant increase (p O objetivo foi investigar a estação do ano, número de lactações, padrão racial e produção de leite como fatores de risco relacionados à ocorrência de helmintos gastrintestinais em vacas durante o periparto. Foram selecionadas randomicamente 84 vacas através de amostragem estratificada proporcional. Para análise dos resultados da contagem de ovos por grama de fezes (OPG, foram utilizados os testes de Spearman , Kruskal-Wallis a 5% de significância e regressão linear. Entre os fatores de risco avaliados, o parto esteve associado à elevada contagem de OPG em todos os grupos estudados. Por ocasião do parto, as vacas apresentaram alta contagem de OPG em relação a todas as variáveis analisadas. Dentre os animais estudados, observou-se que vacas holandesas puras de primeira lactação e de alta produção leiteira apresentaram elevada contagem de OPG (600, constituindo o grupo de maior risco dentro do rebanho estudado. Nesse grupo, observou-se que os animais apresentaram contagem de OPG moderada no pré-parto (300, com aumento significativo (p < 0.01 na contagem

Home iv Antibiotic Therapy through a Medical Day Care Unit

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Marie Gourdeau

1993-01-01

Full Text Available An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%. The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days. Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days. Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

The written mathematical communication profile of prospective math teacher in mathematical proving

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Pantaleon, K. V.; Juniati, D.; Lukito, A.; Mandur, K.

2018-01-01

Written mathematical communication is the process of expressing mathematical ideas and understanding in writing. It is one of the important aspects that must be mastered by the prospective math teacher as tool of knowledge transfer. This research was a qualitative research that aimed to describe the mathematical communication profile of the prospective mathematics teacher in mathematical proving. This research involved 48 students of Mathematics Education Study Program; one of them with moderate math skills was chosen as the main subject. Data were collected through tests, assignments, and task-based interviews. The results of this study point out that in the proof of geometry, the subject explains what is understood, presents the idea in the form of drawing and symbols, and explains the content/meaning of a representation accurately and clearly, but the subject can not convey the argument systematically and logically. Whereas in the proof of algebra, the subject describes what is understood, explains the method used, and describes the content/meaning of a symbolic representation accurately, systematically, logically, but the argument presented is not clear because it is insufficient detailed and complete.

Non-linear quenching of current fluctuations in a self-exciting homopolar dynamo, proved by feedback system theory

OpenAIRE

A. M. de Paor

1998-01-01

International audience; Hide (Nonlinear Processes in Geophysics, 1998) has produced a new mathematical model of a self-exciting homopolar dynamo driving a series- wound motor, as a continuing contribution to the theory of the geomagnetic field. By a process of exact perturbation analysis, followed by combination and partial solution of differential equations, the complete nonlinear quenching of current fluctuations reported by Hide in the case that a parameter ? has the value 1 is proved via ...

Validity and reliability of the Palliative Care Transition Measure for Caregivers (PCTM-C).

Science.gov (United States)

D'Angelo, Daniela; Mastroianni, Chiara; Artico, Marco; Biagioli, Valentina; Latina, Roberto; Guarda, Michela; Piredda, Michela; De Marinis, Maria Grazia

2018-01-21

Patients suffering from advanced disease face different care transitions. The transition from acute to palliative care is challenging and may lead to the discontinuity of care. Family caregivers become important sources of information, as patients begin to experience difficulties in coping with emotional transition events. The Care Transition Measure was developed to evaluate care transitions as experienced by the elderly. It has never been used in palliative care. The aim of this study was to test the validity and reliability of a modified version of the Palliative Care Transition Measure, specifically the Palliative Care Transition Measure for Caregivers (PCTM-C). The study included two main phases. Phase I focused on the construction of a modified version of the Palliative Care Transition Measure through two focus groups and by computing the content validity index. Phase II focused on testing the psychometric properties of the PCTM-C on 272 family caregivers through confirmatory factor analysis. Result The content validity index for each of the items was higher than 0.80, whereas that for the scale was 0.95. The model tested with confirmatory factor analysis fitted the data well and confirmed that the transition measures referred to communication, integrated care and a trusting-relationship, and therefore the core dimensions of continuity according to existing conceptual models. The internal consistency was high (Cronbach's alpha = 0.94). Significance of results The PCTM-C proved to be a suitable measure of the quality of such transitions. It may be used in clinical practice as a continuity quality indicator and has the potential to guide interventions to enhance family caregivers' experience of care continuity.

Organizational capacity for change in health care: Development and validation of a scale.

Science.gov (United States)

Spaulding, Aaron; Kash, Bita A; Johnson, Christopher E; Gamm, Larry

We do not have a strong understanding of a health care organization's capacity for attempting and completing multiple and sometimes competing change initiatives. Capacity for change implementation is a critical success factor as the health care industry is faced with ongoing demands for change and transformation because of technological advances, market forces, and regulatory environment. The aim of this study was to develop and validate a tool to measure health care organizations' capacity to change by building upon previous conceptualizations of absorptive capacity and organizational readiness for change. A multistep process was used to develop the organizational capacity for change survey. The survey was sent to two populations requesting answers to questions about the organization's leadership, culture, and technologies in use throughout the organization. Exploratory and confirmatory factor analyses were conducted to validate the survey as a measurement tool for organizational capacity for change in the health care setting. The resulting organizational capacity for change measurement tool proves to be a valid and reliable method of evaluating a hospital's capacity for change through the measurement of the population's perceptions related to leadership, culture, and organizational technologies. The organizational capacity for change measurement tool can help health care managers and leaders evaluate the capacity of employees, departments, and teams for change before large-scale implementation.

Application of proving-ring technology to measure thermally induced displacements in large boreholes in rock

International Nuclear Information System (INIS)

Patrick, W.C.; Reactor, N.L.; Butkovich, T.R.

1984-03-01

A strain-gauged proving-ring transducer was designed and deployed to measure small diametral displacements in 0.61-m diameter boreholes in rock. The rock surrounding the boreholes was previously heated by storage of spent nuclear fuel assemblies and measurements during post-retrieval cooling of the rock were made. To accomplish this, a transducer was designed to measure displacements in the range of 10 to 100 μm, to function in a time-varying temperature regime of 30 0 to 60 0 C at a relative humidity of 100%, to be of low stiffness, and to be easily and quickly installed. 7 references, 6 figures, 1 table

Storytelling: a care technology in continuing education for active ageing.

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Costa, Nadia Pinheiro da; Polaro, Sandra Helena Isse; Vahl, Eloá Aparecida Caliari; Gonçalves, Lucia Hisako Takase

2016-01-01

assessing relevance and effectiveness of care/educational technology in the form of "storytelling" as a strategy in the cultivation of active ageing (AA) for elderly users of a Basic Health Unit (BHU), from the Amazon region. convergent care research (CCR) held in a BHU in Belém, state of Pará, with eight elderly ladies for testing this technology. An active ageing assessment questionnaire and WHOQOL-BREF - quality of life assessment were applied. After training with a view to continuing education, elderly ladies told stories for an audience that addressed the question: "What did you learn from it for your life?" tThe popular stories elicited reactions from which the following categories emerged: solidarity; respect for the other; imagination, dreams, hopes and culture of the Amazonian. This practice had a positive result, producing changes in the quality of life of the elderly, particularly in the psychological domain. "storytelling" proved to be an innovative technology, a relevant and effective resource in health education, especially for active ageing.

Feasibility of a multifaceted educational strategy for strengthening rural primary health care

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Hortensia Reyes-Morales

2017-05-01

Full Text Available Objective. To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. Materials and methods. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strat­egy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams; Implementation of the strategy among health care teams for six priority causes of visit, through workshops, individual tutorials, and round-table case-review sessions. Feasibility and acceptability were evaluated using checklists, direct observa­tion, questionnaires and in-depth interviews with key players. Results. Despite some organizational barriers, the strategy was perceived as worthy by the participants because of the personalized tutorials and the improved integration of health teams within their usual professional practice. Conclusion. The educational strategy proved to be acceptable; its feasibil­ity for usual care conditions will depend on the improvement of organizational processes at rural facilities.

Early wound infection identification using the WIRE tool in community health care settings: An audit report.

Science.gov (United States)

Siaw-Sakyi, Vincent

2017-12-01

Wound infection is proving to be a challenge for health care professionals. The associated complications and cost of wound infection is immense and can lead to death in extreme cases. Current management of wound infection is largely subjective and relies on the knowledge of the health care professional to identify and initiate treatment. In response, we have developed an infection prediction and assessment tool. The Wound Infection Risk-Assessment and Evaluation tool (WIRE) and its management strategy is a tool with the aim to bring objectivity to infection prediction, assessment and management. A local audit carried out indicated a high infection prediction rate. More work is being done to improve its effectiveness.

Japanese structure survey of radiation oncology in 2007 with special reference to designated cancer care hospitals

International Nuclear Information System (INIS)

Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi

2011-01-01

Background and Purpose: The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution. The effect of changes in the health care policy in Japan on radiotherapy structure was also examined. Material and Methods: The Japanese Society of Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2007. The structures of 349 designated cancer care hospitals and 372 other radiotherapy facilities were compared. Results: Respective findings for equipment and personnel at designated cancer care hospitals and other facilities included the following: linear accelerators/facility: 1.3 and 1.0; annual patients/linear accelerator: 296.5 and 175.0; and annual patient load/full-time equivalent radiation oncologist was 237.0 and 273.3, respectively. Geographically, the number of designated cancer care hospitals was associated with population size. Conclusion: The structure of radiation oncology in Japan in terms of equipment, especially for designated cancer care hospitals, was as mature as that in European countries and the United States, even though the medical costs in relation to GDP in Japan are lower. There is still a shortage of manpower. The survey data proved to be important to fully understand the radiation oncology medical care system in Japan. (orig.)

Grounds of necessity to carry out reforms in health care system in Ukraine: historical aspect

Directory of Open Access Journals (Sweden)

I. P. Krynychna

2015-03-01

Full Text Available The article studies the historical experience of reforming the health care system in Ukraine, which allow clearing up the basic problems of public administration. Thus, the health care legislation is characterized as a fragmentary and complex thing with common overlaps and vaguely defined areas of accountability of financial and material resources and a significant deficit of funding. In turn, there is an urgent need for a fundamental change in strategy of the state policy concerning the restructuring of the health care system, which would involve fundamentally new mechanisms of public administration that must be adapted to the specific social problems and opportunities, particularly in conditions of limited resources. It is determined that reforming the health care systems of the former Soviet Union countries has similar nature with Ukraine, namely: the lack of government funding, poor quality of medical care, high level of medical services payment by citizens, the low level of wages of health care employees, and, as a consequence, the limited availability of the population to qualitative health services. On the basis of the results of the analysis of existing and not solved problems of the health care system it is proved the necessity to introduce new mechanisms of control in this field: the development of a system of compulsory medical insurance; the combination of budget and insurance sources of financing the health care system; the growing funding for the health care system; the development of initial care; adjustment of the state guarantees, according to the state financial opportunities; increasing the wages of health care employees; search for new organizational forms of health care institutions; increase the efficiency of health care resources; privatization and improvement of the structure of the medical care system . Keywords: public administration, health care reform, health insurance, initial care, medical care, medical services

[Cost-effectiveness of addiction care].

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Suijkerbuijk, A W M; van Gils, P F; Greeven, P G J; de Wit, G A

2015-01-01

A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.

Coming out to care: gay and lesbian carers' experiences of dementia services.

Science.gov (United States)

Price, Elizabeth

2010-03-01

This article reports on findings from a qualitative study, undertaken in England that explored the experiences of 21 gay men and lesbian women who care, or cared, for a person with dementia. The aim of the study was to explore how a person's gay or lesbian sexuality might impact upon their experience of providing care in this context. This paper reports on one theme that emerged from the wider study--carers' experiences of 'coming out' to service providers. Respondents were recruited using 'snowballing' methods and the study employed semi-structured interviewing techniques. Data collection occurred over a protracted period (2003-2007), the time scale being determined by (the well documented) difficulties in recruiting respondents from this group of people. Data analysis was undertaken with the intent of developing common and contrary themes using a constant thematic comparative method. The results reported here demonstrate the ways in which carers mediated disclosures of their sexualities to health and social care service providers and, for some, their wider support network. For many carers, responses to these disclosures proved to be a critical issue and one that coloured their experience of providing care. Service providers' reactions are demonstrated as being characterised by, at best, a broad acceptance of gay and lesbian people's circumstances, through to a pervasive disregard of their needs.

Improving immunization delivery using an electronic health record: the ImmProve project.

Science.gov (United States)

Bundy, David G; Persing, Nichole M; Solomon, Barry S; King, Tracy M; Murakami, Peter N; Thompson, Richard E; Engineer, Lilly D; Lehmann, Christoph U; Miller, Marlene R

2013-01-01

Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record-derived immunization prompting. Operating in a large, urban, hospital-based pediatric primary care clinic, we evaluated 2 interventions to improve immunization delivery to children ages 2, 6, and 13 years: point-of-care, patient-specific electronic clinical decision support (CDS) when children overdue for immunizations presented for care, and provider-specific bulletins listing children overdue for immunizations. Overall, the proportion of children up to date for a composite of recommended immunizations at ages 2, 6, and 13 years was not different in the intervention (CDS active) and historical control (CDS not active) periods; historical immunization rates were high. The proportion of children receiving 2 doses of hepatitis A immunization before their second birthday was significantly improved during the intervention period. Human papillomavirus (HPV) immunization delivery was low during both control and intervention periods and was unchanged for 13-year-olds. For 14-year-olds, however, 4 of the 5 highest quarterly rates of complete HPV immunization occurred in the final year of the intervention. Provider-specific bulletins listing children overdue for immunizations increased the likelihood of identified children receiving catch-up hepatitis A immunizations (hazard ratio 1.32; 95% confidence interval 1.12-1.56); results for HPV and the composite of recommended immunizations were of a similar magnitude but not statistically significant. In our patient population, with high baseline uptake of recommended immunizations, electronic health record-derived immunization prompting had a limited effect on immunization delivery. Benefit was more clearly demonstrated for newer immunizations with lower baseline uptake. Copyright © 2013 Academic

Women health seeking behaviour and its influence on their fertility performance: utilization of prenatal and postnatal care

International Nuclear Information System (INIS)

Abbasi, S.U.R.S.; Nawaz, S.; Yousif, F.N.; Zafar, M.I.

2008-01-01

Evidences regarding the effect of pre- and postnatal care on women fertility were scanty and rarely explored in countries struggling to curtail high population growth. This specialized health care enabled women for regular consultation with the health professionals and discussions with fellow women visiting clinics. It enhances their awareness, knowledge and understating about mother-child welfare during pre- and postnatal cares. This improves their control on subsequent fertility and underlines the need to explore the hidden dimension of female fertility. A doctoral level study on the determinants of marital fertility was conducted in district Faisalabad, Pakistan. It also examined the influence of pre- and postnatal care on family size in terms of children ever born. A random sample of 1051 married women was studied from 18 villages and 18 urban localities through formal survey. The study concluded that at least 5 prenatal and 2 postnatal cares proved effective in reducing marital fertility. Improved women access to specialized care, motivation through mass media, involvement of female representatives at union council level and effective use of primary support groups are the measures suggested to enhance women control on their fertility in Pakistan. (author)

Quality of care for people with multimorbidity – a case series

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Michaela L. Schiøtz

2017-11-01

Full Text Available Abstract Background Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. Methods To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients’ medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. Results The review of the patients’ records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment

JPSS Proving Ground Activities with NASA's Short-term Prediction Research and Transition (SPoRT) Center

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Schultz, L. A.; Smith, M. R.; Fuell, K.; Stano, G. T.; LeRoy, A.; Berndt, E.

2015-12-01

Instruments aboard the Joint Polar Satellite System (JPSS) series of satellites will provide imagery and other data sets relevant to operational weather forecasts. To prepare current and future weather forecasters in application of these data sets, Proving Ground activities have been established that demonstrate future JPSS capabilities through use of similar sensors aboard NASA's Terra and Aqua satellites, and the S-NPP mission. As part of these efforts, NASA's Short-term Prediction Research and Transition (SPoRT) Center in Huntsville, Alabama partners with near real-time providers of S-NPP products (e.g., NASA, UW/CIMSS, UAF/GINA, etc.) to demonstrate future capabilities of JPSS. This includes training materials and product distribution of multi-spectral false color composites of the visible, near-infrared, and infrared bands of MODIS and VIIRS. These are designed to highlight phenomena of interest to help forecasters digest the multispectral data provided by the VIIRS sensor. In addition, forecasters have been trained on the use of the VIIRS day-night band, which provides imagery of moonlit clouds, surface, and lights emitted by human activities. Hyperspectral information from the S-NPP/CrIS instrument provides thermodynamic profiles that aid in the detection of extremely cold air aloft, helping to map specific aviation hazards at high latitudes. Hyperspectral data also support the estimation of ozone concentration, which can highlight the presence of much drier stratospheric air, and map its interaction with mid-latitude or tropical cyclones to improve predictions of their strengthening or decay. Proving Ground activities are reviewed, including training materials and methods that have been provided to forecasters, and forecaster feedback on these products that has been acquired through formal, detailed assessment of their applicability to a given forecast threat or task. Future opportunities for collaborations around the delivery of training are proposed

The Effects of GeoGebra Software on Pre-Service Mathematics Teachers' Attitudes and Views toward Proof and Proving

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Zengin, Yilmaz

2017-01-01

The purpose of this study is to determine the effect of GeoGebra software on pre-service mathematics teachers' attitudes towards proof and proving and to determine pre-service teachers' pre- and post-views regarding proof. The study lasted nine weeks and the participants of the study consisted of 24 pre-service mathematics teachers. The study used…

Non-linear quenching of current fluctuations in a self-exciting homopolar dynamo, proved by feedback system theory

Science.gov (United States)

de Paor, A. M.

Hide (Nonlinear Processes in Geophysics, 1998) has produced a new mathematical model of a self-exciting homopolar dynamo driving a series- wound motor, as a continuing contribution to the theory of the geomagnetic field. By a process of exact perturbation analysis, followed by combination and partial solution of differential equations, the complete nonlinear quenching of current fluctuations reported by Hide in the case that a parameter ɛ has the value 1 is proved via the Popov theorem from feedback system stability theory.

Mobile, real-time, and point-of-care augmented reality is robust, accurate, and feasible: a prospective pilot study.

