Sample records for reach definitive care

  1. Improving exposure scenario definitions within REACH

    Lee, Jihyun; Pizzol, Massimo; Thomsen, Marianne

    instruments to support a precautionary chemicals management system and to protect receptor’s health have also been increasing. Since 2007, the European Union adopted REACH (the Regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals): REACH makes industry responsible for assessing...... the different background exposure between two countries allows in fact the definition of a common framework for improving exposure scenarios within REACH system, for monitoring environmental health, and for increasing degree of circularity of resource and substance flows. References 1. European Commission...

  2. Access to expert stroke care with telemedicine: REACH MUSC

    Abby Swanson Kazley


    Full Text Available Stroke is a leading cause of death and disability, and rtPA can significantly reduce the long-term impact of acute ischemic stroke (AIS if given within 3 hours of symptom onset. South Carolina is located in the stroke belt and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality.We used a retrospective cross-sectional design examining Census data from 2000 and Geographic Information Systems (GIS analysis to identify South Carolina residents that live within 30 or 60 minutes of a Primary Stroke Center (PSC or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a Primary Stroke Center (PSC or a REACH MUSC hospital within 30 or 60 minutes. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within sixty minutes given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within sixty minutes of expert stroke care, and 43% of the population to be within 30 minute drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can

  3. RiverCare communication strategy for reaching beyond

    Cortes Arevalo, Juliette; den Haan, Robert Jan; Berends, Koen; Leung, Nick; Augustijn, Denie; Hulscher, Suzanne J. M. H.


    Effectively communicating river research to water professionals and researchers working in multiple disciplines or organizations is challenging. RiverCare studies the mid-term effects of innovative river interventions in the Netherlands to improve river governance and sustainable management. A total of 21 researchers working at 5 universities are part of the consortium, which also includes research institutes, consultancies, and water management authorities. RiverCare results do not only benefit Dutch river management, but can also provide useful insights to challenges abroad. Dutch partner organizations actively involved in RiverCare are our direct users. However, we want to reach water professionals from the Netherlands and beyond. To communicate with and disseminate to these users, we set up a communication strategy that includes the following approaches : (1) Netherlands Centre of River studies (NCR) website to announce activities post news, not limited to RiverCare; (2) A RiverCare newsletter that is published twice per year to update about our progress and activities; (3) A multimedia promotional providing a 'first glance' of RiverCare. It consists of four video episodes and an interactive menu; (4) An interactive knowledge platform to provide access, explain RiverCare results and gather feedback about the added value and potential use of these results; and (5) A serious gaming environment titled Virtual River where actors can play out flood scaling intervention and monitoring strategies to assess maintenance scenarios. The communication strategy and related approaches are being designed and developed during the project. We use participatory methods and systematic evaluation to understand communication needs and to identify needs for improvement. As a first step, RiverCare information is provided via the NCR website. The active collaboration with the NCR is important to extend communication efforts beyond the RiverCare consortium and after the program ends

  4. The ReACH Collaborative--improving quality home care.

    Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A


    Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

  5. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence.

    Felici, N; Marcoccio, I; Giunta, R; Haerle, M; Leclercq, C; Pajardi, G; Wilbrand, S; Georgescu, A V; Pess, G


    The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered "not defined". A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20° for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.

  6. 29 CFR 825.125 - Definition of health care provider.


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

  7. Training in intensive care medicine. A challenge within reach.

    Castellanos-Ortega, A; Rothen, H U; Franco, N; Rayo, L A; Martín-Loeches, I; Ramírez, P; Cuñat de la Hoz, J


    The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.

  8. Cultural democracy: the way forward for primary care of hard to reach New Zealanders.

    Finau, Sitaleki A; Finau, Eseta


    The use of cultural democracy, the freedom to practice one's culture without fear, as a framework for primary care service provision is essential for improved health service in a multi cultural society like New Zealand. It is an effective approach to attaining health equity for all. Many successful health ventures are ethnic specific and have gone past cultural competency to the practice of cultural democracy. That is, the services are freely taking on the realities of clients without and malice from those of other ethnicities. In New Zealand the scientific health service to improve the health of a multi cultural society are available but there is a need to improve access and utilization by hard to reach New Zealanders. This paper discusses cultural democracy and provide example of how successful health ventures that had embraced cultural democracy were implemented. It suggests that cultural democracy will provide the intellectual impetus and robust philosophy for moving from equality to equity in health service access and utilization. This paper would provide a way forward to improved primary care utilization, efficiency, effectiveness and equitable access especially for the hard to reach populations. use the realities of Pacificans in New Zealand illustrate the use of cultural democracy, and thus equity to address the "inverse care law" of New Zealand. The desire is for primary care providers to take cognizance and use cultural democracy and equity as the basis for the design and practice of primary health care for the hard to reach New Zealanders.

  9. Reviewing the definition of crisis in dementia care

    Vroomen Janet MacNeil


    Full Text Available Abstract Background Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice. Methods We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings. Results Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis. If the crisis is not resolved, the cycle continues. Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia. Conclusions This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.

  10. Improving Adherence to Care Among "Hard to Reach" HIV-Infected Patients in Argentina.

    Jones, Deborah L; Sued, Omar; Cecchini, Diego; Bofill, Lina; Cook, Ryan; Lucas, Mar; Bordato, Alejandra; Cassetti, Isabel; Cahn, Pedro; Weiss, Stephen M


    Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.

  11. Training in data definitions improves quality of intensive care data

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF


    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

  12. Adapting a tertiary-care pediatric weight management clinic to better reach Spanish-speaking families.

    Guzman, Angelica; Irby, Megan B; Pulgar, Camila; Skelton, Joseph A


    Pediatric obesity continues to be an epidemic, affecting Hispanic children disproportionately. Recent recommendations outline a step-wise approach to the treatment of overweight and obese children, culminating in tertiary-care, multidisciplinary programs. We detail here how our tertiary-care, family-based, pediatric weight management clinic addressed the problem of few Spanish-speaking families enrolling in treatment after referral by adding a Bilingual Case Manager. Utilizing a family-centered, high-contact, personal approach, our program increased the number of Hispanic families enrolling over ten-fold. Further, outcomes in Hispanic families were equal to or better than other racial/ethnic groups. Lessons learned from this experience may benefit other obesity treatment programs trying to improve care of Spanish-speaking families.

  13. 5 CFR 792.209 - What is the definition of child care subsidy program?


    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What is the definition of child care subsidy program? 792.209 Section 792.209 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Subsidy Program Legislation and to Whom Does It Apply? § 792.209 What is the definition of child care...

  14. 5 CFR 792.212 - What is the definition of a child care contractor?


    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What is the definition of a child care contractor? 792.212 Section 792.212 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... Legislation and to Whom Does It Apply? § 792.212 What is the definition of a child care contractor? Section...

  15. Point-of-care diagnostics: extending the laboratory network to reach the last mile.

    Drain, Paul K; Rousseau, Christine


    More point-of-care (POC) diagnostic tests are becoming available for HIV diagnosis and treatment in resource-limited settings. These novel technologies have the potential to foster decentralized HIV care and treatment for the benefit of clinical laboratories, HIV clinics, and HIV-infected patients. There continue to be many business, technological, and operational challenges that limit product development and regulatory approval, which limits products available for the required operational and cost-effectiveness studies and delays policy adoption and implementation. Although the rapid HIV diagnostic test has been widely successful, the pathways for POC CD4 cell count and HIV viral load assay analyzers have been more challenging. We describe significant hurdles for product development, approval, and implementation, which include the business case, technical development, clinical impact, and integrating laboratory and clinical networks. The objective of this review is to highlight the obstacles for developing and implementing appropriate strategies for POC HIV testing assays to improve the clinical services for HIV-infected patients in resource-limited settings.

  16. Implications of the Definition of an Episode of Care Used in the Comprehensive Care for Joint Replacement Model.

    Ellimoottil, Chad; Ryan, Andrew M; Hou, Hechuan; Dupree, James M; Hallstrom, Brian; Miller, David C


    Under the Comprehensive Care for Joint Replacement (CJR) model, hospitals are held accountable for nearly all Medicare payments that occur during the initial hospitalization until 90 days after hospital discharge (ie, the episode of care). It is not known whether unrelated expenditures resulting from this "broad" definition of an episode of care will affect participating hospitals' average episode-of-care payments. To compare the CJR program's broad definition of an episode of care with a clinically narrow definition of an episode of care. We identified Medicare claims for 23 251 patients in Michigan who were Medicare beneficiaries and who underwent joint replacement during the period from 2011 through 2013 at hospitals located in metropolitan statistical areas. Using specifications from the CJR model and the clinically narrow Hospital Compare payment measure, we constructed episodes of care and calculated 90-day episode payments. We then compared hospitals' average 90-day episode payments using the 2 definitions of an episode of care and fit linear regression models to understand whether payment differences were associated with specific hospital characteristics (average Centers for Medicare & Medicaid Services-hierarchical condition categories risk score, rural hospital status, joint replacement volume, percentage of Medicaid discharges, teaching hospital status, number of beds, percentage of joint replacements performed on African American patients, and median income of the hospital's county). We performed analyses from July 1 through October 1, 2015. The correlation and difference between average 90-day episode payments using the broad definition of an episode of care in the CJR model and the clinically narrow Hospital Compare definition of an episode of care. We identified 23 251 joint replacements (ie, episodes of care). The 90-day episode payments using the broad definition of the CJR model ranged from $17 349 to $29 465 (mean [SD] payment, $22 122

  17. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria.

    Stone, Nimalie D; Ashraf, Muhammad S; Calder, Jennifer; Crnich, Christopher J; Crossley, Kent; Drinka, Paul J; Gould, Carolyn V; Juthani-Mehta, Manisha; Lautenbach, Ebbing; Loeb, Mark; Maccannell, Taranisia; Malani, Preeti N; Mody, Lona; Mylotte, Joseph M; Nicolle, Lindsay E; Roghmann, Mary-Claire; Schweon, Steven J; Simor, Andrew E; Smith, Philip W; Stevenson, Kurt B; Bradley, Suzanne F


    (See the commentary by Moro, on pages 978-980 .) Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.

  18. 5 CFR 792.211 - What is the definition of a Federally sponsored child care center?


    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What is the definition of a Federally sponsored child care center? 792.211 Section 792.211 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Subsidy Program Legislation and to Whom Does It Apply? § 792.211 What is the definition of a Federally...

  19. Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps.

    Sommanustweechai, Angkana; Putthasri, Weerasak; Nwe, Mya Lay; Aung, Saw Thetlya; Theint, Mya Min; Tangcharoensathien, Viroj; Wynn, San Shway


    Myanmar is classified as critical shortage of health workforce. In responses to limited number of trained health workforce in the hard-to-reach and remote areas, the MOH trained the Community Health Worker (CHW) as health volunteers serving these communities on a pro bono basis. This study aimed to assess the socio-economic profiles, contributions of CHW to primary health care services and their needs for supports to maintain their quality contributions in rural hard to reach areas in Myanmar. In 2013, cross-sectional census survey was conducted on all three groups of CHW classified by their training dates: (1) prior to 2000, (2) between 2000 and 2011, and (3) more recently trained in 2012, who are still working in 21 townships of 17 states and regions in Myanmar, using a self-administered questionnaire survey in the Burmese language. The total 715 CHWs from 21 townships had completely responded to the questionnaire. CHWs were trained to support the work of midwives in the sub-centres and health assistant and midwives in rural health centres (RHCs) such as community mobilization for immunization, advocates of safe water and sanitation, and general health education and health awareness for the citizens. CHWs were able to provide some of the services by themselves, such as treatment of simple illnesses, and they provided services to 62 patients in the last 6 months. Their contributions to primary health care services were well accepted by the communities as they are geographically and culturally accessible. However, supports from the RHC were inadequate in particular technical supervision, as well as replenishment of CHW kits and financial support for their work and transportation. In practice, 6 % of service provided by CHWs was funded by the community and 22 % by the patients. The CHW's confidence in providing health services was positively associated with their age, education, and more recent training. A majority of them intended to serve as a CHW for more than

  20. Pharmaceutical care in the Netherlands. History, definition and projects

    van Mil, J.W F


    The evolving concept of Pharmaceutical Care knows different interpretations in a different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical care is tested in the TOM and OMA

  1. Pharmaceutical care in the Netherlands. History, definition and projects

    van Mil, J.W F


    The evolving concept of Pharmaceutical Care knows different interpretations in a different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical care is tested in the TOM and

  2. Pharmaceutical care in the Netherlands. History, definition and projects

    van Mil, J.W F


    The evolving concept of Pharmaceutical Care knows different interpretations in a different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical care is tested in the TOM and OMA

  3. Psychological Care in Nursing Education and Practice: A Search for Definition and Dimensions.

    Priest, Helena M.


    A literature review and analysis of nursing textbooks found little agreement on definition and dimensions of psychological care in nursing. Most texts stress the importance of patients' need for information and education, with less agreement about emotional care, counseling, assessment, and support. (SK)

  4. Definition of Professionalism by Different Groups of Health Care Students

    Zafiropoulos, George


    Professionalism is important in all service-providing professions. Professional bodies have extensive rules and regulations creating the foundations of the definition of professionalism, its meaning and these rules have to be followed. In view of this, healthcare students are given intensive training. A prospective study conducted in a District…

  5. Generic project definitions for improvement of health care delivery: a case-based approach.

    Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap


    The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

  6. Q-methodology: Definition and Application in Health Care Informatics

    Valenta, Annette L.; Wigger, Ulrike


    Objective: To introduce the Q-methodology research technique to the field of health informatics. Q-methodology—the systematic study of subjectivity—was used to identify and categorize the opinions of primary care physicians and medical students that contributed to our understanding of their reasons for acceptance of and/or resistance to adapting information technologies in the health care workplace.

  7. Definition of problems of persons in sheltered care environments

    Fetzner, W. N.


    Innovations in health care using aerospace technologies are described. Voice synthesizer and voice recognition technologies were used in developing voice controlled wheel chairs and optacons. Telephone interface modules are also described.

  8. Canadian ethnographic study of sources and definitions of theological reflection in pastoral care and counseling.

    O'Connor, Thomas St James; Meakes, Elizabeth


    What are the sources and definitions of theological reflection developed by Canadian practitioners of pastoral care and counseling? This study is part of a larger qualitative research project on theological reflection. This research reviews the literature, describes the ethnographic method, and presents the findings with a sample of 75. Main sources are sacred texts, personal experience, experiences of clients, and traditions of faith group. Definitions are meaning making, discovering the divine and discipleship with recommendations for future research listed.

  9. Implications of the 90-day episode definition used for the Comprehensive Care for Joint Replacement model

    Ellimoottil, Chad; Ryan, Andrew M.; Hou, Hechuan; Dupree, James M.; Hallstrom, Brian; Miller, David C.


    Importance Under the Comprehensive Care for Joint Replacement (CJR) model, hospitals are held accountable for nearly all Medicare payments that occur during the initial hospitalization through 90-days post-discharge (i.e., episode of care). It is unknown whether unrelated expenditures resulting from this “broad” episode definition will impact participating hospital’s average 90-day episode payments. Objective To compare the CJR program’s broad episode definition to a clinically-narrow episode definition Design We identified Medicare claims for patients in Michigan who underwent joint replacement from 2011 through 2013. Using specifications from the CJR model and the clinically-narrow Hospital Compare payment measure, we constructed episodes of care and calculated 90-day episode payments. We then compared hospitals’ average 90-day episode payments using the two episode definitions and fit linear regression models to understand whether payment differences were associated with specific hospital characteristics (average CMS-HCC risk score, rural hospital status, joint replacement volume, percentage of Medicaid discharges, teaching hospital status, number of beds, percentage of joint replacements performed on African American patients and median income of the hospital’s county). Setting All Michigan hospitals located in metropolitan statistical areas Participants Medicare beneficiaries Main Outcome and Measure(s) The correlation and difference between average 90-day episode payments using the broad CJR model episode definition and the clinically-narrow Hospital Compare episode definition. Results We identified 23,251 joint replacement episodes. 90-day episode payments using the broad CJR episode definition ranged from $17,349 to $29,465 (mean: $22,122, standard deviation: $2,600). Episode payments were slightly lower (mean: $21,670) when the Hospital Compare episode definition was used. Both methods were strongly correlated (r=0.99, p<0.001). The average

  10. Generic project definitions for improvement of health care delivery: A case-base approach

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.


    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  11. Generic project definitions for improvement of health care delivery: A case-base approach

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.


    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  12. Philosophical debates about the definition of death: who cares?

    Youngner, S J; Arnold, R M


    Since the Harvard Committee's bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committee's proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead.

  13. [Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency].

    Nüchtern, Elisabeth; Gansweid, Barbara; Gerber, Hans; von Mittelstaedt, Gert


    Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their

  14. Lessons learned from the science of caring: Extending the reach of psychosocial oncology: The International Psycho-Oncology Society 2016 Sutherland Award Lecture.

    Bultz, Barry D


    In medicine, referral to a medical oncology specialty is based on recent history, physical examination, pathology, surgery reports, imaging, blood work, and the patient's vital signs. By contrast, referral to a psychosocial specialist has typically been based on the patients expressed request for psychosocial support or the health care team's observation of the patient's limited adjustment or poor coping with the diagnosis, treatment, or end-of-life distress. These observations are usually based on clinical acumen not on metrics. In psychosocial oncology, by committing to the science of caring and relying on the use of standardized tools to screen for distress, the multidisciplinary cancer care team assess, communicate, and intervene on what is measured. That is, health care providers can begin to address the patients' identified concerns. Branding distress as the 6th vital sign and incorporating screening for distress into standard cancer practice can be an effective strategy to challenging the resistance in implementation of psychosocial oncology in cancer care institutions. Accreditation agencies are endorsing the need to assess patient distress and better manage symptoms of distress as part of routine and standardized patient care. While many international organizations and societies support the importance of screening, implementing screening for distress still has a long way to go to be operationalized in many cancer care programs. Screening for distress when implemented does, however, create an opportunity for psychosocial oncology to extend its reach into cancer care programs and institutions. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Rationalizing definitions and procedures for optimizing clinical care and public health in fetal death and stillbirth.

    Joseph, K S; Kinniburgh, Brooke; Hutcheon, Jennifer A; Mehrabadi, Azar; Dahlgren, Leanne; Basso, Melanie; Davies, Cheryl; Lee, Lily


    Despite the recent focus on stillbirth, there remains a profound need to address problems associated with the definitions and procedures related to fetal death and stillbirth. The current definition of fetal death, first proposed in 1950, needs to be updated to distinguish between the timing of fetal death (which has etiologic and prognostic significance) and the timing of stillbirth (ie, the delivery of the dead fetus). Stillbirth registration procedures, modeled after live birth registration and not death registration, also need to be modernized because they can be an unnecessary burden on some grieving families. The problems associated with fetal death definitions and stillbirth-associated procedures are highlighted by selective fetal reduction in multifetal pregnancy; in many countries, the fetus reduced at 10-13 weeks of gestation and delivered at term gestation requires stillbirth registration and a burial permit even if fetal remains cannot be identified. An international consensus is needed to standardize the definition of reportable fetal deaths; ideally this should be based on the timing of fetal death and should address the status of pregnancy terminations. In this article, we list propositions for initiating an international dialogue that will rationalize fetal death definitions, registration criteria, and associated procedures, and thereby improve clinical care and public health.

  16. Using social network methods to reach out-of-care or ART-nonadherent HIV+ injection drug users in Russia: addressing a gap in the treatment cascade

    Yuri Amirkhanian


    Full Text Available Introduction: HIV treatment to reduce downstream HIV incidence and to decrease disease mortality and morbidity at a population level both require that hidden, out-of-care people living with HIV (PLH in the community be reached and engaged to enter care. This research evaluated the feasibility of reaching out-of-care or non-adherent PLH through members of their social networks in St Petersburg, Russia. Materials and Methods: To recruit a social network sample of HIV-positive injection drug users, 16 HIV+ seeds were enrolled into the study through PLH-oriented websites and online forums using recruitment ads or approached in needle exchange sites. Interested persons called the study phone number and completed a brief eligibility interview. Seed inclusion criteria were HIV+ status, being 18 years or older, having ever injected drugs, and having not visited an HIV doctor in the past 6 months. Seeds provided blood specimens tested for HIV to confirm their self-reported status. Eligible seeds were enrolled, completed brief network elicitation interview, and were asked to invite their own HIV+ friends into the study. Incentives were provided as compensation for participants’ time and additional smaller incentives were provided for inviting each HIV+ network member to also participate. The seed's PLH friends established the first ring of participants who, in turn were asked to invite their own PLH friends (second ring. All study participants completed assessment of psychosocial wellbeing and sexual and injection-related HIV risk behaviour. Blood samples were collected from all participants to confirm their HIV+ status. Results: Through this chain referral process, the initial 16 seeds led to the enrolment of a total of 66 PLH from the community (mean=4 per initial seed, most of whom – like the seed – were not presently in HIV care or were ART non-adherent. Conclusions: Implementation of treatment cascade goals requires complementing conventional

  17. Health and beyond...strategies for a better India: using the "prison window" to reach disadvantaged groups in primary care

    Soumyadeep Bhaumik


    Full Text Available As of 2013, the latest statistics available, more than 400,000 individuals are lodged in Indian prisons. Prisoners represent a heterogeneous population, belonging to socially diverse and economically disadvantaged sections of society with limited knowledge about health and healthy lifestyles. There is considerable evidence to show that prisoners in India have an increased risk of mental disorders including self-harm and are highly susceptible to various communicable diseases. Coupled together with abysmal living conditions and poor quality of medical services, health in prisons is a matter of immense human rights concern. However, the concept and the subsequent need to view prison health as an essential part of public health and as a strategic investment to reach persons and communities out of the primary health system ambit is poorly recognized in India. This article discusses the current status of prison healthcare in India and explores various potential opportunities the "prison window" provides. It also briefly deliberates on the various systematic barriers in the Indian prison health system and how these might be overcome to make primary healthcare truly available for all.

  18. A Review of the Construct of Demoralization: History, Definitions, and Future Directions for Palliative Care.

    Robinson, Sophie; Kissane, David W; Brooker, Joanne; Burney, Susan


    Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.

  19. International non-governmental organizations' provision of community-based tuberculosis care for hard-to-reach populations in Myanmar, 2013-2014.

    Soe, Kyaw Thu; Saw, Saw; van Griensven, Johan; Zhou, Shuisen; Win, Le; Chinnakali, Palanivel; Shah, Safieh; Mon, Myo Myo; Aung, Si Thu


    National tuberculosis (TB) programs increasingly engage with international non-governmental organizations (INGOs), especially to provide TB care in complex settings where community involvement might be required. In Myanmar, however, there is limited data on how such INGO community-based programs are organized and how effective they are. In this study, we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar, and assess their contribution to TB case detection. We conducted a descriptive study using program data from four INGOs and the National TB Program (NTP) in 2013-2014. For each INGO, we extracted information on its approach and key activities, the number of presumptive TB cases referred and undergoing TB testing, and the number of patients diagnosed with TB and their treatment outcomes. The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships. All four INGOs implemented community-based TB care in challenging contexts, targeting migrants, post-conflict areas, the urban poor, and other vulnerable populations. Two recruited community volunteers via existing community health volunteers or health structures, one via existing community leaderships, and one directly involved TB infected/affected individuals. Two INGOs compensated volunteers via performance-based financing, and two provided financial and in-kind initiatives. All relied on NTP laboratories for diagnosis and TB drugs, but provided direct observation treatment support and treatment follow-up. A total of 21 995 presumptive TB cases were referred for TB diagnosis, with 7 383 (34%) new TB cases diagnosed and almost all (98%) successfully treated. The four INGOs contributed to the detection of, on average, 36% (7 383/20 663) of the total new TB cases in their respective townships (range: 15-52%). Community-based TB

  20. Rehabilitation Enablement in Chronic Heart Failure—a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial

    Lang, C C; Smith, K; Jolly, K; Davis, R; Hayward, C; Wingham, J; Abraham, C; Green, C; Warren, F C; Britten, N; Greaves, C J; Doherty, P; Austin, J; Van Lingen, R; Singh, S; Buckingham, S; Paul, K; Taylor, R S; Dalal, H M


    Introduction The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed. Methods and analysis A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients. Ethics and dissemination The study is approved by the East of Scotland Research Ethics

  1. Problems Associated with Coordination and Role Definitions in Health Care Teams: A Hospice Program Evaluation and Intervention Case Study.

    Berteotti, Carol R.; And Others

    Using an evaluation of a hospital-based hospice as a case study, this paper analyzes problematic issues surrounding health care teams (HCTs) in light of findings revealed in the literature concerning HCT structures and processes. The factors of coordination and role definitions in HCTs and their manifestations in a particular hospice HCT in terms…

  2. Definitive care in level 3 trauma centres after severe injury: A comparison of clinical characteristics and outcomes.

    Gomez, David; Alali, Aziz S; Xiong, Wei; Zarzaur, Ben L; Mann, N Clay; Nathens, Avery B


    The role of level 3 trauma centres (TC) in inclusive trauma systems has not been well defined. The absence of nationally recognised inter-facility transfer criteria for inclusive systems has often left individual level 3 TCs to decide upon their own what their spectrum of care is and particularly which severely injured patients to admit for definitive care. Retrospective cohort study in which the principal objective was to compare the characteristics and outcomes of severely injured (injury severity score>15) adult patients (≥18 years) who received definitive care at level 3 centres with severely injured adult patients who were transferred to level 1-2 TCs during the same time period. Data were derived from the National Trauma Data Bank (2010-2011). First, we utilised hierarchical logistic regression models to evaluate the risk-adjusted mortality of patients admitted at level 3 TCs compared to those who were transferred to level 1-2 TCs. Subgroup analysis was carried out for patients with isolated traumatic brain injury (iTBI). Finally, we explored the extent of variation in risk-adjusted mortality across level 3 TCs. We identified 6433 severely injured patients who received definitive care across 150 level 3 TCs and 41,165 severely injured patients transferred to level 1-2 centres. Patients who received definitive care at level 3 TCs had a lower comorbidity burden and different injury profiles compared to those transferred to level 1-2 centres. There was no difference in crude mortality (10% vs. 11%, standardised difference 0.04); however, after risk-adjustment, the odds of death for patients who received definitive care at level 3 TCs were 1.24-fold higher (95%CI 1.08-1.43) when compared to those transferred to level 1-2 centres. A trend towards a higher likelihood of death at level 3 centres was observed when analysis was limited to patients with iTBI. Risk-adjusted mortality across level 3 TCs was with few exceptions, homogeneous (trauma centres are providing

  3. Hospital-based, Multidisciplinary, youth mentoring and medical exposure program positively influences and reinforces health care career choice: "The Reach One Each One Program early Experience".

    Danner, Omar K; Lokko, Carl; Mobley, Felicia; Dansby, Montreka; Maze, Michael; Bradley, Brene'; Williams, Elizabeth; Matthews, Leslie Ray; Harrington, Emma; Mack, Lisa; Clark, Clarence; Wilson, Ken; Beech, Derrick; Heron, Sheryl; Childs, Ed


    According to the National Center for Educational Statistics, underrepresented minorities (URMs) are more likely to leave science, technology, engineering and mathematics (STEM) fields at higher rates than their peers during undergraduate studies. Many institutions of higher learning have implemented pipeline programs aimed at preparing and inspiring high school and college aged students in select careers in health sciences with varying levels of success. Research has shown that a health care workforce that mirrors the community they serve is more effective in reducing health disparities and increasing positive health outcomes. We hypothesize that a hospital-based, multidisciplinary youth mentoring and medical exposure program will enhance the decision of URM high school students to choose healthcare careers. A retrospective analysis of the Reach One Each One Program (ROEO) was performed. ROEO is a hospital based, 11-week multidisciplinary youth mentoring and medical exposure program for inner-city high school students. The analysis was based on a phone survey of the twenty-six (26) seniors who completed the program and subsequently graduated from high school between May 2013 and May 2015 to assess the following: 1) College enrollment/attendance, 2) Health profession majors, and 3) Pre-med status. The study was approved by the Morehouse School of Medicine Institutional Review Board. Of the twenty-six students, 23 were female and 3 were male; 25 (96%) of the students were African American and one student was a Caucasian female. Twenty-four (92.3%) of the students were enrolled in college and 2 (7.7%) were scheduled to begin in the spring semester of 2016. Twenty-one of the 24 attending college at the time of the survey (87.5%) were enrolled in a health science degree program and 16 (66.7%) confirmed that they were enrolled in pre-medical (Pre-med) curriculum. Hospital-based, multidisciplinary medical mentoring programs can have a positive impact on the lives and

  4. [Early rehabilitation care in the hospital--definition and indication. Results of the expert group "Early Rehabilitation Care in the Hospital"].

    Leistner, K; Stier-Jarmer, M; Berleth, B; Braun, J; Koenig, E; Liman, W; Lüttje, D; Meindl, R; Pientka, L; Weber, G; Stucki, G


    As a result of the continuing development in recent medicine, and improvements of emergency services, an increasing number of patients are surviving serious disease and injury. This has increased the need for rehabilitation, starting already during the acute hospital stay. Early identification and rehabilitation may reduce overall costs and help patients to regain independence earlier. Since the eighties specialized early post-acute rehabilitation units have been increasingly implemented in German hospitals. With book 9 of the German Social Code (SGB IX) coming into effect in July 2001, early post-acute rehabilitation care in hospitals became accepted as a social right. However, the specifics of early rehabilitation care have not been defined. There is a lack of generally accepted indication criteria for early rehabilitation services. Similarly, the aims, objectives and methods need to be specified. It was the objective of a group of interested experts from different fields and backgrounds to achieve an interdisciplinary consensus in terms of conceptual definitions and terminology for all early rehabilitation care services in the acute hospital. The development of the definitions and criteria was achieved by using a modified Delphi-technique. By publishing this paper the group is providing information about its activities and results. Examples of typical cases from the various fields of early rehabilitation care were identified and described. Furthermore, the report points out a number of other problems in the area of early rehabilitation care, which have yet to be solved.

  5. Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function.

    Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni; De Maria, Elia; Fitzsimons, Donna; Halvorsen, Sigrun; Hassager, Christian; Iakobishvili, Zaza; Magdy, Ahmed; Marandi, Toomas; Mimoso, Jorge; Parkhomenko, Alexander; Price, Susana; Rokyta, Richard; Roubille, Francois; Serpytis, Pranas; Shimony, Avi; Stepinska, Janina; Tint, Diana; Trendafilova, Elina; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zima, Endre; Zukermann, Robert; Lettino, Maddalena


    Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller

  6. 5 CFR 792.222 - What is the definition of a lower income Federal employee and how is the amount of the child care...


    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What is the definition of a lower income... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL... What is the definition of a lower income Federal employee and how is the amount of the child care...

  7. New sepsis definition changes incidence of sepsis in the intensive care unit.

    Fullerton, James N; Thompson, Kelly; Shetty, Amith; Iredell, Jonathan R; Lander, Harvey; Myburgh, John A; Finfer, Simon


    To estimate the impact of adopting the proposed new diagnostic criteria for sepsis, based on Sequential Organ Failure Assessment (SOFA) criteria, on the diagnosis and apparent mortality of sepsis in Australian and New Zealand intensive care units. A two-stage, post hoc analysis of prospectively collected ICU research data from 3780 adult patients in 77 Australian and New Zealand ICUs on 7 study days, between 2009 and 2014. The proportion of patients who were diagnosed with sepsis using the criteria for systemic inflammatory response syndrome (SIRS) and who met the SOFA criteria for sepsis, and the proportion of patients who were admitted to the ICU with a diagnosis consistent with infection, who met either, both or neither sets of criteria for sepsis; comparison of the demographic differences and in-hospital mortality between these groups. Of 926 patients diagnosed with sepsis on a study day using SIRS criteria, 796/923 (86.2% [95% CI, 84.0%-88.5%]) satisfied the SOFA criteria. Inhospital mortality was similar in these groups, with death recorded for 216/872 patients (24.8% [95% CI, 21.9%-27.8%]) who met the SIRS criteria for sepsis, and for 200/747 patients (26.8% [95% CI, 23.6%-30.1%]) who met both the SIRS and SOFA criteria for sepsis. Of 122 patients meeting the SIRS criteria but not the SOFA criteria, 16 (13.1% [95% CI, 7.7%-19.1%]) died. Of 241 patients admitted with an infective condition and complete data, 142 (58.9% [95% CI, 52.4%-65.2%]) satisfied the SIRS criteria for sepsis and 210 (87.1% [95% CI, 82.2%-91.1%]) satisfied the SOFA criteria. Of the 241 patients, 99 (41.1%) were not classified as having sepsis on the study day by SIRS criteria and, of these, 80 (80.8%) met the SOFA criteria. Adopting the SOFA criteria will increase the apparent incidence of sepsis in patients admitted to the ICU with infective conditions without affecting the mortality rate. Prospective evaluation of the effect of adopting the new definition of sepsis is required.