Science.gov (United States)

Kenngott, Hannes Götz; Preukschas, Anas Amin; Wagner, Martin; Nickel, Felix; Müller, Michael; Bellemann, Nadine; Stock, Christian; Fangerau, Markus; Radeleff, Boris; Kauczor, Hans-Ulrich; Meinzer, Hans-Peter; Maier-Hein, Lena; Müller-Stich, Beat Peter

2018-06-01

Augmented reality (AR) systems are currently being explored by a broad spectrum of industries, mainly for improving point-of-care access to data and images. Especially in surgery and especially for timely decisions in emergency cases, a fast and comprehensive access to images at the patient bedside is mandatory. Currently, imaging data are accessed at a distance from the patient both in time and space, i.e., at a specific workstation. Mobile technology and 3-dimensional (3D) visualization of radiological imaging data promise to overcome these restrictions by making bedside AR feasible. In this project, AR was realized in a surgical setting by fusing a 3D-representation of structures of interest with live camera images on a tablet computer using marker-based registration. The intent of this study was to focus on a thorough evaluation of AR. Feasibility, robustness, and accuracy were thus evaluated consecutively in a phantom model and a porcine model. Additionally feasibility was evaluated in one male volunteer. In the phantom model (n = 10), AR visualization was feasible in 84% of the visualization space with high accuracy (mean reprojection error ± standard deviation (SD): 2.8 ± 2.7 mm; 95th percentile = 6.7 mm). In a porcine model (n = 5), AR visualization was feasible in 79% with high accuracy (mean reprojection error ± SD: 3.5 ± 3.0 mm; 95th percentile = 9.5 mm). Furthermore, AR was successfully used and proved feasible within a male volunteer. Mobile, real-time, and point-of-care AR for clinical purposes proved feasible, robust, and accurate in the phantom, animal, and single-trial human model shown in this study. Consequently, AR following similar implementation proved robust and accurate enough to be evaluated in clinical trials assessing accuracy, robustness in clinical reality, as well as integration into the clinical workflow. If these further studies prove successful, AR might revolutionize data access at patient

How to prove the Earth's daily and annual direction of its spinning

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Drago Špoljarić

2014-12-01

Full Text Available Every day, we can observe the Sun's apparent motion around the sky. It rises in the east, gets to its highest point above the horizon at noon, and sets in the west. The stars appear to be fixed on the sky and move around apparently together with the Sun. We have daytime1 and night. The apparent annual motion of the Sun results in seasons when we can see different stars. These directly visible daily and annual changes result from real Earth’s motions – the Earth’s daily and annual spinning (rotation and revolution and they are not easily explainable without understanding the Earth’s motions. In order to understand the apparent daily and annual motions and motion direction of the Sun and stars (night sky, it is very important to know where we are on the Earth, what is our geographic position, i.e. to know the cardinal points. At the same time, one should take into consideration also the direction of the Earth’s rotation and revolution. What is the Earth’s daily or annual direction of spinning as related to the direction of clock hands, and how do we prove it?

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model.

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van Rensburg, André Janse; Fourie, Pieter

2016-01-01

Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource

Non-linear quenching of current fluctuations in a self-exciting homopolar dynamo, proved by feedback system theory

Directory of Open Access Journals (Sweden)

A. M. de Paor

1998-01-01

Full Text Available Hide (Nonlinear Processes in Geophysics, 1998 has produced a new mathematical model of a self-exciting homopolar dynamo driving a series- wound motor, as a continuing contribution to the theory of the geomagnetic field. By a process of exact perturbation analysis, followed by combination and partial solution of differential equations, the complete nonlinear quenching of current fluctuations reported by Hide in the case that a parameter ε has the value 1 is proved via the Popov theorem from feedback system stability theory.

[Challenges for home care services in the pain management of cancer patients : A qualitative study].

Science.gov (United States)

Gnass, I; Krutter, S; Nestler, N

2018-03-21

People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation. By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted. On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment. Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

Caring for family caregivers: An analysis of a family-centered intervention

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Carme Ferré-Grau

2014-08-01

Full Text Available Objective To assess the effectiveness of Problem-Solving Therapy (PST on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.

The development of English primary care group governance. A scenario analysis.

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Sheaff, R

1999-01-01

At present there is a policy vacuum about what English Primary Care Groups' (PCGs) governance will be when they develop into Primary Care Trusts (PCTs). Draft legislation leaves many options open, so PCT governance is likely to 'emerge' as PCTs are created. It also remains uncertain how general practitioners (GPs) will react to the formation of PCTs and how the UK government will then respond in turn. A scenario analysis suggests three possible lines of development. The base (likeliest) scenario predicts a mainly networked form of PCT governance. An alternative scenario is of PCT governance resembling the former National Health Service internal market. A third scenario predicts 'franchise model' PCTs employing some GPs and subcontracting others. To different degrees all three scenarios predict that PCTs will retain elements of networked governance. If it fails to make GPs as accountable to NHS management as the UK government wishes, networked governance may prove only a transitional stage before English PCTs adopt either quasi-market or hierarchical governance.

The Fit Family Challenge: A Primary Care Childhood Obesity Pilot Intervention.

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Jortberg, Bonnie T; Rosen, Raquel; Roth, Sarah; Casias, Luke; Dickinson, L Miriam; Coombs, Letoynia; Awadallah, Nida S; Bernardy, Meaghann K; Dickinson, W Perry

2016-01-01

Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention. A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum. A total of 29 family medicine and pediatric community practices in Colorado participated. Participants included 290 patients, aged 6 to 12 years, with a body mass index (BMI) above the 85th percentile. The main outcome measure included the feasibility of implementation of a childhood obesity program in primary care; secondary outcomes were changes in BMI percentile, BMI z-scores, blood pressure, and changes in lifestyle factors related to childhood obesity. Implementation of FFC is feasible, statically significant changes were seen for decreases in BMI percentile and BMI z-scores for participants who completed 9 to 15 months of follow-up; lifestyle factors related to childhood obesity in proved Spanish-speaking families and food insecurity were associated with less follow-up time (P childhood obesity intervention may result in significant clinical and lifestyle changes. © Copyright 2016 by the American Board of Family Medicine.

Affective reactivity differences in pregnant and postpartum women.

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Rosebrock, Laina; Hoxha, Denada; Gollan, Jackie

2015-06-30

Reactions to emotional cues, termed affective reactivity, promote adaptation and survival. Shifts in affective reactivity during pregnancy and postpartum may invoke altered responses to environmental and biological changes. The development and testing of affective reactivity tasks, with published normative ratings for use in studies of affective reactivity, has been based on responses provided by healthy college students. A comparison of the healthy norms with ratings provided by peripartum women has yet to be conducted, despite its value in highlighting critical differences in affective reactivity during peripartum phases. This study compared arousal ratings of unpleasant, neutral, pleasant, and threat stimuli from the International Affective Picture System (IAPS; Lang, P.J., Bradley, M.M., Cuthbert, B.N. 2008. International Affective Picture System (IAPS): Affective Ratings of Pictures and Instruction Manual (Technical Report A-8). University of Florida, Gainseville, FL.) between three samples: (a) women measured during pregnancy and again at postpartum, (b) age-matched nonpregnant women, and (c) college-aged women from the normative sample used to test the stimuli. Using mixed-design GLMs, results showed that the pregnant and postpartum women and the age-matched women showed suppressed arousal relative to the college-age women. Additionally, postpartum women showed increased arousal to unpleasant/threat images compared to other types of images. The data suggest that future research on peripartum women should include affective reactivity tasks based on norms reflective of this specific population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Some prehistory of New Zealand intensive care medicine.

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Trubuhovich, R V

2009-07-01

In taking 1960 as the foundation year for the practice of intensive care medicine in New Zealand, this paper briefly looks into the previous two centuries for some interventions in life-threatening conditions. With the help of descriptions in early 19th century journals and books by perceptive observers, the author focuses on some beliefs and practices of the Maori people during pre-European and later times, as well as aspects of medical treatment in New Zealand for early settlers and their descendents. Dr Laurie Gluckman's book Tangiwai has proved a valuable resource for New Zealand's medical history prior to 1860, while the recent publication of his findings from the examination of coroners' records for Auckland, 1841 to 1864, has been helpful. Drowning is highlighted as a common cause of accidental death, and consideration is given to alcohol as a factor. Following the 1893 foundation of the New Zealand Medical Journal, a limited number of its papers which are historically relevant to today's intensive care are explored: topics include tetanus, laryngeal diphtheria, direct cardiac massage, traumatic shock, thiopentone management for fitting and the ventilatory failure due to poliomyelitis.

Neutrophil-surface antigens CD11b and CD64 expression: a ...

African Journals Online (AJOL)

Ehab

chorioamnionitis5, or peripartum maternal fever6. Early detection of ... retrospectively, in two groups: sepsis and no infection, on basis of clinical observation over ..... expression in the diagnosis of late-onset nosocomial infection in the very low ...

Management of Labour and Delivery in a Patient With Acquired Factor VII Deficiency With Inhibitor: A Case Report.

Science.gov (United States)

Matei, Anca; Dolan, Sean; Andrews, James; Rivard, Georges-Étienne

2016-02-01

Acquired factor VII (FVII) deficiency with inhibitor increases the risk of hemorrhage during pregnancy. However, there are no published reports guiding its management in the peripartum period. A 24-year-old woman with inhibitory antibodies to FVII delivered at 34 weeks of gestation. The patient was administered recombinant factor VIIa (rFVIIa) and tranexamic acid. There were no bleeding-related complications; however, the FVII level was supratherapeutic. The patient returned during a second pregnancy. A reduced dose of rFVIIa was administered. The delivery was complicated by postpartum hemorrhage, which resolved with the addition of uterotonic agents. Recombinant FVIIa and tranexamic acid offer an effective peripartum treatment in women with inhibitory antibody to FVII. Further research should delineate the optimal time of administration. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Preconception Care and Prenatal Care

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... Twitter Pinterest Email Print About Preconception Care and Prenatal Care What is preconception care? Preconception care is the ... improve the health of your child. What is prenatal care? Prenatal care is the health care a woman ...

Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis

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Abdullah Şimşek

Full Text Available ABSTRACT Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both. Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%. Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%. Smear microscopy of BAL fluid (BALF was performed in 16 patients and was positive for AFB in 10 (62.5%. Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%. Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%; bronchial brushing, in 7 (38.8%; fine-needle aspiration biopsy, in 2 (11.1%; and BAL, in 2 (11.1%. Bronchial anthracofibrosis was observed in 5 (27.7% of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.

Contamination source review for Building E2370, Edgewood Area, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

O`Reilly, D.P.; Glennon, M.A.; Draugelis, A.K.; Rueda, J.; Zimmerman, R.E.

1995-09-01

The US Army Aberdeen Proving Ground (APG) commissioned Argonne National Laboratory (ANL) to conduct a contamination source review to identify and define areas of toxic or hazardous contaminants and to assess the physical condition and accessibility of APG buildings. The information obtained from this review may be used to assist the US Army in planning for the future use or disposition of the buildings. The contamination source review consisted of the following tasks: historical records search, physical inspection, photographic documentation, and geophysical investigation. This report provides the results of the contamination source review for Building E2370. Many of the APG facilities constructed between 1917 and the 1960s are no longer used because of obsolescence and their poor state of repair. Because many of these buildings were used for research, development, testing, and/or pilot-scale production of chemical warfare agents and other military substances, the potential exists for portions of the buildings to be contaminated with these substances, their degradation products, and other laboratory or industrial chemicals. These buildings and associated structures or appurtenances may contribute to environmental concerns at APG.

Advancing the business creed? The framing of decisions about public sector managed care.

Science.gov (United States)

Waitzkin, Howard; Yager, Joel; Santos, Richard

2012-01-01

Relatively little research has clarified how executives of for-profit healthcare organisations frame their own motivations and behaviour, or how government officials frame their interactions with executives. Because managed care has provided an organisational structure for health services in many countries, we focused our study on executives and government officials who were administering public sector managed care services. Emphasising theoretically the economic versus non-economic motivations that guide economic behaviour, we extended a long-term research project on public sector Medicaid managed care (MMC) in the United States. Our method involved in-depth, structured interviews with chief executive officers of managed care organisations, as well as high-ranking officials of state government. Data analysis involved iterative interpretation of interview data. We found that the rate of profit, which proved relatively low in the MMC programme, occupied a limited place in executives' self-described motivations and in state officials' descriptions of corporation-government interactions. Non-economic motivations included a strong orientation toward corporate social responsibility and a creed in which market processes advanced human wellbeing. Such patterns contradict some of the given wisdom about how corporate executives and government officials construct their reality. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

A successful chronic care program in Al Ain-United Arab Emirates

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Al Husaini Alhusini I

2010-02-01

pressure and lipid profiles. Indicators related to lifestyle changes, such as smoking cessation and BMI, failed to improve. Conclusion Chronic disease care is a joint commitment by health care providers and patients. This combined approach proved successful in most areas of the project, but the area of patient self management requires further improvement.

A successful chronic care program in Al Ain-United Arab Emirates.

Science.gov (United States)

Baynouna, Latifa M; Shamsan, Amal I; Ali, Tahira A; Al Mukini, Lolowa A; Al Kuwiti, Moza H; Al Ameri, Thuraya A; Nagelkerke, Nico J D; Abusamak, Ahmad M; Ahmed, Nader M; Al Deen, Sanaa M Zein; Jaber, Tariq M; Elkhalid, Abdulkarim M; Revel, Anthony D; Al Husaini, Alhusini I; Nour, Fouad A; Ahmad, Hayat O; Nazirudeen, Mohammad K; Al Dhahiri, Rowaya; Al Abdeen, Yahya O Zain; Omar, Aziza O

2010-02-22

, such as smoking cessation and BMI, failed to improve. Chronic disease care is a joint commitment by health care providers and patients. This combined approach proved successful in most areas of the project, but the area of patient self management requires further improvement.

Patient satisfaction with HIV/AIDS care at private clinics in Dar es Salaam, Tanzania.

Science.gov (United States)

Miller, James S; Mhalu, Aisa; Chalamilla, Guerino; Siril, Hellen; Kaaya, Silvia; Tito, Justina; Aris, Eric; Hirschhorn, Lisa R

2014-01-01

Health system responsiveness (HSR) measures quality of care from the patient's perspective, an important component of ensuring adherence to medication and care among HIV patients. We examined HSR in private clinics serving HIV patients in Dar es Salaam, Tanzania. We surveyed 640 patients, 18 or older receiving care at one of 10 participating clinics, examining socioeconomic factors, HIV regimen, and self-reported experience with access and care at the clinic. Ordered logistic regression, adjusted for clustering of the clinic sites, was used to measure the relationships between age, gender, education, site size, and overall quality of care rating, as well as between the different HSR domains and overall rating. Overall, patients reported high levels of satisfaction with care received. Confidentiality, communication, and respect were particularly highly rated, while timeliness received lower ratings despite relatively short wait times, perhaps indicating high expectations when receiving care at a private clinic. Respect, confidentiality, and promptness were significantly associated with overall rating of health care, while provider skills and communication were not significantly associated. Patients reported that quality of service and confidentiality, rather than convenience of location, were the most important factors in their choice of a clinic. Site size (patient volume) was also positively correlated with patient satisfaction. Our findings suggest that, in the setting of urban private-sector clinics, flexible clinics hours, prompt services, and efforts to improve respect, privacy and confidentiality may prove more helpful in increasing visit adherence than geographic accessibility. While a responsive health system is valuable in its own right, more work is needed to confirm that improvements in HSR in fact lead to improved adherence to care.

Environmental geophysics at the Southern Bush River Peninsula, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Davies, B.E.; Miller, S.F.; McGinnis, L.D. [and others

1995-05-01

Geophysical studies have been conducted at five sites in the southern Bush River Peninsula in the Edgewood Area of Aberdeen Proving Ground, Maryland. The goals of the studies were to identify areas containing buried metallic objects and to provide diagnostic signatures of the hydrogeologic framework of the site. These studies indicate that, during the Pleistocene Epoch, alternating stands of high and low sea level resulted in a complex pattern of channel-fill deposits. Paleochannels of various sizes and orientations have been mapped throughout the study area by means of ground-penetrating radar and EM-31 techniques. The EM-31 paleochannel signatures are represented onshore either by conductivity highs or lows, depending on the depths and facies of the fill sequences. A companion study shows the features as conductivity highs where they extend offshore. This erosional and depositional system is environmentally significant because of the role it plays in the shallow groundwater flow regime beneath the site. Magnetic and electromagnetic anomalies outline surficial and buried debris throughout the areas surveyed. On the basis of geophysical measurements, large-scale (i.e., tens of feet) landfilling has not been found in the southern Bush River Peninsula, though smaller-scale dumping of metallic debris and/or munitions cannot be ruled out.

Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions.

Science.gov (United States)

Field, Scott S

2016-02-01

Type 1 herpes simplex virus (HSV-1) is very prevalent yet in rare circumstances can lead to fatal neonatal disease. Genital acquisition of type 2 HSV is the usual mode for neonatal herpes, but HSV-1 transmission by genital or extragenital means may result in greater mortality rates. A very rare scenario is presented in which the mode of transmission was likely through breast lesions. The lesions were seen by nurses as well as the lactation consultant and obstetrician in the hospital after delivery of the affected baby but not recognized as possibly being caused by herpes. The baby died 9 days after birth with hepatic failure and disseminated intravascular coagulation. Peripartum health care workers need to be aware of potential nongenital (including from the breast[s]) neonatal herpes acquisition, which can be lethal. © The Author(s) 2015.

[The interaction in clinical nursing education: reflections on care of the person with hypertension].

Science.gov (United States)

Araújo-Girão, Ana L; Martins de Oliveira, Glória Y; Gomes, Emiliana B; Parente-Arruda, Lidyane; Aires de Freitas, Consuelo H

2015-01-01

To identify the knowledge and attitudes about self-care in health among users who received clinical nursing education for hypertension based on the level of knowledge and attitudes of the hypertensive patient through interactive care interventions with patients and relatives in the therapeutic context, with the goal of developing health education. This study represents action research with a qualitative approach on hypertensive patients hospitalized for stroke. Hypertension as a risk factor is most strongly associated with the development of this health problem. Participants were interviewed about their knowledge about the illness before and after the realization of individualized health education activities on the basis of the theory of symbolic interactionism. It was found that the respondents, after participating in the educational process, demonstrated a broader knowledge of hypertension, which motivated them to seek changes in habits that could improve their quality of life. Through the use of symbolic interactionism, health education proved to be a strategy for empowerment and autonomy of the hypertensive subject with respect to their treatment and can be integrated into nursing care.

Health and Socio-Economic Status: Factors impacting care and treatment in ovarian cancer patients

DEFF Research Database (Denmark)

Seibæk, L.; Petersen, L. K.; Blaakaer, J.