  8. Residential age care and domiciliary oral health services: Reach-OHT-The development of a metropolitan oral health programme in Sydney, Australia.

    Wright, F A Clive; Law, Garry; Chu, Steven K-Y; Cullen, John S; Le Couteur, David G


    To describe an oral health care programme for older people in Residential Aged Care Facilities (RACFs) to improve access to care and support facilities. Different models of residential care have been proposed, but few have been comprehensive (providing on-site health promotion and service delivery) or sustainable. A partnership model of oral health care, with dental services plus oral health education, was integrated into the community outreach services of a metropolitan hospital department of aged care. The programme provided annual oral health education and training to staff, and on-site dental care to 10 (RACFs). None of the RACFs had received organised education or on-site dental service care prior to the programme. At the completion of the third year of the programme, 607 residents (75% of the total bed capacity for the 10 RACFs) had received an annual oral health assessment, and 271 (46.5%) had received on-site dental care. More than 120 nursing and allied health staff had received education and training in oral health support to residents. Oral cleanliness, the proportion not experiencing dental pain and referral for additional care decreased significantly over the period, but dental caries experience and periodontal conditions remained a concern. Sustainable domiciliary oral health services and oral health education are feasible and practical using a partnership model within the Australian health system. Adaptability, continuity and the use of oral health therapists/dental hygienists in the coordination and management of the programme further contribute to viability. © 2017 The Authors. Gerodontology published by The Gerodontology Association and John Wiley & Sons Ltd.

  9. Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care.

    Sundler, Annelie J; Höglander, Jessica; Eklund, Jakob Håkansson; Eide, Hilde; Holmström, Inger K


    This study aims to a) explore to what extent older persons express emotional cues and concerns during home care visits; b) describe what cues and concerns these older persons expressed, and c) explore who initiated these cues and concerns. A descriptive and cross-sectional study was conducted. Data consisted of 188 audio recorded home care visits with older persons and registered nurses or nurse assistants, coded with the Verona coding definitions on emotional sequences (VR-CoDES). Emotional expressions of cues and concerns occurred in 95 (51%) of the 188 recorded home care visits. Most frequent were implicit expressions of cues (n=292) rather than explicit concerns (n=24). Utterances with hints to hidden concerns (63,9%, n=202) were most prevalent, followed by vague or unspecific expressions of emotional worries (15,8%, n=50). Most of these were elicited by the nursing staff (63%, n=200). Emotional needs expressed by the older persons receiving home care were mainly communicated implicitly. To be attentive to such vaguely expressed emotions may demand nursing staff to be sensitive and open. The VR-CoDES can be applied on audio recorded home care visits to analyse verbal and emotional communication, and may allow comparative research. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. A new corps of trained Grand-Aides has the potential to extend reach of primary care workforce and save money.

    Garson, Arthur; Green, Donna M; Rodriguez, Lia; Beech, Richard; Nye, Christopher


    Because the Affordable Care Act will expand health insurance to cover an estimated thirty-two million additional people, new approaches are needed to expand the primary care workforce. One possible solution is Grand-Aides®, who are health care professionals operating under the direct supervision of nurses, and who are trained and equipped to conduct telephone consultations or make primary care home visits to patients who might otherwise be seen in emergency departments and clinics. We conducted pilot tests with Grand-Aides in two pediatric Medicaid settings: an urban federally qualified health center in Houston, Texas, and a semi-rural emergency department in Harrisonburg, Virginia. We estimated that Grand-Aides and their supervisors averted 62 percent of drop-in visits at the Houston clinic and would have eliminated 74 percent of emergency department visits at the Virginia test site. We calculated the cost of the Grand-Aides program to be $16.88 per encounter. That compares with current Medicaid payments of $200 per clinic visit in Houston and $175 per emergency department visit in Harrisonburg. In addition to reducing health care costs, Grand-Aides have the potential to make a substantial impact in reducing congestion in primary care practices and emergency departments.

  11. Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs.

    Nichols, Linda O; Martindale-Adams, Jennifer; Zhu, Carolyn W; Kaplan, Erin K; Zuber, Jeffrey K; Waters, Teresa M


    Examine caregiver and care recipient healthcare costs associated with caregivers' participation in Resources for Enhancing Alzheimer's Caregivers Health (REACH II or REACH VA) behavioral interventions to improve coping skills and care recipient management. RCT (REACH II); propensity-score matched, retrospective cohort study (REACH VA). Five community sites (REACH II); 24 VA facilities (REACH VA). Care recipients with Alzheimer's disease and related dementias (ADRD) and their caregivers who participated in REACH II study (analysis sample of 110 caregivers and 197 care recipients); care recipients whose caregivers participated in REACH VA and a propensity matched control group (analysis sample of 491). Previously collected data plus Medicare expenditures (REACH II) and VA costs plus Medicare expenditures (REACH VA). There was no increase in VA or Medicare expenditures for care recipients or their caregivers who participated in either REACH intervention. For VA care recipients, REACH was associated with significantly lower total VA costs of care (33.6%). VA caregiver cost data was not available. In previous research, both REACH II and REACH VA have been shown to provide benefit for dementia caregivers at a cost of less than $5/day; however, concerns about additional healthcare costs may have hindered REACH's widespread adoption. Neither REACH intervention was associated with additional healthcare costs for caregivers or patients; in fact, for VA patients, there were significantly lower healthcare costs. The VA costs savings may be related to the addition of a structured format for addressing the caregiver's role in managing complex ADRD care to an existing, integrated care system. These findings suggest that behavioral interventions are a viable mechanism to support burdened dementia caregivers without additional healthcare costs. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  12. [Surgical therapy and critical care medicine in severely burned patients - Part 2: the basics in definite care].

    Deisz, Robert; Kauczok, Jens; Dembinski, Rolf; Pallua, Norbert; Marx, Gernot


    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial stabilization of the burn victim during the first 24 hours (Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours, AINS 9/12) is followed by a long lasting reconstructive period. During this time calculated fluid replacement to compensate evaporative losses by large bourn wounds is as essential as reconstruction of the integrity of the skin and the modulation of metabolic consequences following severe burn injury. Special attention has to be paid to local and systemic infections.

  13. Use of Color in Child Care Environments: Application of Color for Wayfinding and Space Definition in Alabama Child Care Environments.

    Read, Marilyn A.


    Compared the use of color in physical design features associated with the exterior and interior designs of 101 child care centers in Alabama. Found that color was evidenced on the exterior of the centers at just over half of the sample. The interior environments had warm colors and bright accents in the setting; however, the majority of centers…

  14. [Definition and variables of complexity of nursing care: a literature review].

    Bravetti, Chiara; Cocchieri, Antonello; D'Agostino, Fabio; Vellone, Ercole; Alvaro, Rosaria; Zega, Maurizio


    Complexity of nursing care represents an important indicator in the planning and management of nursing resources and healthcare management. However, the term is not clearly defined in the literature. The aim of this article is to outline the main concepts associated with complexity of nursing care, trying to shed light on the different variables that constitute it. We conducted a review of the literature and selected 12 articles. The terms associated with the concept of complexity of nursing care include nursing intensity, nursing work, nursing workload, patient acuity and severity of illness. The literature review indicates that complexity of nursing care appears to be one of the variables of care intensity, the latter being defined as a commitment of care delivered to the patient. It is associated with the concepts of nursing work, nursing workload, patient acuity and severity of illness. Understanding and clarifying the concept of complexity of care is fundamental in order to measure and evaluate the real demand for nursing care by individual patients.

  15. Contextualizing an Expanded Definition of Health Literacy among Adolescents in the Health Care Setting

    Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.


    The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…

  16. Reach Address Database (RAD)

    U.S. Environmental Protection Agency — The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams,...

  17. A transdisciplinary definition of diagnosis.

    Maitland, Murray E


    Diagnosis is a fundamental abstract reasoning concept in healthcare. It forms the foundation for clinical guidelines, evidence-based practice, and healthcare interventions. The definition of diagnosis is evolving in a manner that may change patient care and clinical research. Currently, dictionary definitions of diagnosis fall into two broad categories, those that stress the original etymology and those that are based on classifying the patient problem according to preexisting labels. Many medical diagnoses are not sufficient to justify allied health, profession-specific interventions. Some authors have suggested profession-specific definitions of diagnosis and profession-specific nomenclature. However, a unique set of labels that are insulated from other health professions has been difficult to achieve because of the interdependence of pathology, impairments, and the patient's role in society. Coordinated interdisciplinary or transdisciplinary patient care, including clinical guidelines, and efficient delivery of services necessitate a definition that facilitates communication across health care professions. A solution to this dilemma may be to create a bridge, recognizing the multifactorial etiology of health and professional autonomy while explicitly stating the context of profession-specific interventions as a team approach. I propose that the definition of diagnosis be modified to: "the process of determining mechanisms by which the patient's health condition arises and the conclusions reached by doing so."

  18. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).

    Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Sari, Nazmi; Harrison, Liz; Jeffery, Cathy; Kutz, Mareike; Khan, Mohammad F; Flynn, Rachel


    Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. PROSPERO CRD42014008853.

  19. Treating childhood pneumonia in hard-to-reach areas: A model-based comparison of mobile clinics and community-based care

    Pitt Catherine


    Full Text Available Abstract Background Where hard-to-access populations (such as those living in insecure areas lack access to basic health services, relief agencies, donors, and ministries of health face a dilemma in selecting the most effective intervention strategy. This paper uses a decision mathematical model to estimate the relative effectiveness of two alternative strategies, mobile clinics and fixed community-based health services, for antibiotic treatment of childhood pneumonia, the world's leading cause of child mortality. Methods A "Markov cycle tree" cohort model was developed in Excel with Visual Basic to compare the number of deaths from pneumonia in children aged 1 to 59 months expected under three scenarios: 1 No curative services available, 2 Curative services provided by a highly-skilled but intermittent mobile clinic, and 3 Curative services provided by a low-skilled community health post. Parameter values were informed by literature and expert interviews. Probabilistic sensitivity analyses were conducted for several plausible scenarios. Results We estimated median pneumonia-specific under-5 mortality rates of 0.51 (95% credible interval: 0.49 to 0.541 deaths per 10,000 child-days without treatment, 0.45 (95% CI: 0.43 to 0.48 with weekly mobile clinics, and 0.31 (95% CI: 0.29 to 0.32 with CHWs in fixed health posts. Sensitivity analyses found the fixed strategy superior, except when mobile clinics visited communities daily, where rates of care-seeking were substantially higher at mobile clinics than fixed posts, or where several variables simultaneously differed substantially from our baseline assumptions. Conclusions Current evidence does not support the hypothesis that mobile clinics are more effective than CHWs. A CHW strategy therefore warrants consideration in high-mortality, hard-to-access areas. Uncertainty remains, and parameter values may vary across contexts, but the model allows preliminary findings to be updated as new or context

  20. Toward a Definition of Quality Care for Patients with Restless Legs Syndrome.

    Trotti, Lynn Marie


    Health care systems and payers are placing increasing emphasis on the measurement and improvement of quality. The process of quality improvement is complex but can be supported by professional organizations such as the American Academy of Sleep Medicine (AASM). In 2013, the AASM commissioned a series of restless legs syndrome (RLS)-specific quality measures, consisting of process and outcome measures. This article provides an overview of the measure development process and discusses the individual RLS quality measures. These measures were designed to support the goals of improved diagnostic accuracy, decreased symptom severity, and reduced treatment complications.

  1. Childhood malaria in the Niger delta area of Nigeria:mothers/care givers 'perception,definition and treatment practices

    Idogun ES; Airauhi LU


    Objective:The objective of the study was to evaluate mothers/care givers perception of malaria,their treat-ment practices and the effects on the outcome of malaria.Methods:Four hundred and sixty children were en-rolled and their mothers/care givers interviewed.The children were screened for malaria parasitaemia and there after,blood specimens were obtained for biochemical and haematological evaluation from those children who met the criteria and tested positive to P.falciparum parasites.Packed cell volume,electrolytes,urea, creatinine,plasma glucose,and serum bilirubin were analyzed.Results:A total of 460 children were studied, 233 (50.7%)males and 227 (49.3%)females.Mild malaria cases were 112 (24.3%)and severe malaria 348 (75.7%).Those who presented early 106 (23.0%)and those who presented late 354 (77.0%).Per-ception and definition of malaria as well as the treatment seeking behaviors vary significantly with the level of education of the mothers and care givers.Those without formal education 68 (51.9%)wrongly perceived that the etiology of malaria can only be diagnosed by native doctors compared to those with primary six education 61 (26.5%)and junior secondary education 10 (10.1%).Only 43 (9.3%)gave the correct dose of chloro-quine syrup to their sick children,while 32 (7.0%)gave at sub optimal doses.Conclusion:Wrong percep-tion of malaria especially the complicated malaria and wrong treatment practices are major contributory factors to the high mortality and morbidity of malaria in Nigeria.There is therefore a need for health education to cor-rect the wrong ideas about the cause and treatment practices of malaria as part of malaria control programme.

  2. Global reach and engagement


    Popular culture reflects both the interests of and the issues affecting the general public. As concerns regarding climate change and its impacts grow, is it permeating into popular culture and reaching that global audience?

  3. Teratology testing under REACH.

    Barton, Steve


    REACH guidelines may require teratology testing for new and existing chemicals. This chapter discusses procedures to assess the need for teratology testing and the conduct and interpretation of teratology tests where required.

  4. Reaching affects saccade trajectories.

    Tipper, S P; Howard, L A; Paul, M A


    The pre-motor theory suggests that, when attention is oriented to a location, the motor systems that are involved in achieving current behavioural goals are activated. For example, when a task requires accurate reaching, attention to a location activates the motor circuits controlling saccades and manual reaches. These actions involve separate neural systems for the control of eye and hand, but we believe that the selection processes acting on neural population codes within these systems are similar and can affect each other. The attentional effect can be revealed in the subsequent movement. The present study shows that the path the eye takes as it saccades to a target is affected by whether a reach to the target is also produced. This effect is interpreted as the influence of a hand-centred frame used in reaching on the spatial frame of reference required for the saccade.

  5. Non-interventional research and usual care: definition, regulatory aspects, difficulties and recommendations.

    Lemaire, François; Ravoire, Sophie; Golinelli, Danielle


    Non-interventional research is an essential approach to gathering data in different situations and it often complements other research methodologies, such as biomedical research and research aimed at evaluating usual care. Yet the legislative framework for this type of research is nonexistent, and this void poses a number of problems for non-interventional researchers, including an absence of any guarantee of quality and therefore of reliability, a limited recognition of the research beyond our borders, cumbersome administrative procedures, and a lack of visibility. In light of the growing demand for data, particularly in post marketing authorisation for drugs, which largely relies on non-interventional methods, the Round Table participants have issued a set of proposals for a future legislative framework for this type of research.

  6. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates.

    van der Zwet, W C; Kaiser, A M; van Elburg, R M; Berkhof, J; Fetter, W P F; Parlevliet, G A; Vandenbroucke-Grauls, C M J E


    The incidence of nosocomial infection in neonatal intensive care units (NICUs) is high compared with other wards. However, no definitions for hospital-acquired infection are available for NICUs. The aim of this study was to measure the incidence of such infections and to identify risk factors in the NICU of the VU University Medical Center, which serves as a level III regional NICU. For this purpose, a prospective surveillance was performed in 1998-2000. We designed definitions by adjusting the current definitions of the Centers for Disease Control and Prevention (CDC) for children risk factors were dichotomized. Analysis of risk factors was performed by Cox regression with time-dependent variables. The relationship between the Clinical Risk Index for Babies (CRIB) and nosocomial infection was investigated. Furthermore, for a random sample of cases, we determined whether bloodstream infection and pneumonia would also have been identified with the CDC definitions. Seven hundred and forty-two neonates were included in the study. One hundred and ninety-one neonates developed 264 infections. Bloodstream infection (N=138, 14.9/1000 patient-days) and pneumonia (N=69, 7.5/1000 patient-days) were the most common infections. Of bloodstream infections, 59% were caused by coagulase-negative staphylococci; in 21% of neonates, blood cultures remained negative. In 25% of pneumonias, Enterobacteriaceae were the causative micro-organisms; 26% of cultures remained negative. Compared with the Nosocomial Infections Surveillance System (NNIS) of the CDC, our device utilization ratios and device-associated nosocomial infection rates were high. The main risk factors for bloodstream infection were birth weight [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.45-2.17] and parenteral feeding with hospital-pharmacy-produced, all-in-one mixture 'Minimix' (HR 3.69, 95%CI 2.03-6.69); administration of intravenous antibiotics (HR 0.39, 95%CI 0.26-0.56) was a protective risk factor. The

  7. Basing and Operational Reach


    Publishing, 2009) 14; Antoine De Jomini, The Art of War (London: Greenhill Books , 2006) 78. 74 recognized definitions of the intermediate...KS: US Army Training and Doctrine Command, 1995. Clausewitz, Carl von. “The Project Gutenberg EBook of On War.” Project Gutenberg. 2006 26- Feb. http...Powerpoint, Washington, DC: US Army TRADO Futures Division, 2005. Jomini, Antoine De. The Art of War. London: Greenhill Books , 2006. Jomini, Baron Henri

  8. Reaching for the Stars

    Terry, Dorothy Givens


    Dr. Mae Jemison is the world's first woman astronaut of color who continues to reach for the stars. Jemison was recently successful in leading a team that has secured a $500,000 federal grant to make interstellar space travel a reality. The Dorothy Jemison Foundation for Excellence (named after Jemison's mother) was selected in June by the Defense…

  9. REACH. Air Conditioning Units.

    Garrison, Joe; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of air conditioning. The instructional units focus on air conditioning fundamentals, window air conditioning, system and installation, troubleshooting and…

  10. REACH. Air Conditioning Units.

    Garrison, Joe; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of air conditioning. The instructional units focus on air conditioning fundamentals, window air conditioning, system and installation, troubleshooting and…

  11. Reaching into Pictorial Spaces

    Volcic, Robert; Vishwanath, Dhanraj; Domini, Fulvio


    While binocular viewing of 2D pictures generates an impression of 3D objects and space, viewing a picture monocularly through an aperture produces a more compelling impression of depth and the feeling that the objects are "out there", almost touchable. Here, we asked observers to actually reach into pictorial space under both binocular- and monocular-aperture viewing. Images of natural scenes were presented at different physical distances via a mirror-system and their retinal size was kept constant. Targets that observers had to reach for in physical space were marked on the image plane, but at different pictorial depths. We measured the 3D position of the index finger at the end of each reach-to-point movement. Observers found the task intuitive. Reaching responses varied as a function of both pictorial depth and physical distance. Under binocular viewing, responses were mainly modulated by the different physical distances. Instead, under monocular viewing, responses were modulated by the different pictorial depths. Importantly, individual variations over time were minor, that is, observers conformed to a consistent pictorial space. Monocular viewing of 2D pictures thus produces a compelling experience of an immersive space and tangible solid objects that can be easily explored through motor actions.

  12. REACH. Refrigeration Units.

    Snow, Rufus; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of refrigeration. The instructional units focus on refrigeration fundamentals, tubing and pipe, refrigerants, troubleshooting, window air conditioning, and…

  13. Reaching for the Stars

    Terry, Dorothy Givens


    Dr. Mae Jemison is the world's first woman astronaut of color who continues to reach for the stars. Jemison was recently successful in leading a team that has secured a $500,000 federal grant to make interstellar space travel a reality. The Dorothy Jemison Foundation for Excellence (named after Jemison's mother) was selected in June by the Defense…

  14. A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness.

    Grigory Sidorenkov

    Full Text Available BACKGROUND: Performance indicators assessing quality of diabetes care often look at single processes, e.g. whether an HbA1c test was conducted. Adequate care, however, consists of consecutive processes which should be taken in time (clinical pathways. We assessed quality of diabetes care by looking at single processes versus clinical pathways. In addition, we evaluated the impact of time period definitions on this quality assessment. METHODOLOGY: We conducted a cohort study in 2007-2008 using the GIANTT (Groningen Initiative to Analyse type 2 diabetes Treatment database. Proportions of patients adequately managed for HbA1c, systolic blood pressure (SBP, LDL-cholesterol (LDL-C, and albumin/creatinine ratio (ACR were calculated for the pathway of (1 risk factor level testing, (2 treatment intensification when indicated, (3 response to treatment evaluation. Strict and wide time periods for each step were defined. Proportions of patients adequately managed regarding the overall pathway and single steps, using strict or wide time periods were compared using odds ratios (OR with 95% confidence intervals. FINDINGS: Of 11,176 patients diagnosed with type 2 diabetes, 9439 with complete follow-up were included. The majority received annual examination of HbA1c (86% and SBP (86%, whereas this was 67% for LDL-C and 49% for ACR. Adequate management regarding the three-step pathway was observed in 73%, 53%, 46%, 41% of patients for HbA1c, SBP, LDL-C, and ACR respectively. Quality scores reduced significantly due to the second step (OR 0.43, 0.18, 0.44, 0.74, but were not much further reduced by the third step. Timely treatment evaluation occurred in 88% for HbA1c, 87% for SBP, 83% for LDL-C, and 76% for ACR. The overall score was not significantly changed by using strict time windows. CONCLUSION: Quality estimates of glycemic, blood pressure and cholesterol management are substantially reduced when looking at clinical pathways as compared to estimates based

  15. Solar Hydrogen Reaching Maturity

    Rongé Jan


    Full Text Available Increasingly vast research efforts are devoted to the development of materials and processes for solar hydrogen production by light-driven dissociation of water into oxygen and hydrogen. Storage of solar energy in chemical bonds resolves the issues associated with the intermittent nature of sunlight, by decoupling energy generation and consumption. This paper investigates recent advances and prospects in solar hydrogen processes that are reaching market readiness. Future energy scenarios involving solar hydrogen are proposed and a case is made for systems producing hydrogen from water vapor present in air, supported by advanced modeling.

  16. The Rome III criteria for the diagnosis of functional dyspepsia in secondary care are not superior to previous definitions.

    Ford, Alexander C; Bercik, Premysl; Morgan, David G; Bolino, Carolina; Pintos-Sanchez, Maria Ines; Moayyedi, Paul


    Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional dyspepsia. In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional dyspepsia, and were not significantly superior to previous definitions. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  17. Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care

    Vekemans Johan


    algorithm for evaluating seriously sick children, improvements to care delivery and a robust training and evaluation programme for clinicians. Conclusions The case definition developed for the pivotal phase III RTS, S vaccine study is consistent with WHO recommendations, is locally applicable and appropriately balances sensitivity and specificity in the diagnosis of severe malaria. Processes set up to standardize severe malaria data collection will allow robust assessment of the efficacy of the RTS, S vaccine against severe malaria, strengthen local capacity and benefit patient care for subjects in the trial. Trial registration NCT00866619

  18. Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care.

    Vekemans, Johan; Marsh, Kevin; Greenwood, Brian; Leach, Amanda; Kabore, William; Soulanoudjingar, Solange; Asante, Kwaku Poku; Ansong, Daniel; Evans, Jennifer; Sacarlal, Jahit; Bejon, Philip; Kamthunzi, Portia; Salim, Nahya; Njuguna, Patricia; Hamel, Mary J; Otieno, Walter; Gesase, Samwel; Schellenberg, David


    , improvements to care delivery and a robust training and evaluation programme for clinicians. The case definition developed for the pivotal phase III RTS, S vaccine study is consistent with WHO recommendations, is locally applicable and appropriately balances sensitivity and specificity in the diagnosis of severe malaria. Processes set up to standardize severe malaria data collection will allow robust assessment of the efficacy of the RTS, S vaccine against severe malaria, strengthen local capacity and benefit patient care for subjects in the trial. NCT00866619.

  19. Westar reaches critical crossroads


    Westar Mining Ltd. has applied for court protection until September 30, 1992 to gain time to draw up a final reorganization plan. The Companies' Creditors Arrangement Act is a federal statute that allows a business to restructure financially without having to declare bankruptcy. Normal trade terms with suppliers are usually maintained during this period. The company is struggling under the effects of falling coal prices, a high Canadian dollar and a high debt burden. Changes in work practices at the company's Balmer mine are a major part of the restructuring. An agreement must be reached with the United Mineworkers of America and other stakeholders or the Balmer mine will close permanently. Employees have been locked out since May 1, 1992 when union members rejected the company's final offer.

  20. Reaching Fleming's dicrimination bound

    Gruebl, Gebhard


    Any rule for identifying a quantum system's state within a set of two non-orthogonal pure states by a single measurement is flawed. It has a non-zero probability of either yielding the wrong result or leaving the query undecided. This also holds if the measurement of an observable $A$ is repeated on a finite sample of $n$ state copies. We formulate a state identification rule for such a sample. This rule's probability of giving the wrong result turns out to be bounded from above by $1/n\\delta_{A}^{2}$ with $\\delta_{A}=|_{1}-_{2}|/(\\Delta_{1}A+\\Delta_{2}A).$ A larger $\\delta_{A}$ results in a smaller upper bound. Yet, according to Fleming, $\\delta_{A}$ cannot exceed $\\tan\\theta$ with $\\theta\\in(0,\\pi/2) $ being the angle between the pure states under consideration. We demonstrate that there exist observables $A$ which reach the bound $\\tan\\theta$ and we determine all of them.

  1. UX-15 Reaches LEP


    The creation of the world's largest sandstone cavern, not a small feat! At the bottom, cave-in preventing steel mesh can be seen clinging to the top of the tunnel. The digging of UX-15, the cavern that will house ATLAS, reached the upper ceiling of LEP on October 10th. The breakthrough which took place nearly 100 metres underground occurred precisely on schedule and exactly as planned. But much caution was taken beforehand to make the LEP breakthrough clean and safe. To prevent the possibility of cave-ins in the side tunnels that will eventually be attached to the completed UX-15 cavern, reinforcing steel mesh was fixed into the walls with bolts. Obviously no people were allowed in the LEP tunnels below UX-15 as the breakthrough occurred. The area was completely evacuated and fences were put into place to keep all personnel out. However, while personnel were being kept out of the tunnels below, this has been anything but the case for the work taking place up above. With the creation of the world's largest...

  2. A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness

    Sidorenkov, G.; Haaijer-Ruskamp, F.M.; Denig, P.; de Zeeuw, Dick


    Background: Performance indicators assessing quality of diabetes care often look at single processes, e. g. whether an HbA1c test was conducted. Adequate care, however, consists of consecutive processes which should be taken in time (clinical pathways). We assessed quality of diabetes care by lookin

  3. "It Was Definitely Very Different": An evaluation of palliative care teaching to medical students using a mixed methods approach.

    Brand, Alison H; Harrison, Amanda; Kumar, Koshila


    Given our ageing population and the increase in chronic disease, palliative care will become an increasingly important part of doctors' workloads, with implications for palliative care education. This study used a mixed methods strategy to evaluate second-year medical students' learning outcomes and experiences within a palliative care education program. Analysis of pre- and post-test scores showed a significant improvement in students' attitudinal scores, but no change in knowledge as measured by multiple-choice questions. Analysis of qualitative data revealed that students' learning experience was marked by a lack of clear learning objectives and experiential learning opportunities. Students also reported divergent reactions to death and dying and noted that palliative care was different from other areas of clinical medicine. This study revealed that palliative care teaching results in improved attitudes toward palliative care, reflecting the holistic and patient-focused nature of the palliative care curriculum.

  4. Health Care and the Social Construction of AIDS: Impact of Disease Definitions on Psychosocial Adaptation and Economic Circumstances.

    Crystal, Stephen; Jackson, Marguerite

    As with other illnesses, Acquired Immune Deficiency Syndrome (AIDS) is a socially constructed phenomenon, not simply a biological entity. Biologically, Human Immunodeficiency Virus (HIV) infection causes immunosuppression, which in turn causes a spectrum of disease states. The official definition of AIDS by the Centers for Disease Control requires…

  5. Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

    Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R


    INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to

  6. Do working environment interventions reach shift workers?

    Nabe-Nielsen, Kirsten; Jørgensen, Marie Birk; Garde, Anne Helene


    workers were less likely to be reached by workplace interventions. For example, night workers less frequently reported that they had got more flexibility (OR 0.5; 95 % CI 0.3-0.7) or that they had participated in improvements of the working procedures (OR 0.6; 95 % CI 0.5-0.8). Quality of leadership......PURPOSE: Shift workers are exposed to more physical and psychosocial stressors in the working environment as compared to day workers. Despite the need for targeted prevention, it is likely that workplace interventions less frequently reach shift workers. The aim was therefore to investigate whether...... the reach of workplace interventions varied between shift workers and day workers and whether such differences could be explained by the quality of leadership exhibited at different times of the day. METHODS: We used questionnaire data from 5361 female care workers in the Danish eldercare sector...

  7. Providing High Quality Care in Low-Income Areas of Maryland: Definitions, Resources, and Challenges from Parents and Child Care Providers' Perspectives. Publication #2012-45

    Forry, Nicole; Simkin, Shana; Wessel, Julia; Rodrigues, Katherine


    Early life experiences are critical to a child's development. Research has shown that, for a variety of reasons, children born into low-income families are at a disadvantage when compared to their higher-income peers. Fortunately, research has also shown a positive association between high quality child care and the academic and social-emotional…

  8. Transition guidelines: An important step in the future care for childhood cancer survivors. A comprehensive definition as groundwork.

    Mulder, R L; van der Pal, H J H; Levitt, G A; Skinner, R; Kremer, L C M; Brown, M C; Bárdi, E; Windsor, R; Michel, G; Frey, E


    Evidence-based clinical practice guidelines are essential to ensure that childhood cancer survivors at risk of chronic health conditions receive effective long-term follow-up care. However, adult survivors of childhood cancer are not always engaged in recommended health promotion and follow-up practices, as many centres do not have a formal transition programme that prepares survivors and their families for successful transfer from child-centred to adult-oriented healthcare. The need for a specific pan-European guideline for the transition of care for childhood cancer survivors has been recognised. The first step is to define the concept of transition of care for survivors of childhood cancer based on existing evidence.

  9. Cultural competence in end-of-life care: terms, definitions, and conceptual models from the British literature

    Evans, N.; Meñaca, A.; Koffman, J.; Harding, R.; Higginson, I.J.; Pool, R.; Gysels, M.


    Background: Cultural competency is increasingly recommended in policy and practice to improve end-of-life (EoL) care for minority ethnic groups in multicultural societies. It is imperative to critically analyze this approach to understand its underlying concepts. Aim: Our aim was to appraise cultura

  10. Reaching and Teaching: A Study in Audience Targeting.

    Ritter, Ellen M.; Welch, Diane T.


    Describes a project conducted by the Texas Agricultural Extension Service to market the Family Day Home Care Providers Program to an unknown clientele. Discusses the problems involved in identifying and reaching the target audience. (JOW)

  11. Pro gaming tips Halo Reach

    Greene, Nicholas


    ABOUT THE BOOK Halo Reach is the latest installment, and goes back to Halo's roots in more ways than one. Set around one of the most frequently referenced events in the Haloverse-The Fall of Reach-Reach puts you in the shoes of Noble 6, an unnamed Spartan, fighting a doomed battle to save the planet. Dual-wielding's gone, health is back, and equipment now takes the form of different "classes," with different weapon loadouts and special abilities (such as sprinting, cloaking, or flight). If you're reading this guide, you're either new to the Halo franchise and looking to get a leg up on all

  12. Lunar Probe Reaches Deep Space


    @@ China's second lunar probe, Chang'e-2, has reached an orbit 1.5 million kilometers from Earth for an additional mission of deep space exploration, the State Administration for Science, Technology and Industry for National Defense announced.

  13. The Role of Acting Participants, Definitions, and the Determining Factors of Adherence to Treatment from Two Perspectives: The Biomedical Model and the Chronic Care Model

    Adrian LUPU


    Full Text Available Management of chronic illness implies significant changing the lifestyle, taking medication, watching the diet, introducing and maintaining exercise in daily life, etc. These actions represent elements of adherence to treatment and they reflect the responsibility of patient’s participation to healthcare. The increase in adherence to treatment and in the quality of care, implicitly, may depend on allotting the resources necessary within therapeutic effort and on the effectiveness of the partnership between patient and doctor. Assuming the medical decision as a team may lead to solving the issue of non-adherence (Armstrong, 2014. Whereas the values of the functional parameters of the body represent an objective measurement of treatment efficiency and to some extent of adherence to it, implicitly, assessing the patient’s lifestyle involves understanding his experience, which is governed by subjectivity. This article has the following objectives: (1 to analyze the definitions of adherence to treatment from a biomedical perspective and from the perspective of Chronic Care Model (CCM; (2 to identify the characteristics specific to the roles of acting participants to healthcare and to analyze the modifications of roles by the choice of theoretical model and (3 to identify the determining factors of adherence to treatment.

  14. [First definition of minimal care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology].

    Bettinardi, Ornella; da Vico, Letizia; Pierobon, Antonia; Iannucci, Manuela; Maffezzoni, Barbara; Borghi, Silvana; Ferrari, Marina; Brazzo, Silvia; Mazza, Antonio; Sommaruga, Marinella; Angelino, Elisabetta; Biffi, Barbara; Agostini, Susanna; Masini, Maria Luisa; Ambrosetti, Marco; Faggiano, Pompilio; Griffo, Raffaele


    Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to "gain health" through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

  15. [Scale Mosaic: definition and testing of a tool for assessing the risk of falling and the care planning during hospitalization].

    Suprani, Riccarda; Taglioni, Mauro


    in year 2008 the Ausl of Ravenna had a small number of patients at risk among the patients fallen, and among the patients evaluated with risk for fall. This could be due to the rating scale used (Conley) that does not recognize the risk factors "drug therapy" and "conditions clinical care". to experiment a rating scale (Mosaic), to evaluate the performance indicators compared to the scales Conley, Fall Risk Assessment Scoring System (FRASS), Stratity; evaluate the effectiveness of actions taken to manage the risk; Operators remain vigilant about the risk falls. using the scale Mosaic for patients admitted in 16 Hospital Units for two-months. Performance indicators: sensitivity, specificity, positive predictive value and negative. Studies considered for comparison: Hospital (AO) Bologna for Conley, AO Bologna and AO Niguarda Cà Granda Milan for Stratify, AO Bergamo for FRASS. were analyzed 1474 tabs. Males are 848 (57.5%) and females 626 (43.5%), the average age is 70.8 years. Of these 42 patients have fallen (2.8%), including 25 males and 17 females and the average age is 72.2. Are not at risk 426 (29%) patients and at risk 1048 (71%) patients. In other assessments the patients at risk was 31% in AUSL Ravenna, 59% (Conley) and 13% (Stratify) in AO Bologna and 41.5% (FRASS) in AO Bergamo. The scale Mosaic has a sensitivity of 0.98 (Conley, Stratify and FRASS amounted to 0.69, to 0.20, to 0.50), a specificity of 0.30 (Conley, Stratify and FRASS amounted to 0.41, 0.87, 0.59.) The patients fallen are at risk in 41 cases (97%) and of these 24 low-risk. The most frequent risk factors are: "mobility and gait" (1209 items), "drug therapy" (850 items) , "conditions clinical care" (841 items). Planned actions have an average of 2.2 in patients fallen, of 3.5 in low-risk patients and of 4.48 in patients at high risk. Compared with the previous year shows a decrease of 14 falls and an increase in the level of outcome "no one" (from 61% to 73.5%). the greater number of falls

  16. 42 CFR 1000.10 - General definitions.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false General definitions. 1000.10 Section 1000.10 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS INTRODUCTION; GENERAL DEFINITIONS Definitions § 1000.10 General definitions. In this...

  17. The Reach of the Arts

    J. de Haan; W.P. Knulst


    Original title: Het bereik van de kunsten. The reach of the arts (Het bereik van de kunsten) is the fourth study in a series which periodically analyses the status of cultural participation, reading and use of other media. The series, Support for culture (Het culturele draagvlak) is sponsored by th

  18. Community health education: reaching ethnically diverse elders.

    States, Rebecca A; Susman, William M; Riquelme, Luis F; Godwin, Ellen M; Greer, Ellen


    To address disparities in access to health care information, we developed a model program of community-based, health education workshops to be delivered in English and Spanish to older urban adults from diverse ethnic, cultural, and language backgrounds. The workshops were created through an interdisciplinary collaboration among faculty from seven health care professions and focused on three healthcare topics identified in Healthy People 2010: dementia and depression, stress reduction, and physical activity. The development of workshop content and structure, including didactic and interactive components, an approach to interdisciplinary student involvement, and program evaluation by clients and community center staff, are presented as a model for other educators. The workshops presented at five senior centers were attended by 1110 mostly female clients with an average age of 74 yrs and with a large proportion self-identified as of minority background. One hundred seven students from seven healthcare programs helped deliver the workshops. Interviews and surveys of the clients demonstrated that most had a positive learning experience, whereas the evidence of intent to take action on health care issues was less definitive. Analysis of student essays demonstrated increased student understanding of older adults and of community services. A website, Geriatric Educational Resources for Instructors and Elders (, was created to provide access to the instructional and resource materials used for the workshops, including presentation materials in Spanish. This model program may help address the substantial health education needs of a growing population of older adults from diverse ethnic, cultural, and language minorities.

  19. Developing a Consensus-based Definition of "Kokoro-no Care" or Mental Health Services and Psychosocial Support: Drawing from Experiences of Mental Health Professionals Who Responded to the Great East Japan Earthquake.

    Suzuki, Yuriko; Fukasawa, Maiko; Nakajima, Satomi; Narisawa, Tomomi; Keiko, Asano; Kim, Yoshiharu


    In this survey, we aimed to build consensus and gather opinions on 'Kokoro-no care' or mental health services and psychosocial support (MHSPSS) after a disaster, among mental health professionals who engaged in care after the Great East Japan Earthquake. We recruited mental health professionals who engaged in support activities after the Great East Japan Earthquake, which included local health professionals in the affected areas and members of mental health care teams dispatched from outside (n = 131). Adopting the Delphi process, we proposed a definition of 'Kokoro-no care', and asked the participants to rate the appropriateness on a 5-point Likert scale. We also solicited free comments based on the participants' experiences during the disaster. After Round 1, we presented the summary statistics and comments, and asked the participants to re-rate the definition that had been modified based on their comments. This process was repeated twice, until the consensus criterion of ≥ 80% of the participants scoring ≥ 4 on the statement was fulfilled. In Round 1, 68.7% of the respondents rated the proposed definition ≥ 4 for its appropriateness, and 88.4% did so in Round 2. The comments were grouped into categories (and subcategories) based on those related to the definition in general (Appropriate, Continuum of MHSPSS, Cautions in operation, Alternative categorisation of care components, Whether the care component should be categorised according to the professional involved, Ambiguous use of psychology, and Others), to mental health services (Appropriate, More specification within mental health services, More explicit remarks on mental health services, and Others), and to psychosocial support (Whether the care component should be categorised according to the professional involved, Raising concerns about the terms, and Others), and others. We achieved a consensus on the definition of 'Kokoro-no care', and systematically obtained suggestions on the concept, and

  20. Environmental Degradation, Disproportionality, and the Double Diversion: Reaching out, Reaching ahead, and Reaching beyond

    Freudenburg, William R.


    Rather than seeking ivory-tower isolation, members of the Rural Sociological Society have always been distinguished by a willingness to work with specialists from a broad range of disciplines, and to work on some of the world's most challenging problems. What is less commonly recognized is that the willingness to reach beyond disciplinary…

  1. Sampling hard to reach populations.

    Faugier, J; Sargeant, M


    Studies on 'hidden populations', such as homeless people, prostitutes and drug addicts, raise a number of specific methodological questions usually absent from research involving known populations and less sensitive subjects. This paper examines the advantages and limitations of nonrandom methods of data collection such as snowball sampling. It reviews the currently available literature on sampling hard to reach populations and highlights the dearth of material currently available on this subject. The paper also assesses the potential for using these methods in nursing research. The sampling methodology used by Faugier (1996) in her study of prostitutes, HIV and drugs is used as a current example within this context.

  2. Reaching remote areas in Latin America.

    Jaimes, R


    Poor communities in remote and inaccessible areas tend to not only be cut off from family planning education and services, but they are also deprived of basic primary health care services. Efforts to bring family planning to such communities and populations should therefore be linked with other services. The author presents three examples of programs to bring effective family planning services to remote communities in Central and South America. Outside of the municipal center in the Tuxtlas region of Mexico, education and health levels are low and people live according to ancient customs. Ten years ago with the help of MEXFAM, the IPPF affiliate in Mexico, two social promoters established themselves in the town of Catemaco to develop a community program of family planning and health care offering education and prevention to improve the quality of people's lives. Through their health brigades taking health services to towns without an established health center, the program has influenced an estimated 100,000 people in 50 villages and towns. The program also has a clinic. In Guatemala, the Family Welfare Association (APROFAM) gave bicycles to 240 volunteer health care workers to facilitate their outreach work in rural areas. APROFAM since 1988 has operated an integrated program to treat intestinal parasites and promote family planning in San Lucas de Toliman, an Indian town close to Lake Atitlan. Providing health care to more than 10,000 people, the volunteer staff has covered the entire department of Solola, reaching each family in the area. Field educators travel on motorcycles through the rural areas of Guatemala coordinating with the health volunteers the distribution of contraceptives at the community level. The Integrated Project's Clinic was founded in 1992 and currently carries out pregnancy and Pap tests, as well as general lab tests. Finally, Puna is an island in the middle of the Gulf of Guayaquil, Ecuador. Women on the island typically have 10

  3. How to reach library users who cannot reach libraries?

    Dragana Ljuić


    Full Text Available The article discusses the ways of getting library activities closer to the individuals or groups of users who have difficulties to or cannot visit the library themselves. The author presents the services offered by the Maribor Public Library and discusses how one of the basic human rights – the right to the access of cultural goods, knowledge and information - is exercised also through library activities. By enabling access to library material and information, public libraries help to fulfill basic human rights and thus raise the quality of living in a social environment. The following forms of library activities are presented in the article: »distance library« – borrowing books at home, in hospital, station for the bibliobus for disabled users, »mobile collections« in the institutions where users, due to their age or illness, have difficulties in accessing or even cannot reach library materials and information by themselves.

  4. [Professional nursing--development and contents of a definition].

    Spichiger, Eilsabeth; Kesselring, Annemarie; Spirig, Rebecca; De Geest, Sabina


    This definition of professional nursing was developed at the Institute of Nursing Science, University of Basel, in collaboration with the group of experts from the project "Future of Swiss Medicine" of the Swiss Academy of Medical Sciences. Starting points were existing definitions and a list of desirable contents. Using Grounded Theory approaches, potential contents were analysed and a first draft was written. Through several feedback rounds, this draft was refined to the definition that is presented here. Professional nursing is defined in two core sentences. As regards content, it relates to promoting and maintaining health, preventing health problems, and assisting people in treating illnesses and in dealing with consequences of illnesses and their therapies. The goal is to achieve the best possible results of treatments and care as well as the best possible quality of life in all phases of life until death for the people cared for. Eight additional paragraphs describe to whom professional nursing is directed, the tasks it includes, its essential basics, who delivers it, how it is put into practice, and its context. The definition has a scientific background and incorporates international perspectives and developments. An addendum outlines further thoughts regarding interprofessional collaboration in health care, focal points of nursing education, and future directions of professional nursing. It calls for an optimal collaboration among the different professional groups to reach the best possible outcomes for people with (potential) health problems. Trends in society and health care, especially the growing numbers of old and chronically ill people, will increase the need for professional care. It is necessary to develop new systems and models of care that meet population needs and have a lasting effect. Nursing education must take these future changes into consideration.

  5. Biomedical and psychosocial factors influencing transtibial prosthesis fit : a Delphi survey among health care professionals

    Baars, Erwin C.; Schrier, Ernst; Geertzen, Jan H.; Dijkstra, Pieter U.


    Purpose: We aimed to reach consensus among professionals caring for prosthesis users, on definitions of biomedical and psychosocial factors, to assess their influence on fit of transtibial prosthesis and to identify new factors. Method: A three-round, internet-based, Delphi survey was conducted amon

  6. Biomedical and psychosocial factors influencing transtibial prosthesis fit : a Delphi survey among health care professionals

    Baars, Erwin C.; Schrier, Ernst; Geertzen, Jan H.; Dijkstra, Pieter U.


    Purpose: We aimed to reach consensus among professionals caring for prosthesis users, on definitions of biomedical and psychosocial factors, to assess their influence on fit of transtibial prosthesis and to identify new factors. Method: A three-round, internet-based, Delphi survey was conducted amon

  7. Has the world economy reached its globalization limit?

    Miskiewicz, Janusz


    The economy globalization measure problem is discussed. Four macroeconomic indices of twenty among the "richest" countries are examined. Four types of "distances" are calculated.Two types of networks are next constructed for each distance measure definition. It is shown that the globalization process can be best characterised by an entropy measure, based on entropy Manhattan distance. It is observed that a globalization maximum was reached in the interval 1970-2000. More recently a deglobalization process is observed.

  8. Reach Envelope of Human Extremities

    YANG Jingzhou(杨景周); ZHANG Yunqing(张云清); CHEN Liping(陈立平); ABDEL-MALEK Karim


    Significant attention in recent years has been given to obtain a better understanding of human joint ranges, measurement, and functionality, especially in conjunction with commands issued by the central nervous system. While researchers have studied motor commands needed to drive a limb to follow a path trajectory, various computer algorithms have been reported that provide adequate analysis of limb modeling and motion. This paper uses a rigorous mathematical formulation to model human limbs, understand their reach envelope, delineate barriers therein where a trajectory becomes difficult to control, and help visualize these barriers. Workspaces of a typical forearm with 9 degrees of freedom, a typical finger modeled as a 4- degree-of-freedom system, and a lower extremity with 4 degrees of freedom are discussed. The results show that using the proposed formulation, joint limits play an important role in distinguishing the barriers.

  9. Extended-reach wells tap outlying reserves

    Nazzal, G. (Eastman Teleco, Houston, TX (United States))


    Extended-reach drilling (ERD) is being used to exploit fields and reserves that are located far from existing platforms. Effective wellbore placement from fewer platforms can reduce development costs, maximize production and increase reserve recovery. Six wells drilled offshore in the US, North Sea and Australia illustrate how to get the most economic benefit from available infrastructure. These wells are divided into three categories by depth (shallow, medium and deep). Vertical depth of these wells range from 963 to 12,791 ft TVD and displacements range from 4,871 to 23,917 ft. Important factors for successful extended-reach drilling included: careful, comprehensive pre-planning; adequate cuttings removal in all sections; hole stability in long, exposed intervals; torque and drag modeling of drilling BHAs, casing and liners; buoyancy-assisted casing techniques where appropriate; critical modifications to drilling rig and top drive, for medium and deep ERD; modified power swivels for shallow operations; drill pipe rubbers or other casing protection during extended periods of drill string rotation; heavy-wall casting across anticipated high-wear areas; survey accuracy and frequency; sound drilling practices and creativity to accomplish goals and objectives. This paper reviews the case history of these sites and records planning and design procedures.

  10. 38 CFR 51.2 - Definitions.


    ... day health care, and hospital care. Hospital care may be provided only when the State home also... convalescents or other persons who are not acutely ill and not in need of hospital care, but who require skilled... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this...

  11. Glossary of Managed Care Definitions

    ... or treatment provided to a plan member. Coverage : decision making process that identifies what services or products are benefits under the employer's or consumer's contract with the plan. Covered products or services ...

  12. Bringing Definitions into High Definition

    Mason, John


    Why do definitions play such a central role in mathematics? It may seem obvious that precision about the terms one uses is necessary in order to use those terms reasonably (while reasoning). Definitions are chosen so as to be definite about the terms one uses, but also to make both the statement of, and the reasoning to justify, theorems as…

  13. Understanding palliative care.

    Martin, Caren McHenry


    While most pharmacists and other health care practitioners are familiar with the programs and philosophy of hospice, they may lack a clear understanding of palliative care. Because myths and misconceptions about palliative care abound, a review of the definitions and components of palliative care can enhance the practice of all practitioners who care for patients with chronic diseases.

  14. Pediatric Primary Care as a Component of Systems of Care

    Brown, Jonathan D.


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

  15. Definitely Life but not Definitively

    Oliver, Joan D.; Perry, Randall S.


    Although there have been attempts at a definition of life from many disciplines, none is accepted by all as definitive. Some people believe that it is impossible to define ‘life’ adequately at the moment. We agree with this point of view on linguistic grounds, examining the different types of definition, the contexts in which they are used and their relative usefulness as aids to arriving at a scientific definition of life. We look at some of the more recent definitions and analyse them in the light of our criteria for a good definition. We argue that since there are so many linguistic and philosophical difficulties with such a definition of life, what is needed is a series of working descriptions, which are suited to the audience and context in which they are used and useful for the intended purpose. We provide some ideas and examples of the forms these may take.

  16. How Do Chinese Enterprises Look at REACH?


    @@ The new European REACH (Registration, Evaluation, Authorization of Chemicals) regulation has come into force. As soon as the REACH white paper was issued, Chinese enterprises started to research the possible impacts of REACH and prepare to cope with them. How then do these Chinese enterprises look at REACH? Following are views of some Chinese enterprises exporting chemical products to the European Union.

  17. 42 CFR 418.3 - Definitions.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Definitions. 418.3 Section 418.3 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE General Provision and Definitions § 418.3 Definitions. For purposes of this...

  18. Eye care in rural communities: reaching the unreached in Sunderbans

    Sameera Ahmed


    Full Text Available Good health is dependent on having services which are accessible and affordable. The Sunderbans in West Bengal, India, is a conglomeration of 106 islands, 52 of which are inhabited, and the remaining of which are home to India’s famous tigers and the world’s biggest mangroves. Small boats are the main mode of transport.

  19. ALMA telescope reaches new heights


    of the Array Operations Site. This means surviving strong winds and temperatures between +20 and -20 Celsius whilst being able to point precisely enough that they could pick out a golf ball at a distance of 15 km, and to keep their smooth reflecting surfaces accurate to better than 25 micrometres (less than the typical thickness of a human hair). Once the transporter reached the high plateau it carried the antenna to a concrete pad - a docking station with connections for power and fibre optics - and positioned it with an accuracy of a few millimetres. The transporter is guided by a laser steering system and, just like some cars today, also has ultrasonic collision detectors. These sensors ensure the safety of the state-of-the-art antennas as the transporter drives them across what will soon be a rather crowded plateau. Ultimately, ALMA will have at least 66 antennas distributed over about 200 pads, spread over distances of up to 18.5 km and operating as a single, giant telescope. Even when ALMA is fully operational, the transporters will be used to move the antennas between pads to reconfigure the telescope for different kinds of observations. "Transporting our first antenna to the Chajnantor plateau is a epic feat which exemplifies the exciting times in which ALMA is living. Day after day, our global collaboration brings us closer to the birth of the most ambitious ground-based astronomical observatory in the world", said Thijs de Graauw, ALMA Director. This first ALMA antenna at the high site will soon be joined by others and the ALMA team looks forward to making their first observations from the Chajnantor plateau. They plan to link three antennas by early 2010, and to make the first scientific observations with ALMA in the second half of 2011. ALMA will help astronomers answer important questions about our cosmic origins. The telescope will observe the Universe using light with millimetre and submillimetre wavelengths, between infrared light and radio waves in

  20. Important ATLAS Forward Calorimeter Milestone Reached

    Loch, P.

    The ATLAS Forward Calorimeter working group has reached an important milestone in the production of their detectors. The mechanical assembly of the first electromagnetic module (FCal1C) has been completed at the University of Arizona on February 25, 2002, only ten days after the originally scheduled date. The photo shows the University of Arizona FCal group in the clean room, together with the assembled FCal1C module. The module consists of a stack of 18 round copper plates, each about one inch thick. Each plate is about 90 cm in diameter, and has 12260 precision-drilled holes in it, to accommodate the tube/rod electrode assembly. The machining of the plates, which was done at the Science Technology Center (STC) at Carleton University, Ottawa, Canada, required high precision to allow for easy insertion of the electrode copper tube. The plates have been carefully cleaned at the University of Arizona, to remove any machining residue and metal flakes. This process alone took about eleven weeks. Exactly 122...

  1. Stream Habitat Reach Summary - NCWAP [ds158

    California Department of Resources — The Stream Habitat - NCWAP - Reach Summary [ds158] shapefile contains in-stream habitat survey data summarized to the stream reach level. It is a derivative of the...

  2. 42 CFR 1000.30 - Definitions specific to Medicaid.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Definitions specific to Medicaid. 1000.30 Section 1000.30 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS INTRODUCTION; GENERAL DEFINITIONS Definitions § 1000.30 Definitions specific...

  3. Neuroretinitis -- definition

    ... page: // Neuroretinitis - definition To use the sharing features on this page, ... this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial ...

  4. Market Definition

    Kaplow, Louis


    Market definition has long held a central place in competition law. This entry surveys recent analytical work that has called the market definition paradigm into question on a number of fronts: whether the process is feasible, whether market share threshold tests are coherent, whether the hypothetical monopolist test in merger guidelines is counterproductive, and whether and when the frequent focus on cross-elasticities is useful.

  5. 'Reaching the hard to reach' - lessons learned from the VCS (voluntary and community Sector. A qualitative study

    Hancock Beverley


    Full Text Available Abstract Background The notion 'hard to reach' is a contested and ambiguous term that is commonly used within the spheres of social care and health, especially in discourse around health and social inequalities. There is a need to address health inequalities and to engage in services the marginalized and socially excluded sectors of society. Methods This paper describes a pilot study involving interviews with representatives from eight Voluntary and Community Sector (VCS organisations. The purpose of the study was to explore the notion of 'hard to reach' and perceptions of the barriers and facilitators to accessing services for 'hard to reach' groups from a voluntary and community sector perspective. Results The 'hard to reach' may include drug users, people living with HIV, people from sexual minority communities, asylum seekers, refugees, people from black and ethnic minority communities, and homeless people although defining the notion of the 'hard to reach' is not straight forward. It may be that certain groups resist engaging in treatment services and are deemed hard to reach by a particular service or from a societal stance. There are a number of potential barriers for people who may try and access services, including people having bad experiences in the past; location and opening times of services and how services are funded and managed. A number of areas of commonality are found in terms of how access to services for 'hard to reach' individuals and groups could be improved including: respectful treatment of service users, establishing trust with service users, offering service flexibility, partnership working with other organisations and harnessing service user involvement. Conclusions If health services are to engage with groups that are deemed 'hard to reach' and marginalised from mainstream health services, the experiences and practices for engagement from within the VCS may serve as useful lessons for service improvement for

  6. Reach preparation enhances visual performance and appearance.

    Rolfs, Martin; Lawrence, Bonnie M; Carrasco, Marisa


    We investigated the impact of the preparation of reach movements on visual perception by simultaneously quantifying both an objective measure of visual sensitivity and the subjective experience of apparent contrast. Using a two-by-two alternative forced choice task, observers compared the orientation (clockwise or counterclockwise) and the contrast (higher or lower) of a Standard Gabor and a Test Gabor, the latter of which was presented during reach preparation, at the reach target location or the opposite location. Discrimination performance was better overall at the reach target than at the opposite location. Perceived contrast increased continuously at the target relative to the opposite location during reach preparation, that is, after the onset of the cue indicating the reach target. The finding that performance and appearance do not evolve in parallel during reach preparation points to a distinction with saccade preparation, for which we have shown previously there is a parallel temporal evolution of performance and appearance. Yet akin to saccade preparation, this study reveals that overall reach preparation enhances both visual performance and appearance.

  7. Physician empathy: Definition, outcome-relevance and its measurement in patient care and medical education [Ärztliche Empathie: Definition, Outcome-Relevanz und Messung in der Patientenversorgung und medizinischen Ausbildung

    Neumann, Melanie


    Full Text Available [english] Objective: The present study gives a brief introduction into FurthermoreThe latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the “Jefferson Scale of Physician Empathy, Student Version” (JSPE-S and the “Interpersonal Reactivity Index” (IRI.Methods: We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. Results: PE includes the of the patient as well as verbal and non-verbal , which should result in a helpful therapeutic action of the physician. Patients’ health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results.Conclusion: PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.[german] Ziel: Die vorliegende Studie gibt einen kurzen Überblick Des Weiteren werden Letzteres Thema wird ausführlich behandelt, da eine Pilotstudie zur Testung zwei deutscher Versionen von Selbsteinschätzungsinstrumenten durchgeführt wurde, die derzeit am häufigsten in der internationalen Medizinischen Ausbildungsforschung genutzt werden. Dazu gehören die “Jefferson Scale of Physician Empathy

  8. Palliative care and pediatric surgical oncology.

    Inserra, Alessandro; Narciso, Alessandra; Paolantonio, Guglielmo; Messina, Raffaella; Crocoli, Alessandro


    Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Competencies of specialised wound care nurses: a European Delphi study.

    Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester


    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses.

  10. Compact muon solenoid magnet reaches full field


    Scientist of the U.S. Department of Energy in Fermilab and collaborators of the US/CMS project announced that the world's largest superconducting solenoid magnet has reached full field in tests at CERN. (1 apge)

  11. Hanford Reach - Ringold Russian Knapweed Treatment

    US Fish and Wildlife Service, Department of the Interior — Increase the diversity of the seed mix on approximately 250 acres in the Ringold Unit of the Hanford Reach National Monument (Monument) treated with aminopyralid as...



    Expanded Program on Immunisation (EPI) training in. Zambia and critically analyses ... excellence in skills such as sport, music or dance, so it is ... only improve through reaching every child both physically and in .... Non-verbal communication.

  13. Women Reaching Equality in Dubious Habit: Drinking

    ... page: Women Reaching Equality in Dubious Habit: Drinking Females also ... 25, 2016 MONDAY, Oct. 24, 2016 (HealthDay News) -- Women have made major strides towards equality with men, ...

  14. Reaching the Overlooked Student in Physical Education

    Esslinger, Keri; Esslinger, Travis; Bagshaw, Jarad


    This article describes the use of live action role-playing, or "LARPing," as a non-traditional activity that has the potential to reach students who are not interested in traditional physical education.

  15. The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database

    Chien-Lung Chan


    Full Text Available Introduction. Length of stay (LOS in the intensive care unit (ICU of spontaneous intracerebral hemorrhage (sICH patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

  16. 45 CFR 160.103 - Definitions.


    ... care, and counseling, service, assessment, or procedure with respect to the physical or mental... 45 Public Welfare 1 2010-10-01 2010-10-01 false Definitions. 160.103 Section 160.103 Public... GENERAL ADMINISTRATIVE REQUIREMENTS General Provisions § 160.103 Definitions. Except as otherwise...

  17. 28 CFR 500.1 - Definitions.


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Definitions. 500.1 Section 500.1 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE GENERAL MANAGEMENT AND ADMINISTRATION GENERAL DEFINITIONS... health care training or experience which support, complement, or supplement the administration of...

  18. The leading joint hypothesis for spatial reaching arm motions.

    Ambike, Satyajit; Schmiedeler, James P


    The leading joint hypothesis (LJH), developed for planar arm reaching, proposes that the interaction torques experienced by the proximal joint are low compared to the corresponding muscle torques. The human central nervous system could potentially ignore these interaction torques at the proximal (leading) joint with little effect on the wrist trajectory, simplifying joint-level control. This paper investigates the extension of the LJH to spatial reaching. In spatial motion, a number of terms in the governing equation (Euler's angular momentum balance) that vanish for planar movements are non-trivial, so their contributions to the joint torque must be classified as net, interaction or muscle torque. This paper applies definitions from the literature to these torque components to establish a general classification for all terms in Euler's equation. This classification is equally applicable to planar and spatial motion. Additionally, a rationale for excluding gravity torques from the torque analysis is provided. Subjects performed point-to-point reaching movements between targets whose locations ensured that the wrist paths lay in various portions of the arm's spatial workspace. Movement kinematics were recorded using electromagnetic sensors located on the subject's arm segments and thorax. The arm was modeled as a three-link kinematic chain with idealized spherical and revolute joints at the shoulder and elbow. Joint torque components were computed using inverse dynamics. Most movements were 'shoulder-led' in that the interaction torque impulse was significantly lower than the muscle torque impulse for the shoulder, but not the elbow. For the few elbow-led movements, the interaction impulse at the elbow was low, while that at the shoulder was high, and these typically involved large elbow and small shoulder displacements. These results support the LJH and extend it to spatial reaching motion.

  19. Why Patient Centered Care Coordination Is Important in Developing Countries?

    Luna, D.; Marcelo, A.; Househ, M.; Mandirola, H.; Curioso, W.; Pazos, P.; Villalba, C.


    Summary Patient Centered Care Coordination (PCCC) focuses on the patient health care needs. PCCC involves the organization, the patients and their families, that must coordinate resources in order to accomplish the goals of PCCC. In developing countries, where disparities are frequent, PCCC could improve clinical outcomes, costs and patients satisfaction. Objective the IMIA working group Health Informatics for Development analyzes the benefits, identifies the barriers and proposes strategies to reach PCCC. Methods Discussions about PCCC emerged from a brief guide that posed questions about what is PCCC, why consider PCCC important, barriers to grow in this direction and ask about resources considered relevant in the topic. Results PCCC encompasses a broad definition, includes physical, mental, socio-environmental and self care. Even benefits are proved, in developing countries the lack of a comprehensive and integrated healthcare network is one of the main barriers to reach this objective. Working hard to reach strong health policies, focus on patients, and optimizing the use of resources could improve the performance in the devolvement of PCCC programs. International collaboration could bring benefits. We believe information IT, and education in this field will play an important role in PCCC. Conclusion PCCC in developing countries has the potential to improve quality of care. Education, IT, policies and cultural issues must be addressed in an international collaborative context in order to reach this goal. PMID:26123907

  20. General care plan in a Paediatric Intensive Care Unit

    Mª Teresa Martín Alonso


    Full Text Available The care plan we expose is a general one applicable to all the children who are admitted in the unit, no matter what pathology they present/display, their physiopathological situation or their age. We present the common nursing actions which are applied to all the patients at the time of their admittance. The factor related to the studied problems is the hospitalization and what it has associate, from separation of the parents and rupture familiar ties, up to immobilization, the use of bloody devices and the generally hostile and stranger background.The protocol is based on the NANDA, the nursing outcomes classification NOC and the nursing intervention classification NIC. It is part of the nursing process and promotes systematized, humanistic and effective care, focuses on the child and his parents.We have selected the most relevant problems, ordered according to the deficits in the different selfcare requirements of Dorotea E. Orem. Each problem has its definition, the outcomes we pretend to reach with our care and the interventions to get the outcomes (these two last topics have the corresponding codification. In them all the most important factor is hospitalization in a unit of intensive care and the separation of the child from his habitual environment.

  1. Example of the application of the PERSONA methodology in the definition of needs and requirements for the WeTakeCare system.

    Barbera-Guillem, Ricard; Poveda-Puente, Rakel; Neumann, Silke; Becker, Heidrun; Ramírez, Miguel; Wienholtz, Arno; Schaedler, Inge


    In user-centred design and marketing, personas are fictional characters created to represent the different user types that might use a site, brand, or product in a similar way [1]. As in other projects, the main application and use value of the persona approach in WeTakeCare project has been to depict and thus make "vivid" the characters and the milieus created and selected. It has helped to better understand and communicate the differences among the potential users. It has also helped to understand the heterogeneity and diversity of the users' lives and to focus on how to meet their actual needs [2].