2011-01-01

To provide knowledge about health status, socio-economic status and use of public health care in women undergoing ovarian cancer surgery, in order to improve their care during the perioperative period. Method: An epidemiological methodology was applied. The material consisted of data from...... the Registry of Health and Social Conditions and the Danish Gynaecological Cancer Database on women diagnosed in 2007; this material underwent descriptive statistical analysis. Results: Data from 666 women were suitable for analysis. The majority were older, with moderate to severe systemic illness...... and a tendency to be overweight. Many had a low educational level, were retired, and lived alone with few financial resources. The quality of the surgical treatment had improved in terms of centralisation and staging procedures. Conclusions: As a group the women proved to be in a vulnerable position in terms...

Two decades of external peer review of cancer care in general hospitals; the Dutch experience.

Science.gov (United States)

Kilsdonk, Melvin J; Siesling, Sabine; Otter, Rene; van Harten, Wim H

2016-03-01

External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

The metabolic score: A decision making tool in diabetes care.

Science.gov (United States)

Kalra, Sanjay; Gupta, Yashdeep

2015-11-01

The heterogeneity of diabetes mellitus, and the various metabolic abnormalities associated with it, are well known. Current management guidelines used to help choose glucose-lowering drugs in diabetes mellitus describe various drug classes in detail, but do not take the overall metabolic profile into consideration. To help physicians choose appropriate oral therapy, we propose a discrete metabolic score, based upon the presence and absence of metabolic comorbidities included in the definition of metabolic syndrome. This communication describes how to choose an appropriate oral antidiabetic drug using such a score. The metabolic score based decision making aid should be able to prove its utility in all health care settings, especially resource constrained societies.

Il Servizio Nazionale di Valutazione e le prove Invalsi. Stato dell’arte e proposte per una valutazione come agente di cambiamento

Directory of Open Access Journals (Sweden)

Roberto Trinchero

2014-12-01

Full Text Available Qual è la funzione del Servizio Nazionale di Valutazione formativa degli istituti scolastici? A cosa servono davvero le prove Invalsi? Le critiche che spesso vengono mosse a queste prove sono veramente fondate? Come può la valutazione dell’offerta formativa scolastica costituire davvero un agente di miglioramento? Il presente articolo intende fornire alcune risposte a queste domande, partendo dalle istanze che hanno ispirato l’autonomia scolastica e offrendo spunti per un utilizzo non fazioso della valutazione. La valutazione può essere davvero agente di cambiamento a patto che: i sia attribuito ai dati il corretto significato; ii la scuola sia in grado di comprendere i potenziali suggerimenti che la valutazione può dare e si apra al cambiamento positivo. La valutazione applicata ad una “scuola che si difende” non può che provocare inutili esiti di facciata. La valutazione applicata ad una “scuola che apprende” può davvero aiutarla ad esplicare appieno tutte le proprie potenzialità.

Primary care units in Emilia-Romagna, Italy: an assessment of organizational culture.

Science.gov (United States)

Pracilio, Valerie P; Keith, Scott W; McAna, John; Rossi, Giuseppina; Brianti, Ettore; Fabi, Massimo; Maio, Vittorio

2014-01-01

This study investigates the organizational culture and associated characteristics of the newly established primary care units (PCUs)-collaborative teams of general practitioners (GPs) who provide patients with integrated health care services-in the Emilia-Romagna Region (RER), Italy. A survey instrument covering 6 cultural dimensions was administered to all 301 GPs in 21 PCUs in the Local Health Authority (LHA) of Parma, RER; the response rate was 79.1%. Management style, organizational trust, and collegiality proved to be more important aspects of PCU organizational culture than information sharing, quality, and cohesiveness. Cultural dimension scores were positively associated with certain characteristics of the PCUs including larger PCU size and greater proportion of older GPs. The presence of female GPs in the PCUs had a negative impact on collegiality, organizational trust, and quality. Feedback collected through this assessment will be useful to the RER and LHAs for evaluating and guiding improvements in the PCUs. © 2013 by the American College of Medical Quality.

[Use of music in palliative care].

Science.gov (United States)

Skrbina, Dijana; Simunović, Dubravka; Santek, Vjerocka; Njegovan-Zvonarević, Tatjana

2011-12-01

Man is mortal, which means that as the earthly body perishes being, final. Disease and death will always be an inevitable and integral part of human experience. The way in which we try to identify and respond to the unique and individual needs of the dying is an indication of our maturity as a society. The number of people requiring palliative care is growing. Palliative care does not intend to either accelerate or postpone death she emphasizes the life and looks at dying as a normal process. It is an active form of care for patients with advanced, progressive illness, with the aim of suppressing pain and other symptoms in addition to providing psychological, social and spiritual support which ensures the best possible quality of life for patients and their families. Therefore requires a coordinated and interdisciplinary contribution team. The variety of professions in a team, and determine the needs of patients should be ready to provide physical, psychological, social and spiritual support using methods that result from an interdisciplinary, collaborative team approach. Development of a holistic approach and awareness in the medical and allied professions has led to a renewal of interest in the inclusion of music and other expressive media in contemporary concepts of palliative care, which are consistent with problem areas, clinical manifestations and the needs of patients. Music offers a direct and uncomplicated medium of intimacy, living in a man who listens to her, has a place where words lose their power. Music is like our existence, constantly polarizing and emotionally stimulating, as it touches the medium of the earliest layers of our becoming. The use of music in palliative care has proved very effective for a variety of effects that music creates in patients. These effects are achieved through the use of various musical techniques, such as musical improvisation, songwriting, receiving creative techniques, guided by imagination and music. These techniques

The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices.

Science.gov (United States)

Szasz, A

1990-01-01

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.

Diseases causing acute renal failure in a tertiary care hospital

International Nuclear Information System (INIS)

Khan, G.; Hussain, K.; Rehman, A.

2011-01-01

Objective: This study was done to evaluate frequency of acute renal failure ( ARF ), its causes and out come of the patients. Study Design: Descriptive analytic study Place and Duration of Study: March to Dec 2007 at Combined Military Hospital Lahore. Patients and Methods: All patients, admitted in different wards of the hospital, who developed acute renal failure (doubling of serum creatinine measured on two occasions 12 hours apart), were included in this study. Results: A total of 39 patients were included in the study. Males were 19 (48.71%) and 20 (51.28%) were female. Mean age of patients was 40.2 years (SD=18.0). The major cause was acute Gastroenteritis seen in 23 (58.97%) cases. Others developed ARF due to, Abruptio Placentae 5 (12.82%), Postoperative 5 (12.82%), Eclampsia 3 (7.69%) and Drug induced 3 (7.69%) . Oliguric phase developed in 28 (71.79%) patients and lasted for 8.45 +- 4.16 days. Of these 17 (60.71%) patients had acute gastroenteritis. Conclusion: Gastroenteritis is the most common and important cause of ARF though gynaecological and surgical etiologies must be kept in mind. It is evident that the gynaecological and surgical patients need critical peri-partum and peri-operative monitoring to prevent development of ARF. Early institution of therapy will prevent subsequent morbidity associated with this disease. (author)

Potential health impacts from range fires at Aberdeen Proving Ground, Maryland

International Nuclear Information System (INIS)

Willians, G.P.; Hermes, A.M.; Policastro, A.J.; Hartmann, H.M.; Tomasko, D.

1998-03-01

This study uses atmospheric dispersion computer models to evaluate the potential for human health impacts from exposure to contaminants that could be dispersed by fires on the testing ranges at Aberdeen Proving Ground, Maryland. It was designed as a screening study and does not estimate actual human health risks. Considered are five contaminants possibly present in the soil and vegetation from past human activities at APG--lead, arsenic, trichloroethylene (TCE), depleted uranium (DU), and dichlorodiphenyltrichloroethane (DDT); and two chemical warfare agents that could be released from unexploded ordnance rounds heated in a range fire--mustard and phosgene. For comparison, dispersion of two naturally occurring compounds that could be released by burning of uncontaminated vegetation--vinyl acetate and 2-furaldehyde--is also examined. Data from previous studies on soil contamination at APG are used in conjunction with conservative estimates about plant uptake of contaminants, atmospheric conditions, and size and frequency of range fires at APG to estimate dispersion and possible human exposure. The results are compared with US Environmental Protection Agency action levels. The comparisons indicate that for all of the anthropogenic contaminants except arsenic and mustard, exposure levels would be at least an order of magnitude lower than the corresponding action levels. Because of the compoundingly conservative nature of the assumptions made, they conclude that the potential for significant human health risks from range fires is low. The authors recommend that future efforts be directed at fire management and control, rather than at conducting additional studies to more accurately estimate actual human health risk from range fires

Potential health impacts from range fires at Aberdeen Proving Ground, Maryland.

Energy Technology Data Exchange (ETDEWEB)

Willians, G.P.; Hermes, A.M.; Policastro, A.J.; Hartmann, H.M.; Tomasko, D.

1998-03-01

This study uses atmospheric dispersion computer models to evaluate the potential for human health impacts from exposure to contaminants that could be dispersed by fires on the testing ranges at Aberdeen Proving Ground, Maryland. It was designed as a screening study and does not estimate actual human health risks. Considered are five contaminants possibly present in the soil and vegetation from past human activities at APG--lead, arsenic, trichloroethylene (TCE), depleted uranium (DU), and dichlorodiphenyltrichloroethane (DDT); and two chemical warfare agents that could be released from unexploded ordnance rounds heated in a range fire--mustard and phosgene. For comparison, dispersion of two naturally occurring compounds that could be released by burning of uncontaminated vegetation--vinyl acetate and 2-furaldehyde--is also examined. Data from previous studies on soil contamination at APG are used in conjunction with conservative estimates about plant uptake of contaminants, atmospheric conditions, and size and frequency of range fires at APG to estimate dispersion and possible human exposure. The results are compared with US Environmental Protection Agency action levels. The comparisons indicate that for all of the anthropogenic contaminants except arsenic and mustard, exposure levels would be at least an order of magnitude lower than the corresponding action levels. Because of the compoundingly conservative nature of the assumptions made, they conclude that the potential for significant human health risks from range fires is low. The authors recommend that future efforts be directed at fire management and control, rather than at conducting additional studies to more accurately estimate actual human health risk from range fires.

Bathe the baby to make it strong and healthy: plant use and child care among Saramaccan Maroons in Suriname.

Science.gov (United States)

Ruysschaert, Sofie; van Andel, Tinde; Van de Putte, Kobeke; Van Damme, Patrick

2009-01-12

Young children are vulnerable to a range of illnesses and evil forces. Ethnobotanical folk remedies often play a major role in combating these afflictions. Here we show that plant use is highly valued and practiced within the Saramaccan Maroon Society in Suriname to maintain the general health and well-being of children. To assess the plant use importance in child care, we (1) quantified diversity and current status of herbal pharmacopoeia used in child care and (2) elucidated the reasons why care takers (mostly mothers) use these plants. We collected botanical vouchers of plants used in child care, carried out an ethnobotanical household survey with 105 women and interviewed 19 key informants. A total of 178 plant species were used in child care for different purposes. Preventive practices were preferred over curing remedies and plants were most frequently used to keep young children strong and healthy. Child care had a strong magical connotation. Bathing proved to be the most important type of application, often combined with drinking small amounts of the bath water. Plants play an important role in child care, but more research is needed on how Maroon plant use reflects actual health problems in young children in the Surinamese interior.

Patient Autonomy in a High-Tech Care Context - A Theoretical Framework.

Science.gov (United States)

Lindberg, Catharina; Fagerström, Cecilia; Willman, Ania

2018-06-12

To synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high-tech care context. Putting the somewhat abstract concept of patient autonomy into practice can prove difficult since when it is highlighted in healthcare literature the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could therefore be considered paradoxical, as in most cases these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important. Theory development. The basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group. A theoretical framework - the control-partnership-transition framework - was delineated disclosing different parts co-creating the prerequisites for patient autonomy in high-tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients were revealed: the strategy of control, the strategy of partnership, the strategy of trust, and the strategy of transition. An extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high-tech care environments. The control-partnership-transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high-tech care contexts. The

FLIPPED CLASSROOM LEARNING METHOD TO IMPROVE CARING AND LEARNING OUTCOME IN FIRST YEAR NURSING STUDENT

Directory of Open Access Journals (Sweden)

Ni Putu Wulan Purnama Sari

2017-08-01

Full Text Available Background and Purpose: Caring is the essence of nursing profession. Stimulation of caring attitude should start early. Effective teaching methods needed to foster caring attitude and improve learning achievement. This study aimed to explain the effect of applying flipped classroom learning method for improving caring attitude and learning achievement of new student nurses at nursing institutions in Surabaya. Method: This is a pre-experimental study using the one group pretest posttest and posttest only design. Population was all new student nurses on nursing institutions in Surabaya. Inclusion criteria: female, 18-21 years old, majoring in nursing on their own volition and being first choice during students selection process, status were active in the even semester of 2015/2016 academic year. Sample size was 67 selected by total sampling. Variables: 1 independent: application of flipped classroom learning method; 2 dependent: caring attitude, learning achievement. Instruments: teaching plan, assignment descriptions, presence list, assignment assessment rubrics, study materials, questionnaires of caring attitude. Data analysis: paired and one sample t test. Ethical clearance was available. Results: Most respondents were 20 years old (44.8%, graduated from high school in Surabaya (38.8%, living with parents (68.7% in their homes (64.2%. All data were normally distributed. Flipped classroom learning method could improve caring attitude by 4.13%. Flipped classroom learning method was proved to be effective for improving caring attitude (p=0.021 and learning achievement (p=0.000. Conclusion and Recommendation: Flipped classroom was effective for improving caring attitude and learning achievement of new student nurse. It is recommended to use mix-method and larger sample for further study.

Taking care of Care

NARCIS (Netherlands)

Evelien Eggink; Debbie Oudijk; Isolde Woittiez

2010-01-01

Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

Contamination source review for Building E3236, Edgewood Area, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Zellmer, S.D.; Smits, M.P.; Draugelis, A.K.; Glennon, M.A.; Rueda, J.; Zimmerman, R.E.

1995-09-01

The US Army Aberdeen Proving Ground (APG) commissioned Argonne National Laboratory (ANL) to conduct a contamination source review to identify and define areas of toxic or hazardous contaminants and to assess the physical condition and accessibility of APG buildings. The information obtained from the review may be used to assist the US Army in planning for the future use or disposition of the buildings. The contamination source review consisted of the following tasks: historical records search, physical inspection, photographic documentation, geophysical investigation, and review of available records regarding underground storage tanks associated with each building. This report provides the results of the contamination source review for Building E3236. Many of the APG facilities constructed between 1917 and the 1960s are no longer used because of obsolescence and their poor state of repair. Because many of these buildings were used for research, development, testing, and/or pilot- scale production of chemical warfare agents and other military substances, the potential exists for portions of the buildings to be contaminated with these substances, their degradation products, and other laboratory or industrial chemicals. These buildings and associated structures or appurtenances may contribute to environmental concerns at APG.

Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease.

Science.gov (United States)

Sato, J; Ishii, Y; Noguchi, H

2016-02-01

We investigated the demographic characteristics of patients who were diagnosed with intersection syndrome and also investigated the dominance of the affected hand, duration of symptoms and any precipitating factor for pain of the wrist. These features were compared with patients who had de Quervain's disease. Ultrasonography was used to confirm the clinical diagnosis. Intersection syndrome occurred more frequently in men and in the dominant hand than de Quervain's disease when all the patients were compared and when peripartum women were excluded. It occurred at a younger age than de Quervain's disease only when the comparison excluded peripartum women. Patients with intersection syndrome presented with a much shorter duration of symptoms. These results were consistent with previous reports about occupational factors in intersection syndrome, and might be helpful in the understanding of epidemiological difference between the two conditions. Level 3. © The Author(s) 2015.

Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI).

Science.gov (United States)

Vasan, Ashwin; Ellner, Andrew; Lawn, Stephen D; Gove, Sandy; Anatole, Manzi; Gupta, Neil; Drobac, Peter; Nicholson, Tom; Seung, Kwonjune; Mabey, David C; Farmer, Paul E

2014-01-14

More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of 'health for all', high-quality primary care services remain undelivered to the great majority of the world's poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization's Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in

Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

Science.gov (United States)

Edlynn, Emily S; Derrington, Sabrina; Morgan, Helene; Murray, Jennifer; Ornelas, Beatriz; Cucchiaro, Giovanni

2013-04-01

We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

Physician organization-practice team integration for the advancement of patient-centered care.

Science.gov (United States)

Wise, Christopher G; Alexander, Jeffrey A; Green, Lee A; Cohen, Genna R

2012-01-01

The patient-centered medical home is being promoted as a cornerstone for transforming primary care. Physician organizations (POs) are playing a more prominent role by facilitating practices' transformation to the patient-centered medical home. Using a framework of organizational integration, we investigated the changing relationship between POs and practices through qualitative interviews. Through increased integration, POs can support both the big picture and day-to-day activities of practice transformation. Most PO-practice unit connections we identified reflected new areas of engagement-competencies that POs were not developing in the past-that are proving integral to the broad-scale practice change of patient-centered medical home implementation.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada.

Science.gov (United States)

Romain, Sandra J

2013-01-01

Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requiring that all public and private sector essential services offer verbal and written communication in Inuit languages (Inuktitut and Inuinnaqtun) by 2012. While the legislation mandates compliance, policy implementation for pharmaceutical services is problematic. Not a single pharmacist in Nunavut is fluent in either of the Inuit languages. Pharmacists have indicated challenges in formally translating written documentation into Inuit languages based on concerns for patient safety. These challenges of negotiating the joint requirements of language legislation and patient safety have resulted in pharmacies using verbal on-site translation as a tenuous solution regardless of its many limitations. The complex issues of pharmaceutical health care and communication among the Inuit of Nunavut are best examined through multimethod research to encompass a wide range of perspectives. This methodology combines the richness of ethnographic data, the targeted depth of interviews with key informants and the breadth of cross-Canada policy and financial analyses. The analysis of this information would provide valuable insights into the current relationships between health care providers, pharmacists and Inuit patients and suggest future directions for policy that will improve the efficacy of pharmaceuticals and health care spending for the Inuit in Canada.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada

Directory of Open Access Journals (Sweden)

Sandra J. Romain

2013-08-01

Full Text Available Background. Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requiring that all public and private sector essential services offer verbal and written communication in Inuit languages (Inuktitut and Inuinnaqtun by 2012. Methods. While the legislation mandates compliance, policy implementation for pharmaceutical services is problematic. Not a single pharmacist in Nunavut is fluent in either of the Inuit languages. Pharmacists have indicated challenges in formally translating written documentation into Inuit languages based on concerns for patient safety. These challenges of negotiating the joint requirements of language legislation and patient safety have resulted in pharmacies using verbal on-site translation as a tenuous solution regardless of its many limitations. Results. The complex issues of pharmaceutical health care and communication among the Inuit of Nunavut are best examined through multimethod research to encompass a wide range of perspectives. This methodology combines the richness of ethnographic data, the targeted depth of interviews with key informants and the breadth of cross-Canada policy and financial analyses. Conclusions. The analysis of this information would provide valuable insights into the current relationships between health care providers, pharmacists and Inuit patients and suggest future directions for policy that will improve the efficacy of pharmaceuticals and health care spending for the Inuit in Canada.

[Secure e-mail between physicians--aspect of a telemedicine platform for the health care system].

Science.gov (United States)

Goetz, C F

2001-10-01

Ever since the Roland-Berger-Study in 1997, the concept of a "telematics platform" for health care describes the combination of all technical and organizational components and services for the online transmission of patient data. This platform works on an interoperable collection of standards for addressing, security and content-description. In this context the security for application and transport data is based on data protection as well as medical non-disclosure rules. The methods of cryptography can provide security services for data transmitted realizing addressed, direct and indirect privacy. The first German health professional card, the electronic physicians' ID, provides central tools for such applications. First functionally simple pilot projects will prove the effectiveness of chosen methods in this year, even if not all identified construction sites in health care telematics have yet been lead towards a finalized solution.

Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses

Directory of Open Access Journals (Sweden)

Amy B. Martin

2012-09-01

Full Text Available Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

Parental perspectives regarding primary-care weight-management strategies for school-age children.

Science.gov (United States)

Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn

2016-04-01

To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (body mass index ≥ 85th percentile) 6-12-year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies and feasibility of specific dietary strategies. Focus groups were recorded, transcribed and analysed using margin coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American and 23%, white. Parents' recommendations on the primary-care provider's role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up and using discretion during weight discussions. Weight-management components identified as key included emphasising healthy lifestyles and enjoyment, small changes to routines and parental role modelling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasising servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement and deemphasising specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximise parental acceptance. © 2014 John Wiley & Sons Ltd.

Headache service quality: evaluation of quality indicators in 14 specialist-care centres.

Science.gov (United States)

Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil; Jensen, Rigmor; Siva, Aksel; Uygunoglu, Ugur; Gvantsa, Giorgadze; Mania, Maka; Braschinsky, Mark; Filatova, Elena; Latysheva, Nina; Osipova, Vera; Skorobogatykh, Kirill; Azimova, Julia; Straube, Andreas; Eren, Ozan Emre; Martelletti, Paolo; De Angelis, Valerio; Negro, Andrea; Linde, Mattias; Hagen, Knut; Radojicic, Aleksandra; Zidverc-Trajkovic, Jasna; Podgorac, Ana; Paemeleire, Koen; De Pue, Annelien; Lampl, Christian; Steiner, Timothy J; Katsarava, Zaza

2016-12-01

The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

Depleted uranium human health risk assessment, Jefferson Proving Ground, Indiana

International Nuclear Information System (INIS)

Ebinger, M.H.; Hansen, W.R.

1994-01-01

The risk to human health from fragments of depleted uranium (DU) at Jefferson Proving Ground (JPG) was estimated using two types of ecosystem pathway models. A steady-state, model of the JPG area was developed to examine the effects of DU in soils, water, and vegetation on deer that were hunted and consumed by humans. The RESRAD code was also used to estimate the effects of farming the impact area and consuming the products derived from the farm. The steady-state model showed that minimal doses to humans are expected from consumption of deer that inhabit the impact area. Median values for doses to humans range from about 1 mrem (±2.4) to 0.04 mrem (±0.13) and translate to less than 1 x 10 -6 detriments (excess cancers) in the population. Monte Carlo simulation of the steady-state model was used to derive the probability distributions from which the median values were drawn. Sensitivity analyses of the steady-state model showed that the amount of DU in airborne dust and, therefore, the amount of DU on the vegetation surface, controlled the amount of DU ingested by deer and by humans. Human doses from the RESRAD estimates ranged from less than 1 mrem/y to about 6.5 mrem/y in a hunting scenario and subsistence fanning scenario, respectively. The human doses exceeded the 100 mrem/y dose limit when drinking water for the farming scenario was obtained from the on-site aquifer that was presumably contaminated with DU. The two farming scenarios were unrealistic land uses because the additional risk to humans due to unexploded ordnance in the impact area was not figured into the risk estimate. The doses estimated with RESRAD translated to less than 1 x 10 -6 detriments to about 1 x 10 -3 detriments. The higher risks were associated only with the farming scenario in which drinking water was obtained on-site

Caring Science or Science of Caring.

Science.gov (United States)

Turkel, Marian C; Watson, Jean; Giovannoni, Joseph

2018-01-01

The concepts caring science and science of caring have different meanings; however, they are often used interchangeably. The purpose of this paper is to present an overview of the synthesis of the scholarly literature on the definitions of the science of caring and caring science and to affirm the authors' perspective relating to the language of caring science. Caring science advances the epistemology and ontology of caring. Ideas related to caring science inquiry are presented, and the authors acknowledge the future of caring science as unitary caring science.

Mind the (knowledge) gap: the effect of a communication instrument on emergency department patients' comprehension of and satisfaction with care.

Science.gov (United States)

Simmons, Stefanie; Sharp, Brian; Fowler, Jennifer; Fowkes, Hope; Paz-Arabo, Patricia; Dilt-Skaggs, Mary Kate; Singal, Bonita; Carter, Thomas

2015-02-01

We developed a communication instrument to be used in the Emergency Department (ED) and hypothesized that use of this guide would increase patient comprehension of and satisfaction with care. This multi-site trial enrolled 643 patients in treatment and control groups. Comprehension of care was assessed by chart review and satisfaction measured via validated survey. Use of the instrument was not associated with improvements in patient knowledge about their care, with a mean of 4.6 (95% CI: 4.8-5.8) comprehension defects in the control group and 4.4 (95% CI: 3.9-4.9) in the treatment group. There was no significant effect on patient satisfaction 76.4% versus 76.9%, p=0.34. Elderly patients in both groups were found to have 1.1 (ppatients. Patients frequently misunderstand medical care in the ED. Comprehension decreases with increasing age. An isolated communication instrument does not improve satisfaction with or understanding of the care received. Providing a structured place for providers and patients to record details of care does not seem to improve satisfaction with or comprehension of care. Interventions that focus on communication skills and face time with patients may prove more effective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Children who acquire HIV infection perinatally are at higher risk of early death than those acquiring infection through breastmilk: a meta-analysis.

Directory of Open Access Journals (Sweden)

Renaud Becquet

Full Text Available Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally are thus needed.A pooled analysis was conducted of individual data of all available intervention cohorts and randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant characteristics. The Kaplan-Meier method was used to estimate survival curves by child's HIV infection status and timing of HIV infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000 child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6-3.0, maternal CD4<350 cells/ml (1.4, 1.1-1.7, postnatal (3.1, 2.1-4.1 or peri-partum HIV-infection (12.4, 10.1-15.3.These results update previous work and inform future UNAIDS modelling by providing survival estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate antiretroviral care and support for HIV-infected children.

Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London.

Science.gov (United States)

Gowland, Emily; Ball, Karen Le; Bryant, Catherine; Birns, Jonathan

2016-10-01

Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects. © Royal College of Physicians 2016. All rights reserved.

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Science.gov (United States)

Mears, Simon C.

2015-01-01

Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures. PMID:26246957

Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability.

Science.gov (United States)

DuBard, C Annette; Jackson, Carlos T

2018-04-01

Care management of high-cost/high-needs patients is an increasingly common strategy to reduce health care costs. A variety of targeting methodologies have emerged to identify patients with high historical or predicted health care utilization, but the more pertinent question for program planners is how to identify those who are most likely to benefit from care management intervention. This paper describes the evolution of complex care management targeting strategies in Community Care of North Carolina's (CCNC) work with the statewide non-dual Medicaid population, culminating in the development of an "Impactability Score" that uses administrative data to predict achievable savings. It describes CCNC's pragmatic approach for estimating intervention effects in a historical cohort of 23,455 individuals, using a control population of 14,839 to determine expected spending at an individual level, against which actual spending could be compared. The actual-to-expected spending difference was then used as the dependent variable in a multivariate model to determine the predictive contribution of a multitude of demographic, clinical, and utilization characteristics. The coefficients from this model yielded the information required to build predictive models for prospective use. Model variables related to medication adherence and historical utilization unexplained by disease burden proved to be more important predictors of impactability than any given diagnosis or event, disease profile, or overall costs of care. Comparison of this approach to alternative targeting strategies (emergency department super-utilizers, inpatient super-utilizers, or patients with highest Hierarchical Condition Category risk scores) suggests a 2- to 3-fold higher return on investment using impactability-based targeting.

Different paths to high-quality care: three archetypes of top-performing practice sites.

Science.gov (United States)

Feifer, Chris; Nemeth, Lynne; Nietert, Paul J; Wessell, Andrea M; Jenkins, Ruth G; Roylance, Loraine; Ornstein, Steven M

2007-01-01

Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes. This study used an observational case study design. A practice-level measure of adherence to clinical guidelines was used to identify the highest performing practices in a network of internal and family medicine practices participating in a national demonstration project. We analyzed qualitative and quantitative information derived from project documents, field notes, and evaluation questionnaires to develop and compare case studies. Nine cases are described. All use many of the same improvement strategies. Differences in the way improvements are organized define 3 distinct archetypes: the Technophiles, the Motivated Team, and the Care Enterprise. There is no single approach that explains the superior performance of high-performing practices, though each has adopted variations of PPRNet's improvement model. Practices will vary in their path to high-quality care. The archetypes could prove to be a useful guide to other practices selecting an overall quality improvement approach.

Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE): study protocol for a randomised controlled trial

Science.gov (United States)

2014-01-01

Background Osteoporosis and vertebral fracture can have a considerable impact on an individual’s quality of life. There is increasing evidence that physiotherapy including manual techniques and exercise interventions may have an important treatment role. This pragmatic randomised controlled trial will investigate the clinical and cost-effectiveness of two different physiotherapy approaches for people with osteoporosis and vertebral fracture, in comparison to usual care. Methods/Design Six hundred people with osteoporosis and a clinically diagnosed vertebral fracture will be recruited and randomly allocated to one of three management strategies, usual care (control - A), an exercise-based physiotherapy intervention (B) or a manual therapy-based physiotherapy intervention (C). Those in the usual care arm will receive a single session of education and advice, those in the active treatment arms (B + C) will be offered seven individual physiotherapy sessions over 12 weeks. The trial is designed as a prospective, adaptive single-blinded randomised controlled trial. An interim analysis will be completed and if one intervention is clearly superior the trial will be adapted at this point to continue with just one intervention and the control. The primary outcomes are quality of life measured by the disease specific QUALLEFO 41 and the Timed Loaded Standing test measured at 1 year. Discussion There are a variety of different physiotherapy packages used to treat patients with osteoporotic vertebral fracture. At present, the indication for each different therapy is not well defined, and the effectiveness of different modalities is unknown. Trial registration Reference number ISRCTN49117867. PMID:24422876

Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial

NARCIS (Netherlands)

Saba, J.; Haverkamp, G.; Gray, G.; McIntyre, J.; Mmiro, F.; Ndugwa, C.; Coovadia, H. M.; Moodley, J.; Kilewo, C.; Massawe, A.; Kituuka, P.; Okong, P.; von Briesen, H.; Goudsmit, J.; Biberfeld, G.; Grulich, A.; Weverling, G. J.; Lange, J. M. A.

2002-01-01

Background Large reductions in transmission of HIV-1 from mother to child have been achieved in more-developed countries due to the use of antiretrovirals. Short-course regimens, suitable for resource-poor countries, have also been shown to significantly reduce peripartum HIV-1 transmission. We

Abnormally invasive placenta—prevalence, risk factors and antenatal suspicion

DEFF Research Database (Denmark)

Thurn, L.; Lindqvist, P. G.; Jakobsson, M.

2016-01-01

among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and AIP from 2009 to 2012 The Nordic Obstetric Surveillance Study (NOSS). Methods: In the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against...

[Hypoxic brain injuries notified to the Danish Patient Insurance Association during 1992-2004. Secondary publication

DEFF Research Database (Denmark)

Bock, J.; Christoffersen, J.K.; Hedegaard, M.

2008-01-01

We investigated the files of the Danish Patient Insurance Association for newborns suffering from hypoxic brain injuries. From 1992 to 2004, a total of 127 approved claims concerning peripartum hypoxic injury were registered. Thirty-eight newborns died and the majority of the 89 surviving children...

A Mechanically Proved and an Incremental Development of the Session Initiation Protocol INVITE Transaction

Directory of Open Access Journals (Sweden)

Rajaa Filali

2014-01-01

Full Text Available The Session Initiation Protocol (SIP is an application layer signaling protocol used to create, manage, and terminate sessions in an IP based network. SIP is considered as a transactional protocol. There are two main SIP transactions, the INVITE transaction and the non-INVITE transaction. The SIP INVITE transaction specification is described in an informal way in Request for Comments (RFC 3261 and modified in RFC 6026. In this paper we focus on the INVITE transaction of SIP, over reliable and unreliable transport mediums, which is used to initiate a session. In order to ensure the correctness of SIP, the INVITE transaction is modeled and verified using event-B method and its Rodin platform. The Event-B refinement concept allows an incremental development by defining the studied system at different levels of abstraction, and Rodin discharges almost all proof obligations at each level. This interaction between modeling and proving reduces the complexity and helps in assuring that the INVITE transaction SIP specification is correct, unambiguous, and easy to understand.

Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community.

Science.gov (United States)

Gibson, S Jo

2016-03-01

The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program. Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps. The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic. Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities. ©2015 American Association of Nurse Practitioners.

Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement.

Science.gov (United States)

Gabrysch, Sabine; McMahon, Shannon A; Siling, Katja; Kenward, Michael G; Campbell, Oona M R

2016-03-02

It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman's ability to act upon her own preferences. How autonomy should be constructed and measured - namely, as an individual or cluster-level variable - has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman's autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts.

Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement

Science.gov (United States)

Gabrysch, Sabine; McMahon, Shannon A.; Siling, Katja; Kenward, Michael G.; Campbell, Oona M. R.

2016-01-01

It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman’s ability to act upon her own preferences. How autonomy should be constructed and measured – namely, as an individual or cluster-level variable – has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman’s autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts. PMID:26931301

Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey

Directory of Open Access Journals (Sweden)

de Graaff Fuusje M

2009-01-01

Full Text Available Abstract Background Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care for terminally ill Turkish and Moroccan migrants and their families in the Netherlands. Methods Questionnaires were sent to home care organizations and GPs working in areas where most of these migrants are living. 93 nurses and 78 GPs provided information about their experiences and opinions regarding home care for this group of patients. The data were analyzed by descriptive statistics. Results GPs refer relatively few patients from these migrant groups to home care. They often find it difficult to assess the needs of these patients and their families. In 40% of the GPs' cases in which terminally ill Turkish and Moroccan migrants were not referred to home care, the GP regretted this afterwards: the patients had not received sufficient qualified care, and their informal carers had often become overburdened. In addition, home care nurses often express dissatisfaction with the home care given to terminally ill Turkish or Moroccan patients, because of communication problems, the patients' lack of knowledge of the disease, or difficulties in making suitable appointments with the patient or with the family. Conclusion Nurses and GPs cite chiefly similar factors influencing access to and use of home care as family members did in a previous study. However, according to GPs and nurses, the main barrier to the use of home care concerns communication problems, while relatives cited the preference for family care as the main reason for abstaining from the use of home care.

Job satisfaction of neonatal intensive care nurses.

Science.gov (United States)

McDonald, Katie; Rubarth, Lori Baas; Miers, Linda J

2012-08-01

The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. A descriptive, correlational design was used to study job satisfaction among NICU nurses. Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU

Hydrogeologic and chemical data for the O-Field area, Aberdeen Proving Ground, Maryland

International Nuclear Information System (INIS)

Nemoff, P.R.; Vroblesky, D.A.

1989-01-01

O-Field, located at the Edgewood area of Aberdeen Proving Ground, Maryland, was periodically used for disposal of munitions, waste chemicals, and chemical-warfare agents from World War II through the 1950's. This report includes various physical, geologic, chemical, and hydrologic data obtained from well-core, groundwater, surface water, and bottom-sediment sampling sites at and near the O-Field disposal area. The data are presented in tables and hydrographs. Three site-location maps are also included. Well-core data include lithologic logs for 11 well-cluster sites, grain-size distributions, various chemical characteristics, and confining unit characteristics. Groundwater data include groundwater chemistry, method blanks for volatile organic carbon, available data on volatile and base/neutral organics, and compilation of corresponding method blanks, chemical-warfare agents, explosive-related products, radionuclides, herbicides, and groundwater levels. Surface-water data include field-measured characteristics; concentrations of various inorganic constituents including arsenic; selected organic constituents with method blanks; detection limits of organics; and a compilation of information on corresponding acids, volatiles, and semivolatiles; and method blanks corresponding to acids, volatiles, and semivolatiles. A set of 15 water-level hydrographs for the period March 1986 through September 1987 also is included in the report. 3 refs., 18 figs., 24 tabs

Ecological risk assessment of depleted uranium in the environment at Aberdeen Proving Ground

International Nuclear Information System (INIS)

Clements, W.H.; Kennedy, P.L.; Myers, O.B.

1993-01-01

A preliminary ecological risk assessment was conducted to evaluate the effects of depleted uranium (DU) in the Aberdeen Proving Ground (APG) ecosystem and its potential for human health effects. An ecological risk assessment of DU should include the processes of hazard identification, dose-response assessment, exposure assessment, and risk characterization. Ecological risk assessments also should explicitly examine risks incurred by nonhuman as well as human populations, because risk assessments based only on human health do not always protect other species. To begin to assess the potential ecological risk of DU release to the environment we modeled DU transport through the principal components of the aquatic ecosystem at APG. We focused on the APG aquatic system because of the close proximity of the Chesapeake Bay and concerns about potential impacts on this ecosystem. Our objective in using a model to estimate environmental fate of DU is to ultimately reduce the uncertainty about predicted ecological risks due to DU from APG. The model functions to summarize information on the structure and functional properties of the APG aquatic system, to provide an exposure assessment by estimating the fate of DU in the environment, and to evaluate the sources of uncertainty about DU transport

An Instantaneous Low-Cost Point-of-Care Anemia Detection Device

Directory of Open Access Journals (Sweden)

Jaime Punter-Villagrasa

2015-02-01

Full Text Available We present a small, compact and portable device for point-of-care instantaneous early detection of anemia. The method used is based on direct hematocrit measurement from whole blood samples by means of impedance analysis. This device consists of a custom electronic instrumentation and a plug-and-play disposable sensor. The designed electronics rely on straightforward standards for low power consumption, resulting in a robust and low consumption device making it completely mobile with a long battery life. Another approach could be powering the system based on other solutions like indoor solar cells, or applying energy-harvesting solutions in order to remove the batteries. The sensing system is based on a disposable low-cost label-free three gold electrode commercial sensor for 50 µL blood samples. The device capability for anemia detection has been validated through 24 blood samples, obtained from four hospitalized patients at Hospital Clínic. As a result, the response, effectiveness and robustness of the portable point-of-care device to detect anemia has been proved with an accuracy error of 2.83% and a mean coefficient of variation of 2.57% without any particular case above 5%.