  2. Psychosocial child adjustment and family functioning in families reached with an assertive outreach intervention

    C. Rots-de Vries; I. van de Goor; K. Stronks; H. Garretsen


    Families who experience a chronic complex of socio-economic and psychosocial problems are hard to reach with mainstream care. Evidence exists that the core of this problem is a problematic interaction between this type of family and current systems of care and services. To improve access to problem

  3. REACH. Analytical characterisation of petroleum UVCB substances

    De Graaff, R.; Forbes, S.; Gennart, J.P.; Gimeno Cortes, M.J.; Hovius, H.; King, D.; Kleise, H.; Martinez Martin, C.; Montanari, L.; Pinzuti, M.; Pollack, H.; Ruggieri, P.; Thomas, M.; Walton, A.; Dmytrasz, B.


    The purpose of this report is to summarise the findings of the scientific and technical work undertaken by CONCAWE to assess the feasibility and potential benefit of characterising petroleum UVCB substances (Substances of Unknown or Variable Composition, Complex reaction products or Biological Materials) beyond the recommendations issued by CONCAWE for the substance identification of petroleum substances under REACH. REACH is the European Community Regulation on chemicals and their safe use (EC 1907/2006). It deals with the Registration, Evaluation, Authorisation and Restriction of Chemical substances. The report is based on Member Company experience of the chemical analysis of petroleum UVCB substances, including analysis in support of REACH registrations undertaken in 2010. This report is structured into four main sections, namely: Section 1 which provides an introduction to the subject of petroleum UVCB substance identification including the purpose of the report, regulatory requirements, the nature of petroleum UVCB substances, and CONCAWE's guidance to Member Companies and other potential registrants. Section 2 provides a description of the capabilities of each of the analytical techniques described in the REACH Regulation. This section also includes details on the type of analytical information obtained by each technique and an evaluation of what each technique can provide for the characterisation of petroleum UVCB substances. Section 3 provides a series of case studies for six petroleum substance categories (low boiling point naphthas, kerosene, heavy fuel oils, other lubricant base oils, residual aromatic extracts and bitumens) to illustrate the value of the information derived from each analytical procedure, and provide an explanation for why some techniques are not scientifically necessary. Section 4 provides a summary of the conclusions reached from the technical investigations undertaken by CONCAWE Member Companies, and summarising the

  4. Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review

    Judith Tiao


    Full Text Available Background: Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality. Materials and Methods: We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF. Results: We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18% used the same definition of an IHF. Three (27% used a definition based on Abbreviated Injury Scale (AIS Codes and five (45% on International Classification of Diseases (ICD codes. Four (36% studies had inclusion criteria based on age, five (45% on secondary injuries, and four (36% on the mechanism of injury. Eight studies (73% had good overall methodological quality. Conclusions: We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care.

  5. Polishing Difficult-To-Reach Cavities

    Malinzak, R. Michael; Booth, Gary N.


    Springy abrasive tool used to finish surfaces of narrow cavities made by electrical-discharge machining. Robot arm moves vibrator around perimeters of cavities, polishing walls of cavities as it does so. Tool needed because such cavities inaccessible or at least difficult to reach with most surface-finishing tools.

  6. REACH. Electricity Units, Post-Secondary.

    Smith, Gene; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this postsecondary student manual contains individualized instructional units in the area of electricity. The instructional units focus on electricity fundamentals, electric motors, electrical components, and controls and installation.…

  7. Reliability of the Advanced REACH Tool (ART)

    Schinkel, J.; Fransman, W.; McDonnell, P.E.; Entink, R.K.; Tielemans, E.; Kromhout, H.


    Objectives: The aim of this study was to assess the reliability of the Advanced REACH Tool (ART) by (i) studying interassessor agreement of the resulting exposure estimates generated by the ART mechanistic model, (ii) studying interassessor agreement per model parameters of the ART mechanistic model

  8. Reliability of the Advanced REACH Tool (ART)

    Schinkel, J.; Fransman, W.; McDonnell, P.E.; Entink, R.K.; Tielemans, E.; Kromhout, H.


    Objectives: The aim of this study was to assess the reliability of the Advanced REACH Tool (ART) by (i) studying interassessor agreement of the resulting exposure estimates generated by the ART mechanistic model, (ii) studying interassessor agreement per model parameters of the ART mechanistic

  9. Guiding Warfare to Reach Sustainable Peace

    Vestenskov, David; Drewes, Line

    The conference report Guiding Warfare to Reach Sustainable Peace constitutes the primary outcome of the conference It is based on excerpts from the conference presenters and workshop discussions. Furthermore, the report contains policy recommendations and key findings, with the ambition of develo...

  10. ATLAS Barrel Toroid magnet reached nominal field


     On 9 November the barrel toroid magnet reached its nominal field of 4 teslas, with an electrical current of 21 000 amperes (21 kA) passing through the eight superconducting coils as shown on this graph

  11. Science Experiments: Reaching Out to Our Users

    Nolan, Maureen; Tschirhart, Lori; Wright, Stephanie; Barrett, Laura; Parsons, Matthew; Whang, Linda


    As more users access library services remotely, it has become increasingly important for librarians to reach out to their user communities and promote the value of libraries. Convincing the faculty and students in the sciences of the value of libraries and librarians can be a particularly "hard sell" as more and more of their primary…

  12. The REACH Youth Program Learning Toolkit

    Sierra Health Foundation, 2011


    Believing in the value of using video documentaries and data as learning tools, members of the REACH technical assistance team collaborated to develop this toolkit. The learning toolkit was designed using and/or incorporating components of the "Engaging Youth in Community Change: Outcomes and Lessons Learned from Sierra Health Foundation's…

  13. Expanding the Lodgment to Extend Operational Reach


    operational much sooner had Operation Market Garden not consumed so much of Montgomery’s forces and attention. Eisenhower allowed Montgomery to...carefully. This constraint forced Allied commanders to curb their momentum and, after missteps during Operation Market Garden, carefully maintain a broad...successful mission completion. SOUTHCOM had the luxury of an existing airfield at Howard Air Force Base, but this airfield could not accommodate enough

  14. Caring as a Managerial Strategy

    Kroth, Michael; Keeler, Carolyn


    The purpose of this article is to broaden the discourse about caring as a managerial strategy by describing caring from three perspectives: nursing, education, and management. The authors suggest that current organizational models inadequately address the caring connection between manager and employee. Definitions of managerial caring and care…

  15. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

    Sundby Johanne


    Full Text Available Abstract Background Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. Methods We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. Results The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. Conclusion Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to

  16. Acute respiratory distress syndrome: the Berlin Definition.

    Ranieri, V Marco; Rubenfeld, Gordon D; Thompson, B Taylor; Ferguson, Niall D; Caldwell, Ellen; Fan, Eddy; Camporota, Luigi; Slutsky, Arthur S


    The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.

  17. 42 CFR 456.601 - Definitions.


    ... for Mental Diseases § 456.601 Definitions. For purposes of this subpart— Facility means an institution for mental diseases, or an intermediate care facility. Intermediate care facility includes... institutions as defined in § 440.170(b) of this chapter. Institution for mental diseases includes a...

  18. Bridging the digital divide: reaching vulnerable populations.

    Chang, Betty L; Bakken, Suzanne; Brown, S Scott; Houston, Thomas K; Kreps, Gary L; Kukafka, Rita; Safran, Charles; Stavri, P Zoe


    The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.

  19. ESPEN guidelines on definitions and terminology of clinical nutrition

    Cederholm, T; Barazzoni, R; Austin, P;


    risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral......BACKGROUND: A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. OBJECTIVE: This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures....... METHODS: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. RESULTS: Five...

  20. Does workplace health promotion reach shift workers?

    Nabe-Nielsen, Kirsten; Garde, Anne Helene; Clausen, Thomas;


    OBJECTIVES: One reason for health disparities between shift and day workers may be that workplace health promotion does not reach shift workers to the same extent as it reaches day workers. This study aimed to investigate the association between shift work and the availability of and participation...... in workplace health promotion. METHODS: We used cross-sectional questionnaire data from a large representative sample of all employed people in Denmark. We obtained information on the availability of and participation in six types of workplace health promotion. We also obtained information on working hours, ie......). RESULTS: In the general working population, fixed evening and fixed night workers, and employees working variable shifts including night work reported a higher availability of health promotion, while employees working variable shifts without night work reported a lower availability of health promotion...

  1. Olefins and chemical regulation in Europe: REACH.

    Penman, Mike; Banton, Marcy; Erler, Steffen; Moore, Nigel; Semmler, Klaus


    REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) is the European Union's chemical regulation for the management of risk to human health and the environment (European Chemicals Agency, 2006). This regulation entered into force in June 2007 and required manufacturers and importers to register substances produced in annual quantities of 1000 tonnes or more by December 2010, with further deadlines for lower tonnages in 2013 and 2018. Depending on the type of registration, required information included the substance's identification, the hazards of the substance, the potential exposure arising from the manufacture or import, the identified uses of the substance, and the operational conditions and risk management measures applied or recommended to downstream users. Among the content developed to support this information were Derived No-Effect Levels or Derived Minimal Effect Levels (DNELs/DMELs) for human health hazard assessment, Predicted No Effect Concentrations (PNECs) for environmental hazard assessment, and exposure scenarios for exposure and risk assessment. Once registered, substances may undergo evaluation by the European Chemicals Agency (ECHA) or Member State authorities and be subject to requests for additional information or testing as well as additional risk reduction measures. To manage the REACH registration and related activities for the European olefins and aromatics industry, the Lower Olefins and Aromatics REACH Consortium was formed in 2008 with administrative and technical support provided by Penman Consulting. A total of 135 substances are managed by this group including 26 individual chemical registrations (e.g. benzene, 1,3-butadiene) and 13 categories consisting of 5-26 substances. This presentation will describe the content of selected registrations prepared for 2010 in addition to the significant post-2010 activities. Beyond REACH, content of the registrations may also be relevant to other European activities, for

  2. Distance Reached in the Anteromedial Reach Test as a Function of Learning and Leg Length

    Bent, Nicholas P.; Rushton, Alison B.; Wright, Chris C.; Batt, Mark E.


    The Anteromedial Reach Test (ART) is a new outcome measure for assessing dynamic knee stability in anterior cruciate ligament-injured patients. The effect of learning and leg length on distance reached in the ART was examined. Thirty-two healthy volunteers performed 15 trials of the ART on each leg. There was a moderate correlation (r = 0.44-0.50)…

  3. Biomedical and psychosocial factors influencing transtibial prosthesis fit: a Delphi survey among health care professionals.

    Baars, Erwin C; Schrier, Ernst; Geertzen, Jan H; Dijkstra, Pieter U


    We aimed to reach consensus among professionals caring for prosthesis users, on definitions of biomedical and psychosocial factors, to assess their influence on fit of transtibial prosthesis and to identify new factors. A three-round, internet-based, Delphi survey was conducted among experts recruited via the Dutch National Amputee and Prosthesis Work Group. The main outcome measure was consensus among care professionals on statements concerning new and presented biomechanical and psychosocial factors that influence transtibial prosthesis fit. Fifty-four experts participated in the survey, and consensus was reached on 67% (46/69) of all statements. Consensus on statements relevant for good prosthesis fit was reached in most of the statements concerning psychosocial factors and on statements concerning the biomedical factors "prosthesis support and suspension". Least consensus was reached on statements concerning the biomedical factor "skin problems and pain in the residual limb". Biomedical and psychosocial factors influence transtibial prosthesis fit. Consensus was reached among care professionals in a majority of the presented statements concerning these factors. Implications for Rehabilitation Prosthesis fit and comfort is suboptimal in many prosthesis users. Both biomedical and psychosocial factors influence fit. Biomedical and psychosocial factors should be checked during transtibial prosthesis prescription to achieve and maintain an optimal fit. Consensus on many factors influencing prosthesis fit is achieved among care professionals. Consensus was largest regarding prosthesis support and suspension and least regarding skin problems and pain in the residual limb. This consensus contributes to systematic assessment of prosthesis fit.

  4. What Providers Should Know about Child Care Assistance for Families: A Targeted Effort to Reach Hispanic Families and Providers = Lo que Deben Saber los Proveedores Sobre el Programa de Ayuda de Cuidado Infantil para las Familias: Un Esfuerzo Especial para Alcanzar Familias y Proveedores Hispanos

    Child Care Bureau, 2004


    Federal and State governments can help families pay for child care. The families one serves may be eligible for this assistance, and one may receive this funding for services one provides, thus becoming a "participating provider." This paper provides answers to the following questions: (1) How can parents receive child care assistance?; (2) How do…

  5. Reaching Diverse Audiences through NOAO Education Programs

    Pompea, Stephen M.; Sparks, R. T.; Walker, C. E.


    NOAO education programs are designed to reach diverse audiences. Examples described in this poster include the Hands-On Optics Project nationwide, an extension of the Hands-On Optics program at Boys and Girls Clubs in Arizona and in Hawaii, a professional development program for Navajo and Hopi teachers, a number of programs for the Tohono O'odham Nation, and a project collecting and reviewing Spanish language astronomy materials. Additionally NOAO is also involved in several local outreach projects for diverse and underserved audiences.

  6. The Need To Define "Care" in Pharmaceutical Care: An Examination across Research, Practice and Education.

    Galt, Kimberly A.


    This article examines the concept of "care" and how it relates to pharmacy. Five areas from a cross-discipline review of the literature are presented: the definition of care, care as behavior, the relationship of caring behaviors to health, the relationship of caring behaviors to outcomes, and the teaching of caring behaviors. (Author)

  7. Advances in stroke treatment are within reach.

    Taylor, Allan; Le Feuvre, David; Mngomezulu, Victor; Royston, Duncan; Harrichandparsard, Rohen; De Vries, Coert; Winter, Arthur; Potgieter, Francois


    Five recent trials have shown that mechanical removal of clot from cerebral arteries after a stroke can achieve a functional independent outcome in up to 60% of patients. This was an absolute benefit of between 13.5% and 31% for patients who had clot removal initiated within 6 hours of symptoms over those who had best medical treatment. Coupled with this, there is a strong drive to develop stroke units internationally and in South Africa. As a starting point, more primary stroke care centres that can administer intravenous thrombolysis are needed. Comprehensive stroke centres that can offer mechanical thrombectomy are available, but more will be required as referral of patients increases. Collaboration of all roleplayers will ensure that we can deliver training and care at the best level for stroke patients.

  8. Can donated media placements reach intended audiences?

    Cooper, Crystale Purvis; Gelb, Cynthia A; Chu, Jennifer; Polonec, Lindsey


    Donated media placements for public service announcements (PSAs) can be difficult to secure, and may not always reach intended audiences. Strategies used by the Centers for Disease Control and Prevention's (CDC) Screen for Life: National Colorectal Cancer Action Campaign (SFL) to obtain donated media placements include producing a diverse mix of high-quality PSAs, co-branding with state and tribal health agencies, securing celebrity involvement, monitoring media trends to identify new distribution opportunities, and strategically timing the release of PSAs. To investigate open-ended recall of PSAs promoting colorectal cancer screening, CDC conducted 12 focus groups in three U.S. cities with men and women either nearing age 50 years, when screening is recommended to begin, or aged 50-75 years who were not in compliance with screening guidelines. In most focus groups, multiple participants recalled exposure to PSAs promoting colorectal cancer screening, and most of these individuals reported having seen SFL PSAs on television, in transit stations, or on the sides of public buses. Some participants reported exposure to SFL PSAs without prompting from the moderator, as they explained how they learned about the disease. Several participants reported learning key campaign messages from PSAs, including that colorectal cancer screening should begin at age 50 years and screening can find polyps so they can be removed before becoming cancerous. Donated media placements can reach and educate mass audiences, including millions of U.S. adults who have not been screened appropriately for colorectal cancer.

  9. Napa River Restoration Project: Rutherford Reach Completion and Oakville to Oak Knoll Reach

    Information about the SFBWQP Napa River Restoration Project: Rutherford Reach Completion/Oakville to Oak Knoll, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  10. Phenotype definition in epilepsy.

    Winawer, Melodie R


    Phenotype definition consists of the use of epidemiologic, biological, molecular, or computational methods to systematically select features of a disorder that might result from distinct genetic influences. By carefully defining the target phenotype, or dividing the sample by phenotypic characteristics, we can hope to narrow the range of genes that influence risk for the trait in the study population, thereby increasing the likelihood of finding them. In this article, fundamental issues that arise in phenotyping in epilepsy and other disorders are reviewed, and factors complicating genotype-phenotype correlation are discussed. Methods of data collection, analysis, and interpretation are addressed, focusing on epidemiologic studies. With this foundation in place, the epilepsy subtypes and clinical features that appear to have a genetic basis are described, and the epidemiologic studies that have provided evidence for the heritability of these phenotypic characteristics, supporting their use in future genetic investigations, are reviewed. Finally, several molecular approaches to phenotype definition are discussed, in which the molecular defect, rather than the clinical phenotype, is used as a starting point.

  11. Definitions of oppression.

    LeBlanc, R G


    How we begin to serve others as healthcare professionals and how it is we define underserved and oppressed peoples is important in understanding issues in the organization and allocation of health care. This exploration, based on feminist post-structuralist theory, explores how nurses formulate definitions of 'underserved' and 'vulnerable'. This study goes beyond prescribed definitions to locate meanings used to identify oppression. I present, through an analysis of a literature search, the context and construction of the terms 'vulnerable population' and 'medically underserved'. Professional nursing journals are the source of relevant text. The implications of working with particular understandings of the terms 'vulnerable' and 'underserved' is based on my assumption that healthcare providers need to critically focus on the personal and political meanings they attribute to the labels used to define the clients and communities with whom they work. The presentation of this material supports that the way we define 'vulnerable' and 'underserved' is related to how our work fighting racism, ageism, AIDS, poverty, homophobia, addiction, domestic violence, sexism and colonization is realized.

  12. Reach and get capability in a computing environment

    Bouchard, Ann M [Albuquerque, NM; Osbourn, Gordon C [Albuquerque, NM


    A reach and get technique includes invoking a reach command from a reach location within a computing environment. A user can then navigate to an object within the computing environment and invoke a get command on the object. In response to invoking the get command, the computing environment is automatically navigated back to the reach location and the object copied into the reach location.

  13. Evolving definitions of mental illness and wellness.

    Manderscheid, Ronald W; Ryff, Carol D; Freeman, Elsie J; McKnight-Eily, Lela R; Dhingra, Satvinder; Strine, Tara W


    Understanding of the definitions of wellness and illness has changed from the mid-20th century to modern times, moving from a diagnosis-focused to a person-focused definition of mental illnesses, and from an "absence of disease" model to one that stresses positive psychological function for mental health. Currently, wellness refers to the degree to which one feels positive and enthusiastic about oneself and life, whereas illness refers to the presence of disease. These definitions apply to physical as well as mental illness and wellness. In this article, we build on the essential concepts of wellness and illness, discuss how these definitions have changed over time, and discuss their importance in the context of health reform and health care reform. Health reform refers to efforts focused on health, such as health promotion and the development of positive well-being. Health care reform refers to efforts focused on illness, such as treatment of disease and related rehabilitation efforts.

  14. Speeded reaching movements around invisible obstacles.

    Todd E Hudson

    Full Text Available We analyze the problem of obstacle avoidance from a Bayesian decision-theoretic perspective using an experimental task in which reaches around a virtual obstacle were made toward targets on an upright monitor. Subjects received monetary rewards for touching the target and incurred losses for accidentally touching the intervening obstacle. The locations of target-obstacle pairs within the workspace were varied from trial to trial. We compared human performance to that of a Bayesian ideal movement planner (who chooses motor strategies maximizing expected gain using the Dominance Test employed in Hudson et al. (2007. The ideal movement planner suffers from the same sources of noise as the human, but selects movement plans that maximize expected gain in the presence of that noise. We find good agreement between the predictions of the model and actual performance in most but not all experimental conditions.

  15. Priority setting in the REACH system.

    Hansson, Sven Ove; Rudén, Christina


    Due to the large number of chemicals for which toxicological and ecotoxicological information is lacking, priority setting for data acquisition is a major concern in chemicals regulation. In the current European system, two administrative priority-setting criteria are used, namely novelty (i.e., time of market introduction) and production volume. In the proposed Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) system, the novelty criterion is no longer used, and production volume will be the main priority-setting criterion for testing requirements, supplemented in some cases with hazard indications obtained from QSAR modelling. This system for priority setting has severe weaknesses. In this paper we propose that a multicriteria system should be developed that includes at least three additional criteria: chemical properties, results from initial testing in a tiered system, and voluntary testing for which efficient incentives can be created. Toxicological and decision-theoretical research is needed to design testing systems with validated priority-setting mechanisms.

  16. Reaching Consensus by Allowing Moments of Indecision

    Svenkeson, A.; Swami, A.


    Group decision-making processes often turn into a drawn out and costly battle between two opposing subgroups. Using analytical arguments based on a master equation description of the opinion dynamics occurring in a three-state model of cooperatively interacting units, we show how the capability of a social group to reach consensus can be enhanced when there is an intermediate state for indecisive individuals to pass through. The time spent in the intermediate state must be relatively short compared to that of the two polar states in order to create the beneficial effect. Furthermore, the cooperation between individuals must not be too low, as the benefit to consensus is possible only when the cooperation level exceeds a specific threshold. We also discuss how zealots, agents that remain in one state forever, can affect the consensus among the rest of the population by counteracting the benefit of the intermediate state or making it virtually impossible for an opposition to form.

  17. Paediatric trauma care

    In this review, paediatric trauma care will be considered primarily for ... to technology increases, injury becomes a major source of childhood ..... reached include the nursing profession, workers in industry, ... New York: Freeman, 1984. 21.

  18. Morphodynamics of a pseudomeandering gravel bar reach

    Bartholdy, J.; Billi, P.


    A large number of rivers in Tuscany have channel planforms, which are neither straight nor what is usually understood as meandering. In the typical case, they consist of an almost straight, slightly incised main channel fringed with large lateral bars and lunate-shaped embayments eroded into the former flood plain. In the past, these rivers have not been recognised as an individual category and have often been considered to be either braided or meandering. It is suggested here that this type of river planform be termed pseudomeandering. A typical pseudomeandering river (the Cecina River) is described and analysed to investigate the main factors responsible for producing this channel pattern. A study reach (100×300 m) was surveyed in detail and related to data on discharge, channel changes after floods and grain-size distribution of bed sediments. During 18 months of topographic monitoring, the inner lateral bar in the study reach expanded and migrated towards the concave outer bank which, concurrently, retreated by as much as 25 m. A sediment balance was constructed to analyse bar growth and bank retreat in relation to sediment supply and channel morphology. The conditions necessary to maintain the pseudomeandering morphology of these rivers by preventing them from developing a meandering planform, are discussed and interpreted as a combination of a few main factors such as the flashy character of floods, sediment supply (influenced by both natural processes and human impact), the morphological effects of discharges with contrasting return intervals and the short duration of flood events. Finally, the channel response to floods with variable sediment transport capacity (represented by bed shear stress) is analysed using a simple model. It is demonstrated that bend migration is associated with moderate floods while major floods are responsible for the development of chute channels, which act to suppress bend growth and maintain the low sinuosity configuration of

  19. Reaching women in Egypt: a success story

    Ahmed Mousa


    Full Text Available Women in Egypt are more likely than men to suffer from low vision or blindness from avoidable causes.1–3 This is, in large part, because women are not using eye care services as frequently as men, especially in rural areas.4–5 A 2002 community-based survey of 4,500 people in Al Minya Governorate, Upper Egypt showed that the prevalence of cataract in women was double that in men and that trachomatous trichiasis was four times as prevalent in women as in men

  20. Implementing Data Definition Consistency for Emergency Department Operations Benchmarking and Research.

    Yiadom, Maame Yaa A B; Scheulen, James; McWade, Conor M; Augustine, James J


    The objective was to obtain a commitment to adopt a common set of definitions for emergency department (ED) demographic, clinical process, and performance metrics among the ED Benchmarking Alliance (EDBA), ED Operations Study Group (EDOSG), and Academy of Academic Administrators of Emergency Medicine (AAAEM) by 2017. A retrospective cross-sectional analysis of available data from three ED operations benchmarking organizations supported a negotiation to use a set of common metrics with identical definitions. During a 1.5-day meeting-structured according to social change theories of information exchange, self-interest, and interdependence-common definitions were identified and negotiated using the EDBA's published definitions as a start for discussion. Methods of process analysis theory were used in the 8 weeks following the meeting to achieve official consensus on definitions. These two lists were submitted to the organizations' leadership for implementation approval. A total of 374 unique measures were identified, of which 57 (15%) were shared by at least two organizations. Fourteen (4%) were common to all three organizations. In addition to agreement on definitions for the 14 measures used by all three organizations, agreement was reached on universal definitions for 17 of the 57 measures shared by at least two organizations. The negotiation outcome was a list of 31 measures with universal definitions to be adopted by each organization by 2017. The use of negotiation, social change, and process analysis theories achieved the adoption of universal definitions among the EDBA, EDOSG, and AAAEM. This will impact performance benchmarking for nearly half of US EDs. It initiates a formal commitment to utilize standardized metrics, and it transitions consistency in reporting ED operations metrics from consensus to implementation. This work advances our ability to more accurately characterize variation in ED care delivery models, resource utilization, and performance. In

  1. Continental reach: The Westcoast Energy story

    Newman, P. C.


    A historical account is given of the spectacular success that was Westcoast Energy Inc., a Canadian natural gas giant that charted a wilderness pipeline from natural gas fields in Canada's sub-arctic solitude. The beginning of the company is traced to an event in 1934 when near the bank of the Pouce Coupe River, close to the Alberta-British Columbia border, Frank McMahon, a solitary wildcatter and the eventual founder of the company, first sighted the fiery inferno of a runaway wildcat well, drilled by geologists of the Imperial Oil Company during their original search for the Canadian petroleum basin's motherlode. It was on this occasion in 1934 that McMahon first conceived a geological profile that connected the gas-bearing sandstone of Pouce Coupe with the reservoir rock of the biggest natural gas field of Alberta, and a pipeline from this sandstone storehouse across the rugged heart of British Columbia to Vancouver, and south into the United States. It took the better part of a quarter century to realize the dream of that pipeline which, in due course, turned out to be only the first step towards reaching the top rank of Canadian corporations in operational and financial terms, and becoming one of only a handful in terms of a story that became a Canadian corporate legend. By chronicling the lives and contributions of the company's founder and senior officials over the years, the book traces the company's meteoric rise from a gleam in its founder's eye to a cautious regional utility, and to the aggressive Canadian adventurer that went on to burst the boundaries of its Pacific Coast world, until the continental reach of its operations and interests run from Canada's Pacific shoreline to its Atlantic basins and Mexico's Campeche Bay to Alaska's Prudhoe Bay. The company's independent existence came to an end in 2002 when Westcoast Energy, by then a $15 billion operation, was acquired by Duke Energy Limited of North

  2. New symmetry of intended curved reaches

    Torres Elizabeth B


    Full Text Available Abstract Background Movement regularities are inherently present in automated goal-directed motions of the primate's arm system. They can provide important signatures of intentional behaviours driven by sensory-motor strategies, but it remains unknown if during motor learning new regularities can be uncovered despite high variability in the temporal dynamics of the hand motions. Methods We investigated the conservation and violation of new movement regularity obtained from the hand motions traced by two untrained monkeys as they learned to reach outwardly towards spatial targets while avoiding obstacles in the dark. The regularity pertains to the transformation from postural to hand paths that aim at visual goals. Results In length-minimizing curves the area enclosed between the Euclidean straight line and the curve up to its point of maximum curvature is 1/2 of the total area. Similar trend is found if one examines the perimeter. This new movement regularity remained robust to striking changes in arm dynamics that gave rise to changes in the speed of the reach, to changes in the hand path curvature, and to changes in the arm's postural paths. The area and perimeter ratios characterizing the regularity co-varied across repeats of randomly presented targets whenever the transformation from posture to hand paths was compliant with the intended goals. To interpret this conservation and the cases in which the regularity was violated and recovered, we provide a geometric model that characterizes arm-to-hand and hand-to-arm motion paths as length minimizing curves (geodesics in a non-Euclidean space. Whenever the transformation from one space to the other is distance-metric preserving (isometric the two symmetric ratios co-vary. Otherwise, the symmetric ratios and their co-variation are violated. As predicted by the model we found empirical evidence for the violation of this movement regularity whenever the intended goals mismatched the actions. This

  3. LEP Dismantling Reaches Half-Way Stage


    LEP's last superconducting module leaves its home port... Just seven months into the operation, LEP dismantling is forging ahead. Two of the eight arcs which form the tunnel have already been emptied and the last of the accelerator's radiofrequency (RF) cavities has just been raised to the surface. The 160 people working on LEP dismantling have reason to feel pleased with their progress. All of the accelerator's 72 superconducting RF modules have already been brought to the surface, with the last one being extracted on 2nd May. This represents an important step in the dismantling process, as head of the project, John Poole, explains. 'This was the most delicate part of the project, because the modules are very big and they could only come out at one place', he says. The shaft at point 1.8 through which the RF cavity modules pass is 18 metres in diameter, while each module is 11.5 metres long. Some modules had to travel more than 10 kilometres to reach the shaft. ... is lifted up the PM 1.8 shaft, after a m...

  4. CAST reaches milestone but keeps on searching

    CERN Courier (september 2011 issue)


    After eight years of searching for the emission of a dark matter candidate particle, the axion, from the Sun, the CERN Axion Solar Telescope (CAST) has fulfilled its original physics programme.   Members of the CAST collaboration in July, together with dipole-based helioscope. CAST, the world’s most sensitive axion helioscope, points a recycled prototype LHC dipole magnet at the Sun at dawn and dusk, looking for the conversion of axions to X-rays. It incorporates four state-of-the-art X-ray detectors: three Micromegas detectors and a pn-CCD imaging camera attached to a focusing X-ray telescope that was recovered from the German space programme (see CERN Courier April 2010).  Over the years, CAST has operated with the magnet bores - the location of the axion conversion - in different conditions: first in vacuum, covering axion masses up to 20 meV/c2, and then with a buffer gas (4He and later 3He) at various densities, finally reaching the goal of 1.17 eV/c2 on 22 ...

  5. Media perspective - new opportunities for reaching audiences

    Haswell, Katy


    The world of media is experiencing a period of extreme and rapid change with the rise of internet television and the download generation. Many young people no longer watch standard TV. Instead, they go on-line, talking to friends and downloading pictures, videos, music clips to put on their own websites and watch/ listen to on their laptops and mobile phones. Gone are the days when TV controllers determined what you watched and when you watched it. Now the buzzword is IPTV, Internet Protocol Television, with companies such as JOOST offering hundreds of channels on a wide range of subjects, all of which you can choose to watch when and where you wish, on your high-def widescreen with stereo surround sound at home or on your mobile phone on the train. This media revolution is changing the way organisations get their message out. And it is encouraging companies such as advertising agencies to be creative about new ways of accessing audiences. The good news is that we have fresh opportunities to reach young people through internet-based media and material downloaded through tools such as games machines, as well as through the traditional media. And it is important for Europlanet to make the most of these new and exciting developments.