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African Journals Online (AJOL)

Items 201 - 250 of 577 ... Issue, Title. Vol 20, No 2 (2003), Emergency Contraception: A Global Overview of Knowledge, Attitudes and Practices Among Providers, Abstract PDF. Deborah Haggai. Vol 23 (2006):, Emergency laparotomy for peripartum haemorrhage in Bida North Central Nigeria, Abstract PDF. Sunny Abiodun O ...

Prioritising integrated care initiatives on a national level. Experiences from Austria

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Karin Eger

2009-09-01

Full Text Available Introduction and background: Based on a policy initiative and the foundation of the Competence Centre for Integrated Care by the Austrian Social Security Institutions in 2006, the aim of the project was to identify and prioritise potential diseases and target groups for which integrated care models should be developed and implemented within the Austrian health system. The project was conducted as a cooperation between the Competence Centre for Integrated Care of the Viennese Health Insurance Fund and the Institute of Social Medicine of the Medical University Vienna to ensure the involvement of both, theory and practice. Project report: The focus of the project was to develop an evidence-based process for the identification and prioritisation of diseases and target groups for integrated care measures. As there was no evidence of similar projects elsewhere, the team set out to design the prioritisation process and formulate the selection criteria based on the work in a focus group, literature reviews and a scientific council of national and international experts. The method and criteria were evaluated by an expert workshop. Discussion: The active involvement of all stakeholders from the beginning was crucial for the success. The time constraint proved also beneficial since it allowed the project team to demand focus and cooperation from all experts and stakeholders included. Conclusion: Our experience demonstrates that, with a clear concept and model, an evidence-based prioritisation including all stakeholders can be achieved. Ultimately however, the prioritisation is a political discussion and decision. Our model can only help base these decisions on sound and reasonable assumptions.

Computer-aided system for diabetes care in Berlin, G.D.R.

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Thoelke, H; Meusel, K; Ratzmann, K P

1990-01-01

In the Centre of Diabetes and Metabolic Disorders of Berlin, G.D.R., a computer-aided care system has been used since 1974, aiming at relieving physicians and medical staff from routine tasks and rendering possible epidemiological research on an unselected diabetes population of a defined area. The basis of the system is the data bank on diabetics (DB), where at present data from approximately 55,000 patients are stored. DB is used as a diabetes register of Berlin. On the basis of standardised criteria of diagnosis and therapy of diabetes mellitus in our dispensary care system, DB facilitates representative epidemiological analyses of the diabetic population, e.g. prevalence, incidence, duration of diabetes, and modes of treatment. The availability of general data on the population or the selection of specified groups of patients serves the management of the care system. Also, it supports the computer-aided recall of type II diabetics, treated either with diet alone or with diet and oral drugs. In this way, the standardised evaluation of treatment strategies in large populations of diabetics is possible on the basis of uniform metabolic criteria (blood glucose plus urinary glucose). The system consists of a main computer in the data processing unit and of personal computers in the diabetes centre which can be used either individually or as terminals to the main computer. During 14 years of experience, the computer-aided out-patient care of type II diabetics has proved efficient in a big-city area with a large population.

[Satisfaction according to health care insurance systems in an emergency department].

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Dávila, F A; Herrera, J S; Yasnó, D A; Forero, L C; Alvarado, M V

Health satisfaction is a fundamental measure of the quality of health services. This study aims to validate and analyse the results of a quality of care questionnaire to assess the level of satisfaction of patients attended in the emergency department of a high complexity hospital. Observational, cross-sectional study, with a questionnaire designed to assess the quality of service and satisfaction at the end of care in the emergency department. Descriptive statistics of scale were established and presented, as well as determining the construct validity, overall reliability, internal and concurrent validity of an overall against a uni-dimensional scale. A total of 5,961 records were reviewed, most of them (77.3%) reported by patients in the Mandatory Health Plan. High levels of satisfaction overall and by subgroups were found. There were no significant differences between subgroups, with 86.8 for those with Pre-paid Medical Care Plan and 84.4 for mandatory health plan. Cronbach's alpha for the questionnaire was 0.90. The questionnaire proved to be reliable and valid in determining the quality and satisfaction with care. The results showed high levels of satisfaction overall and in the domains. A low consistency between the results of the multidimensional and unidimensional satisfaction scales suggests that there were aspects of satisfaction not investigated on the multidimensional scale. Ecologically-designed before and after studies are required to evaluate the effectiveness of interventions in satisfaction. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial

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Martínez, Pablo; Zitko, Pedro; Irarrázaval, Matías; Luttges, Carolina; Araya, Ricardo

2018-01-01

psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). Conclusions This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) PMID:29386172

Methodology of proving long-term safety of a salt dome repository with existing insecurities forming the background

International Nuclear Information System (INIS)

Storck, R.

1992-01-01

Existing methods to prove safety can consider the insecurities of input data within the framework of probabilistic analyses. The results of application calculations show that inspite of considerable band widths of input data the scattering widths of radiation exposures are comparably limited, and calculated radiation exposures are clearly below acceptable limits. Moreover it can be demonstrated that in the event of an assumed brine influx into the repository radionuclides are released only if parameter combinations are unfavourable. Therefore such incident in general does not have any radiological consequences. Insecurities in model approaches can be taken into consideration only partly so far by using alternative models, or indirectly through data insecurities. (orig./DG) [de

Current trends in Irish perinatal mortality.

LENUS (Irish Health Repository)

Mahony, R

2010-06-01

This was a retrospective review of normally formed perinatal deaths among 176,620 births at the National Maternity Hospital (1984-2007). Prelabor stillbirths were categorised by presumed cause of death including unexplained, intrauterine growth retardation (IUGR), placental abruption, red cell alloimmunisation (RCA) and deaths related to prematurity. Peripartum deaths included intrapartum and first week neonatal deaths. The post-mortem rate, initially almost 100%, fell to 60%. Data were analysed using the Mantel-Haenszel chi square test for trends. In the study period there was a significant reduction in the PNM, largely because of a fall in death related to prematurity, term peripartum death, death at 42 weeks or greater, placental abruption, death related to IUGR and RCA (P < 0.01). Overall the unexplained still birth rate was unchanged throughout the study period (p = 0.8) despite a highly significant (p < 0.001) increase in obstetric intervention particularly induction of labor and caesarean section.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.

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Revill, Paul; Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J

2018-01-01

important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

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Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J.

2018-01-01

gains in population health. Implications The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented. PMID:29293611

Agonizing care: care ethics, agonistic feminism and a political theory of care.

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Cloyes, Kristin G

2002-09-01

'Care' is central to nursing theory and practice, and has been described in a variety of ways. Intense conversations about care have been developing in other fields of study as well, from the social sciences to the humanities. Care ethics has grown out of intellectual exchange between feminist thought, moral theory and the critique of traditional western political philosophy. However, care ethics is not without its critics, as these accounts of care have also sparked vigorous challenges. This paper traces the construct of care through nursing theory, care ethics, feminist critiques of moral and political theory and agonistic feminism to outline a set of problematics that a political theory of care should engage. It discusses how care is conventionally posited in more or less essentialist, universalizing and naturalizing terms. It introduces the ideas of feminist theorists who resist dichotomizing care and the political, and situate care in the context of power and politics. The tensions between care feminism and agonistic feminism are highlighted in order to explore the potential of theorizing both care and nursing in political terms.

Remediation application strategies for depleted uranium contaminated soils at the US Army Yuma Proving Ground

International Nuclear Information System (INIS)

Vandel, D.S.; Medina, S.M.; Weidner, J.R.

1994-03-01

The US Army Yuma Proving Ground (YPG), located in the southwest portion of Arizona conducts firing of projectiles into the Gunpoint (GP-20) firing range. The penetrators are composed of titanium and DU. The purpose of this project was to determine feasible cleanup technologies and disposal alternatives for the cleanup of the depleted uranium (DU) contaminated soils at YPG. The project was split up into several tasks that include (a) collecting and analyzing samples representative of the GP-20 soils, (b) evaluating the data results, (c) conducting a literature search of existing proven technologies for soil remediation, and (0) making final recommendations for implementation of this technology to the site. As a result of this study, several alternatives for the separation, treatment, and disposal procedures are identified that would result in meeting the cleanup levels defined by the Nuclear Regulatory Commission for unrestricted use of soils and would result in a significant cost savings over the life of the firing range

Introduction of Mercury-free Gold Extraction Methods to Medium-Scale Miners and Education of Health Care Providers to Reduce the use of Mercury in Sorata, Bolivia

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Peter W. U. Appel

2015-01-01

Conclusions. The gold ores tested during the project proved amenable to mercury-free gold extraction using borax smelting. The miners also realized that gold recovery increased when performing mercury-free gold extraction. The miners decided to stop using mercury and a follow-up project cleaned their mining equipment for mercury and modified the processing lines. The health care providers were also successfully trained.

On opportunity for emergency cesarean hysterectomy and pregnancy outcomes of patients with placenta accreta.

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Kong, Xiang; Kong, Yan; Yan, Jin; Hu, Jin-Ju; Wang, Fang-Fang; Zhang, Lei

2017-09-01

Effective diagnosis and clinical management of placenta accreta (PA) in China are not clear. The purpose of the study was to analyze the risk factors and diagnosis of PA, maternal and neonatal outcomes in patients with PA. It was a retrospective study of cases with PA, confirmed by histologically and/or clinically suspected during 3 years in 2 tertiary referral hospitals. The incidence rate of patients with PA, who had history of artificial abortion, cesarean section (CS), and placenta previa (PP) was 94%, 70%, and 72%, respectively. In 29 patients of scheduled CS group, 12 cases were performed with cesarean hysterectomy. Mean estimated blood loss (EBL) was 1.5 L, and 17 babies were admitted to neonatal intensive care unit (NICU). In the 18 cases of emergency CS group, 6 cases were performed cesarean hysterectomy. Mean EBL was 2.4 L, and 16 babies were admitted to NICU. The difference of mean EBL, cases of fetal admitted to intensive care unit in 2 groups was significant difference (P emergency CS. Emergency peripartum hysterectomy is a feasible method under the circumstances of heave, fast bleeding, and the failure of conservative surgery.

Palliative Care: Delivering Comprehensive Oncology Nursing Care.

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Dahlin, Constance

2015-11-01

To describe palliative care as part of comprehensive oncology nursing care. A review of the palliative care, oncology, and nursing literature over the past 10 years. Palliative care is mandated as part of comprehensive cancer care. A cancer diagnosis often results in distress in the physical, psychosocial, spiritual, and emotional domains of care. Oncology nurses are essential in providing palliative care from diagnosis to death to patients with cancer. They address the myriad aspects of cancer. With palliative care skills and knowledge, oncology nurses can provide quality cancer care. There are many opportunities in which oncology nurses can promote palliative care. Oncology nurses must obtain knowledge and skills in primary palliative care to provide comprehensive cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

[Nursing as a situative activity. A realistic concept for the assurance of quality and efficiency in geriatric care].

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Böhle, F; Brater, M; Maurus, A

1997-02-01

In institutional care for the elderly effective and efficient professional action is needed as well as in acute care settings. That means rational-systematic acting. This includes the establishment of goals, systematic planning and realization of these plans, deductive-logical thinking, objective perception and gaining an unbiased objective relationship towards the work to be done. However, an explorative investigation of the ways, how successful and experienced nurses do their job-being viewed by their colleagues as qualitatively effective and efficient concerning their time budget-provides the following results. In direct care procedures which go beyond rational-systematic action prove to be more economic and successful. This type of action is characterized by interactive procedures of dialogical nature, the patterns of rationality tend to be associative, the perception of the elderly to be taken care of can be considered as intuitive-subjective and the relationship towards them as personal-empathic. Those patterns of professional action we refer to as "subjectifying" or "situative" patterns of action. They can also be found in the process of an artist's work. The consequences of this change of paradigma concerning training and cost-effective nursing are discussed in this paper.

The balanced scorecard: an incremental approach model to health care management.

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Pineno, Charles J

2002-01-01

The balanced scorecard represents a technique used in strategic management to translate an organization's mission and strategy into a comprehensive set of performance measures that provide the framework for implementation of strategic management. This article develops an incremental approach for decision making by formulating a specific balanced scorecard model with an index of nonfinancial as well as financial measures. The incremental approach to costs, including profit contribution analysis and probabilities, allows decisionmakers to assess, for example, how their desire to meet different health care needs will cause changes in service design. This incremental approach to the balanced scorecard may prove to be useful in evaluating the existence of causality relationships between different objective and subjective measures to be included within the balanced scorecard.

The use of peracetic acid in drinking water systems: flow tests; L'acido peracetico in potabilizzazione: prove in flusso

Energy Technology Data Exchange (ETDEWEB)

Ragazzo, P. [Consorzio per l' Acquedotto del Basso Piave, San Dona' di Piave, VE (Italy); Navazio, G. [Padua Univ., Padua (Italy). Dipt. dei Processi Chimici dell' Ingegneria; Cavadone, A. [Solvay Chimica Italia S.p.A., Milan (Italy)

2000-09-01

In a previous research, a preliminary study was carried out on the disinfection efficiency of peracetic acid (PAA), comparing it to that of other disinfectants that are typically used, in batch tests with dosage values ranging from 0.5 to 5 ppm. The study was carried out on samples of water collected from several significant points of the treatment process at the main water treatment plant in Jesolo (Venice, Italy). On the basis of results (basically positive at that time) obtained from these tests, a 400 litre/hour pilot plant was built, as a lower scale reproduction of the drink water treatment system mentioned earlier, in order to study the characteristics of PAA even in tests that could more realistically simulate the flow of water along the process. These tests essentially confirmed the kinetics of the spontaneous hydrolysis to CH{sub 3} COOH+H{sub 2}O{sub 2} and those of dismutation to CH{sub 3}COOH+O{sub 2}, with half-life time values ranging from 3 to 12 hours, depending on the characteristics of the water (especially the pH factor) and the PAA concentration values. [Italian] In un precedente lavoro e' stato effettuato un preventivo studio sull'efficienza disinfettiva dell'acido peracetico, anche in confronto con gli altri piu' usuali disinfettanti, in prove condotte in batch, con dosaggi compresi tra 0.5 e 5 ppm, su campioni di acqua prelevati dai diversi punti significativi della linea di trattamento della centrale di Jesolo (Torre Caligo), gestita dal Consorzio Acquedottistico del Basso Piave di S. Dona' di Piave (Venezia). Sulla base dei risultati, sostanzialmente positivi, e' stato costruito un impianto pilota da 400l/h, riproducente, in scala, la linea di potabilizzazione su ricordata, per studiare le caratteristiche del PAA anche in prove piu' probanti condotte in flusso. In tali prove sono state sostanzialmente riconfermate le cinetiche delle reazioni spontanee di dirolisi a CH{sub 3}COOH+H{sub 2}O{sub 2} e di

Screening of Dementia in Portuguese Primary Care: Methodology, Assessment Tools, and Main Results

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Laetitia Teixeira

2017-11-01

Full Text Available The objectives of this article are as follows: (1 to describe the assessment protocol used to outline people with probable dementia in Primary Health Care; (2 to show the methodological design and procedure to obtain a representative sample of patients with probable dementia; and (3 to report the main characteristics of the sample collected in the context of the study “Characteristics and needs of people with probable dementia.” The study protocol was based on the “Community Assessment of Risk and Treatment Strategies (CARTS Program” and is composed by a set of instruments that allow the assessment of older adults with probable dementia in several areas (health, psychological, functionality, and other. Descriptive analysis was used to characterize the final sample (n = 436. The study protocol as well as the methodological procedure to obtain the referral of research participants and data collection on the condition of people with probable dementia in Primary Health Care proved to be a valuable tool to obtain a sample of patients distributed by the full range of probable dementia in a large geographical area. Results may allocate the design of care pathways for old people with cognitive disorders to prevent, delay impairment, and/or optimize quality of life of patients.

Care coordination and unmet specialty care among children with special health care needs.

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Boudreau, Alexy Arauz; Perrin, James M; Goodman, Elizabeth; Kurowski, Daniel; Cooley, W Carl; Kuhlthau, Karen

2014-06-01

Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families. Secondary data analysis of participants in the 2009–2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income. Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47–0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16–0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home.

Economic Evidence and Point-of-Care Testing

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St John, Andrew; Price, Christopher P

2013-01-01

Health economics has been an established feature of the research, policymaking, practice and management in the delivery of healthcare. However its role is increasing as the cost of healthcare begins to drive changes in most healthcare systems. Thus the output from cost effectiveness studies is now being taken into account when making reimbursement decisions, e.g. in Australia and the United Kingdom. Against this background it is also recognised that the health economic tools employed in healthcare, and particularly the output from the use of these tools however, are not always employed in the routine delivery of services. One of the notable consequences of this situation is the poor record of innovation in healthcare with respect to the adoption of new technologies, and the realisation of their benefits. The evidence base for the effectiveness of diagnostic services is well known to be limited, and one consequence of this has been a very limited literature on cost effectiveness. One reason for this situation is undoubtedly the reimbursement strategies employed in laboratory medicine for many years, simplistically based on the complexity of the test procedure, and the delivery as a cost-per-test service. This has proved a disincentive to generate the required evidence, and little effort to generate an integrated investment and disinvestment business case, associated with care pathway changes. Point-of-care testing creates a particularly challenging scenario because, on the one hand, the unit cost-per-test is larger through the loss of the economy of scale offered by automation, whilst it offers the potential of substantial savings through enabling rapid delivery of results, and reduction of facility costs. This is important when many health systems are planning for complete system redesign. We review the literature on economic assessment of point-of-care testing in the context of these developments. PMID:24151342

Long-term fate of depleted uranium at Aberdeen and Yuma Proving Grounds: Human health and ecological risk assessments

Energy Technology Data Exchange (ETDEWEB)

Ebinger, M.H.; Beckman, R.J.; Myers, O.B. [Los Alamos National Lab., NM (United States); Kennedy, P.L.; Clements, W.; Bestgen, H.T. [Colorado State Univ., Ft. Collins, CO (United States). Dept. of Fishery and Wildlife Biology

1996-09-01

The purpose of this study was to evaluate the immediate and long-term consequences of depleted uranium (DU) in the environment at Aberdeen Proving Ground (APG) and Yuma Proving Ground (YPG) for the Test and Evaluation Command (TECOM) of the US Army. Specifically, we examined the potential for adverse radiological and toxicological effects to humans and ecosystems caused by exposure to DU at both installations. We developed contaminant transport models of aquatic and terrestrial ecosystems at APG and terrestrial ecosystems at YPG to assess potential adverse effects from DU exposure. Sensitivity and uncertainty analyses of the initial models showed the portions of the models that most influenced predicted DU concentrations, and the results of the sensitivity analyses were fundamental tools in designing field sampling campaigns at both installations. Results of uranium (U) isotope analyses of field samples provided data to evaluate the source of U in the environment and the toxicological and radiological doses to different ecosystem components and to humans. Probabilistic doses were estimated from the field data, and DU was identified in several components of the food chain at APG and YPG. Dose estimates from APG data indicated that U or DU uptake was insufficient to cause adverse toxicological or radiological effects. Dose estimates from YPG data indicated that U or DU uptake is insufficient to cause radiological effects in ecosystem components or in humans, but toxicological effects in small mammals (e.g., kangaroo rats and pocket mice) may occur from U or DU ingestion. The results of this study were used to modify environmental radiation monitoring plans at APG and YPG to ensure collection of adequate data for ongoing ecological and human health risk assessments.

Long-term fate of depleted uranium at Aberdeen and Yuma Proving Grounds: Human health and ecological risk assessments

International Nuclear Information System (INIS)

Ebinger, M.H.; Beckman, R.J.; Myers, O.B.; Kennedy, P.L.; Clements, W.; Bestgen, H.T.

1996-09-01

The purpose of this study was to evaluate the immediate and long-term consequences of depleted uranium (DU) in the environment at Aberdeen Proving Ground (APG) and Yuma Proving Ground (YPG) for the Test and Evaluation Command (TECOM) of the US Army. Specifically, we examined the potential for adverse radiological and toxicological effects to humans and ecosystems caused by exposure to DU at both installations. We developed contaminant transport models of aquatic and terrestrial ecosystems at APG and terrestrial ecosystems at YPG to assess potential adverse effects from DU exposure. Sensitivity and uncertainty analyses of the initial models showed the portions of the models that most influenced predicted DU concentrations, and the results of the sensitivity analyses were fundamental tools in designing field sampling campaigns at both installations. Results of uranium (U) isotope analyses of field samples provided data to evaluate the source of U in the environment and the toxicological and radiological doses to different ecosystem components and to humans. Probabilistic doses were estimated from the field data, and DU was identified in several components of the food chain at APG and YPG. Dose estimates from APG data indicated that U or DU uptake was insufficient to cause adverse toxicological or radiological effects. Dose estimates from YPG data indicated that U or DU uptake is insufficient to cause radiological effects in ecosystem components or in humans, but toxicological effects in small mammals (e.g., kangaroo rats and pocket mice) may occur from U or DU ingestion. The results of this study were used to modify environmental radiation monitoring plans at APG and YPG to ensure collection of adequate data for ongoing ecological and human health risk assessments

[Analgesia and sedation in neonatal-pediatric intensive care].

Science.gov (United States)

Schlünder, C; Houben, F; Hartwig, S; Theisohn, M; Roth, B

1991-01-01

In pediatric intensive care, analgesia and sedation has become increasingly important for newborns as well as prematures in recent years. However, its importance is frequently not well recognized and sedation is confounded with analgesia. In our intensive-care unit (ICU), fentanyl and midazolam have proved to be useful. In newborn and premature infants, fentanyl alone has been sufficient because of its analgesic and sedative action. In a study on 20 newborns and prematures suffering from severe respiratory problems as compared with a historical group that did not receive fentanyl, we could show that in subjects receiving fentanyl, considerably less treatment with sedatives and other analgesics was necessary. Cardiopulmonary tolerance was satisfactory. The highest bilirubin values were reached about 1 day earlier and were slightly higher than those measured in the control group, but oral nutrition could be initiated sooner. In small infants, additional midazolam was given after cardiac surgery. During the first 72 h, we found a correlation between serum levels of midazolam and the depth of sedation; however, after 72 h of medication, the dose had to be raised because of an increase in metabolic clearance. During the concomitant administration of midazolam and fentanyl, significantly less midazolam was needed to achieve appropriate analog-sedation. Prior to the administration of analgesics and sedatives, care should be taken to ensure that circulatory conditions are stable and that there is no hypovolemia, and the drugs must be given slowly during several minutes. Especially in a pediatric ICU, light and noise should be diminished and contact between the parents and the child should be encouraged, even when the child is undergoing mechanical ventilation.

Data mining usage in health care management: literature survey and decision tree application

Directory of Open Access Journals (Sweden)

Dijana Ćosić

2008-02-01

Full Text Available Aim To show the benefits of data mining in health care management.In this example, we are going to show a way to raise awarenessof women in terms of contraceptive methods they use (do notuse.Methods Goal of the data mining analysis was to determine ifthere are common characteristics of the women according to theirchoice of contraception (typical classification problem. Therefore,we decided to use decision trees. We have generated a CHAIDmodel in “Statistica”, based on the database that was formed as aresult of an Indonesian research that was conducted in 1987. Thesample contains married women who were either not pregnant ordid not know if they were pregnant at the time of the interview.The database consists of 1473 cases. Also, an extensive internetsearch was conducted in order to detect a number of articles citedin scientific databases published on the subject of data mining inhealth care management.Results It has shown that the most important variable in case ofwomen’s choice of contraceptive methods is – a husband’s profession.Also we retrieved 221 articles published on the application ofdata mining in health care.Conclusion The goal of the paper is achieved in two ways: first,retrieving 221 articles published on the subject we have proved thebenefits of data mining in the health care management. Second,the decision tree method is successfully applied in explanation ofwomen’s choice of contraceptive methods.

The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians.

Science.gov (United States)

Schaden, Eva; Herczeg, Petra; Hacker, Stefan; Schopper, Andrea; Krenn, Claus G

2010-10-21

Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008). Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings.

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Hirdes, John P; Poss, Jeffrey W; Mitchell, Lori; Korngut, Lawrence; Heckman, George

2014-01-01

Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940), complex continuing care hospitals/units (n = 88,721), and nursing homes (n = 185,309) in seven Canadian provinces/territories. CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada) that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings.

Directory of Open Access Journals (Sweden)

John P Hirdes

Full Text Available Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions.Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940, complex continuing care hospitals/units (n = 88,721, and nursing homes (n = 185,309 in seven Canadian provinces/territories.CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings.CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

[Personal budget for persons in need of care. A socio-economic change with new perspectives for supply and demand].

Science.gov (United States)

Meyer, Dirk

2005-11-01

In October 2004, in Germany a pre-operating study was started in order to prove the feasibility and consequences of the use of personal budgets by persons who are in need of nursing care. About 1000 care dependent persons living in seven regions are included in this triannual study. For three years they receive a budget amounting to 100 percent of their right of benefit in kind according to the German compulsory long-term care insurance. This budget has to be used exclusively for care-related services and must not be spent for assistance delivered by family members or neighbours. From socio-economic perspectives, the personal budget will result in a promotion of individuals instead of certain services or service institutions. An analysis shows, that the consequences might be an increased efficiency and effectiveness as well as structural changes within the supply of nursing care services. But to achieve these advantages, certain conditions must be provided. At first, the amount of the budget has to correspond to the individual need of care, which can change over time. Secondly, a misapplication of the personal fund has to be prevented without to exclude the potential of local or family dedication. And finally, new ways of quality assurance are requested due to the scope for development, which arises through deregulation.

Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge.

Science.gov (United States)

Reich, P J; Boyle, M G; Hogan, P G; Johnson, A J; Wallace, M A; Elward, A M; Warner, B B; Burnham, C-A D; Fritz, S A

2016-07-01

Methicillin-resistant Staphylococcus aureus (MRSA) infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). We characterized the clinical and molecular epidemiology of MRSA strains colonizing NICU patients. Nasal MRSA isolates (n = 250, from 96 NICU patients) recovered through active surveillance from 2009 to 2014 were characterized with staphylococcal cassette chromosome mec (SCCmec) typing and detection of mupA (marker of high-level mupirocin resistance) and qacA/B (marker associated with chlorhexidine resistance). Factors associated with community-associated (CA-) or healthcare-associated (HA-) MRSA were evaluated. The overall prevalence of MRSA nasal colonization was 3.9%. Of 96 neonates in our retrospective cohort, 60 (63%) were colonized with CA-MRSA strains and 35 (36%) were colonized with HA-MRSA strains. Patients colonized with HA-MRSA were more likely to develop MRSA infections than patients colonized with CA-MRSA (13/35, 37% versus 8/60, 13%; p 0.007), although the interval from colonization to infection was shorter in CA-MRSA-colonized infants (median 0 days, range -1 to 4 versus HA-MRSA-colonized infants, 7 days, -1 to 43; p 0.005). Maternal peripartum antibiotics were associated with CA-MRSA colonization (adjusted odds ratio (aOR) 8.7; 95% CI 1.7-45.0); intubation and surgical procedures were associated with HA-MRSA colonization (aOR 7.8; 95% CI 1.3-47.6 and aOR 6.0; 95% CI 1.4-24.4, respectively). Mupirocin- and chlorhexidine-resistant MRSA was isolated from four and eight patients, respectively; carriage of a mupirocin-resistant strain precluded decolonization. CA-MRSA strains are prominent in the NICU and associated with distinct risk factors. Given community reservoirs for MRSA acquisition and transmission, novel infection prevention strategies are needed. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Efeito da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no periparto Effect of propylene glycol, cobalt and vitamin B12 on the metabolic profile and enzymatic in Santa Inês ewes in peripartum

Directory of Open Access Journals (Sweden)

Rogério Adriano dos Santos

2012-12-01

Full Text Available O presente estudo teve por objetivo avaliar a influência da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no período do periparto. Foram utilizadas 18 ovelhas prenhes, pesando em torno de 40kg. Aproximadamente 30 dias antes da data prevista para o parto foram separadas de maneira aleatória em três grupos e administrados os suplementos conforme a seguir: (G1/n=6 grupo que recebeu propileno glicol (30mL por via oral diariamente; (G2/n=6 grupo que recebeu cobalto (1mg de cloreto de cobalto a 1%, via oral diariamente associado a vitamina B12 (2mg via intramuscular, semanalmente e (G3/n=6 grupo controle. As amostras de sangue das ovelhas para avaliação do perfil metabólico e enzimático (glicose, β-hidroxibutirato-BHB, NEFA, proteína total, albumina, uréia, creatinina, AST, GGT, FA e CK foram colhidas 30 dias antes da data prevista para o parto, uma semana antes (ante-parto, no parto, às 24h, 72h, 5 dias, 15 dias e 30 dias após o parto. Não foi observado cetonúria nos momentos que antecederam ao parto. A administração dos suplementos não influenciou sobre o perfil metabólico, protéico e energético, assim como não houve comprometimento hepático das ovelhas no período do periparto.The aim of this study was to evaluate the influence of the administration of propylene glycol and cobalt associated with vitamin B12 on the metabolic profile and enzymatic activity of Santa Inês ewes in the peripartum period. A total of 18 pregnant ewes, weighing around 40kg were used. Approximately 30 days before the expected date of delivery were randomly separated into three groups and administered supplements as follows: (G1/n = 6 group received propylene glycol (30mL orally daily; (G2/n = 6 group receiving cobalt (1mg cobalt chloride 1%, orally daily associated with vitamin B12 (2mg intramuscular weekly and (G3/n = 6 control group. Blood

Delayed and successful manual removal of abnormally adherent ...

African Journals Online (AJOL)

Encouraging results reported in recent years have led to a gradual shift towards conservative management of select cases of placenta accreta, with the primary aim of conservation of the uterus and fertility. This strategy also avoids the surgical morbidity of peripartum hysterectomy. We report a case of placenta accreta in ...

Incomplete Markets and Imperfect Institutions: Some Challenges Posed by Trust for Contemporary Health Care and Health Policy.

Science.gov (United States)

Schlesinger, Mark; Gray, Bradford H

2016-08-01

As contemporary health policy promotes evidence-based practices using targeted incentives, policy makers may lose track of vital aspects of care that are difficult to measure. For more than a half century, scholars have recognized that these latter aspects play a crucial role in high-quality care and equitable health system performance but depend on the potentially frail reed of providers' trustworthiness: that is, their commitment to facets and outcomes of care not easily assessed by external parties. More recently, early experience with pay for performance in health settings suggests that enhancing financial rewards for the measurable undermines providers' commitment to the unmeasurable, degrading the trustworthiness of their practices. Reformers have looked to revised professional norms or reorganized practice arrangements to bolster the intrinsic motivations required for trustworthiness. We suggest here that these responses are likely to prove inadequate. We propose that they be complemented by a renewed policy-making commitment to nonprofit ownership among health care providers, insurers, and integrated delivery systems. We identify some of the concerns raised in the past with ownership-based policies and propose a set of responses. If these are pursued in combination, they hold the promise of a sustainable ownership-based policy reform for the United States. Copyright © 2016 by Duke University Press.

Perspectives and attitudes of pediatricians concerning post-discharge care practice of premature infants.

Science.gov (United States)

Gad, A; Parkinson, E; Khawar, N; Elmeki, A; Narula, P; Hoang, D

2017-01-01

Survival rates of premature infants are at a historical high and increasingly more pediatricians are caring for former premature infants. The goal of this study was to describe the perspectives and attitudes of pediatricians, as well as, the challenges of rendering post-neonatal intensive care unit (NICU) discharge care for premature infants. An anonymous 22-question web-based survey was emailed to pediatricians who are current members of the American Academy of Pediatrics (AAP) and practicing in Kings County, New York. There were 148 completed surveys with 79% being general pediatricians. Of all respondents, 63% believed that premature infants should have a neonatal high risk follow-up visit within days after discharge and 64% were satisfied with the NICU discharge summary acquisition. While 74% of pediatricians felt comfortable following up with former extremely premature infants, 65% referred to specialists, most often to child development, neurology, and physical and/or occupational therapy. The majority (85%) were more likely to refer premature infants to early intervention. Participating pediatricians varied in their knowledge of immunization and breastfeeding guidelines. Finally, 88% of respondents acknowledged that caregivers of premature infants experience increased stress, with 53% stating that the stress should be addressed. Understanding the perceptions and challenges of pediatricians who care for premature infants may help improve post NICU quality of care. Transition to the outpatient setting is a crucial step in the management of premature infants and a focus on improved hand-off procedures between hospital and physicians may prove beneficial. Also, pediatricians must stay abreast of current recommendations for breastfeeding and vaccinations. Furthermore, emphasis should be given to stress reduction and management for caregivers of former premature infants.

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

Science.gov (United States)

2013-01-01

Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries

Demonstration of the Military Ecological Risk Assessment Framework (MERAF): Apache Longbow - Hell Missile Test at Yuma Proving Ground

Energy Technology Data Exchange (ETDEWEB)

Efroymson, R.A.

2002-05-09

This ecological risk assessment for a testing program at Yuma Proving Ground, Arizona, is a demonstration of the Military Ecological Risk Assessment Framework (MERAF; Suter et al. 2001). The demonstration is intended to illustrate how risk assessment guidance concerning-generic military training and testing activities and guidance concerning a specific type of activity (e.g., low-altitude aircraft overflights) may be implemented at a military installation. MERAF was developed with funding from the Strategic Research and Development Program (SERDP) of the Department of Defense. Novel aspects of MERAF include: (1) the assessment of risks from physical stressors using an ecological risk assessment framework, (2) the consideration of contingent or indirect effects of stressors (e.g., population-level effects that are derived from habitat or hydrological changes), (3) the integration of risks associated with different component activities or stressors, (4) the emphasis on quantitative risk estimates and estimates of uncertainty, and (5) the modularity of design, permitting components of the framework to be used in various military risk assessments that include similar activities. The particular subject of this report is the assessment of ecological risks associated with a testing program at Cibola Range of Yuma Proving Ground, Arizona. The program involves an Apache Longbow helicopter firing Hellfire missiles at moving targets, i.e., M60-A1 tanks. Thus, the three component activities of the Apache-Hellfire test were: (1) helicopter overflight, (2) missile firing, and (3) tracked vehicle movement. The demonstration was limited, to two ecological endpoint entities (i.e., potentially susceptible and valued populations or communities): woody desert wash communities and mule deer populations. The core assessment area is composed of about 126 km{sup 2} between the Chocolate and Middle Mountains. The core time of the program is a three-week period, including fourteen days of

Demonstration of the Military Ecological Risk Assessment Framework (MERAF): Apache Longbow - Hell Missile Test at Yuma Proving Ground

International Nuclear Information System (INIS)

Efroymson, R.A.

2002-01-01

This ecological risk assessment for a testing program at Yuma Proving Ground, Arizona, is a demonstration of the Military Ecological Risk Assessment Framework (MERAF; Suter et al. 2001). The demonstration is intended to illustrate how risk assessment guidance concerning-generic military training and testing activities and guidance concerning a specific type of activity (e.g., low-altitude aircraft overflights) may be implemented at a military installation. MERAF was developed with funding from the Strategic Research and Development Program (SERDP) of the Department of Defense. Novel aspects of MERAF include: (1) the assessment of risks from physical stressors using an ecological risk assessment framework, (2) the consideration of contingent or indirect effects of stressors (e.g., population-level effects that are derived from habitat or hydrological changes), (3) the integration of risks associated with different component activities or stressors, (4) the emphasis on quantitative risk estimates and estimates of uncertainty, and (5) the modularity of design, permitting components of the framework to be used in various military risk assessments that include similar activities. The particular subject of this report is the assessment of ecological risks associated with a testing program at Cibola Range of Yuma Proving Ground, Arizona. The program involves an Apache Longbow helicopter firing Hellfire missiles at moving targets, i.e., M60-A1 tanks. Thus, the three component activities of the Apache-Hellfire test were: (1) helicopter overflight, (2) missile firing, and (3) tracked vehicle movement. The demonstration was limited, to two ecological endpoint entities (i.e., potentially susceptible and valued populations or communities): woody desert wash communities and mule deer populations. The core assessment area is composed of about 126 km 2 between the Chocolate and Middle Mountains. The core time of the program is a three-week period, including fourteen days of

Bring about benefit, forestall harm: what communication studies say about spirituality and cancer care.