  6. Recovery definitions: Do they change?

    Kaskutas, Lee Ann; Witbrodt, Jane; Grella, Christine E


    The term "recovery" is widely used in the substance abuse literature and clinical settings, but data have not been available to empirically validate how recovery is defined by individuals who are themselves in recovery. The "What Is Recovery?" project developed a 39-item definition of recovery based on a large nationwide online survey of individuals in recovery. The objective of this paper is to report on the stability of those definitions one to two years later. To obtain a sample for studying recovery definitions that reflected the different pathways to recovery, the parent study involved intensive outreach. Follow-up interviews (n=1237) were conducted online and by telephone among respondents who consented to participate in follow-up studies. Descriptive analyses considered endorsement of individual recovery items at both surveys, and t-tests of summary scores studied significant change in the sample overall and among key subgroups. To assess item reliability, Cronbach's alpha was estimated. Rates of endorsement of individual items at both interviews was above 90% for a majority of the recovery elements, and there was about as much transition into endorsement as out of endorsement. Statistically significant t-test scores were of modest magnitude, and reliability statistics were high (ranging from .782 to .899). Longitudinal analyses found little evidence of meaningful change in recovery definitions at follow-up. Results thus suggest that the recovery definitions developed in the parent "What Is Recovery?" survey represent stable definitions of recovery that can be used to guide service provision in Recovery-Oriented Systems of Care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Planning of the Extended Reach well Dieksand 2; Planung der Extended Reach Bohrung Dieksand 2

    Frank, U.; Berners, H. [RWE-DEA AG, Hamburg (Germany). Drilling Team Mittelplate und Dieksand; Hadow, A.; Klop, G.; Sickinger, W. [Wintershall AG Erdoelwerke, Barnstdorf (Germany); Sudron, K.


    The Mittelplate oil field is located 7 km offshore the town of Friedrichskoog. Reserves are estimated at 30 million tonnes of oil. At a production rate of 2,500 t/d, it will last about 33 years. The transport capacity of the offshore platform is limited, so that attempts were made to enhance production by constructing the extended reach borehole Dieksand 2. Details are presented. (orig.) [Deutsch] Das Erdoelfeld Mittelplate liegt am suedlichen Rand des Nationalparks Schleswig Holsteinisches Wattenmeer, ca. 7000 m westlich der Ortschaft Friedrichskoog. Die gewinnbaren Reserven betragen ca. 30 Millionen t Oel. Bei einer Foerderkapazitaet von 2.500 t/Tag betraegt die Foerderdauer ca. 33 Jahre. Aufgrund der begrenzten Transportkapazitaeten von der Insel, laesst sich durch zusaetzliche Bohrungen von der kuenstlichen Insel Mittelplate keine entscheidende Erhoehung der Foerderkapazitaet erzielen. Ab Sommer 1996 wurde erstmals die Moeglichkeit der Lagerstaettenerschliessung von Land untersucht. Ein im Mai 1997 in Hamburg etabliertes Drilling Team wurde mit der Aufgabe betraut, die Extended Reach Bohrung Dieksand 2 zu planen und abzuteufen. Die Planungsphasen fuer die Extended Reach Bohrung Dieksand 2 wurden aufgezeigt. Die fuer den Erfolg einer Extended Reach Bohrung wichtigen Planungsparameter wurden erlaeutert. Es wurden Wege gezeigt, wie bei diesem Projekt technische und geologische Risiken in der Planung mit beruecksichtigt und nach Beginn der Bohrung weiter bearbeitet werden koennen. (orig.)

  8. Intentional signals during saccadic and reaching delays in the human posterior parietal cortex.

    Galati, Gaspare; Committeri, Giorgia; Pitzalis, Sabrina; Pelle, Gina; Patria, Fabiana; Fattori, Patrizia; Galletti, Claudio


    In the monkey posterior parietal cortex (PPC), there is clear evidence of anatomically segregated neuronal populations specialized for planning saccades and arm-reaching movements. However, functional neuroimaging studies in humans have yielded controversial results. Here we show that the human PPC contains distinct subregions responsive to salient visual cues, some of which combine spatial and action-related signals into 'intentional' signals. Participants underwent event-related functional magnetic resonance imaging while performing delayed saccades and long-range arm reaches instructed by visual cues. We focused on activity in the time period following the cue and preceding the actual movement. The use of individual cortical surface reconstructions with detailed sulcal labeling allowed the definition of six responsive regions with distinctive anatomical locations in the PPC. Each region exhibited a distinctive combination of transient and sustained signals during the delay, modulated by either the cue spatial location (contralateral vs. ipsilateral), the instructed action (saccades vs. reaching) or both. Importantly, a lateral and a medial dorsal parietal region showed sustained responses during the delay preferentially for contralateral saccadic and reaching trials, respectively. In the lateral region, preference for saccades was evident only as a more sustained response during saccadic vs. reaching delays, whereas the medial region also showed a higher transient response to cues signaling reaching vs. saccadic actions. These response profiles closely match the behavior of neurons in the macaque lateral and medial intraparietal area, respectively, and suggest that these corresponding human regions are encoding spatially directed action plans or 'intentions'.

  9. Columbia River Estuary Ecosystem Classification Hydrogeomorphic Reach

    Cannon, Charles M.; Ramirez, Mary F.; Heatwole, Danelle W.; Burke, Jennifer L.; Simenstad, Charles A.; O'Connor, Jim E.; Marcoe, Keith


    Estuarine ecosystems are controlled by a variety of processes that operate at multiple spatial and temporal scales. Understanding the hierarchical nature of these processes will aid in prioritization of restoration efforts. This hierarchical Columbia River Estuary Ecosystem Classification (henceforth "Classification") of the Columbia River estuary is a spatial database of the tidally-influenced reaches of the lower Columbia River, the tidally affected parts of its tributaries, and the landforms that make up their floodplains for the 230 kilometers between the Pacific Ocean and Bonneville Dam. This work is a collaborative effort between University of Washington School of Aquatic and Fishery Sciences (henceforth "UW"), U.S. Geological Survey (henceforth "USGS"), and the Lower Columbia Estuary Partnership (henceforth "EP"). Consideration of geomorphologic processes will improve the understanding of controlling physical factors that drive ecosystem evolution along the tidal Columbia River. The Classification is organized around six hierarchical levels, progressing from the coarsest, regional scale to the finest, localized scale: (1) Ecosystem Province; (2) Ecoregion; (3) Hydrogeomorphic Reach; (4) Ecosystem Complex; (5) Geomorphic Catena; and (6) Primary Cover Class. For Levels 4 and 5, we mapped landforms within the Holocene floodplain primarily by visual interpretation of Light Detection and Ranging (LiDAR) topography supplemented with aerial photographs, Natural Resources Conservation Service (NRCS) soils data, and historical maps. Mapped landforms are classified as to their current geomorphic function, the inferred process regime that formed them, and anthropogenic modification. Channels were classified primarily by a set of depth-based rules and geometric relationships. Classification Level 5 floodplain landforms ("geomorphic catenae") were further classified based on multivariate analysis of land-cover within the mapped landform area and attributed as "sub

  10. Parallel explicit and implicit control of reaching.

    Pietro Mazzoni

    Full Text Available BACKGROUND: Human movement can be guided automatically (implicit control or attentively (explicit control. Explicit control may be engaged when learning a new movement, while implicit control enables simultaneous execution of multiple actions. Explicit and implicit control can often be assigned arbitrarily: we can simultaneously drive a car and tune the radio, seamlessly allocating implicit or explicit control to either action. This flexibility suggests that sensorimotor signals, including those that encode spatially overlapping perception and behavior, can be accurately segregated to explicit and implicit control processes. METHODOLOGY/PRINCIPAL FINDINGS: We tested human subjects' ability to segregate sensorimotor signals to parallel control processes by requiring dual (explicit and implicit control of the same reaching movement and testing for interference between these processes. Healthy control subjects were able to engage dual explicit and implicit motor control without degradation of performance compared to explicit or implicit control alone. We then asked whether segregation of explicit and implicit motor control can be selectively disrupted by studying dual-control performance in subjects with no clinically manifest neurologic deficits in the presymptomatic stage of Huntington's disease (HD. These subjects performed successfully under either explicit or implicit control alone, but were impaired in the dual-control condition. CONCLUSION/SIGNIFICANCE: The human nervous system can exert dual control on a single action, and is therefore able to accurately segregate sensorimotor signals to explicit and implicit control. The impairment observed in the presymptomatic stage of HD points to a possible crucial contribution of the striatum to the segregation of sensorimotor signals to multiple control processes.

  11. Reaching rural Ohio with intellectual disability psychiatry.

    Gentile, Julie P; Cowan, Allison E; Harper, Beth; Mast, Ryan; Merrill, Brian


    Individuals with intellectual disability experience higher rates of mental illness when compared with the general population, and there is a lack of medical and mental health professionals in rural and under-served areas. With the increase in discharge of individuals from institutional settings back to their home communities into the least restrictive environments, there are more patients with complex needs being added to the schedules of physicians in the outpatient delivery care system. Patients with disabilities may not travel well or tolerate changes in routine so may not have access to psychiatry. Utilization of telepsychiatry is well suited to this specialized patient population because it allows a highly traumatized group to meet with a psychiatrist and other mental health professionals from a location of their choice. Ohio's Telepsychiatry Project for Intellectual Disability was initiated in 2012 to serve outlying communities with a lack of infrastructure and resources, to provide specialized mental health services to individuals with co-occurring mental illness and intellectual disability. After five years, over 900 patients with intellectual disability from 64 of Ohio's 88 counties receive specialized mental health treatment through this statewide grant-funded project.

  12. Spiking and LFP activity in PRR during symbolically instructed reaches


    The spiking activity in the parietal reach region (PRR) represents the spatial goal of an impending reach when the reach is directed toward or away from a visual object. The local field potentials (LFPs) in this region also represent the reach goal when the reach is directed to a visual object. Thus PRR is a candidate area for reading out a patient's intended reach goals for neural prosthetic applications. For natural behaviors, reach goals are not always based on the location of a visual obj...

  13. Historical centres: changing definitions

    Roberta Lazzarotti


    Full Text Available Since the end of the Second World War, the architectural and planning culture has been showing a fluctuating attention to the theme of historical centres and their enhancement. First of all this uneven progress explains the difficulty to reach a homogeneous definition and this is still lacking. During a long phase of this period, the historical parts of the town were considered as objects to be preserved in an integral way, as urban monuments. This is mostly due to the high symbolic value of these settlements, that represent fundamental landmarks. Identity building and empowerment of local communities are indispensable conditions for any development programme, especially in the case of centres or other historic environments at risk of abandonment. The progressive evolution of this concept brings awareness of the impossibility of separating – either in analytical or in planning terms ­ historical centres from their urban and territorial contexts, which are linked by mutual, deep relationships. This article attempts to retrace the steps signaled by the publication of international documents and conventions, from the Charter of Gubbio (1960 to the Charter of Krakow and the European Landscape Convention (2000; they obviously represent particular points of view, not exhaustive of the richness of the positions in the debate, but extremely significant in terms of diffusion and consensus.

  14. Cultural competence: a constructivist definition.

    Blanchet Garneau, Amélie; Pepin, Jacinthe


    In nursing education, most of the current teaching practices perpetuate an essentialist perspective of culture and make it imperative to refresh the concept of cultural competence in nursing. The purpose of this article is to propose a constructivist definition of cultural competence that stems from the conclusions of an extensive critical review of the literature on the concepts of culture, cultural competence, and cultural safety among nurses and other health professionals. The proposed constructivist definition is situated in the unitary-transformative paradigm in nursing as defined by Newman and colleagues. It makes the connection between the field of competency-based education and the nursing discipline. Cultural competence in a constructivist paradigm that is oriented toward critical, reflective practice can help us develop knowledge about the role of nurses in reducing health inequalities and lead to a comprehensive ethical reflection about the social mandate of health care professionals.

  15. Just caring.

    Hussey, Trevor


    Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. © 2011 Blackwell Publishing Ltd.

  16. Crossing the caring chasm

    Kitson, Alison; Sørensen, Erik Elgaard


    upon prevention and screening, the trend will continue to be around providing care and support for individuals, families and communities for chronic and life-style induced diseases. The emphasis will therefore be on the need for evidence-based care as much as evidence-based medicine (or cure......). By definition, patients with chronic conditions cannot be cured; this means their fundamental care needs are at the centre of their course of care and hence, nursing (Henderson 1966). This article is protected by copyright. All rights reserved....

  17. 32 CFR 564.37 - Medical care.


    ... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care; policies outlining the manner, conditions, procedures, and eligibility for care; and the sources from...

  18. Analyzing Differences in Operational Disease Definitions Using Ontological Modeling

    Peelen, Linda; Klein, Michel; Schlobach, Stefan; Keizer, de Nicolette; Peek, Niels


    In medicine, there are many diseases which cannot be precisely characterized but are considered as natural kinds. In the communication between health care professionals, this is generally not problematic. In biomedical research, however, crisp definitions are required to unambiguously distinguish

  19. Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals.

    Huber, Evelyn; Kleinknecht-Dolf, Michael; Müller, Marianne; Kugler, Christiane; Spirig, Rebecca


    To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Hybrid model of concept development and embedded mixed-methods design. The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. © 2016 John Wiley & Sons Ltd.

  20. Breaking the fixed-arrival-time restriction in reaching movements of neural prosthetic devices.

    Srinivasan, Lakshminarayan; da Silva, Marco


    We routinely generate reaching arm movements to function independently. For paralyzed users of upper extremity neural prosthetic devices, flexible, high-performance reaching algorithms will be critical to restoring quality-of-life. Previously, algorithms called real-time reach state equations (RSE) were developed to integrate the user's plan and execution-related neural activity to drive reaching movements to arbitrary targets. Preliminary validation under restricted conditions suggested that RSE might yield dramatic performance improvements. Unfortunately, real-world applications of RSE have been impeded because the RSE assumes a fixed, known arrival time. Recent animal-based prototypes attempted to break the fixed-arrival-time assumption by proposing a standard model (SM) that instead restricted the user's movements to a fixed, known set of targets. Here, we leverage general purpose filter design (GPFD) to break both of these critical restrictions, freeing the paralyzed user to make reaching movements to arbitrary target sets with various arrival times and definitive stopping. In silico validation predicts that the new approach, GPFD-RSE, outperforms the SM while offering greater flexibility. We demonstrate the GPFD-RSE against SM in the simulated control of an overactuated 3-D virtual robotic arm with a real-time inverse kinematics engine.

  1. 5 CFR 890.1003 - Definitions.


    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Definitions. 890.1003 Section 890.1003 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers General...

  2. 24 CFR 6.3 - Definitions.


    ... business of providing education, health care, housing, social services, or parks and recreation; or (ii... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Definitions. 6.3 Section 6.3 Housing and Urban Development Office of the Secretary, Department of Housing and Urban...

  3. 42 CFR 475.1 - Definitions.


    ... interest equals at least 5 percent of the value of the property or assets of the entity. Health care... 42 Public Health 4 2010-10-01 2010-10-01 false Definitions. 475.1 Section 475.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  4. 42 CFR 421.501 - Definitions.


    ..., training, or medical expertise of a licensed health care professional. Non-random prepayment complex... been paid. Provider-specific probe review means the complex medical review of a small sample of claims... PROGRAM MEDICARE CONTRACTING Medical Review § 421.501 Definitions. As used in this subpart—...

  5. The dipoles reach the half-way mark


    With the positioning of the 616th magnet, installation of the LHC dipoles has reached the half-way mark. Only half the dipoles remain to be installed! The 616th dipole out of a total of 1232 was installed at 3 a.m on Wednesday 12 July. Night and day, the tunnel is the setting for a never-ending series of carefully choreographed installation operations. At a rate of around twenty per week, there has been a steady underground flow of dipole magnets, each measuring 15 metres in length and weighing 34 tonnes. 'In order to recover the accumulated delays, installation is proceeding three times faster than planned', confides Claude Hauviller, who is supervising LHC installation. Four dipoles can be transported underground at the same time. It is a real challenge, which the 65-man team responsible for this difficult task faces on a daily basis. This is because there is very little space in the tunnel and there are no passing places for the magnet transport vehicles. The room for manoeuvre can sometimes be measured ...

  6. Consumer exposure modelling under REACH: Assessing the defaults.

    Oltmanns, J; Neisel, F; Heinemeyer, G; Kaiser, E; Schneider, K


    Consumer exposure to chemicals from products and articles is rarely monitored. Since an assessment of consumer exposure has become particularly important under the European REACH Regulation, dedicated modelling approaches with exposure assessment tools are applied. The results of these tools are critically dependent on the default input values embedded in the tools. These inputs were therefore compiled for three lower tier tools (ECETOC TRA (version 3.0), EGRET and REACT)) and benchmarked against a higher tier tool (ConsExpo (version 4.1)). Mostly, conservative input values are used in the lower tier tools. Some cases were identified where the lower tier tools used less conservative values than ConsExpo. However, these deviations only rarely resulted in less conservative exposure estimates compared to ConsExpo, when tested in reference scenarios. This finding is mainly due to the conservatism of (a) the default value for the thickness of the product layer (with complete release of the substance) used for the prediction of dermal exposure and (b) the complete release assumed for volatile substances (i.e. substances with a vapour pressure ⩾10Pa) for inhalation exposure estimates. The examples demonstrate that care must be taken when changing critical defaults in order to retain conservative estimates of consumer exposure to chemicals.

  7. Late presentation of HIV infection: a consensus definition

    Antinori, A; Coenen, T; Costagiola, D


    clinical definition of late presentation. The objective of this article is to present a consensus definition of late presentation of HIV infection. Methods Over the past year, two initiatives have moved towards a harmonized definition. In spring 2009, they joined efforts to identify a common definition...... of what is meant by a 'late-presenting' patient. Results Two definitions were agreed upon, as follows. Late presentation: persons presenting for care with a CD4 count below 350 cells/muL or presenting with an AIDS-defining event, regardless of the CD4 cell count. Presentation with advanced HIV disease...... able to implement this definition (either on its own or alongside their own preferred definition) when reporting surveillance or research data relating to late presentation of HIV infection....

  8. ERF1 -- Enhanced River Reach File 1.2

    U.S. Geological Survey, Department of the Interior — U.S. Environmental Protection Agency's River Reach File 1 (RF1)to ensure the hydrologic integrity of the digital reach traces and to quantify the mean water time of...

  9. Reaching hard-to-reach individuals: Nonselective versus targeted outbreak response vaccination for measles.

    Minetti, Andrea; Hurtado, Northan; Grais, Rebecca F; Ferrari, Matthew


    Current mass vaccination campaigns in measles outbreak response are nonselective with respect to the immune status of individuals. However, the heterogeneity in immunity, due to previous vaccination coverage or infection, may lead to potential bias of such campaigns toward those with previous high access to vaccination and may result in a lower-than-expected effective impact. During the 2010 measles outbreak in Malawi, only 3 of the 8 districts where vaccination occurred achieved a measureable effective campaign impact (i.e., a reduction in measles cases in the targeted age groups greater than that observed in nonvaccinated districts). Simulation models suggest that selective campaigns targeting hard-to-reach individuals are of greater benefit, particularly in highly vaccinated populations, even for low target coverage and with late implementation. However, the choice between targeted and nonselective campaigns should be context specific, achieving a reasonable balance of feasibility, cost, and expected impact. In addition, it is critical to develop operational strategies to identify and target hard-to-reach individuals.

  10. Proprioceptive recalibration arises slowly compared to reach adaptation.

    Zbib, Basel; Henriques, Denise Y P; Cressman, Erin K


    When subjects reach in a novel visuomotor environment (e.g. while viewing a cursor representing their hand that is rotated from their hand's actual position), they typically adjust their movements (i.e. bring the cursor to the target), thus reducing reaching errors. Additionally, research has shown that reaching with altered visual feedback of the hand results in sensory changes, such that proprioceptive estimates of hand position are shifted in the direction of the visual feedback experienced (Cressman and Henriques in J Neurophysiol 102:3505-3518, 2009). This study looked to establish the time course of these sensory changes. Additionally, the time courses of implicit sensory and motor changes were compared. Subjects reached to a single visual target while seeing a cursor that was either aligned with their hand position (50 trials) or rotated 30° clockwise relative to their hand (150 trials). Reach errors and proprioceptive estimates of felt hand position were assessed following the aligned reach training trials and at seven different times during the rotated reach training trials by having subjects reach to the target without visual feedback, and provide estimates of their hand relative to a visual reference marker, respectively. Results revealed a shift in proprioceptive estimates throughout the rotated reach training trials; however, significant sensory changes were not observed until after 70 trials. In contrast, results showed a greater change in reaches after a limited number of reach training trials with the rotated cursor. These findings suggest that proprioceptive recalibration arises more slowly than reach adaptation.

  11. Reach/frequency for printed media: Personal probabilities or models

    Mortensen, Peter Stendahl


    The author evaluates two different ways of estimating reach and frequency of plans for printed media. The first assigns reading probabilities to groups of respondents and calculates reach and frequency by simulation. the second estimates parameters to a model for reach/frequency. It is concluded...

  12. Spiking and LFP activity in PRR during symbolically instructed reaches.

    Hwang, Eun Jung; Andersen, Richard A


    The spiking activity in the parietal reach region (PRR) represents the spatial goal of an impending reach when the reach is directed toward or away from a visual object. The local field potentials (LFPs) in this region also represent the reach goal when the reach is directed to a visual object. Thus PRR is a candidate area for reading out a patient's intended reach goals for neural prosthetic applications. For natural behaviors, reach goals are not always based on the location of a visual object, e.g., playing the piano following sheet music or moving following verbal directions. So far it has not been directly tested whether and how PRR represents reach goals in such cognitive, nonlocational conditions, and knowing the encoding properties in various task conditions would help in designing a reach goal decoder for prosthetic applications. To address this issue, we examined the macaque PRR under two reach conditions: reach goal determined by the stimulus location (direct) or shape (symbolic). For the same goal, the spiking activity near reach onset was indistinguishable between the two tasks, and thus a reach goal decoder trained with spiking activity in one task performed perfectly in the other. In contrast, the LFP activity at 20-40 Hz showed small but significantly enhanced reach goal tuning in the symbolic task, but its spatial preference remained the same. Consequently, a decoder trained with LFP activity performed worse in the other task than in the same task. These results suggest that LFP decoders in PRR should take into account the task context (e.g., locational vs. nonlocational) to be accurate, while spike decoders can robustly provide reach goal information regardless of the task context in various prosthetic applications.

  13. Changes in context and perception of maximum reaching height.

    Wagman, Jeffrey B; Day, Brian M


    Successfully performing a given behavior requires flexibility in both perception and behavior. In particular, doing so requires perceiving whether that behavior is possible across the variety of contexts in which it might be performed. Three experiments investigated how (changes in) context (ie point of observation and intended reaching task) influenced perception of maximum reaching height. The results of experiment 1 showed that perceived maximum reaching height more closely reflected actual reaching ability when perceivers occupied a point of observation that was compatible with that required for the reaching task. The results of experiments 2 and 3 showed that practice perceiving maximum reaching height from a given point of observation improved perception of maximum reaching height from a different point of observation, regardless of whether such practice occurred at a compatible or incompatible point of observation. In general, such findings show bounded flexibility in perception of affordances and are thus consistent with a description of perceptual systems as smart perceptual devices.

  14. On geo-basis of river regulation——A case study for the middle reaches of the Yangtze River


    From the point of view that people have to obey the river’s geo-attributes in the river regulation, the definition and the meaning of the geo-attributes of a river are discussed. The geo-basis of the river regulation of the middle reaches of the Yangtze River is expounded in five aspects, including the structural geomorphology environment of flood storage and discharge, the distribution characteristics of subsidence and the sedimentation areas of Dongting Basin, the history evolution of Jianghan Basin, the function of Jianghan Basin and Dongting Basin as the flood water detention areas of Jingjiang River reach in ancient time, and the geological characteristic of Jingjiang River reach. Based on the geo-attributes of the middle reaches of the Yangtze River, some ideas about the middle reach regulation of the Yangtze River are put forward: to process the interchange between the lakes and diked marsh areas in Dongting Basin, to canal the new river route as the flood diversion channel of Jingjiang River reach with the paleo river, to recover the function of Jianghan Basin as flood detention area of the middle reaches. And we should take into consideration the geo-environment of the whole Yangtze River in the river regulation of middle reaches.

  15. On geo-basis of river regulation-A case study for the middle reaches of the Yangtze River

    LIU GuoWei


    From the point of view that people have to obey the river's geo-attributes in the river regulation,the definition and the meaning of the geo-attributes of a river are discussed.The geo-basis of the river regulation of the middle reaches of the Yangtze River is expounded in five aspects,including the structural geomorphol-ogy environment of flood storage and discharge,the distribution characteristics of subsidence and the sedimentation areas of Dongting Basin,the history evolution of Jianghan Basin,the function of Jianghan Basin and Dongting Basin as the flood water detention areas of Jingjiang River reach in ancient time,and the geological characteristic of Jingjiang River reach.Based on the geo-attributes of the middle reaches of the Yangtze River,some ideas about the middle reach regulation of the Yangtze River are put forward:to process the interchange between the lakes and diked marsh areas in Dongting Basin,to canal the new river route as the flood di-version channel of Jingjiang River reach with the paleo river,to recover the func-tion of Jianghan Basin as flood detention area of the middle reaches.And we should take into consideration the geo-environment of the whole Yangtze River in the river regulation of middle reaches.

  16. Identification of temporal consistency in rating curve data: Bidirectional Reach (BReach)

    Van Eerdenbrugh, Katrien; Van Hoey, Stijn; Verhoest, Niko E. C.


    In this paper, a methodology is developed to identify consistency of rating curve data based on a quality analysis of model results. This methodology, called Bidirectional Reach (BReach), evaluates results of a rating curve model with randomly sampled parameter sets in each observation. The combination of a parameter set and an observation is classified as nonacceptable if the deviation between the accompanying model result and the measurement exceeds observational uncertainty. Based on this classification, conditions for satisfactory behavior of a model in a sequence of observations are defined. Subsequently, a parameter set is evaluated in a data point by assessing the span for which it behaves satisfactory in the direction of the previous (or following) chronologically sorted observations. This is repeated for all sampled parameter sets and results are aggregated by indicating the endpoint of the largest span, called the maximum left (right) reach. This temporal reach should not be confused with a spatial reach (indicating a part of a river). The same procedure is followed for each data point and for different definitions of satisfactory behavior. Results of this analysis enable the detection of changes in data consistency. The methodology is validated with observed data and various synthetic stage-discharge data sets and proves to be a robust technique to investigate temporal consistency of rating curve data. It provides satisfying results despite of low data availability, errors in the estimated observational uncertainty, and a rating curve model that is known to cover only a limited part of the observations.

  17. Definition of postprandial lipaemia

    Kolovou, Genovefa D; Mikhailidis, Dimitri P; Nordestgaard, Børge G


    At the present time, there is no widely agreed definition of postprandial lipaemia (PPL). This lack of a shared definition limits the identification and treatment of patients with exaggerated PPL as well as the evaluation of potential therapeutic agents. PPL is a complex syndrome characterized...... by non-fasting hypertriglyceridaemia that is associated with an increased risk of vascular events. This review considers the definition of PPL and the methodology for assessing this process....

  18. Postural control during standing reach in children with Down syndrome.

    Chen, Hao-Ling; Yeh, Chun-Fu; Howe, Tsu-Hsin


    The purpose of the present study was to investigate the dynamic postural control of children with Down syndrome (DS). Specifically, we compared postural control and goal-directed reaching performance between children with DS and typically developing children during standing reach. Standing reach performance was analyzed in three main phases using the kinematic and kinetic data collected from a force plate and a motion capture system. Fourteen children with DS, age and gender matched with fourteen typically developing children, were recruited for this study. The results showed that the demand of the standing reach task affected both dynamic postural control and reaching performance in children with DS, especially in the condition of beyond arm's length reaching. More postural adjustment strategies were recruited when reaching distance was beyond arm's length. Children with DS tended to use inefficient and conservative strategies for postural stability and reaching. That is, children with DS perform standing reach with increased reaction and execution time and decreased amplitudes of center of pressure displacements. Standing reach resembled functional balance that is required in daily activities. It is suggested to be considered as a part of strength and balance training program with graded task difficulty.

  19. What is Good Quality of Health Care?

    Magne Nylenna


    Full Text Available A diversity of definitions of quality exists, that frequently contain aspects of complexity, relativity and subjectivity. This paper provides an overview of key components in the quality debate within health care, including different perspectives and dimensions of the quality of care. Definitions of the quality of health care reflect the characteristics of health services, and are useful for measurements and quality improvement. Over time the patient perspective of quality has gotten increasing weight, and in quality improvement there has been a shift from individual responsibility for doctors and health care personnel to systems thinking. We argue that the quality approach in health care should be more standardized and that health care-specific definitions of quality should be used when the relationship between physician professionalism and quality is investigated.Keywords: quality, health care, systems thinking, patient perspective, outcome, indicator, measurement, improvement.

  20. Reach/frequency for printed media: Personal probabilities or models

    Mortensen, Peter Stendahl


    that, in order to prevent bias, ratings per group must be used as reading probabilities. Nevertheless, in most cases, the estimates are still biased compared with panel data, thus overestimating net ´reach. Models with the same assumptions as with assignments of reading probabilities are presented......The author evaluates two different ways of estimating reach and frequency of plans for printed media. The first assigns reading probabilities to groups of respondents and calculates reach and frequency by simulation. the second estimates parameters to a model for reach/frequency. It is concluded...

  1. Reach Scale Sediment Balance of Goodwin Creek Watershed, Mississippi

    Ran, L.; Garcia, T.; Ye, S.; Harman, C. J.; Hassan, M. A.; Simon, A.


    Several reaches of Goodwin Creek, an experimental watershed within the Mississippi river basin, were analyzed for the period 1977-2007 in terms of long-term trends in sediment gain and loss in each reach, the relation of input and output to within-reach sediment fluxes, and the impacts of land use and bank erosion on reach sediment dynamics. Over the period 1977-2007, degradational and aggradational reaches were identified indicating slight vertical adjustment along the mainstream. Lateral adjustment was the main response of the channel to changes in flow and sediment regimes. Event-based sediment load was estimated using suspended concentration data, bedload transport rate, and changes in cross-sectional data. Bank erosion was estimated using cross-sectional data and models. The spatial and temporal patterns of within-reach sediment dynamics correspond closely with river morphology and also reflect basin conditions over the last three decades; thus they are conditioned by coeval trends in climate, hydrology, and land use. The sediment exchange within the mainstream was calculated by the development of reach sediment balances that reveal complex spatial and temporal patterns of sediment dynamics. Sediment load during the rising limb of the hydrograph was slightly higher than those estimated for the falling limb indicating the relative importance of sediment supply on reach sediment dynamic in the basin. Cumulative plots of sediment exchange reveal that major changes in within reach sediment storage are associated with large floods or major inputs from bank erosion.

  2. Engineering Definitional Interpreters

    Midtgaard, Jan; Ramsay, Norman; Larsen, Bradford


    A definitional interpreter should be clear and easy to write, but it may run 4--10 times slower than a well-crafted bytecode interpreter. In a case study focused on implementation choices, we explore ways of making definitional interpreters faster without expending much programming effort. We imp...

  3. Engineering Definitional Interpreters

    Midtgaard, Jan; Ramsay, Norman; Larsen, Bradford


    A definitional interpreter should be clear and easy to write, but it may run 4--10 times slower than a well-crafted bytecode interpreter. In a case study focused on implementation choices, we explore ways of making definitional interpreters faster without expending much programming effort. We imp...

  4. Definition of postprandial lipaemia

    Kolovou, Genovefa D; Mikhailidis, Dimitri P; Nordestgaard, Børge G


    At the present time, there is no widely agreed definition of postprandial lipaemia (PPL). This lack of a shared definition limits the identification and treatment of patients with exaggerated PPL as well as the evaluation of potential therapeutic agents. PPL is a complex syndrome characterized by...

  5. Productivity of Stream Definitions

    Endrullis, Jörg; Grabmayer, Clemens; Hendriks, Dimitri; Isihara, Ariya; Klop, Jan


    We give an algorithm for deciding productivity of a large and natural class of recursive stream definitions. A stream definition is called ‘productive’ if it can be evaluated continuously in such a way that a uniquely determined stream is obtained as the limit. Whereas productivity is undecidable

  6. Productivity of stream definitions

    Endrullis, J.; Grabmayer, C.A.; Hendriks, D.; Isihara, A.; Klop, J.W.


    We give an algorithm for deciding productivity of a large and natural class of recursive stream definitions. A stream definition is called ‘productive’ if it can be evaluated continually in such a way that a uniquely determined stream in constructor normal form is obtained as the limit. Whereas prod

  7. Definition of intractable epilepsy.

    Sinha, Shobhit; Siddiqui, Khurram A


    Defining intractable epilepsy is essential not only to identify up to 40% of patients refractory to pharmacological management, but also to facilitate selection and comparison of such patients for research purposes. The ideal definition still eludes us. Multiple factors including number of antiepileptic drug (AED) failures, seizure frequency and duration of unresponsiveness, etiology, and epilepsy syndromes are considered in formulating the definition of pharmaco-resistant epilepsy. Most definitions used in the literature agree on the number of AED failures, which seem to be 2 or 3, however, the seizure frequency and time factor are varied. The International League Against Epilepsy proposed a definition of drug-resistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. This for now, could provide an operational definition for clinical and research settings. However, with emergence of new data and novel treatments the criteria for intractability may change.

  8. Child immunization coverage in rural hard-to-reach Haor areas of Bangladesh: possible alternative strategies.

    Uddin, Md Jasim; Larson, Charles P; Oliveras, Elizabeth; Khan, Azharul Islam; Quaiyum, Md Abdul; Chandra Saha, Nirod


    This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.

  9. Reaching out and reaching up - developing a low cost drug treatment system in Cambodia

    Klein Axel


    Full Text Available Abstract Cambodia, confronted by the spread of drug misuse among young people, requested support from international agencies to develop a drug treatment programme in 2000. The initial plan developed by the United Nations Office on Drugs and Crime was to set up a number of conventional drug treatment centres in urban areas. During the planning phase, however, the project was redesigned as a community based outreach programme. Ten Community Counselling Teams have been formed and trained in pilot areas, and within the first year of operation 462 drug and alcohol users contacted. Comprising former drug users, family members affected by drug use and health care staff, they have drug scene credibility, local knowledge and connectivity, and a rudimentary level of medical competence. Crucially, they enjoy the support of village elders, who are involved in the planning and reporting stages. While the Community Counselling Teams with their basic training in addiction counselling are in no position as yet to either provide or refer clients to treatment, they can provide brief interventions, organise self help groups, and most importantly provide an alternative to law enforcement. By taking a development centred approach, with emphasis on community, empowerment and inclusion, it provides a constructive and inclusive alternative to medical approaches and the compulsory drug treatment centres. The paper is based on an evaluation involving interviews with a range of stakeholders and a review of project documents.

  10. Caring and the Teaching of English.

    White, Brian


    Discusses Nel Noddings's definition of caring and critiques aspects of her formulation, focusing on her discussion of reciprocity and her insistence that principled approaches to caring undermine relationship. Argues that, although Noddings's work has paved the way for more caring approaches to teaching, these aspects of her formulation must be…

  11. Pain management: lessons from palliative care.

    Langlois, John P


    Reducing suffering and helping patients to control their symptoms are key components of palliative care. This commentary will offer a comprehensive definition of palliative care and will present a case history to illustrate how palliative care can benefit patients with chronic pain.

  12. Becoming Care Helper

    Jensen, Anne Winther

    The paper discusses the shaping of students´ identity within a vocational education programme for elderly care in Denmark. The focus is on the correlation between identity construction within the theoretical periods and students´ experiences in the traineeships. In the school setting the future...... care helper is being constructed within the overall term ‘professional’, but students may meet differing ways of being care helper in the traineeships, and the paper points to an ongoing struggle about the definition of ‘being care helper’. The analysis of the identity issues mobilises the concepts...... ‘positioning’ and ‘storyline’, c.f. Bronwyn Davies, and the empirical material consists of interviews and observations in the theoretical periods and in the traineeships. The paper suggests that a shift from identity to subjectivity may help students to deal with the diversity of ‘care helpers’ and thereby...

  13. Quaternary: status, rank, definition, survival

    Marie-PierreAubry; WilliamA.Berggren; JohnVanCouvering; BrianMcGowran; BradPillans; FritsHilgen


    The long controversy over the term ‘Quaternary' as a chronostratigraphic unit may be reaching an apotheosis, judging from recent papers (Pillans and Naish, 2004; Gibbard et al., 2005; and referencest herein). The debate is no longer centered on whether there should be a place in the geological time scale for a unit termed ‘Quaternary'-despite its dubious past, it cannot be denied that a large body of earth-historical research is strongly identified with this term. The challenge now concerns an appropriate rank and definition of Quaternary with regard to other chronostratigraphic units. Several options have been proposed (Pillans and Naish, 2004), and Gibbard et al. (2005) encourage a debate on these before decision is reached. In this brief note, we describe an arrangement not previously considered that seems advantageous. It is instructive, however, to first review the Pleistocene Series and Neogene System, the two units that are directly affected by introduction of the Quaternary into the chronostratigraphic hierarchy.

  14. Should these potential CMR substances have been registered under REACH?

    Wedebye, Eva Bay; Nikolov, Nikolai Georgiev; Dybdahl, Marianne;


    (Q)SAR models were applied to screen around 68,000 REACH pre-registered substances for CMR properties (carcinogenic, mutagenic or toxic to reproduction). Predictions from 14 relevant models were combined to reach overall calls for C, M and R. Combining predictions may reduce “noise” and increase...

  15. Guaranteed performance in reaching mode of sliding mode controlled systems

    G K Singh; K E Holé


    Conventionally, the parameters of a sliding mode controller (SMC) are selected so as to reduce the time spent in the reaching mode. Although, an upper bound on the time to reach (reaching time) the sliding surface is easily derived, performance guarantee in the state/error space needs more consideration. This paper addresses the design of constant plus proportional rate reaching law-based SMC for second-order nonlinear systems. It is shown that this controller imposes a bounding second-order error-dynamics, and thus guarantees robust performance during the reaching phase. The choice of the controller parameters based on the time to reach a desirable level of output tracking error (OTE), rather than on the reaching time is proposed. Using the Lyapunov theory, it is shown that parameter selections, based on the reaching time criterion, may need substantially larger time to achieve the OTE. Simulation results are presented for a nonlinear spring-massdamper system. It is seen that parameter selections based on the proposed OTE criterion, result in substantially quicker tracking, while using similar levels of control effort.

  16. Ethical persuasion: the rhetoric of communication in critical care.

    Dubov, Alex


    This article reviews the ethics of rhetoric in critical care. Rational appeals in critical care fail to move patients or surrogates to a better course of action. Appeals to their emotions are considered illegitimate because they may preclude autonomous choice. This article discusses whether it is always unethical to change someone's beliefs, whether persuasive communication is inherently harmful and whether it leaves no space for voluntariness. To answer these questions, the article engages with Aristotle's work, Rhetoric. In considering whether there is a place for emotionally charged messages in a patient-provider relationship, the article intends to delineate the nature of this relationship and describe the duties this relationship implies. The article presents examples of persuasive communication used in critical care and discusses whether providers may have a duty to persuade patients. This duty is supported by the fact that doctors often influence patients' and families' choices by framing presented options. Doctors should assume responsibility in recognizing these personal and contextual influences that may influence the medical choices of their patients. They should attempt to modify these contextual factors and biases in a way that would assist patients and families in reaching the desired outcomes. The opening sections surveyed a number of definitions found in relevant literature and outlined some of the concepts included in the proposed definition. This definition helps to distinguish instances of persuasion from cases of manipulation, coercion and deception. Considering the fact that patients and families often make irrational decisions and the fact that doctors inadvertently influence their choices, the article suggested that persuasion can be a positive tool in medical communication. When patients or families clearly do not understand the risks or make decisions that contradict their long-term goals, persuasion can be used as a positive influence.

  17. The promise of telecommunication tools to 'reach' the disengaged patient with diabetes.

    Amante, Daniel J; Thompson, Michael J


    To discuss recent research on the use of telecommunication technologies to improve care for disengaged patients with diabetes. It is established that patients who are disengaged with their healthcare have worse health outcomes. Reasons for disengagement vary but could be because of difficulties accessing or affording care or not possessing the skills or tools required to manage their disease. New patient-facing technologies are being used to improve communication and coordination of care for patients with diabetes. Early results show improvements in health outcomes. Utilizing these technologies to reach patient groups susceptible for disengagement has begun to demonstrate improvement. Research over the past year has continued to demonstrate the promise of using telecommunication tools to assist patients in the management of diabetes. Although a few studies looked specifically at disengaged patients, efforts to utilize appropriate technological interventions targeting specific groups of patients are needed.

  18. The definition of cross polarization

    Ludwig, Arthur


    There are at least three different definitions of cross polarization used in the literature. The alternative definitions are discussed with respect to several applications, and the definition which corresponds to one standard measurement practice is proposed as the best choice.......There are at least three different definitions of cross polarization used in the literature. The alternative definitions are discussed with respect to several applications, and the definition which corresponds to one standard measurement practice is proposed as the best choice....

  19. Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project.

    Torán-Monserrat, Pere; Cebrià-Andreu, Jordi; Arnau-Figueras, Josep; Segura-Bernal, Jordi; Ibars-Verdaguer, Anna; Massons-Cirera, Josep; Barreiro-Montaña, M Carmen; Santamaria-Bayes, Sandra; Limón-Ramírez, Esther; Montero-Alia, Juan José; Pérez-Testor, Carles; Pera-Blanco, Guillem; Muñoz-Ortiz, Laura; Palma-Sevillano, Carolina; Segarra-Gutiérrez, Gerard; Corbella-Santomà, Sergi


    Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation. It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals. It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention

  20. Evolving Definitions of Mental Illness and Wellness

    Tara W. Strine, MPH


    Full Text Available Understanding of the definitions of wellness and illness has changed from the mid-20th century to modern times, moving from a diagnosis-focused to a person-focused definition of mental illnesses, and from an “absence of disease” model to one that stresses positive psychological function for mental health. Currently, wellness refers to the degree to which one feels positive and enthusiastic about oneself and life, whereas illness refers to the presence of disease. These definitions apply to physical as well as mental illness and wellness. In this article, we build on the essential concepts of wellness and illness, discuss how these definitions have changed over time, and discuss their importance in the context of health reform and health care reform. Health reform refers to efforts focused on health, such as health promotion and the development of positive well-being. Health care reform refers to efforts focused on illness, such as treatment of disease and related rehabilitation efforts.

  1. An investigation of the neural circuits underlying reaching and reach-to-grasp movements: from planning to execution.

    Chiara eBegliomini


    Full Text Available Experimental evidence suggests the existence of a sophisticated brain circuit specifically dedicated to reach-to-grasp planning and execution, both in human and non human primates (Castiello, 2005. Studies accomplished by means of neuroimaging techniques suggest the hypothesis of a dichotomy between a reach-to-grasp circuit, involving the intraparietal area (AIP, the dorsal and ventral premotor cortices (PMd and PMv - Castiello and Begliomini, 2008; Filimon, 2010 and a reaching circuit involving the medial intraparietal area (mIP and the Superior Parieto-Occipital Cortex (SPOC (Culham et al., 2006. However, the time course characterizing the involvement of these regions during the planning and execution of these two types of movements has yet to be delineated. A functional magnetic resonance imaging (fMRI study has been conducted, including reach-to grasp and reaching only movements, performed towards either a small or a large stimulus, and Finite Impulse Response model (FIR - Henson, 2003 was adopted to monitor activation patterns from stimulus onset for a time window of 10 seconds duration. Data analysis focused on brain regions belonging either to the reaching or to the grasping network, as suggested by Castiello & Begliomini (2008.Results suggest that reaching and grasping movements planning and execution might share a common brain network, providing further confirmation to the idea that the neural underpinnings of reaching and grasping may overlap in both spatial and temporal terms (Verhagen et al., 2013.

  2. Proprioceptive body illusions modulate the visual perception of reaching distance.

    Agustin Petroni

    Full Text Available The neurobiology of reaching has been extensively studied in human and non-human primates. However, the mechanisms that allow a subject to decide-without engaging in explicit action-whether an object is reachable are not fully understood. Some studies conclude that decisions near the reach limit depend on motor simulations of the reaching movement. Others have shown that the body schema plays a role in explicit and implicit distance estimation, especially after motor practice with a tool. In this study we evaluate the causal role of multisensory body representations in the perception of reachable space. We reasoned that if body schema is used to estimate reach, an illusion of the finger size induced by proprioceptive stimulation should propagate to the perception of reaching distances. To test this hypothesis we induced a proprioceptive illusion of extension or shrinkage of the right index finger while participants judged a series of LEDs as reachable or non-reachable without actual movement. Our results show that reach distance estimation depends on the illusory perceived size of the finger: illusory elongation produced a shift of reaching distance away from the body whereas illusory shrinkage produced the opposite effect. Combining these results with previous findings, we suggest that deciding if a target is reachable requires an integration of body inputs in high order multisensory parietal areas that engage in movement simulations through connections with frontal premotor areas.

  3. The impact of REACH on classification for human health hazards.

    Oltmanns, J; Bunke, D; Jenseit, W; Heidorn, C


    The REACH Regulation represents a major piece of chemical legislation in the EU and requires manufacturers and importers of chemicals to assess the safety of their substances. The classification of substances for their hazards is one of the crucial elements in this process. We analysed the effect of REACH on classification for human health endpoints by comparing information from REACH registration dossiers with legally binding, harmonised classifications. The analysis included 142 chemicals produced at very high tonnages in the EU, the majority of which have already been assessed in the past. Of 20 substances lacking a harmonised classification, 12 chemicals were classified in REACH registration dossiers. More importantly, 37 substances with harmonised classifications for human health endpoints had stricter classifications in registration dossiers and 29 of these were classified for at least one additional endpoint not covered by the harmonised classification. Substance-specific analyses suggest that one third of these additional endpoints emerged from experimental studies performed to fulfil information requirements under REACH, while two thirds resulted from a new assessment of pre-REACH studies. We conclude that REACH leads to an improved hazard characterisation even for substances with a potentially good data basis.

  4. Proprioceptive Body Illusions Modulate the Visual Perception of Reaching Distance

    Petroni, Agustin; Carbajal, M. Julia; Sigman, Mariano


    The neurobiology of reaching has been extensively studied in human and non-human primates. However, the mechanisms that allow a subject to decide—without engaging in explicit action—whether an object is reachable are not fully understood. Some studies conclude that decisions near the reach limit depend on motor simulations of the reaching movement. Others have shown that the body schema plays a role in explicit and implicit distance estimation, especially after motor practice with a tool. In this study we evaluate the causal role of multisensory body representations in the perception of reachable space. We reasoned that if body schema is used to estimate reach, an illusion of the finger size induced by proprioceptive stimulation should propagate to the perception of reaching distances. To test this hypothesis we induced a proprioceptive illusion of extension or shrinkage of the right index finger while participants judged a series of LEDs as reachable or non-reachable without actual movement. Our results show that reach distance estimation depends on the illusory perceived size of the finger: illusory elongation produced a shift of reaching distance away from the body whereas illusory shrinkage produced the opposite effect. Combining these results with previous findings, we suggest that deciding if a target is reachable requires an integration of body inputs in high order multisensory parietal areas that engage in movement simulations through connections with frontal premotor areas. PMID:26110274

  5. Dengue disease outbreak definitions are implicitly variable

    Oliver J. Brady


    Full Text Available Infectious diseases rarely exhibit simple dynamics. Outbreaks (defined as excess cases beyond response capabilities have the potential to cause a disproportionately high burden due to overwhelming health care systems. The recommendations of international policy guidelines and research agendas are based on a perceived standardised definition of an outbreak characterised by a prolonged, high-caseload, extra-seasonal surge. In this analysis we apply multiple candidate outbreak definitions to reported dengue case data from Brazil to test this assumption. The methods identify highly heterogeneous outbreak characteristics in terms of frequency, duration and case burden. All definitions identify outbreaks with characteristics that vary over time and space. Further, definitions differ in their timeliness of outbreak onset, and thus may be more or less suitable for early intervention. This raises concerns about the application of current outbreak guidelines for early warning/identification systems. It is clear that quantitatively defining the characteristics of an outbreak is an essential prerequisite for effective reactive response. More work is needed so that definitions of disease outbreaks can take into account the baseline capacities of treatment, surveillance and control. This is essential if outbreak guidelines are to be effective and generalisable across a range of epidemiologically different settings.

  6. 50 years sets with positive reach - a survey -

    Christoph Thäle


    Full Text Available The purpose of this paper is to summarize results on various aspects of sets with positive reach, which are up to now not available in such a compact form. After recalling briefly the results before 1959, sets with positive reach and their associated curvature measures are introduced. We develop an integral and current representation of these curvature measures and show how the current representation helps to prove integralgeometric formulas, such as the principal kinematic formula. Also random sets with positive reach and random mosaics (or the more general random cell-complexes with general cell shape are considered.

  7. REACH Basics for Chinese Producers of Electric Household Appliances

    Dr.Klaus W.Mehl


    The following article explains the EU chemical regulation "REACH', explicates the requirements that Chinese producers are facing, and shows how they can fulfill the requirements and secure their access to the EU market. The consequences of failing to fulfill REACH requirements are given in REACH Article 5: No data, no market: ... substances ... in articles ... shall not be ... placed on the market unless they have been registered In other words: Without registration of chemicals Chinese producers of electric household appliances may loose their EU market.

  8. Classroom Engagement towards Using Definitions for Developing Mathematical Objects: The Case of Function

    Tabach, Michal; Nachlieli, Talli


    For mathematicians, definitions are the ultimate tool for reaching agreement about the nature and properties of mathematical objects. As research in school mathematics has revealed, however, mathematics learners are often reluctant, perhaps even unable, to help themselves with definitions while categorizing mathematical objects. In the research…

  9. Stream Habitat Reach Summary - North Coast [ds63

    California Department of Resources — The shapefile is based on habitat unit level data summarized at the stream reach level. The database represents salmonid stream habitat surveys from 645 streams of...

  10. Helping the Library Reach Out to the Future

    ... Issues Helping the Library Reach Out to the Future Past Issues / Fall 2007 Table of Contents For ... of this page please turn Javascript on. Encouraging future medical researchers: (l-r) NLM Director Dr. Donald ...

  11. Hanford Reach - Snively Basin Rye Field Rehabilitation 2014

    US Fish and Wildlife Service, Department of the Interior — The Snively Basin area of the Arid Lands Ecology Reserve within the Hanford Reach National Monument was historically used to farm cereal rye (Secale cereale), among...

  12. PNW River Reach Files -- 1:100k Waterbodies (polygons)

    Pacific States Marine Fisheries Commission — This feature class includes the POLYGON waterbody features from the 2001 version of the PNW River Reach files Arc/INFO coverage. Separate, companion feature classes...

  13. Reach tracking reveals dissociable processes underlying cognitive control.

    Erb, Christopher D; Moher, Jeff; Sobel, David M; Song, Joo-Hyun


    The current study uses reach tracking to investigate how cognitive control is implemented during online performance of the Stroop task (Experiment 1) and the Eriksen flanker task (Experiment 2). We demonstrate that two of the measures afforded by reach tracking, initiation time and reach curvature, capture distinct patterns of effects that have been linked to dissociable processes underlying cognitive control in electrophysiology and functional neuroimaging research. Our results suggest that initiation time reflects a response threshold adjustment process involving the inhibition of motor output, while reach curvature reflects the degree of co-activation between response alternatives registered by a monitoring process over the course of a trial. In addition to shedding new light on fundamental questions concerning how these processes contribute to the cognitive control of behavior, these results present a framework for future research to investigate how these processes function across different tasks, develop across the lifespan, and differ among individuals. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Birth Defects from Zika More Far-Reaching Than Thought

    ... gov/news/fullstory_162538.html Birth Defects From Zika More Far-Reaching Than Thought Studies found greater ... 14, 2016 WEDNESDAY, Dec. 14, 2016 (HealthDay News) -- Zika's ability to damage the infant brain may be ...

  15. Monitoring Weather Station Fire Rehabilitation Treatments: Hanford Reach National Monument

    US Fish and Wildlife Service, Department of the Interior — The Weather Station Fire (July, 2005) burned across 4,918 acres in the Saddle Mountain Unit of the Hanford Reach National Monument, which included parts of the...

  16. PNW River Reach Files -- 1:100k Watercourses (arcs)

    Pacific States Marine Fisheries Commission — This feature class includes the ARC features from the 2001 version of the PNW River Reach files Arc/INFO coverage. Separate, companion feature classes are also...

  17. Optical technologies in extended-reach access networks

    Wong, Elaine; Amaya Fernández, Ferney Orlando; Tafur Monroy, Idelfonso


    The merging of access and metro networks has been proposed as a solution to lower the unit cost of customer bandwidth. This paper reviews some of the recent advances and challenges in extended-reach optical access networks....

  18. Hanford Reach - Strategic Control of Phragmites Within Saddle Mountain Lakes

    US Fish and Wildlife Service, Department of the Interior — The Saddle Lakes Fire of 2015 burned 14,200 acres of habitat on Saddle Mountain National Wildlife Refuge, part of the Hanford Reach National Monument. Within the...

  19. Hanford Reach - Snively Basin Rye Field Rehabilitation 2012

    US Fish and Wildlife Service, Department of the Interior — The Snively Basin area of the Arid Lands Ecology Reserve (ALE) within the Hanford Reach National Monument was historically used to farm cereal rye, among other...

  20. A Community of Caring: Reaching Out to the Children of Kosovo.

    Mason, Linda


    Reports on an educator's mission to examine the status of young children and early childhood education in war-torn Kosovo. Relates the story of a 10-year-old girl and her family during and after the hostilities. Describes relief efforts of Americans and American organizations, particularly Mercy Corps International, Children's Resources…

  1. Distal symmetrical polyneuropathy: definition for clinical research.

    England, J D; Gronseth, G S; Franklin, G; Miller, R G; Asbury, A K; Carter, G T; Cohen, J A; Fisher, M A; Howard, J F; Kinsella, L J; Latov, N; Lewis, R A; Low, P A; Sumner, A J


    The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.

  2. Multi-temporal image analysis for river reach morphological changes identification

    Giordan, Daniele; Franzi, Luca; Rinaldi, Stefano; Dutto, Furio; Baldo, Marco; Allasia, Paolo


    The study of river reach evolution can be very important for the definition of the level of risk of building and infrastructures that are located nearby. Usually, these studies are based on the use of aerial photos and/or LiDAR surveys that could be analyzed for the definition of the river reach boundaries and their evolution over the time. In the past, the typical approach was the use of aerial photo for the identification of main morphological elements of the river and the definition of their changes over the time. LiDAR systems introduced an important add value related to the possibility to acquire also a DTM of the studied area and not only an orthophoto. The comparison of DTMs acquired in different periods can be useful for the identification of the changes in altimetry that can be a very important element for the comprehension of the morphological evolution of the studied area. When a river reach is characterized by a frequent changes in time, a detailed investigation needs frequent surveys and mapping. In this frame the recourse to frequent use of LiDAR could be very expensive, and therefore other cheaper solutions can be preferable. The use of RPAS system can be considered a good means for the acquisition of orthophoto and digital surface models, expecially for limited portions of river reaches and for the most active sectors. The high resolution of the orthophoto and the DSM are two important products that can be used for the identification and the measurement of main morphological changer of a river reach. The combination of aerial photos, LiDAR surveys and RPAS acquisition has been tested on the Orco River, Piemonte region (NW Italy). Orco is a gravel multichannel river with several sectors characterized by a strong inclination to the wandering of the main channel. One of the most critical sector is located not far from the confluence with Po River, where the wandering of the main channel changed the direction of the main flux of the water that now risks

  3. Analyzing Differences in Operational Disease Definitions Using Ontological Modeling

    Peelen, Linda; Klein, Michel; Schlobach, Stefan; Keizer, de, Rob J.W.; Peek, Niels


    In medicine, there are many diseases which cannot be precisely characterized but are considered as natural kinds. In the communication between health care professionals, this is generally not problematic. In biomedical research, however, crisp definitions are required to unambiguously distinguish patients with and without the disease. In practice, this results in different operational definitions being in use for a single disease. This paper presents an approach to compare different operation...

  4. Analyzing Differences in Operational Disease Definitions Using Ontological Modeling

    Peelen, Linda; Klein, Michel; Schlobach, Stefan; Keizer, de, M.; Peek,Niels


    In medicine, there are many diseases which cannot be precisely characterized but are considered as natural kinds. In the communication between health care professionals, this is generally not problematic. In biomedical research, however, crisp definitions are required to unambiguously distinguish patients with and without the disease. In practice, this results in different operational definitions being in use for a single disease. This paper presents an approach to compare different operation...

  5. Psychosocial child adjustment and family functioning in families reached with an assertive outreach intervention.

    Rots-de Vries, Carin; van de Goor, Ien; Stronks, Karien; Garretsen, Henk


    Families who experience a chronic complex of socio-economic and psychosocial problems are hard to reach with mainstream care. Evidence exists that the core of this problem is a problematic interaction between this type of family and current systems of care and services. To improve access to problem families, an assertive outreach intervention was implemented into the field of preventive child health care, The Netherlands. The study aimed to provide a more detailed insight into characteristics of the target group. Although there is consensus about some general features of hard to reach problem families, little is known about their specific characteristics because empirical studies among this group are rarely conducted. Especially, the problems of the children is shed insufficient light on. The studied population consisted of families included in the assertive outreach intervention delivered during one year (N=116). To assess psychosocial adjustment of the children, the Strengths and Difficulties Questionnaire was filled in by the parents. Furthermore, a Dutch questionnaire on family functioning was completed by professional carers. Descriptive data were calculated. The findings show that by using the assertive outreach intervention, programme staff came into contact with families characterised by a considerably higher than average proportion of single parents and unemployed households receiving social benefits. The families faced a high level of risk and a wide range of severe and multiple difficulties, including a lack of basic child care, an inadequate social network and poor parenting. Children in these families were also facing a number of risks. The proportion of psychosocial problems was well above the (inter)national average. The findings reveal the problem areas of unreached families and a need to improve the access to care for these families.

  6. [How do Prevention Projects Reach their Target Groups? Results of a Survey with Prevention Projects].

    Brand, T; Böttcher, S; Jahn, I


     The aim of this study was to assess methods used to access target groups in prevention projects funded within the prevention research framework by the German Federal Ministry of Education and Research.  A survey with prevention projects was conducted. Access strategies, communication channels, incentives, programme reach, and successful practical recruitment strategies were explored.  38 out of 60 projects took part in the survey. Most projects accessed their target group within structured settings (e. g., child day-care centers, schools, workplaces). Multiple communication channels and incentives were used, with written information and monetary incentives being used most frequently. Only few projects were able to report their programme reach adequately; programme reach was highest for programmes accessing the target groups in structured settings. The respondents viewed active recruitment via personal communication with the target group and key persons in the settings as the most successful strategy.  The paper provides an overview on recruitment strategies used in current preven-tion projects. More systematic research on programme reach is necessary. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Telehealth in audiology: the need and potential to reach underserved communities.

    Swanepoel, De Wet; Clark, Jackie L; Koekemoer, Dirk; Hall, James W; Krumm, Mark; Ferrari, Deborah V; McPherson, Bradley; Olusanya, Bolajoko O; Mars, Maurice; Russo, Iêda; Barajas, Jose J


    Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.

  8. Telepsychiatry as an Economically Better Model for Reaching the Unreached: A Retrospective Report from South India.

    Moirangthem, Sydney; Rao, Sabina; Kumar, Channaveerachari Naveen; Narayana, Manjunatha; Raviprakash, Neelaveni; Math, Suresh Bada


    In a resource-poor country such as India, telepsychiatry could be an economical method to expand health-care services. This study was planned to compare the costing and feasibility of three different service delivery models. The end user was a state-funded long-stay Rehabilitation Center (RC) for the homeless. Model A comprised patients going to a tertiary care center for clinical care, Model B was community outreach service, and Model C comprised telepsychiatry services. The costing included expenses incurred by the health system to complete a single consultation for a patient on an outpatient basis. It specifically excluded the cost borne by the care-receiver. No patients were interviewed for the study. The RC had 736 inmates, of which 341 had mental illness of very long duration. On comparing the costing, Model A costed 6047.5 INR (100$), Model B costed 577.1 INR (9.1$), and Model C costed 137.2 INR (2.2$). Model C was found fifty times more economical when compared to Model A and four times more economical when compared to Model B. Telepsychiatry services connecting tertiary center and a primary health-care center have potential to be an economical model of service delivery compared to other traditional ones. This resource needs to be tapped in a better fashion to reach the unreached.

  9. Definition of tolerable soil erosion values

    G. Sparovek


    Full Text Available Although the criteria for defining erosion tolerance are well established, the limits generally used are not consistent with natural, economical and technological conditions. Rates greater than soil formation can be accepted only until a minimum of soil depth is reached, provided that they are not associated with environmental hazard or productivity losses. A sequence of equations is presented to calculate erosion tolerance rates through time. The selection of equation parameters permits the definition of erosion tolerance rates in agreement with environmental, social and technical needs. The soil depth change that is related to irreversible soil degradation can be calculated. The definition of soil erosion tolerance according to these equations can be used as a guideline for sustainable land use planning and is compatible with expert systems.

  10. Safe Public Debt: Towards an Operational Definition

    Xavier Debrun


    Full Text Available The paper proposes an operational definition of safe public debt levels and discusses various concrete approaches to calculate them. A public debt level is considered safe if it is associated with a low probability of reaching levels likely to generate significant economic costs within a given time frame. Like debt sustainability assessments, implementing such a broad definition requires medium-term projections of the debt-to-GDP ratio. This implies that different sets of plausible assumptions can yield fairly different “safe” debt levels for the same country. However, the proposed framework has the merit to force policymakers and analysts to be explicit about the assumptions underlying their calculations.

  11. Concept of REACH and impact on evaluation of chemicals.

    Foth, H; Hayes, Aw


    Industrial chemicals have been in use for many decades and new products are regularly invented and introduced to the market. Also for decades, many different chemical laws have been introduced to regulate safe handling of chemicals in different use patterns. The patchwork of current regulation in the European Union is to be replaced by the new regulation on industrial chemical control, REACH. REACH stands for registration, evaluation, and authorization of chemicals. REACH entered force on June 1, 2007. REACH aims to overcome limitations in testing requirements of former regulation on industrial chemicals to enhance competitiveness and innovation with regard to manufacture safer substances and to promote the development of alternative testing methods. A main task of REACH is to address data gaps regarding the properties and uses of industrial chemicals. Producers, importers, and downstream users will have to compile and communicate standard information for all chemicals. Information sets to be prepared include safety data sheets (SDS), chemical safety reports (CSR), and chemical safety assessments (CSA). These are designed to guarantee adequate handling in the production chain, in transport and in use and to prevent the substances from being released to and distributed within the environment. Another important aim is to identify the most harmful chemicals and to set incentives to substitute them with safer alternatives. On one hand, REACH will have substantial impact on the basic understanding of the evaluation of chemicals. However, the toxicological sciences can also substantially influence the workability of REACH that supports the transformation of data to the information required to understand and manage acceptable and non acceptable risks in the use of industrial chemicals. The REACH regulation has been laid down in the main document and 17 Annexes of more than 849 pages. Even bigger technical guidance documents will follow and will inform about the rules for

  12. Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study.

    Ramirez, Amelie G; Pérez-Stable, Eliseo J; Talavera, Gregory A; Penedo, Frank J; Carrillo, J Emilio; Fernandez, Maria E; Muñoz, Edgar; Long Parma, Dorothy; Holden, Alan Ec; San Miguel de Majors, Sandra; Nápoles, Anna; Castañeda, Sheila F; Gallion, Kipling J


    Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities. As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care

  13. Freedom of Reach for Young Children: Nonsexist Early Childhood Education.

    Henslee, Tish; Jones, Peg

    This handbook presents ideas for developing nonsexist early childhood education programs for young children. The book is organized into six sections. Section I presents some background information, including definitions of terms, discussions of current attitudes towards and implications of nonsexist education, traditional and nontraditional roles…

  14. Household-based cash transfer targeting strategies in Zimbabwe: are we reaching the most vulnerable children?

    Robertson, Laura; Mushati, Phyllis; Eaton, Jeffrey W; Sherr, Lorraine; Makoni, Jeremiah C; Skovdal, Morten; Crea, Tom; Mavise, Gideon; Dumba, Lovemore; Schumacher, Christina; Munyati, Shungu; Nyamukapa, Constance; Gregson, Simon


    Census data, collected in July 2009, from 27,672 children were used to compare the effectiveness, coverage and efficacy of three household-based methods for targeting cash transfers to vulnerable children in eastern Zimbabwe: targeting the poorest households using a wealth index; targeting HIV-affected households using socio-demographic information (households caring for orphans, chronically-ill or disabled members; child-headed households); and targeting labour-constrained households using dependency ratios. All three methods failed to identify large numbers of children with poor social and educational outcomes. The wealth index approach was the most efficient at reaching children with poor outcomes whilst socio-demographic targeting reached more vulnerable children but was less efficient.