Science.gov (United States)

Tullis, Jillian A

2010-01-01

Technological advances in medicine allow health care providers to diagnose diseases earlier, diminish suffering, and prolong life. These advances, although widely revered for changing the face of cancer care, come at a cost for patients, families, and even health care providers. One widely cited consequence of better diagnostics and improved treatment regiments is the sense that there is always one more test or therapy available to extend life. Such an approach to cancer care can prove detrimental to patients? healing. In addition, these new tests and treatments further focus attention on the body as the site of healing and cure while downplaying other aspects of health. The absence of psychological, social, and spiritual care from a patient's cancer care plan compromises healing and makes palliative and end of life care more complicated. In this essay, I discuss the tensions that exist between contemporary cancer care and spirituality and use Communication Studies scholarship to navigate the challenges of integrating a patient's religious or spiritual beliefs into their cancer treatment and care. In addition to discussing the challenges of communicating about sensitive topics such as illness, spirituality, and dying, this article uses narrative examples from a comprehensive cancer center and a hospice (both in the United States) to understand how people with cancer and other terminal illnesses communicate their spirituality and how these conversations influence health care choices and provide comfort. By understanding how patients communicate about topics such as the meaning of life, quality of life, dying and death, providers are better equipped to offer care that is consistent with a patient's beliefs and life goals. This approach maintains that communication is more than a means of transferring information, but is constitutive. By understanding that communication creates our lives and shapes our worlds, lay and professional caregivers can meet patients where

Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach

Directory of Open Access Journals (Sweden)

Sarah Amador

2016-06-01

Full Text Available In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i identity mobilisation and (ii context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care

Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach.

Science.gov (United States)

Amador, Sarah; Goodman, Claire; Mathie, Elspeth; Nicholson, Caroline

2016-06-03

In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

Filtered air plastic chamber as an experimental facility to prove visible damage of crops due to air pollution

Energy Technology Data Exchange (ETDEWEB)

Matsuoka, Y; Yoda, H; Omichi, S; Shiratori, K

1975-01-01

An experimental filtered air chamber was constructed to prove the visible damage of crops due to air pollution. The chamber was provided with another room into which non-filtered ambient air was introduced. The purified air was prepared by filtering ambient air with activated carbon. The average content of air pollutants in the purified air chamber was less than 10 to 20% of the ozone and 20% of the sulfur oxides in the ambient air. However, cultivated vegetables such as tobacco and spinach, which are susceptible to oxidant, showed no visible damage in the filtered air chamber, and showed the same damage in the nonfiltered air chamber as was seen in fields at the same time.

Secure and Efficient Two-Factor User Authentication Scheme with User Anonymity for Network Based E-Health Care Applications.

Science.gov (United States)

Li, Xiong; Niu, Jianwei; Karuppiah, Marimuthu; Kumari, Saru; Wu, Fan

2016-12-01

Benefited from the development of network and communication technologies, E-health care systems and telemedicine have got the fast development. By using the E-health care systems, patient can enjoy the remote medical service provided by the medical server. Medical data are important privacy information for patient, so it is an important issue to ensure the secure of transmitted medical data through public network. Authentication scheme can thwart unauthorized users from accessing services via insecure network environments, so user authentication with privacy protection is an important mechanism for the security of E-health care systems. Recently, based on three factors (password, biometric and smart card), an user authentication scheme for E-health care systems was been proposed by Amin et al., and they claimed that their scheme can withstand most of common attacks. Unfortunate, we find that their scheme cannot achieve the untraceability feature of the patient. Besides, their scheme lacks a password check mechanism such that it is inefficient to find the unauthorized login by the mistake of input a wrong password. Due to the same reason, their scheme is vulnerable to Denial of Service (DoS) attack if the patient updates the password mistakenly by using a wrong password. In order improve the security level of authentication scheme for E-health care application, a robust user authentication scheme with privacy protection is proposed for E-health care systems. Then, security prove of our scheme are analysed. Security and performance analyses show that our scheme is more powerful and secure for E-health care systems when compared with other related schemes.

Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model

Directory of Open Access Journals (Sweden)

Jacqueline Loonen

2018-01-01

Full Text Available Survivors of childhood and adult-onset cancer are at lifelong risk for the development of late effects of treatment that can lead to serious morbidity and premature mortality. Regular long-term follow-up aiming for prevention, early detection and intervention of late effects can preserve or improve health. The heterogeneous and often serious character of late effects emphasizes the need for specialized cancer survivorship care clinics. Multidisciplinary cancer survivorship care requires a coordinated and well integrated health care environment for risk based screening and intervention. In addition survivors engagement and adherence to the recommendations are also important elements. We developed an innovative model for integrated care for cancer survivors, the “Personalized Cancer Survivorship Care Model”, that is being used in our clinic. This model comprises 1. Personalized follow-up care according to the principles of Person Centered Care, aiming to empower survivors and to support self management, and 2. Organization according to a multidisciplinary and risk based approach. The concept of person centered care is based on three components: initiating, integrating and safeguarding the partnership with the patient. This model has been developed as a universal model of care that will work for all cancer survivors in different health care systems. It could be used for studies to improve self efficacy and the cost-effectiveness of cancer survivorship care.

Imagining and Tinkering with Assistive Robotics in Care for the Disabled

DEFF Research Database (Denmark)

Nickelsen, Niels Christian M

2018-01-01

The media and political/managerial levels focus on the opportunities to re-perform the Scandinavian welfare states through digitization. Especially in Denmark, this trend is prominent. Welfare technology is a Scandinavian notion used to point at assistive technologies intending to support...... the elderly and the disabled and their care providers. Feeding assistive robotics (FAR) is a welfare technology, relevant to citizens with no function in their arms. Despite national dissemination strategies, it proves difficult to recruit suitable citizens. There have been many promises for the potential...... implementation. The study exemplifies and demonstrates how ethnography may be used as an important methodological tool in HRI research. The Actor Network Theory idea of ‘follow the actor’ inspired the study that took place as multi-sited ethnography at different locations in Denmark and Sweden. Based on desk...

Telemedicine compared with standard care in type 2 diabetes mellitus

DEFF Research Database (Denmark)

Rasmussen, O. W.; Lauszus, Finn F; Loekke, M

2016-01-01

Introduction Good metabolic control is important in type 2 diabetes mellitus to improve quality of life, work ability and life expectancy, and the use of telemedicine has proved efficient as an add-on to the usual treatment. However, few studies in type 2 diabetes patients have directly compared...... telemedicine with conventional outpatient treatment, and we wanted to evaluate whether telemedicine, compared with standard care, provides equivalent clinical outcomes. Methods Forty patients with type 2 diabetes mellitus allocated from October 2011-July 2012 were randomized to either treatment at home...... by video conferences only or standard outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-hour blood pressure, cholesterol levels and albuminuria. The video-telephone was a broadband solution installed and serviced by the Danish Telephone Company (TDC...

Modeling exposure to depleted uranium in support of decommissioning at Jefferson Proving Ground, Indiana

Energy Technology Data Exchange (ETDEWEB)

Ebinger, M.H. [Los Alamos National Lab., NM (United States); Oxenburg, T.P. [Army Test and Evaluation Command, Aberdeen Proving Ground, MD (United States)

1997-02-01

Jefferson Proving Ground was used by the US Army Test and Evaluation Command for testing of depleted uranium munitions and closed in 1995 under the Base Realignment and Closure Act. As part of the closure of JPG, assessments of potential adverse health effects to humans and the ecosystem were conducted. This paper integrates recent information obtained from site characterization surveys at JPG with environmental monitoring data collected from 1983 through 1994 during DU testing. Three exposure scenarios were evaluated for potential adverse effects to human health: an occasional use scenario and two farming scenarios. Human exposure was minimal from occasional use, but significant risk were predicted from the farming scenarios when contaminated groundwater was used by site occupants. The human health risk assessments do not consider the significant risk posed by accidents with unexploded ordnance. Exposures of white-tailed deer to DU were also estimated in this study, and exposure rates result in no significant increase in either toxicological or radiological risks. The results of this study indicate that remediation of the DU impact area would not substantially reduce already low risks to humans and the ecosystem, and that managed access to JPG is a reasonable model for future land use options.

Transgenic Drosophila simulans strains prove the identity of the speciation gene Lethal hybrid rescue.

Science.gov (United States)

Prigent, Stéphane R; Matsubayashi, Hiroshi; Yamamoto, Masa-Toshi

2009-10-01

Speciation genes are responsible for genetic incompatibilities in hybrids of incipient species and therefore participate in reproductive isolation leading to complete speciation. Hybrid males between Drosophila melanogaster females and D. simulans males die at late larval or prepupal stages due to a failure in chromosome condensation during mitosis. However a mutant male of D. simulans, named Lethal hybrid rescue (Lhr), produces viable hybrid males when crossed to females of D. melanogaster. Recently the Lhr gene has been proposed as corresponding to the CG18468 gene in D. melanogaster. However this identification relied on sequence characteristics more than on a precise mapping and the use of the GAL4/UAS system to drive the transgene in D. melanogaster might have increased the complexity of interaction. Thus here we propose an independent identification of the Lhr gene based on a more precise mapping and transgenic experiments in D. simulans. We have mapped the Lhr gene by using Single Nucleotide Polymorphisms (SNPs) and identified within the candidate region the gene homologous to CG18468 as the Lhr gene as it was previously reported. Transgenic experiments in D. simulans with the native promoter of CG18468 prove that it is the Lhr gene of D. simulans by inducing the lethality of the hybrid males.

Review of analytical results from the proposed agent disposal facility site, Aberdeen Proving Ground

Energy Technology Data Exchange (ETDEWEB)

Brubaker, K.L.; Reed, L.L.; Myers, S.W.; Shepard, L.T.; Sydelko, T.G.

1997-09-01

Argonne National Laboratory reviewed the analytical results from 57 composite soil samples collected in the Bush River area of Aberdeen Proving Ground, Maryland. A suite of 16 analytical tests involving 11 different SW-846 methods was used to detect a wide range of organic and inorganic contaminants. One method (BTEX) was considered redundant, and two {open_quotes}single-number{close_quotes} methods (TPH and TOX) were found to lack the required specificity to yield unambiguous results, especially in a preliminary investigation. Volatile analytes detected at the site include 1, 1,2,2-tetrachloroethane, trichloroethylene, and tetrachloroethylene, all of which probably represent residual site contamination from past activities. Other volatile analytes detected include toluene, tridecane, methylene chloride, and trichlorofluoromethane. These compounds are probably not associated with site contamination but likely represent cross-contamination or, in the case of tridecane, a naturally occurring material. Semivolatile analytes detected include three different phthalates and low part-per-billion amounts of the pesticide DDT and its degradation product DDE. The pesticide could represent residual site contamination from past activities, and the phthalates are likely due, in part, to cross-contamination during sample handling. A number of high-molecular-weight hydrocarbons and hydrocarbon derivatives were detected and were probably naturally occurring compounds. 4 refs., 1 fig., 8 tabs.

Evaluation of extrapolation methods for actual state expenditures on health care in Russian Federation

Directory of Open Access Journals (Sweden)

S. A. Banin

2016-01-01

Full Text Available Forecasting methods, extrapolation ones in particular, are used in health care for medical, biological and clinical research. The author, using accessible internet space, has not met a single publication devoted to extrapolation of financial parameters of health care activities. This determined the relevance of the material presented in the article: based on health care financing dynamics in Russia in 2000–2010 the author examined possibility of application of basic perspective extrapolation methods - moving average, exponential smoothing and least squares. It is hypothesized that all three methods can equally forecast actual public expenditures on health care in medium term in Russia’s current financial and economic conditions. The study result was evaluated in two time periods: within the studied interval and a five-year period. It was found that within the study period all methods have an average relative extrapolation error of 3–5%, which means high precision of the forecast. The study shown a specific feature of the least squares method which were gradually accumulating results so their economic interpretation became possible only in the end of the studied period. That is why the extrapolating results obtained by least squares method are not applicable in an entire study period and rather have a theoretical value. Beyond the study period, however, this feature was found to be the most corresponding to the real situation. It was the least squares method that proved to be the most appropriate for economic interpretation of the forecast results of actual public expenditures on health care. The hypothesis was not confirmed, the author received three differently directed results, while each method had independent significance and its application depended on evaluation study objectives and real social, economic and financial situation in Russian health care system.

Proceedings of the Scientific Conference on Obscuration and Aerosol Research Held in Aberdeen Proving Ground, Maryland on 17-21 June 1985.

Science.gov (United States)

1986-07-01

Chem. Engrs., 32, 35 (1954). 9. Littman, H., Vukovic , D.V., Zdansk, F.K., and Grabavtit, Z.B., Can. J . Chem. Eng., 54, 33 (1976). 10. Morgan, M.H...COMMAND Aberdeen Proving Ground, Maryland 21010-5423 DISTRIBUTIONSTATEMENW A, Approvod iapublic releaB6~ s11 "’ftbui U o ited’ ^ J .. Di scl aimer The...PARTICLE COMPOSITION R. G. Keesee and A. W. Castleman, Jr ........ ........................ .13 NUCLEATION AND PARTICLE GROWTH " S. G. Kim and J . R

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China

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Wenxi Tang

2015-03-01

Full Text Available Background: While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system.Methods: To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences.Discussion: This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1 improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2 improvement on quality of care through continuous care and coordinated supplier behaviours; (3 improvement on the system efficiency through active interaction between suppliers and patients

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China.

Science.gov (United States)

Tang, Wenxi; Sun, Xiaowei; Zhang, Yan; Ye, Ting; Zhang, Liang

2015-01-01

While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. The integrated care system needs collaborative work from different levels

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China

Directory of Open Access Journals (Sweden)

Wenxi Tang

2015-03-01

Full Text Available Background: While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. Methods: To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. Discussion: This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1 improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2 improvement on quality of care through continuous care and coordinated supplier behaviours; (3 improvement on the system efficiency through active interaction between suppliers and patients. Conclusion

The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

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Schopper Andrea

2010-10-01

Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

Infant Care--Does Anybody Care?

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Mills, Belen C.; And Others

1988-01-01

Discusses infant care in the United States by comparing U.S. practices of infant care to that in other industrialized nations. Suggests that in comparison to several other industrialized nations, the U.S. falls behind in providing support for mothers either to stay at home or to have quality alternative child care. (RJC)

Models of psychological service provision under Australia's Better Outcomes in Mental Health Care program.

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Pirkis, Jane; Burgess, Philip; Kohn, Fay; Morley, Belinda; Blashki, Grant; Naccarella, Lucio

2006-08-01

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Test to prove the resistance to incidents of components of electric and control systems in the safety containment of nuclear power plants

International Nuclear Information System (INIS)

1982-01-01

The marginal program for proving the suitability of safety-relevant components of electric and control systems in the safety containment during a loss-of-coolant incident is described. Variant test conditions are established in the component-specific test program. Special attention has been paid to the representation of the course of pressure and temperature for the performance test of the valve room of the Nuclear Power Plant Philippsburg 2. (DG) [de

Care Aides' Relational Practices and Caring Contributions.

Science.gov (United States)

Andersen, Elizabeth A; Spiers, Jude

2016-11-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Care Aides' Relational Practices and Caring Contributions" found on pages 24-30, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Define the application of Swanson's Middle Range Theory of Caring in care aides' relational care practices for nursing home

In situ analysis of soil at an open burning/open detonation disposal facility: J-Field, Aberdeen Proving Ground, Maryland

International Nuclear Information System (INIS)

Martino, L.; Cho, E.; Wrobel, J.

1994-01-01

Investigators have used a field-portable X-Ray Fluorescence (XRF) Analyzer to screen soils for a suite of metals indicative of the open burning and open detonation (OB/OD) activities that occurred at the J-Field site at Aberdeen Proving Ground, Maryland. The field XRF results were incorporated into a multiphase investigation of contaminants at the Toxic Burning Pits Area of Concern at J-Field. The authors determined that the field-portable XRF unit used for the study and the general concept of field XRF screening are invaluable tools for investigating an OB/OD site where intrusive sampling techniques could present unacceptable hazards to site workers

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study.

Science.gov (United States)

Schöttle, Daniel; Schimmelmann, Benno G; Ruppelt, Friederike; Bussopulos, Alexandra; Frieling, Marietta; Nika, Evangelia; Nawara, Luise Antonia; Golks, Dietmar; Kerstan, Andrea; Lange, Matthias; Schödlbauer, Michael; Daubmann, Anne; Wegscheider, Karl; Rohenkohl, Anja; Sarikaya, Gizem; Sengutta, Mary; Luedecke, Daniel; Wittmann, Linus; Ohm, Gunda; Meigel-Schleiff, Christina; Gallinat, Jürgen; Wiedemann, Klaus; Bock, Thomas; Karow, Anne; Lambert, Martin

2018-01-01

The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required. Clinical Trial Registration Number: NCT01888627.

Temporal changes in sphingolipids and systemic insulin sensitivity during the transition from gestation to lactation.

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J Eduardo Rico

Full Text Available Reduced insulin action develops naturally during the peripartum to ensure maternal nutrient delivery to the fetus and neonate. However, increased insulin resistance can facilitate excessive lipolysis which in turn promotes metabolic disease in overweight dairy cattle. Increased fatty acid availability favors the accumulation of the sphingolipid ceramide and is implicated in the pathogenesis of insulin resistance, however, the relationship between sphingolipid metabolism and insulin resistance during the peripartum remains largely unknown. Our objectives were to characterize temporal responses in plasma and tissue sphingolipids in lean and overweight peripartal cows and to establish the relationships between sphingolipid supply and lipolysis, hepatic lipid deposition, and systemic insulin action. Twenty-one multiparous lean and overweight Holstein cows were enrolled in a longitudinal study spanning the transition from gestation to lactation (d -21 to 21, relative to parturition. Plasma, liver, and skeletal muscle samples were obtained, and sphingolipids were profiled using LC/MS/MS. Insulin sensitivity was assessed utilizing intravenous insulin and glucose challenges. Our results demonstrated the following: first, insulin resistance develops postpartum concurrently with increased lipolysis and hepatic lipid accumulation; second, ceramides and glycosylated ceramides accumulate during the transition from gestation to lactation and are further elevated in overweight cows; third, ceramide accrual is associated with lipolysis and liver lipid accumulation, and C16:0- and C24:0-ceramide are inversely associated with systemic insulin sensitivity postpartum; fourth, plasma sphingomyelin, a potential source of ceramides reaches a nadir at parturition and is closely associated with feed intake; fifth, select sphingomyelins are lower in the plasma of overweight cows during the peripartal period. Our results demonstrate that dynamic changes occur in

Temporal changes in sphingolipids and systemic insulin sensitivity during the transition from gestation to lactation

Science.gov (United States)

Rico, J. Eduardo; Saed Samii, Sina; Mathews, Alice T.; Lovett, Jacqueline; Haughey, Norman J.; McFadden, Joseph W.