  15. Memory-guided reaching in a patient with visual hemiagnosia.

    Cornelsen, Sonja; Rennig, Johannes; Himmelbach, Marc


    The two-visual-systems hypothesis (TVSH) postulates that memory-guided movements rely on intact functions of the ventral stream. Its particular importance for memory-guided actions was initially inferred from behavioral dissociations in the well-known patient DF. Despite of rather accurate reaching and grasping movements to visible targets, she demonstrated grossly impaired memory-guided grasping as much as impaired memory-guided reaching. These dissociations were later complemented by apparently reversed dissociations in patients with dorsal damage and optic ataxia. However, grasping studies in DF and optic ataxia patients differed with respect to the retinotopic position of target objects, questioning the interpretation of the respective findings as a double dissociation. In contrast, the findings for reaching errors in both types of patients came from similar peripheral target presentations. However, new data on brain structural changes and visuomotor deficits in DF also questioned the validity of a double dissociation in reaching. A severe visuospatial short-term memory deficit in DF further questioned the specificity of her memory-guided reaching deficit. Therefore, we compared movement accuracy in visually-guided and memory-guided reaching in a new patient who suffered a confined unilateral damage to the ventral visual system due to stroke. Our results indeed support previous descriptions of memory-guided movements' inaccuracies in DF. Furthermore, our data suggest that recently discovered optic-ataxia like misreaching in DF is most likely caused by her parieto-occipital and not by her ventral stream damage. Finally, multiple visuospatial memory measurements in HWS suggest that inaccuracies in memory-guided reaching tasks in patients with ventral damage cannot be explained by visuospatial short-term memory or perceptual deficits, but by a specific deficit in visuomotor processing.

  16. Stretch bending - the plane within the sheet where strains reach the forming limit curve

    Neuhauser, F. M.; Terrazas, O. R.; Manopulo, N.; Hora, P.; Van Tyne, C. J.


    Finite element analysis (FEA) was used to model the angular stretch bend test, where a strip of sheet metal is locked at both ends and a tool with a radius stretches and bends the center of the strip until failure. The FEA program used in the study was Abaqus. The FEA model was verified by experimental work using a dual phase steel (DP600) and with a simplified analytical analysis. The FEA model was used to simulate the experimental test for various frictional conditions and various radii of an upward moving tool. The primary objective of the study was to evaluate the concave-side rule, which states that during stretch bending the forming limit occurs when the strains on the concave surface plane of the bent sheet (i.e. bottom plane) reach the forming limit curve (FLC). The verification with experimental data indicates that the FEA model represents the process very well. Only conditions where failure occurred on or near the tooling are included in the results. The FEA simulations showed that the actual forming limit of the sheet occurs when the strains on the bottom plane of the sheet (i.e. concave side of the bend) reach the forming limit curve for high friction and small tool radii. For lower friction and for larger tool radii the actual forming limit occurs when strains on other planes in the sheet (i.e. mid planes or top surface plane) reach the forming limit curve. The implications of these results suggest that care must be taken in assessing forming operations when both stretch and bending occur. Although it is known that the FLC cannot predict the forming limit for small bend radii, the common assumption that the forming limit occurs when the strains for the middle thickness plane of the sheet reach the forming limit curve or that the concave side rule is often made. Understanding the limits of this assumption needs to be carefully and critically evaluated.

  17. Tracheostomy care

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

  18. Critical Care

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

  19. Distinguishing the Transition Reach between Torrent and River Using Longitudinal and Cross-Sectional Morphology in River Course

    Chu, F. Y.; Chen, S. C.; An, H. P.


    To distinguish a transition reach between river and torrent, this study designed a method to quantify the morphology of channel cross-section. The 5m DEM, which administered by central government, was used to obtain cross-sections from third and fourth order river of 10 main drainages in Taiwan with an interval of 140 to 150 m. We designed a Cross-Sectional Complex-Index (Ics) to determine the morphological complexity and quantify the degrees of wide-shallow for each sections. This index can be applied to define the location of notch, because it can be knew form river regime that a notch is defined as a narrow-deep cross-section and narrow-deep and relatively large slope to adjacent reach. Therefore, this study defined notch index (Inotch) as the gradient divided by cross-sectional complex-index, and applied it to present the distribution of notch-type sections in study drainages, and the results of field investigation in 22 site showed that a section can be defined as notch while Inotch is lager then 60. The distribution of notch in a drainage shown that the notch which conform our quantitative definitions almost concentrated into several reaches intersecting with some broad-shallow section, and the gradient of these reaches are between 2% to 3%. Therefore, we can define that these reaches are the transition reaches between river and torrent. There are 54 sites of transition reach in our study drainages, 80% of the sites had a watershed area within a range of 2000 to 6000 ha. It proof that our method can define transition reach effectively and consistently. In addition, because of the type of disaster is collapse and debris flow in torrent and flood damages in river. It can be found that type of disaster are derived from the river morphology. Therefore, our method and result can be applied to determine the disaster type and strategic planning of disaster prevention as a reference.

  20. Reach capacity in older women submitted to flexibility training

    Elciana de Paiva Lima Vieira


    Full Text Available The aim of this study was to analyze the effect of flexibility training on the maximum range of motion levels and reach capacity of older women practitioners of aquatic exercises of the Prev-Quedas project. Participants were divided into two groups: intervention (IG, n = 25, which were submitted to flexibility training program and control (CG, n = 21, in which older women participated only in aquatic exercises. Flexibility training lasted three months with weekly frequency of two days, consisting of stretching exercises involving trunk and lower limbs performed after aquatic exercises. The stretching method used was passive static. Assessment consisted of the functional reach, lateral and goniometric tests. Statistical analysis was performed using the following tests: Shapiro-Wilk normality, ANCOVA, Pearson and Spearman correlations. Significant results for GI in gains of maximum range of motion for the right hip joint (p = 0.0025, however, the same result was not observed in other joints assessed, and there was no improvement in functional and lateral reach capacity for both groups. Significant correlations between reach capacity and range of motion in the trunk, hip and ankle were not observed. Therefore, flexibility training associated with the practice of aquatic exercises promoted increased maximum range of motion only for the hip joint; however, improvement in the reach capacity was not observed. The practice of aquatic exercises alone did not show significant results.

  1. Health campaign channels: tradeoffs among reach, specificity, and impact.

    Schooler, C; Chaffee, S H; Flora, J A; Roser, C


    Stanford University's Five-City Multifactor Risk Reduction Project (FCP) was a 14-year trial of community-wide cardiovascular disease (CVD) risk reduction through integrated programs of community organization and mass media health promotion. The project was launched in 1978 in 5 central California cities, including Monterey, Salinas, Modesto, and San Luis Obispo. TV public service announcements (PSAs), TV shows, booklets, printed tip sheets with brief health suggestions on 7 topics, and newspaper coverage were the types of mass media approaches used in the FCP. These strategies are compared with regard to reach, specificity, and impact for a 5-year study period from 1979/80. Reach is measured as the number of messages intervention community residents remembered, specificity was assessed by examining whether the campaign differentially reached people who were already knowledgeable and practicing cardiovascular disease risk reduction, and impact is defined as the amount of knowledge gained during the course of the campaign. Reach was highest for tip sheets, while specificity was highest for booklets followed by TV programs. Newspaper messages had the most impact, followed by booklets and TV PSAs, tip sheets, and TV programs. Communication channels varied according to reach, specificity, and impact, with each criterion being distinct. No channel was optimal for all 3 of the outcome measures.

  2. Familial hypercholesterolaemia reduces the quality of life of patients not reaching treatment targets

    Mortensen, Gitte Lee; Madsen, Ivan Bredbjerg; Kruse, Charlotte


    . They had experienced severe side-effects and worried about their own and their relatives' health. They were concerned about the long-term impact of not being effectively treated including the risk that coronary heart disease could cause their premature death or disability and inability to care...... for their children, in particular. The women had issues with stigma and self-efficacy. CONCLUSIONS: The QoL impact of FH is related to treatment efficacy. These findings need to be addressed in the management of FH patients. Particular attention should be paid to those who are not presently reaching the target...

  3. reaching Creativity Via An Interactive Approac In English Class%reaching Creativity Via An Interactive Approac In English Class

    Lu Wen Rong


    Creativity is "a cognitive activity that results in a a new or novel way of viewing a problem or situation." This definition does no restrict creative processes to utilitarianacts. Therefore, applying the creative process to English class is quite meaningful to language pedagogy. This ariticle aimes to analyze the creative process and apply it to English Class.

  4. REACH-related substitution within the Danish printing industry

    Larsen, Henrik Fred; Bøg, Carsten; Markussen, Helene

    The accomplishment of the EU REACH regulation will most probably promote substitution within sectors handling a lot of different chemicals like the printing industry. With the aim of being at the cutting edge of this development the Danish EPA together with the Danish printing industry and IPU...... are running a substitution project. A major part of the work has been mapping the presence of chemicals which are potential candidates for substitution (e.g. PBT, CMR, vPvB, EDS) within the Danish printing industry. The mapping comprises a combination of a literature study and an investigation of the actual...... fulfil one or more of the criteria (e.g. CMR, EDS) for the REACH Annex XIV candidate list (authorisation). The paper presents the results of the mapping of chemical candidates and the first results of the actual substitutions. Keywords: REACH, chemicals, substitution, printing industry....

  5. High-Definition Medicine.

    Torkamani, Ali; Andersen, Kristian G; Steinhubl, Steven R; Topol, Eric J


    The foundation for a new era of data-driven medicine has been set by recent technological advances that enable the assessment and management of human health at an unprecedented level of resolution-what we refer to as high-definition medicine. Our ability to assess human health in high definition is enabled, in part, by advances in DNA sequencing, physiological and environmental monitoring, advanced imaging, and behavioral tracking. Our ability to understand and act upon these observations at equally high precision is driven by advances in genome editing, cellular reprogramming, tissue engineering, and information technologies, especially artificial intelligence. In this review, we will examine the core disciplines that enable high-definition medicine and project how these technologies will alter the future of medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Prebiotics: why definitions matter.

    Hutkins, Robert W; Krumbeck, Janina A; Bindels, Laure B; Cani, Patrice D; Fahey, George; Goh, Yong Jun; Hamaker, Bruce; Martens, Eric C; Mills, David A; Rastal, Robert A; Vaughan, Elaine; Sanders, Mary Ellen


    The prebiotic concept was introduced twenty years ago, and despite several revisions to the original definition, the scientific community has continued to debate what it means to be a prebiotic. How prebiotics are defined is important not only for the scientific community, but also for regulatory agencies, the food industry, consumers and healthcare professionals. Recent developments in community-wide sequencing and glycomics have revealed that more complex interactions occur between putative prebiotic substrates and the gut microbiota than previously considered. A consensus among scientists on the most appropriate definition of a prebiotic is necessary to enable continued use of the term.

  7. Definition of Entity Authentication

    Ahmed, Naveed; Jensen, Christian D.


    Authentication is considered a pre-requisite for communication security, but the definition of authentication is generally not agreed upon. Many attacks on authentication protocols are the result of misunderstanding of the goals of authentication. This state of affairs indicate limitations...... in theoretical understanding of the meanings of authentication. We provide a new insight in this direction and formalize it in CFPS (Common Framework for authentication Protocols' Specifications). CFPS provides a precise scope of definition for authentication protocols, which could make the design and analysis...

  8. Prebiotics: why definitions matter

    Hutkins, Robert W; Krumbeck, Janina A; Bindels, Laure B; Cani, Patrice D; Fahey, George; Goh, Yong Jun; Hamaker, Bruce; Martens, Eric C; Mills, David A; Rastal, Robert A; Vaughan, Elaine; Sanders, Mary Ellen


    The prebiotic concept was introduced twenty years ago, and despite several revisions to the original definition, the scientific community has continued to debate what it means to be a prebiotic. How prebiotics are defined is important not only for the scientific community, but also for regulatory agencies, the food industry, consumers and healthcare professionals. Recent developments in community-wide sequencing and glycomics have revealed that more complex interactions occur between putative prebiotic substrates and the gut microbiota than previously considered. A consensus among scientists on the most appropriate definition of a prebiotic is necessary to enable continued use of the term. PMID:26431716

  9. Definition of Information

    Boris Sunik


    Full Text Available This definition can be applied to information of every kind, level and complexity. Information is considered as the feature manifesting itself in the relations between certain real world
    entities. The real world has to be seen in terms of objects, actions, relations and properties.. The defintion is used as the basis of the Theory of Meaningful Information [1] that explains the nature and functionality of information and enables the production of relevant definitions regarding language and knowledge, which remain operative also in the case of non-human languages and
    knowledge systems.

  10. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Lockey David


    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  11. Predictive validity of the UPDRS postural stability score and the Functional Reach Test, when compared with ecologically valid reaching tasks.

    Jenkins, M E; Johnson, A M; Holmes, J D; Stephenson, F F; Spaulding, S J


    Balance problems and falls are a common concern among individuals with Parkinson's disease (PD). Falls frequently occur during daily activities such as reaching into cupboards in the kitchen or bathroom. This study compared the correlation among two standard postural stability tests - the postural stability score on the Unified Parkinson's Disease Rating Scale (UPDRS) and the Functional Reach Test (FRT) - and ecologically valid reaching tasks that correspond to reaching at different cupboard heights among 20 individuals with PD and 20 age-matched controls. Both the FRT and the UPDRS postural stability tests are quick measures that can be performed during the clinical examination. The FRT, but not the postural stability score, demonstrated a significant correlation with the ecologically valid reaching tasks, among individuals with PD. Furthermore the FRT scores did not correlate with the UPDRS postural stability scores, indicating that these are measuring different aspects of balance. This study suggests that the FRT score may better predict the risk of postural instability encountered during daily activities among individuals with PD.

  12. Reaching the parts that other theories and methods can't reach: how and why a policy-as-discourse approach can inform health-related policy.

    Shaw, Sara E


    This article illustrates how conceptualizing policy-as-discourse offers opportunities for those with a vested interest in policy to 'reach the parts that other theories and methods can't reach'. First, it explores the dialogical relationship between theory and method in the context of policy analysis, summarizing contemporary writing on conceptualizing and analysing policy and drawing on the work of Bacchi to describe the theoretical underpinnings of three different policy representations along with methodological corollaries, research practices and disclosures about the world that flow from each. This involves reflecting on three different answers to the question 'what is policy?': considering how policy might be conceptualized and analysed under each and narrating the kind of research stories that emerge. Second, the article focuses on one of Bacchi's representations - policy-as-discourse - to provide readers with a case study of this dialogical relationship and drawing on published research exploring the development of primary care research policy to illustrate what elements of discursive policy analysis might look like. Last, the article concludes by reflecting on the ways in which such an approach may (and may not) prove valuable in analysing health-related policy.

  13. What is the health care product?

    France, K R; Grover, R


    Because of the current competitive environment, health care providers (hospitals, HMOs, physicians, and others) are constantly searching for better products and better means for delivering them. The health care product is often loosely defined as a service. The authors develop a more precise definition of the health care product, product line, and product mix. A bundle-of-elements concept is presented for the health care product. These conceptualizations help to address how health care providers can segment their market and position, promote, and price their products. Though the authors focus on hospitals, the concepts and procedures developed are applicable to other health care organizations.

  14. Living with a chronic illness - reaching out to others

    ... with your self-care tasks, getting to appointments, shopping, or household chores. Keep a list of people ... the first to achieve this important distinction for online health information and services. Learn more about A. ...

  15. Advanced REACH tool: A Bayesian model for occupational exposure assessment

    McNally, K.; Warren, N.; Fransman, W.; Entink, R.K.; Schinkel, J.; Van Tongeren, M.; Cherrie, J.W.; Kromhout, H.; Schneider, T.; Tielemans, E.


    This paper describes a Bayesian model for the assessment of inhalation exposures in an occupational setting; the methodology underpins a freely available web-based application for exposure assessment, the Advanced REACH Tool (ART). The ART is a higher tier exposure tool that combines disparate sourc

  16. An Assessment of EU 2020 Strategy: Too Far to Reach?

    Colak, Mehmet Selman; Ege, Aylin


    In 2010, EU adopted a new growth strategy which includes three growth priorities and five headline targets to be reached by 2020. The aim of this paper is to investigate the current performance of the EU member and candidate states in achieving these growth priorities and the overall strategy target by allocating the headline targets into the…

  17. Reaching the Summit: Deaf Adults as Essential Partners in Education

    Bourne-Firl, Bridgetta


    How do we reach the summit in terms of supporting the best transition possible for each young deaf or hard of hearing individual in the United States? Should professionals who are hearing work alone to succeed with deaf and hard of hearing students? No matter how good the intention, if we want deaf and hard of hearing students to transition from…

  18. Reach for the Stars: Visions for Literacy Coaching Programs

    DeFord, Diane


    This brief by the Literacy Coaching Clearinghouse is about reaching for the stars--stories of vision and commitment from educators in small and large schools. Everyone knows of people who are held up as "visionaries" throughout history: Leonardo Da Vinci, Mahatma Gandhi, Jules Verne, Thomas Edison, Susan Anthony, or John Dewey, to name a few. The…

  19. Reaching a Moveable Visual Target: Dissociations in Brain Tumour Patients

    Buiatti, Tania; Skrap, Miran; Shallice, Tim


    Damage to the posterior parietal cortex (PPC) can lead to Optic Ataxia (OA), in which patients misreach to peripheral targets. Recent research suggested that the PPC might be involved not only in simple reaching tasks toward peripheral targets, but also in changing the hand movement trajectory in real time if the target moves. The present study…

  20. Nanshan Aluminum Reached Strategic Cooperation with CSR Corporation Limited


    As a key supplier of aluminum profiles and aluminum plate,sheet and trip products for CSR Corporation Limited,Nanshan Aluminum will join hands with CSR Corporation Limited to reach strategic cooperation.On January 5,Nanshan Aluminum signed strategic cooperation agreement with CSR Sifang Locomotive&Rolling; Stock Co.,Ltd,both

  1. Reaching an understanding innovations in how we view reading assessment

    Sabatini, John; O'Reilly, Tenaha


    Reaching an Understanding: Innovations in How We View Reading Assessment builds upon the editors previous book Measuring Up: Advances in How We Assess Reading Ability by representing some early attempts to apply theory to help guide the development of new assessments and measurement models.

  2. Advanced reach tool (ART) : Development of the mechanistic model

    Fransman, W.; Tongeren, M. van; Cherrie, J.W.; Tischer, M.; Schneider, T.; Schinkel, J.; Kromhout, H.; Warren, N.; Goede, H.; Tielemans, E.


    This paper describes the development of the mechanistic model within a collaborative project, referred to as the Advanced REACH Tool (ART) project, to develop a tool to model inhalation exposure for workers sharing similar operational conditions across different industries and locations in Europe. T

  3. Priming of Reach and Grasp Actions by Handled Objects

    Masson, Michael E. J.; Bub, Daniel N.; Breuer, Andreas T.


    Pictures of handled objects such as a beer mug or frying pan are shown to prime speeded reach and grasp actions that are compatible with the object. To determine whether the evocation of motor affordances implied by this result is driven merely by the physical orientation of the object's handle as opposed to higher-level properties of the object,…

  4. Variation in reach-scale hydraulic conductivity of streambeds

    Stewardson, M. J.; Datry, T.; Lamouroux, N.; Pella, H.; Thommeret, N.; Valette, L.; Grant, S. B.


    Streambed hydraulic conductivity is an important control on flow within the hyporheic zone, affecting hydrological, ecological, and biogeochemical processes essential to river ecosystem function. Despite many published field measurements, few empirical studies examine the drivers of spatial and temporal variations in streambed hydraulic conductivity. Reach-averaged hydraulic conductivity estimated for 119 surveys in 83 stream reaches across continental France, even of coarse bed streams, are shown to be characteristic of sand and finer sediments. This supports a model where processes leading to the accumulation of finer sediments within streambeds largely control hydraulic conductivity rather than the size of the coarse bed sediment fraction. After describing a conceptual model of relevant processes, we fit an empirical model relating hydraulic conductivity to candidate geomorphic and hydraulic drivers. The fitted model explains 72% of the deviance in hydraulic conductivity (and 30% using an external cross-validation). Reach hydraulic conductivity increases with the amplitude of bedforms within the reach, the bankfull channel width-depth ratio, stream power and upstream catchment erodibility but reduces with time since the last streambed disturbance. The correlation between hydraulic conductivity and time since a streambed mobilisation event is likely a consequence of clogging processes. Streams with a predominantly suspended load and less frequent streambed disturbances are expected to have a lower streambed hydraulic conductivity and reduced hyporheic fluxes. This study suggests a close link between streambed sediment transport dynamics and connectivity between surface water and the hyporheic zone.

  5. Postural control during reaching in preterm children with cerebral palsy

    van der Heide, JC; Begeer, C; Fock, JM; Otten, B; Stremmelaar, E; van Eykern, LA; Hadders-Algra, M


    Postural control during reaching with the dominant arm was assessed in 58 preterm children with cerebral palsy (CP) aged 2 to 11 years, comprising 34 with spastic hemiplegia (17 males, 17 females) and 24 with bilateral spastic CP (bilateral CP; 15 male, 9 females). Assessments were made by multiple

  6. Perceiving Children's Behavior and Reaching Limits in a Risk Environment

    Cordovil, Rita; Santos, Carlos; Barreiros, Joao


    The purpose of this study was to investigate the accuracy of parents' perception of children's reaching limits in a risk scenario. A sample of 68 parents of 1- to 4-year-olds were asked to make a prior estimate of their children's behavior and action limits in a task that involved retrieving a toy out of the water. The action modes used for…

  7. LTRM Fish Sampling Strata, UMRS La Grange Reach

    U.S. Geological Survey, Department of the Interior — The data set includes delineation of sampling strata for the six study reaches of the UMRR Program’s LTRM element. Separate strata coverages exist for each of the...

  8. Control of reaching movements by muscle synergy combinations

    Andrea eD'avella


    Full Text Available Controlling the movement of the arm to achieve a goal, such as reaching for an object, is challenging because it requires coordinating many muscles acting on many joints. The central nervous system might simplify the control of reaching by directly mapping initial states and goals into muscle activations through the combination of muscle synergies, coordinated recruitment of groups of muscles with specific activation profiles. Here we review recent results from the analysis of reaching muscle patterns supporting such a control strategy. Muscle patterns for point-to-point movements can be reconstructed by the combination of a small number of time-varying muscle synergies, modulated in amplitude and timing according to movement directions and speeds. Moreover, the modulation and superposition of the synergies identified from point-to-point movements captures the muscle patterns underlying multi-phasic movements, such as reaching through a via-point or to a target whose location changes after movement initiation. Thus, the sequencing of time-varying muscle synergies might implement an intermittent controller which would allow the construction of complex movements from simple building blocks.

  9. The Internet and the Global Reach of EU law

    Kuner, Christopher Barth

    , and fundamental rights. There are many examples of the EU exerting its global reach regarding the Internet, particularly in data protection law, but also in areas such as Internet governance, international agreements, and private international law. This occurs through a variety of mechanisms, including emulation...

  10. An Assessment of EU 2020 Strategy: Too Far to Reach?

    Colak, Mehmet Selman; Ege, Aylin


    In 2010, EU adopted a new growth strategy which includes three growth priorities and five headline targets to be reached by 2020. The aim of this paper is to investigate the current performance of the EU member and candidate states in achieving these growth priorities and the overall strategy target by allocating the headline targets into the…

  11. Veterans Crisis Line: Videos About Reaching out for Help

    Full Text Available ... the U.S. Department of Veterans Affairs and other organizations about reaching out for help. Bittersweet More Videos ... Health Administration I am A Veteran Family/Friend Active Duty/Reserve and Guard Signs of Crisis Identifying ...

  12. Development of postural adjustments during reaching in infants with CP

    Hadders-Algra, M; van der Fits, IBM; Stremmelaar, EF; Touwen, BCL


    The development of postural adjustments during reaching movements was longitudinally studied in seven infants with cerebral palsy (CP) between 4 and 18 months of age. Five infants developed spastic hemiplegia, one spastic tetraplegia, and one spastic tetraplegia with athetosis. Each assessment consi

  13. Reaching a Representative Sample of College Students: A Comparative Analysis

    Giovenco, Daniel P.; Gundersen, Daniel A.; Delnevo, Cristine D.


    Objective: To explore the feasibility of a random-digit dial (RDD) cellular phone survey in order to reach a national and representative sample of college students. Methods: Demographic distributions from the 2011 National Young Adult Health Survey (NYAHS) were benchmarked against enrollment numbers from the Integrated Postsecondary Education…

  14. The influence of object identity on obstacle avoidance reaching behaviour.

    de Haan, A M; Van der Stigchel, S; Nijnens, C M; Dijkerman, H C


    When reaching for target objects, we hardly ever collide with other objects located in our working environment. Behavioural studies have demonstrated that the introduction of non-target objects into the workspace alters both spatial and temporal parameters of reaching trajectories. Previous studies have shown the influence of spatial object features (e.g. size and position) on obstacle avoidance movements. However, obstacle identity may also play a role in the preparation of avoidance responses as this allows prediction of possible negative consequences of collision based on recognition of the obstacle. In this study we test this hypothesis by asking participants to reach towards a target as quickly as possible, in the presence of an empty or full glass of water placed about half way between the target and the starting position, at 8 cm either left or right of the virtual midline. While the spatial features of full and empty glasses of water are the same, the consequences of collision are clearly different. Indeed, when there was a high chance of collision, reaching trajectories veered away more from filled than from empty glasses. This shows that the identity of potential obstacles, which allows for estimating the predicted consequences of collision, is taken into account during obstacle avoidance.

  15. Science Behind Bars: Reaching Inmates from Rikers Island

    Mocsy, Agnes


    I report on the project ``Science Behind Bars: Reaching Inmates on Rikers Island'' partially funded through an APS Public Outreach and Informing the Public grant. This project involves developing leave-behind materials and setting up meetings to speak with Rikers Island inmates about science, evidence-based reasoning, and the dangers of stereotype threat. APS Mini Grant.

  16. Arctic sea ice reaches second lowest in satellite record


    Xinhua reports that the blanket of sea ice that floats on the Arctic Ocean appears to have reached its lowest extent for 2011, the second lowest recorded since satellites began measuring it in 1979, according to a report released on September 15 by the University of Colorado Boulder's National Snow and Ice Data Center (NSIDC).

  17. LTRM Water Quality Sampling Strata, UMRS La Grange Reach

    U.S. Geological Survey, Department of the Interior — The data set includes delineation of sampling strata for the six study reaches of the UMRR Program’s LTRM element. Separate strata coverages exist for each of the...

  18. Imaginative Play during Childhood: Required for Reaching Full Potential

    Stephens, Karen


    At a brisk pace, research findings focused on children's play are finally reaching the light of day in popular media. No longer left sitting in archives of academic journals, the benefits of play to lifelong success have been touted in radio, television, magazines, and newspapers. It gives early childhood professionals a powerful, credible…

  19. 关于界定医疗卫生机构为公共场所的探讨%Exploration of the Definition of Health Care Institutions for Public Spaces

    宁超; 苏天照; 李淼; 王蓉


    This article analyzed the relevant laws and regulations to define the concept of public places.According to the relevant information from the "Hospital Workplace Violence Survey Report on medical injury" of Chinese Hospital Association,to explore the necessity and feasibility of defining health care institutions as public spaces;pro-posing five ways to protect the medical order and then build a harmonious doctor-patient relationship.The five ways were legislation to improve,health care reform,institutional reform,scientific communication,medical education and publicity,respectively.%分析相关法律法规,对公共场所的概念进行界定;依据中国医院协会《医院场所暴力伤医情况调研报告》中的相关资料,探讨界定医疗卫生机构为公共场所的必要性和可行性;提出了完善立法、审视医改、制度改革、科学沟通、医教宣传等5个途径保障医疗秩序,构建和谐医患关系。

  20. Avaliação do desempenho dos testes functional reach e lateral reach em amostra populacional brasileira Assessment of performance in the functional reach and lateral reach tests in a Brazilian population sample

    KRM Silveira


    Full Text Available OBJETIVOS: O objetivo deste estudo foi avaliar os padrões de desempenho dos testes Functional Reach e Lateral Reach em uma amostra de indivíduos saudáveis de 20 a 87 anos e verificar a influência do gênero, idade, estatura do indivíduo, peso corporal, comprimentos do braço e do pé. MÉTODO: foi realizado um estudo observacional transversal com 98 pessoas de ambos os gêneros, que residiam na capital e interior de São Paulo. Os voluntários tiveram suas medidas descritivas registradas e posteriormente foram submetidos aos testes Functional Reach e Lateral Reach. RESULTADOS: Para o FR, todas as variáveis tiveram influência, exceto o comprimento do braço (p=0,057, o peso corporal (p=0,746 e a base de suporte usada no momento da avaliação (p=0,384. As variáveis que exerceram maior influência foram o gênero (p=0,001, a idade (pOBJECTIVE: To assess the performance in the functional reach test (FR and lateral reach test (LR among a sample of healthy individuals aged 20 to 87 years and to verify the influence of gender, age, height, body weight, arm length and foot length. METHOD: A cross-sectional observational study was conducted on 98 people of both genders living in the city of São Paulo and other places in the State of São Paulo. The volunteers were measured and then underwent FR and LR. RESULTS: All the variables had an influence on FR, except arm length (p=0.057, body weight (p=0.746 and the support base used at the time of assessment (p=0.384. The variables exerting greatest influence were the individual's gender (p=0.001, age (p<0.001 and height (p=0.004. This analysis showed that women had less anterior and lateral functional reach than men. There was a substantial positive correlation (r=0.696 between the left and right LR findings. FR had a moderate positive correlation of 0.405 with the left LR and a substantial positive correlation of 0.614 with the right LR. For LR, the height, weight, foot length and arm length

  1. Subjective poverty line definitions

    J. Flik; B.M.S. van Praag (Bernard)


    textabstractIn this paper we will deal with definitions of subjective poverty lines. To measure a poverty threshold value in terms of household income, which separates the poor from the non-poor, we take into account the opinions of all people in society. Three subjective methods will be discussed

  2. Definition of Entity Authentication

    Ahmed, Naveed; Jensen, Christian D.


    Authentication is considered a pre-requisite for communication security, but the definition of authentication is generally not agreed upon. Many attacks on authentication protocols are the result of misunderstanding of the goals of authentication. This state of affairs indicate limitations in the...

  3. Romanian definite article revisited

    Sorin Paliga


    Full Text Available I shall attempt to resume a long, almost endless discussion: the origin of the Romanian definite article. Any grammar of Romanian or any comparative grammar the Romance languages (e. g. Tagliavini 1977 always observes that Romanian, an iso­ lated case in the Romance family, has an agglutinated definite article. The typology is not indeed rare: Bulgarian, Albanian, Armenian, Basque and Swedish witness the same mechanism. We cannot approach the topic by analysing all these languages, yet a comparative analysis would be finally useful. In our case, it is obvious that Romanian cannot be isolated from Albanian and Bulgarian. A potential solution must explain the situation in ALL these three "Balkanic" languages, even if Romanian is not Balkanic stricto sensu1. The paper shall focus on the deep roots of the Romanian and Albanian definite arti­ cle, its typological relations with other linguistic areas, and shall attempt to explain this isolated situation in the field of Romance linguistics. For sure, the Romanian definite article mainly reflects the Latin heritage. Nevertheless, by saying only this, the tableau is not complete: some forms are not Latin but Pre-Latin, Thracian. This paper will try to substantiate this assertion.