2017-01-01

Reduced insulin action develops naturally during the peripartum to ensure maternal nutrient delivery to the fetus and neonate. However, increased insulin resistance can facilitate excessive lipolysis which in turn promotes metabolic disease in overweight dairy cattle. Increased fatty acid availability favors the accumulation of the sphingolipid ceramide and is implicated in the pathogenesis of insulin resistance, however, the relationship between sphingolipid metabolism and insulin resistance during the peripartum remains largely unknown. Our objectives were to characterize temporal responses in plasma and tissue sphingolipids in lean and overweight peripartal cows and to establish the relationships between sphingolipid supply and lipolysis, hepatic lipid deposition, and systemic insulin action. Twenty-one multiparous lean and overweight Holstein cows were enrolled in a longitudinal study spanning the transition from gestation to lactation (d -21 to 21, relative to parturition). Plasma, liver, and skeletal muscle samples were obtained, and sphingolipids were profiled using LC/MS/MS. Insulin sensitivity was assessed utilizing intravenous insulin and glucose challenges. Our results demonstrated the following: first, insulin resistance develops postpartum concurrently with increased lipolysis and hepatic lipid accumulation; second, ceramides and glycosylated ceramides accumulate during the transition from gestation to lactation and are further elevated in overweight cows; third, ceramide accrual is associated with lipolysis and liver lipid accumulation, and C16:0- and C24:0-ceramide are inversely associated with systemic insulin sensitivity postpartum; fourth, plasma sphingomyelin, a potential source of ceramides reaches a nadir at parturition and is closely associated with feed intake; fifth, select sphingomyelins are lower in the plasma of overweight cows during the peripartal period. Our results demonstrate that dynamic changes occur in peripartal sphingolipids

What does an experimental test of quantum contextuality prove or disprove?

International Nuclear Information System (INIS)

Winter, Andreas

2014-01-01

The possibility of experimentally testing the Bell–Kochen–Specker theorem is investigated critically, following the demonstrations by Meyer, Kent, and Clifton–Kent that the predictions of quantum mechanics are indistinguishable (up to arbitrary precision) from those of a non-contextual model, and the subsequent debate about the extent to which these models are actually classical or non-contextual. The present analysis starts from a careful consideration of these ‘finite-precision’ approximations. A stronger condition for non-contextual models, dubbed ontological faithfulness, is exhibited. It is shown that this allows us to approximately formulate the constraints in Bell–Kochen–Specker theorems, such as to render the usual proofs robust. Consequently, one can experimentally test to finite precision ontologically faithful non-contextuality, and thus experimentally refute explanations from this smaller class. We include a discussion of the relation of ontological faithfulness to other proposals to overcome the finite precision objection. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical devoted to ‘50 years of Bell’s theorem’. (paper)

[Philosophy of care, care and nursing care: a literature review for a research at the intersection of philosophy and care].

Science.gov (United States)

Remy-Largeau, Isabelle

2011-12-01

Very recently the concept of care has burst on the French philosophical scene. What are the contours of this developing "philosophy of care"? How does it place itself in relation to what are today called the ethics of care? And how does it take account of nursing care, as a discipline understood in its triple dimension: social, pedagogical and epistemological? The research presented in this paper examines some of the founding texts of this philosophy of care through the prism of these questions. It is the partial presentation of a reflection developed from a literature review that will include two other sections. The second section will focus on studying the way in which the ethics of care allow for nursing care and enter into dialogue with the nascent philosophy of care. The third will focus, conversely, on the way nurses integrate reflections derived from ethics of care and the philosophy of care into the evolution of their own discipline and contribute back to the development of a philosophy of care. These three questions are in turn part of more extensive research carried out in preparation for a philosophy thesis. They are meant as an invitation and a contribution towards what we hope will be a successful encounter between philosophy and nursing care.

Health behavior change in advance care planning: an agent-based model

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Natalie C. Ernecoff

2016-02-01

Full Text Available Abstract Background A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1 the rates at which individuals complete the process, 2 how individuals respond to barriers, facilitators, and behavioral variables, and 3 the interactions between these variables. Methods We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process. Results We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature. Conclusions Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating

Health behavior change in advance care planning: an agent-based model.

Science.gov (United States)

Ernecoff, Natalie C; Keane, Christopher R; Albert, Steven M

2016-02-29

A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP) behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM) allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1) the rates at which individuals complete the process, 2) how individuals respond to barriers, facilitators, and behavioral variables, and 3) the interactions between these variables. We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process. We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature. Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating longitudinal data to capture behavioral dynamics.

Interim progress report -- geophysics: Decommissioning of Buildings E5974 and E5978, Aberdeen Proving Ground

International Nuclear Information System (INIS)

McGinnis, M.G.; McGinnis, L.D.; Miller, S.F.; Thompson, M.D.

1992-11-01

Buildings E5974 and E5978, located near the mouth of Canal Creek, were among 10 potentially contaminated sites in the Westwood and Canal Creek areas of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May of 1992. Noninvasive geophysical surveys, including the complementary technologies of magnetics, electrical resistivity, and ground-penetrating radar, were conducted around the perimeters of the buildings to guide a sampling program prior to decommissioning and dismantling. The magnetic anomalies and the electrically conductive areas around these buildings have a spatial relationship similar to that observed in low-lying sites in the Canal Creek area; they are probably associated with construction fill. Electrically conductive terrain is dominant on the eastern side of the site, and resistive terrain predominates on the west. The smaller magnetic anomalies are not imaged with ground radar or by electrical profiling. The high resistivities in the northwest quadrant are believed to be caused by a natural sand lens. The causes of three magnetic anomalies in the high-resistivity area are unidentified, but they are probably anthropogenic

Care management in nursing within emergency care units

Directory of Open Access Journals (Sweden)

Roberta Juliane Tono de Oliveira

2015-12-01

Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

Care management in nursing within emergency care units.

Science.gov (United States)

Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma

2015-12-01

Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

Caring about caring: developing a model to implement compassionate relationship centred care in an older people care setting.

Science.gov (United States)

Dewar, Belinda; Nolan, Mike

2013-09-01

This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments. Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover. The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts. The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'. The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and

Critical Care Implications of the Affordable Care Act.

Science.gov (United States)

Dogra, Anjali P; Dorman, Todd

2016-03-01

To provide an overview of key elements of the Affordable Care Act. To evaluate ways in which the Affordable Care Act will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the Affordable Care Act. Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office. As all of the Affordable Care Act's provisions will not be fully implemented until 2019, we also drew upon cost, population, and utilization projections, as well as the experience of existing state-based healthcare reforms. The Affordable Care Act represents the furthest reaching regulatory changes in the U.S. healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The Affordable Care Act aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the Affordable Care Act outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-Affordable Care Act era.

Cyber security risk management: public policy implications of correlated risk, imperfect ability to prove loss, and observability of self-protection.

Science.gov (United States)

Oğüt, Hulisi; Raghunathan, Srinivasan; Menon, Nirup

2011-03-01

The correlated nature of security breach risks, the imperfect ability to prove loss from a breach to an insurer, and the inability of insurers and external agents to observe firms' self-protection efforts have posed significant challenges to cyber security risk management. Our analysis finds that a firm invests less than the social optimal levels in self-protection and in insurance when risks are correlated and the ability to prove loss is imperfect. We find that the appropriate social intervention policy to induce a firm to invest at socially optimal levels depends on whether insurers can verify a firm's self-protection levels. If self-protection of a firm is observable to an insurer so that it can design a contract that is contingent on the self-protection level, then self-protection and insurance behave as complements. In this case, a social planner can induce a firm to choose the socially optimal self-protection and insurance levels by offering a subsidy on self-protection. We also find that providing a subsidy on insurance does not provide a similar inducement to a firm. If self-protection of a firm is not observable to an insurer, then self-protection and insurance behave as substitutes. In this case, a social planner should tax the insurance premium to achieve socially optimal results. The results of our analysis hold regardless of whether the insurance market is perfectly competitive or not, implying that solely reforming the currently imperfect insurance market is insufficient to achieve the efficient outcome in cyber security risk management. © 2010 Society for Risk Analysis.

Prejudices and elderly patients' personality -- the problem of quality of care and quality of life in geriatric medicine.

Science.gov (United States)

Błachnio, Aleksandra; Buliński, Leszek

2013-08-16

The article discusses the position of elderly patients in medical intervention context. The phenomenon of greying population has changed the attitude towards the old but common observations prove that quality of geriatric care is still unsatisfactory. In order to improve specialists' understanding of ageing, the comparative study on personality among people at different age was designed. The results are discussed in relation to the elderly patient-centred paradigm and in order to counterbalance still present ageist practices. The research involved 164 persons in the early and late adulthood stage ages. Among the old there were the young old (aged 65-74) and the older old (aged 75+). All participants were asked to fill the NEO-FFI. The results prove age-related differences in personality. In late adulthood in comparison to early adulthood there is the decline in openness to experiences. Two traits: agreeableness and conscientiousness increase significantly. Age did not differentiate significantly the level of neuroticism and of extraversion. The results of cluster analyses show the further differences in taxonomies of personality traits at different period of life. The results challenge the stereotypes that present older people as neurotic, and aggressive. The age did not differentiate significantly the level of neuroticism and of extraversion. In general, the obtained results prove that the ageist assumption that the geriatric patients are troublesome is not arguable. This article builds support for effective change in geriatric professional practices and improvement in the elderly patients' quality of life.

[Gender-inclusive care of victims of violence : The model project "Gender Gewaltkonzept" at the University Hospital Aachen].

Science.gov (United States)

Evler, A; Scheller, M; Wagels, L; Bergs, R; Clemens, B; Kohn, N; Pütz, A; Voss, B; Schneider, F; Habel, U

2016-07-01

Violence is a topic of great social relevance, frequently causing tremendous health consequences for those affected and high consequential costs for health care and the national economy. The established consulting and assistance services are usually restricted to offers for ambulant supply, mainly from private agencies or societies. As a result, there is no identification and care for patients who have experienced violence and who are treated in hospital. Another deficiency is the identification and care of male victims of violence. Despite wide-ranging offers of assistance, only very few gender-specific consulting and support services have been available to date.Therefore, the model project "Gender Gewaltkonzept" was initiated at Aachen University Hospital to assess the prevalence of violence and the potential consequences of the violence experienced on the patients' health. In addition, we investigated whether males and females are in need of different supply requirements.Based on the results of the project "Gender Gewaltkonzept" so far, and on prevalence estimates proving that there is a high rate of violent experiences in both males and females, this overview is aimed at presenting the aid and protection concepts available for victims of violence, in addition to the existing deficiencies of the care system. We present approaches to resolving these deficiencies to be able to establish all-encompassing gender-appropriate support for victims of violence.

Contingencies of the will: Uses of harm reduction and the disease model of addiction among health care practitioners.

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Szott, Kelly

2015-09-01

The concept of addiction as a disease is becoming firmly established in medical knowledge and practice at the same time as the logics of the harm reduction approach are gaining broader acceptance. How health care practitioners understand and intervene upon drug use among their patients is complicated by these two models. While harm reduction can be understood as a form of governmentality wherein drug-taking individuals express their regulated autonomy through self-governance, the notion of addiction as a disease removes the option of self-governance through negating the will of the individual. Through analysis of qualitative interviews conducted with 13 health care practitioners who provide care for economically marginalized people who use drugs in New York City, it was found that the absence of will articulated in constructions of addiction as disease offered a gateway through which health care practitioners could bring in ideological commitments associated with harm reduction, such as the de-stigmatization of drug use. Despite differences in the attribution of agency, sewing together these two approaches allowed health care practitioners to work with drug-using patients in practical and compassionate ways. This resembles the strategic deployment of diverse subjectivities found in feminist, post-structural liberatory projects wherein differential subjectification proves tactical and productive. Although drug-using patients may enjoy the benefits of practical and compassionate health care, the conjoint facilitation and denouncement of their will occasioned by the use of both harm reduction and the disease model of addiction imply their management by both pastoral and disciplinary technologies of power. © The Author(s) 2014.

Contingencies of the will: Uses of harm reduction and the disease model of addiction among health care practitioners

Science.gov (United States)

Szott, Kelly

2015-01-01

The concept of addiction as a disease is becoming firmly established in medical knowledge and practice at the same time as the logics of the harm reduction approach are gaining broader acceptance. How health care practitioners understand and intervene upon drug use among their patients is complicated by these two models. While harm reduction can be understood as a form of governmentality wherein drug-taking individuals express their regulated autonomy through self-governance, the notion of addiction as a disease removes the option of self-governance through negating the will of the individual. Through analysis of qualitative interviews conducted with 13 health care practitioners who provide care for economically marginalized people who use drugs in New York City, it was found that the absence of will articulated in constructions of addiction as disease offered a gateway through which health care practitioners could bring in ideological commitments associated with harm reduction, such as the de-stigmatization of drug use. Despite differences in the attribution of agency, sewing together these two approaches allowed health care practitioners to work with drug-using patients in practical and compassionate ways. This resembles the strategic deployment of diverse subjectivities found in feminist, post-structural liberatory projects wherein differential subjectification proves tactical and productive. Although drug-using patients may enjoy the benefits of practical and compassionate health care, the conjoint facilitation and denouncement of their will occasioned by the use of both harm reduction and the disease model of addiction imply their management by both pastoral and disciplinary technologies of power. PMID:25394654

Beyond Care Avoidance and Care Paralysis : Theorizing Public Mental Health Care

NARCIS (Netherlands)

Schout, Gert; de Jong, Gideon; Zeelen, Jacques

Care avoidance refers to the condition wherein clients do not seek assistance and do not attend appointments although they are in need of help. Care avoidance is linked to another phenomenon, the inability to help clients with multiple and complex problems by social services and care facilities, in

Caring Science and the Development of Forensic Psychiatric Caring.

Science.gov (United States)

Hörberg, Ulrica

2015-10-01

This study aimed to discuss how caring science can contribute and provide a theoretical foundation for the development of caring within forensic psychiatric care. It is not only a challenge but also a great opportunity to use caring science theory within forensic psychiatric care when caring for the patients and supporting their health processes. There is a need for more knowledge about, understanding of, and willingness to care for patients within forensic psychiatric settings in a "true caring" way. In order to achieve this, a caring culture is required, one that supports carers and provides them with opportunities to further develop a caring attitude. © 2014 Wiley Periodicals, Inc.

Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

Directory of Open Access Journals (Sweden)

Carlfjord Siw

2010-08-01

Full Text Available Abstract Background Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC. The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden. Methods A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption. Results The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process. Conclusion When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the

Metabolic control of feed intake: implications for metabolic disease of fresh cows.

Science.gov (United States)

Allen, Michael S; Piantoni, Paola

2013-07-01

The objective of this article is to discuss metabolic control of feed intake in the peripartum period and its implications for metabolic disease of fresh cows. Understanding how feed intake is controlled during the transition from gestation to lactation is critical to both reduce risk and successfully treat many metabolic diseases. Copyright © 2013. Published by Elsevier Inc.

Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

Science.gov (United States)

Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

2016-01-01

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

Science.gov (United States)

Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

2016-05-01

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

Factors of human capital related to project success in health care work units.

Science.gov (United States)

Suhonen, Marjo; Paasivaara, Leena

2011-03-01

To explore factors of human capital related to project success that employees expect from nurse managers. Human capital refers to those resources that managers working with projects possess, such as abilities, knowledge and qualities of character. The data were collected by open interviews (n=14) with nurses, public health nurses and nurse managers working in primary health care and a hospital. Data analysis was carried out using qualitative content analysis. The main factors of human capital related to project success proved to be as follows: (1) management of enthusiastic project culture, (2) management of regeneration and (3) management of emotional intelligence. Future research is needed on the kind of means nurse managers use in human capital management in projects and how they see their possibilities in managing human capital. Human capital management skills should be underlined as an important competence area when recruiting a nurse manager. The success of health care projects cannot be improved only through education or by training of nurse managers; in addition, projects need nurse managers who understand workplace spirituality and have high emotional intelligence. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Dementia Care: Intersecting Informal Family Care and Formal Care Systems

Directory of Open Access Journals (Sweden)

Prabhjot Singh

2014-01-01

Full Text Available Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement.

Unfinished nursing care, missed care, and implicitly rationed care: State of the science review.

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Jones, Terry L; Hamilton, Patti; Murry, Nicole

2015-06-01

The purposes of this review of unfinished care were to: (1) compare conceptual definitions and frameworks associated with unfinished care and related synonyms (i.e. missed care, implicitly rationed care; and care left undone); (2) compare and contrast approaches to instrumentation; (3) describe prevalence and patterns; (4) identify antecedents and outcomes; and (5) describe mitigating interventions. A literature search in CINAHL and MEDLINE identified 1828 articles; 54 met inclusion criteria. Search terms included: implicit ration*, miss* care, ration* care, task* undone, and unfinish*care. Analysis was performed in three phases: initial screening and sorting, comprehensive review for data extraction (first author), and confirmatory review to validate groupings, major themes, and interpretations (second author). Reviewed literature included 42 quantitative reports; 7 qualitative reports; 1 mixed method report; and 4 scientific reviews. With one exception, quantitative studies involved observational cross-sectional survey designs. A total of 22 primary samples were identified; 5 involved systematic sampling. The response rate was >60% in over half of the samples. Unfinished care was measured with 14 self-report instruments. Most nursing personnel (55-98%) reported leaving at least 1 task undone. Estimates increased with survey length, recall period, scope of response referent, and scope of resource scarcity considered. Patterns of unfinished care were consistent with the subordination of teaching and emotional support activities to those related to physiologic needs and organizational audits. Predictors of unfinished care included perceived team interactions, adequacy of resources, safety climate, and nurse staffing. Unfinished care is a predictor of: decreased nurse-reported care quality, decreased patient satisfaction; increased adverse events; increased turnover; decreased job and occupational satisfaction; and increased intent to leave. Unfinished care is a

[Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

Science.gov (United States)

Bauer, M; Bach, A

1998-06-01

Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law.

The meaning of care dependency as shared by care givers and care recipients : a concept analysis

NARCIS (Netherlands)

Boggatz, Thomas; Dijkstra, Ate; Lohrmann, Christa; Dassen, Theo

2007-01-01

Aim. This paper is a report of a concept analysis to identify a meaning of care dependency that can be shared by both care givers and care recipients. Background. Care dependency can be perceived from the care recipient's and the care giver's perspective. To allow for comparisons, both sides should