  4. Subjective poverty line definitions

    J. Flik; B.M.S. van Praag (Bernard)


    textabstractIn this paper we will deal with definitions of subjective poverty lines. To measure a poverty threshold value in terms of household income, which separates the poor from the non-poor, we take into account the opinions of all people in society. Three subjective methods will be discussed a

  5. The definition of sarcopenia

    Bijlsma, Astrid Y.


    Sarcopenia in old age has been associated with a higher mortality, poor physical functioning, poor outcome of surgery and higher drug toxicity. There is no general consensus on the definition of sarcopenia. The aim of the research presented in this thesis was to assess the implications of the use of

  6. Definition af primitiver

    Christensen, Morten


    tidspunkt, kan der spares meget tid senere, hvor det er besværligt at definerer primitiverne helt om.I denne rapport er de primitiver, der skal bruges til Sydkrafts net gennemgået. Der er taget stilling til hver enkelt tilstand for de forskellige primitiver. Dette er gjort for at få en definition, som er...

  7. Definition of Professional Development

    Learning Forward, 2015


    President Obama signed into law the Every Student Succeeds Act, the reauthorization of the Elementary and Secondary Education Act, on December 10, 2015. "Learning Forward's focus in this new law is its improved definition of professional learning," said Stephanie Hirsh, executive director of Learning Forward. "We've long advocated…

  8. The definition of sarcopenia

    Bijlsma, Astrid Y.


    Sarcopenia in old age has been associated with a higher mortality, poor physical functioning, poor outcome of surgery and higher drug toxicity. There is no general consensus on the definition of sarcopenia. The aim of the research presented in this thesis was to assess the implications of the use of

  9. COPD: Definition and Phenotypes

    Vestbo, J.


    particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. The evolution of this definition and the diagnostic criteria currently in use are discussed. COPD is increasingly divided in subgroups or phenotypes based on specific features and association...

  10. Population targeting amid complex mental health programming: Are California's Full Service Partnerships reaching underserved children?

    Cordell, Katharan D; Snowden, Lonnie R


    California's Mental Health Services Act (MHSA) created Full Service Partnership programs (FSPs) targeting socially and economically vulnerable children with mental illness who are underserved by counties' public mental health treatment system. To determine whether FSPs reach a distinctive group of children, this study compares indicators of FSP-targeted underservice for FSP entrants (n = 15,598) versus everyone treated in the counties' public mental health systems (n = 282,178) and for FSP entrants versus entrants in the most intensive Medicaid delivered program in California, Therapeutic Behavioral Services (TBS, n = 11,993). Results identify that, despite first encountering mental health services systems at earlier ages, FSP clients had fewer months of treatment and were less likely to have been treated in the prior 6 months, except for crisis care, as compared to all other children served, after considering clinical severity and indicators of service need. FSP entrants also had more substance abuse and trauma-related problems. Although less seriously ill than TBS served children, FSP served children were significantly underserved. The results indicate that, amid overlapping policies and programs, carving out and reaching a distinctly underserved population can be achieved in practice, and that specialized programs, such as the FSP program, which target underserved children, have the potential to augment a system's ability to reach the underserved. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  11. Patient autonomy in chronic care: solving a paradox

    Reach G


    Full Text Available Gérard Reach Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital AP-HP, and EA 3412, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France Abstract: The application of the principle of autonomy, which is considered a cornerstone of contemporary bioethics, is sometimes in obvious contradiction with the principle of beneficence. Indeed, it may happen in chronic care that the preferences of the health care provider (HCP, who is largely focused on the prevention of long term complications of diseases, differ from those, more present oriented, preferences of the patient. The aims of this narrative review are as follows: 1 to show that the exercise of autonomy by the patient is not always possible; 2 where the latter is not possible, to examine how, in the context of the autonomy principle, someone (a HCP can decide what is good (a treatment for someone else (a patient without falling into paternalism. Actually this analysis leads to a paradox: not only is the principle of beneficence sometimes conflicting with the principle of autonomy, but physician's beneficence may enter into conflict with the mere respect of the patient; and 3 to propose a solution to this paradox by revisiting the very concepts of the autonomous person, patient education, and trust in the patient–physician relationship: this article provides an ethical definition of patient education. Keywords: preference, autonomy, person, reflexivity, empathy, sympathy, patient education, trust, respect, care

  12. Care ethics for guiding the process of multiple sclerosis diagnosis.

    Krahn, Timothy Mark


    Multiple sclerosis (MS) is a chronic neurological disorder for which there is no definitive diagnostic test. Uncertainty characterises most of its features with diagnosis reached through a process of elimination. Coping with uncertainty has been recognised as a significant problem for MS patients. Discussions in the literature concerning the ethics of MS diagnosis have focused on an ethics of duty emphasising the rules for disclosure and healthcare professionals' obligations to provide information to patients. This narrow construal of the ethics at stake with MS diagnosis may be driven by a common misperception that diagnosis is an event, or series of events, rather than a process. Scant attention has been given to the dynamic, situated relational space between patient and physician as they journey potentially together (or apart) through the process of diagnosis. The healthcare provider cannot properly judge 'the how, what and when' of MS disclosure merely by applying rules pertaining to general professional duties to tell the truth and patients' rights to know their medical status. Proper disclosure and effective communication require the practice of flexible, caring responsibility and sustained, ongoing attention to the particular relational needs of 'this' patient in her own situational context. Accordingly, this article argues that care ethics is especially useful (but not without certain limitations) for attending to a broader swath of responsibilities (different from minimal duties) and affective components implicated in meeting patients' overall needs for care as the patient and physician cope with uncertainty through the process of establishing an MS diagnosis.

  13. [Social inequality in home care].

    Möller, A; Osterfeld, A; Büscher, A


    Social inequality in Germany is discussed primarily with regard to educational or social welfare issues. There is a political consensus that more action should be taken to ensure equality of chances and fulfillment of basic needs for everyone. In long-term care these considerations have not yet taken place and there are hardly any research studies in this field. However, the startling rise of the need for long-term care will definitely require a discussion of social inequality in various care arrangements. To learn more about social inequality in home care, a qualitative approach was used and 16 home care nurses were interviewed. Our study shows that many care recipients face numerous problems they cannot handle on their own, which may even worsen their situation. In addition, the results reveal that facing social inequalities place a burden on nurses and influence their work performance.

  14. Health care reforms

    Marušič Dorjan


    Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  15. Health care reforms.

    Marušič, Dorjan; Prevolnik Rupel, Valentina


    In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  16. Redesigning Schools to Reach Every Student with Excellent Teachers: Change Management--Key Theories to Consider when Extending Reach

    Barrett, Sharon Kebschull


    As schools, their teachers, and outside facilitators redesign jobs and incorporate technology to extend the reach of excellent teachers to more students and develop an Opportunity Culture for all, choosing the right school models is just one part of the task. The human experience--and experience in education--says that even perfect design will not…

  17. Reaching to Throw Compared to Reaching to Place: A Comparison across Individuals with and without Developmental Coordination Disorder

    Wilmut, Kate; Byrne, Maia; Barnett, Anna L.


    When picking up an object, adults show a longer deceleration phase when the onward action has a greater precision requirement. Tailoring action in this way is thought to need forward modelling in order to predict the consequences of movement. Some evidence suggests that young children also tailor reaching in this way; however, how this skill…

  18. On some positive definite functions

    Bhatia, Rajendra; Jain, Tanvi


    We study the function $(1 - \\|x\\|)\\slash (1 - \\|x\\|^r),$ and its reciprocal, on the Euclidean space $\\mathbb{R}^n,$ with respect to properties like being positive definite, conditionally positive definite, and infinitely divisible.

  19. Definitions of Health Terms: Nutrition

    ... gov/definitions/nutritiondefinitions.html Definitions of Health Terms: Nutrition To use the sharing features on this page, ... National Institutes of Health, Office of Dietary Supplements Nutrition This field of study focuses on foods and ...

  20. Auxiliary midwives in hard to reach rural areas of Myanmar: filling MCH gaps.

    Wangmo, Sangay; Suphanchaimat, Rapeepong; Htun, Wai Mar Mar; Tun Aung, Tin; Khitdee, Chiraporn; Patcharanarumol, Walaiporn; Htoon, Pe Thet; Tangcharoensathien, Viroj


    Auxiliary Midwives (AMWs) are community health volunteers supporting the work of midwives, especially maternal and child health services in hard to-reach areas in Myanmar. This paper assessed the contributions of AMW to maternal and child health services, factors influencing their productivity and their willingness to serve the community. The study applied quantitative cross-sectional survey using census method. Total of 1,185 AMWs belonging to three batches: trained prior to 2000, between 2000 and 2011, and in 2012, from 21 townships of 17 states and regions in Myanmar participated in the study. Multiple logit regression was used to examine the impact of age, marital status, education, domicile, recruitment pattern and 'batch of training', on AMW's confidence level in providing care, and their intention to serve the community more than 5 years. All AMWs were able to provide essential maternal and child health services including antenatal care, normal delivery and post-natal care. They could identify and refer high-risk pregnancies to larger health facilities for proper management. On average, 9 deliveries, 11 antenatal and 9 postnatal cases were performed by an AMW during the six months prior to this study. AMWs had a comparative advantage for longer service in hard-to-reach villages where they lived, spoke the same dialect as the locals, understood the socio-cultural dimensions, and were well accepted by the community. Despite these contributions, 90 % of the respondents expressed receiving no adequate supervision, refresher training, replenishment of the AMW kits and transportation cost. AMWs in the elder age group are significantly more confident in taking care of the patients than those in the younger groups. Over 90 % of the respondents intended to stay more than five years in the community. The confidence in catering services appeared to have significant association with a longer period of stay in AMW jobs as evidenced by the odds ratio of 3.5, compared

  1. Sepsis Definitions: The Search for Gold and What CMS Got Wrong.

    Kalantari, Annahieta; Mallemat, Haney; Weingart, Scott D


    On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.

  2. A New Definition of Creativity

    Dorin, Alan; Korb, Kevin B.

    Creative artifacts can be generated by employing A-Life software, but programmers must first consider, explicitly or implicitly, what would count as creative. Most apply standard definitions that incorporate notions of novelty, value and appropriateness. Here we re-assess this approach. Some basic facts about creativity suggest criteria that guide us to a new definition of creativity. We briefly defend our definition against some plausible objections and explore the ways in which this new definition differs and improves upon the alternatives.

  3. A Definition of Artificial Intelligence


    In this paper we offer a formal definition of Artificial Intelligence and this directly gives us an algorithm for construction of this object. Really, this algorithm is useless due to the combinatory explosion. The main innovation in our definition is that it does not include the knowledge as a part of the intelligence. So according to our definition a newly born baby also is an Intellect. Here we differs with Turing's definition which suggests that an Intellect is a person with knowledge gai...

  4. The effect of homecare team visits in terminal cancer patients: Role of health teams reaching patients homes

    Pratik Banerjee


    Conclusion: The eagerness of patients wanting the teams to reach their residence may be judged by the given figures. The total number of patients visited by the homecare teams of Cansupport in the year 2008-2009 was 1025. Out of them, there were about 104 patients who were discharged. The term discharge means that the patients were not interested in our visit or were not available in our subsequent visit. It has to be mentioned here that the service is a definite demand by society provided that the cost may be catered too.

  5. Key Design Requirements for Long-Reach Manipulators

    Kwon, D.S.


    Long-reach manipulators differ from industrial robots and teleoperators typically used in the nuclear industry in that the aspect ratio (length to diameter) of links is much greater and link flexibility, as well as joint or drive train flexibility, is likely to be significant. Long-reach manipulators will be required for a variety of applications in the Environmental Restoration and Waste Management Program. While each application will present specific functional, kinematic, and performance requirements, an approach for determining the kinematic applicability and performance characteristics is presented, with a focus on waste storage tank remediation. Requirements are identified, kinematic configurations are considered, and a parametric study of link design parameters and their effects on performance characteristics is presented.

  6. Hand preferences in preschool children: Reaching, pointing and symbolic gestures.

    Cochet, Hélène; Centelles, Laurie; Jover, Marianne; Plachta, Suzy; Vauclair, Jacques


    Manual asymmetries emerge very early in development and several researchers have reported a significant right-hand bias in toddlers although this bias fluctuates depending on the nature of the activity being performed. However, little is known about the further development of asymmetries in preschoolers. In this study, patterns of hand preference were assessed in 50 children aged 3-5 years for different activities, including reaching movements, pointing gestures and symbolic gestures. Contrary to what has been reported in children before 3 years of age, we did not observe any difference in the mean handedness indices obtained in each task. Moreover, the asymmetry of reaching was found to correlate with that of pointing gestures, but not with that of symbolic gestures. In relation to the results reported in infants and adults, this study may help deciphering the mechanisms controlling the development of handedness by providing measures of manual asymmetries in an age range that has been so far rather neglected.

  7. Incidents when older homebound women tried to reach help quickly.

    Porter, Eileen J; Markham, Melinda Stafford; Ganong, Lawrence H


    During a longitudinal study of the experience of reaching help quickly, 34 homebound women (ages 85 to 97) who lived alone reported 106 reach-help-quickly incidents (RHQIs). The purpose of this study was to expand knowledge about RHQIs and intentions relative to them and to compare those facets of experience for subscribers to a personal emergency response system (PERS) and non-subscribers. We used a descriptive phenomenological method to analyze interview data, discerning six types of RHQIs, including finding myself down right here, realizing that I might not be alright after falling and getting up on my own, and realizing that something I cannot explain is or could be wrong with me. Intentions were focused on self-help before help seeking. The overall phenomenon was Handling a Situation When I Am Alone at Home and Probably Need Help Quickly. Practitioners should explore intentions about handling specific types of RHQIs and offer appropriate anticipatory guidance. Copyright 2013, SLACK Incorporated.

  8. Vehicle fingertip reach controls--human factors recommendations.

    Moussa-Hamouda, E; Mourant, R R


    Interviews were conducted with 405 drivers of cars equipped with fingertip reach controls. A high percentage of finding problems was reported when the horn was mounted on a stalk and also when the turn signal was on a right stalk. Drivers of configurations with two left stalks had a large percentage of inadvertent operation problems for the turn signal and for the headlight beam selector. A laboratory experiment was conducted to evaluate modes of operation for the wiper on/off, wiper speed and washer on/off functions. Subjects performed best when the wiper on/off and speed control were actuated by a rotating had switch. Subjects' reactions to stalk mounted controls were much faster than their reactions to dash mounted controls. Recommendations to eliminate finding and inadvertent operation problems associated with fingertip reach controls are given.

  9. Definitions of Health Terms: Fitness

    ... this page: Definitions of Health Terms: Fitness To use the sharing features on ... the most of your exercise routine. Find more definitions on Fitness | General Health | Minerals | Nutrition | Vitamins Activity Count Physical activity is ...

  10. Definitions of Health Terms: Minerals

    ... this page: Definitions of Health Terms : Minerals To use the sharing features on ... of the minerals that you need. Find more definitions on Fitness | General Health | Minerals | Nutrition | Vitamins Antioxidants Antioxidants are substances that ...

  11. Do Economists Reach a Conclusion on Household and Municipal Recycling?

    Matthew Gunter


    Do economists reach a conclusion on household and municipal recycling? I explore the policy judgments of published economists on recycling and find that there is no broad consensus. The mainstream recycling literature is dominated by a guided-market approach; taxes and subsidies are advocated to correct for market failures. There are two less popular but still significant approaches: a minimal government laissez faire approach and a command and control regulatory approach. Laissez faire econo...

  12. Can factitious disorder reach delusional level? A case study

    Dubiel Rafał


    Full Text Available The paper describes a patient, who has been consulted and hospitalized multiple times, due to dermatological lesions on his face. We will present his medical history and describe circumstances leading to the final diagnosis of factitious disorder. In the theoretical part we will try to answer the question, whether the extreme severity of the factitious disorders can, at some point, reach the level of delusions.

  13. Reaching consumers: How the tobacco industry uses email marketing

    Betsy Brock; Samantha C. Carlson; Molly Moilanen; Barbara A. Schillo


    Tobacco companies are restricted from engaging in many traditional forms of marketing. Direct marketing is one way tobacco companies can reach consumers while complying with regulation and avoiding negative public perception. There is little research on this type of opt-in marketing, which includes mail marketing, email marketing, web marketing, and mobile marketing, and its impact is not well understood. This study examined 6990 tobacco company emails received by individuals living in the st...

  14. Using Facebook to Reach People Who Experience Auditory Hallucinations

    Crosier, Benjamin Sage; Brian, Rachel Marie; Ben-Zeev, Dror


    Background Auditory hallucinations (eg, hearing voices) are relatively common and underreported false sensory experiences that may produce distress and impairment. A large proportion of those who experience auditory hallucinations go unidentified and untreated. Traditional engagement methods oftentimes fall short in reaching the diverse population of people who experience auditory hallucinations. Objective The objective of this proof-of-concept study was to examine the viability of leveraging...

  15. Developing human health exposure scenarios for petroleum substances under REACH

    Carter, M.; De Wilde, P.; Maksimainen, K.; Margary, A.; Money, C.; Pizzella, G.; Svanehav, T.; Tsang, W.; Urbanus, J.; Rohde, A.


    This report describes the approaches that were adopted by CONCAWE to prepare the human exposure estimates in the chemical safety assessments of the REACH registration dossiers for petroleum substances based on all applicable regulatory guidance. Separate exposure estimates were developed for workers and for consumers and included inhalation and dermal routes. The complex nature of petroleum substances required various scientifically justified refinements of the regulatory guidance.

  16. MultiCASE Expert Systems and the REACH Initiative.

    Saiakhov, Roustem D; Klopman, Gilles


    ABSTRACT This article is a review of the MultiCASE Inc. software and expert systems and their use to assess acute toxicity, mutagenicity, carcinogenicity, and other health effects. It is demonstrated that MultiCASE expert systems satisfy the guidelines of the Organisation for Economic Cooperation and Development (OECD) principles and that the portfolio of available endpoints closely overlaps with the list of tests required by REACH.

  17. Limit analysis of extended reach drilling in South China Sea

    Gao Deli; Tan Chengjin; Tang Haixiong


    Extended reach wells (ERWs), especially horizontal extended reach well with a high HD (horizontal displacement) to TVD (true vertical depth) ratio, represent a frontier technology and challenge the drilling limitations.Oil and gas reservoir in beaches or lakes and offshore can be effectively exploited by using extended reach drilling (ERD) technology.This paper focuses on the difficult technological problems encountered during exploiting the Liuhua 11-1 oil field in the South China Sea, China.Emphasis is on investigating the key subjects including prediction and control of open hole limit extension in offshore ERD, prediction of casing wear and its prevention and torque reduction, φ244.5mm casing running with floating collars to control drag force, and steerable drilling modes.The basic concept of limit extension in ERD is presented and the prediction method for open hole limit extension is given in this paper.A set of advanced drilling mechanics and control technology has been established and its practical results are verified by field cases.All those efforts may be significant for further investigating and practicing ERD limit theory and control technology in the future.

  18. Distractor interference during a choice limb reaching task.

    Matthew Ray

    Full Text Available According to action-centered models of attention, the patterns of distractor interference that emerge in selective reaching tasks are related to the time and effort required to resolve a race for activation between competing target and non-target response producing processes. Previous studies have only used unimanual aiming tasks and, as such, only examined the effects of competition that occurs within a limb. The results of studies using unimanual aiming movements often reveal an "ipsilateral effect"--distractors on the same side of space as the effector cause greater interference than distractors on the opposite side of space. The cost of the competition when response selection is between the limbs has yet to be addressed. Participants in the present study executed reaching movements to 1 of 4 (2 left, 2 right possible target locations with and without a distractor. Participants made ipsilateral reaches (left hand to left targets, right hand to right targets. In contrast to studies using unimanual aiming movements, a "contralateral effect" was observed; distractors affording responses for the other hand (in contralateral space caused more interference than distractors affording responses for the same hand. The findings from the present research demonstrate that when certain portions of response planning must be resolved prior to response initiation, distractors that code for that dimension cause the greatest interference.

  19. Ability of youth operators to reach farm tractor controls.

    Fathallah, F A; Chang, J H; Pickett, W; Marlenga, B


    Farm tractor work is commonly assigned to young people on North American farms, where tractors account for the majority of deaths and major portions of non-fatal trauma to working youths. However, little is known about the potential mismatch between the anthropometric and physical characteristics of children and tractor characteristics. The purpose of this study was to evaluate the ability of children of varying ages and percentiles to reach major controls on 45 tractors in common use in the US. The main study finding was that many tractor controls, especially those that are hand-operated, may not be effectively reached by the majority of youth operators aged 12 to 16 years. The study raises further serious questions about the ability of children to safely operate tractors in common use on US farms and calls for reconsideration of age guidelines for the assignment of children to tractor work on farms. This study provides novel ergonomic evidence about the ability of children to reach controls inside agricultural tractor cabins. The approach could be applied in similar situations where youths may operate other vehicles or machines. Study findings support the establishment and refinement of policies and guidelines related to youth tractor operation.

  20. Hazard and risk assessment of teratogenic chemicals under REACH.

    Prutner, Wiebke


    In 2007, a new European chemicals legislation was implemented: Regulation (EC) No. 1907/2006, also known as "REACH." It obliges companies to take the main responsibility for the valid information on the safe use of the chemicals they manufacture and/or place on the European market. So they must, for example, register their chemicals at the European Chemicals Agency (ECHA) and submit extensive substance-related registration dossiers containing information on the substances' intrinsic hazardous properties and documentation of their risk assessment. REACH regulates the registration and evaluation process as well as the authorization and restriction procedure. In addition, classification, labeling, and packaging of chemicals apply in accordance with Regulation (EC) No. 1272/2008 ("CLP Regulation"). It implements almost completely the provisions of the United Nations Globally Harmonised System of Classification and Labelling of Chemicals (UN GHS) into European legislation and will fully replace the Dangerous Substances Directive (67/548/EEC) and the Dangerous Preparations Directive (1999/45/EC) by 2015. According to both the old and the new classification system, teratogenic chemicals are classified as developmental toxicants, with developmental toxicity falling within the hazard class of reproductive toxicity. REACH as well as the CLP Regulation provide several procedures in which reproductive toxicants take a special position because their harmful effects are considered particularly serious. Teratogenic substances are not explicitly named by these legal texts but, as they constitute as developmental toxicants a hazard differentiation of reproductive toxicity, they are implicitly always included by the provisions.

  1. Palliative Care

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

  2. Hospice Care

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

  3. Criteria for definition of a complex abdominal wall hernia

    Slater, N.J.; Montgomery, A.; Berrevoet, F.; Carbonell, A.M.; Chang, A.; Franklin, M.; Kercher, K.W.; Lammers, B.J.; Parra-Davilla, E.; Roll, S.; Towfigh, S.; Geffen, E. van; Conze, J.; Goor, H. van


    PURPOSE: A clear definition of "complex (abdominal wall) hernia" is missing, though the term is often used. Practically all "complex hernia" literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and

  4. 42 CFR 422.350 - Basis, scope, and definitions.


    ... organization. Health care delivery assets (HCDAs) means any tangible assets that are part of a PSO's operation... 42 Public Health 3 2010-10-01 2010-10-01 false Basis, scope, and definitions. 422.350 Section 422.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  5. Criteria for definition of a complex abdominal wall hernia

    Slater, N.J.; Montgomery, A.; Berrevoet, F.; Carbonell, A.M.; Chang, A.; Franklin, M.; Kercher, K.W.; Lammers, B.J.; Parra-Davilla, E.; Roll, S.; Towfigh, S.; Geffen, E. van; Conze, J.; Goor, H. van


    PURPOSE: A clear definition of "complex (abdominal wall) hernia" is missing, though the term is often used. Practically all "complex hernia" literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and allo

  6. Why and how to make a REACH registration of combustion ash; Moejligheter vid REACH-registrering av energiaskor

    Loevgren, Linnea; Wik, Ola


    The new chemical regulation, REACH (1997/2006/EC), Registration, Evaluation, Authorization and restriction of Chemicals, took effect the 1st of June 2007. The background to this report was the introduction of REACH and the difficulties to understand the implications for ash. The most important consequence of REACH is that all chemical substances that are manufactured, handled and used above one tonne per annum per legal entity shall be registered according to this regulation. The registration includes specifying the chemical, physical, toxicity and ecotoxicity properties of the substance and risk assessing the identified areas of use. The report describes the use of ash in connection to the waste legislation and its planned end-of-waste-criteria, the chemical legislation and the Construction Products Directive. The target audience of this report is companies producing ashes and having a use or seeing a use for its ash. The report describes how to make a REACH registration of ash independent if a company did or did not pre-register ash during 2008. It describes how to change from one ash registration into another if the pre-registration was done for one type of ash but the company changes opinion during the sameness check, i.e. changing SIEF (Appendix A). Taking part in REACH registration projects during 2009-2010 can be advantageous since knowledge and financing are shared. Ash can be REACH registered also in the future but it is important to know that the registration have to be done prior the production and marketing starts. If ash is consider to be a waste the handling is covered by the community and national waste legislation. In Sweden ashes are by and large being regarded as waste, and recycling is risk assessed and permits are given case by case. End-of-waste criteria for different waste material are being elaborated within the EU. Such criteria will among other details cover chemical safety. When a material fulfils the end-of-waste criteria such material

  7. Scaling under REACH. Development of a guideline for the evaluation of the safe recommendations for use of chemicals by scaling; Scaling unter REACH. Entwicklung einer Handlungsanleitung zur Bestimmung der sicheren Verwendungsbedingungen von Chemikalien durch Scaling

    Bunke, Dirk; Gross, Rita; Vogel, Steffen [Oeko-Institut e.V. - Institut fuer Angewandte Oekologie e.V., Freiburg im Breisgau (Germany)


    Scaling in the context of REACH means: use of simple mathematics to check, whether chemi-cals are used in a safe way. Even in case if certain conditions of use deviate from the exposure scenario. In specific cases, scaling offers downstream users the opportunity to demonstrate coverage by an exposure scenario for their individual conditions of use. In this report we describe the duty of downstream users to check their conditions of use. We give a definition of scaling related to REACH. We describe objectives and results of scaling. We characterise available scaling tools in a structured way. We describe options for further development and harmonisation of scaling tools. Under use of the experience with existing tools, we develop a guidance document on scaling. Three examples in this guidance make clear how scaling works. In five steps. The guidance is addressed to persons using substances in industrial or professional applications - downstream users according to REACH. In addition, the guidance supports producers of substances and formulators who want to develop scaling tools for their customers. The report includes a calculation table for scaling related to the environment (REACH Scale Environment). In addition, it includes a template to generate product-specific scaling tools. This report focuses on scaling related to environmental exposure assessment. Scaling is possible related to workers and consumer exposure, too. References for this are given in chapter 7. (orig.)

  8. REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience

    Robert J. Adams


    Full Text Available REACH MUSC provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV thrombolysis and 369 were transferred to Medical University of South Carolina (MUSC including 42 for intra-arterial revascularization (with or without IV tPA. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al. 2011, in press. Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tissue plasminogen activator (tPA, time milestones were: Onset to Door: 62 min (mean, 50 (median; Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7 minutes, Consult Start to tPA Decision: 31 and 25 minutes; Decision to Infusion: 20 and 14 minutes, and total Door to Needle: 98 and 87 minutes. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75 minutes; Door to REACH Consult: 61 and 41 minutes; Consult Request to Consult Start 9 and 7 minutes, Consult Start to tPA Decision 27 and 23 minutes. While the consultants respond to consult requests in < 10 minutes, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of < 60 minutes. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage,will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system.

  9. Evaluation of a hydrological model based on Bidirectional Reach (BReach)

    Van Eerdenbrugh, Katrien; Van Hoey, Stijn; Verhoest, Niko E. C.


    Evaluation and discrimination of model structures is crucial to ensure an appropriate use of hydrological models. When evaluating model results by aggregating their quality in (a subset of) individual observations, overall results of this analysis sometimes conceal important detailed information about model structural deficiencies. Analyzing model results within their local (time) context can uncover this detailed information. In this research, a methodology called Bidirectional Reach (BReach) is proposed to evaluate and analyze results of a hydrological model by assessing the maximum left and right reach in each observation point that is used for model evaluation. These maximum reaches express the capability of the model to describe a subset of the evaluation data both in the direction of the previous (left) and of the following data (right). This capability is evaluated on two levels. First, on the level of individual observations, the combination of a parameter set and an observation is classified as non-acceptable if the deviation between the accompanying model result and the measurement exceeds observational uncertainty. Second, the behavior in a sequence of observations is evaluated by means of a tolerance degree. This tolerance degree expresses the condition for satisfactory model behavior in a data series and is defined by the percentage of observations within this series that can have non-acceptable model results. Based on both criteria, the maximum left and right reaches of a model in an observation represent the data points in the direction of the previous respectively the following observations beyond which none of the sampled parameter sets both are satisfactory and result in an acceptable deviation. After assessing these reaches for a variety of tolerance degrees, results can be plotted in a combined BReach plot that show temporal changes in the behavior of model results. The methodology is applied on a Probability Distributed Model (PDM) of the river

  10. Maven The Definitive Guide

    Company, Sonatype


    Written by Maven creator Jason Van Zyl and his team at Sonatype, Maven: The Definitive Guide clearly explains how this popular tool can bring order to your software development projects. The first part of the book demonstrates Maven's capabilities through the development of several sample applications from ideation to deployment, and the second part offers a complete reference guide. Concise and to the point, this is the only guide you need to manage your project.

  11. The Logic of Definition


    Wittgenstein , in his Philosophical Investigations (1953), observed that, for many phenomena, there are no necessary conditions common to all members of... Wittgenstein 1953: §66, p.27e). Wittgenstein refers to these overlapping similarities as “family resemblances” (Ibid., §67, p.27e). Few, if any, of...that is, we may resort to stipulative definition). But this is not necessary for the concept to be usable. Indeed, as Wittgenstein says, sometimes

  12. XMPP The Definitive Guide

    Saint-Andre, Peter; Smith, Kevin


    This practical book provides everything you need to know about the Extensible Messaging and Presence Protocol (XMPP) -- the open technology for real-time communication used in instant messaging, Voice over IP, real-time collaboration, social networking, microblogging, lightweight middleware, cloud computing, and more. XMPP: The Definitive Guide walks you through the thought processes and design decisions involved in building a complete XMPP-enabled application, and adding real-time interfaces to existing applications.

  13. Definition Study PHARUS


    definitie studie zijn gebruikt in het voorontwerp van het PHARUS systeem . TNO report STUDelft Page 6 ABSTRACT 3 SAMENVAlTING 4 CONTENTS 6 1 INTRODUCTION 9...University of Technology, Laboratory for Telecommunication and Remote Sensing Technology. FEL-TNO had tke lead and was responsible for the project management ...Aerospace Programs in Delft was responsible for the program management . The definition study PHARUS was started in the first half of 1988 and ended

  14. Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

    Stephens, Samuel A.


    Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

  15. Controversy around the definition of waste

    Oelofse, Suzanna HH


    Full Text Available This paper presents the information concerning the definition of waste. Discussing the importance of the clear definition, ongoing debates, broad definition of waste, problems with the broad definition, interpretation, current waste management model...

  16. A New Definition of Virus

    HE Hongjun; CAO Sihua; LUO Li; FENG Tao; PAN Li; ZOU Zhiji


    Security experts have not formally defined the distinction between viruses and normal programs. The paper takes user's intension as the criteria for malice, gives a formal definition of viruses that aim at stealing or destroying files, and proposes an algorithm to detect virus correctly. Compared with traditional definitions, this new definition is easy to understand, covers more malwares, adapts development of virus technology, and defines virus on the spot. The paper has also analyzed more than 250 real viruses and finds that they are all in the domain of the new definition, this implies that the new definition has great practical significance.

  17. 1 Reaching the poor through community-based distributors of ...

    Introduction. The level of ... Many studies have been done focusing on implementation of CBD programmes, but, inequity in ... counselling and testing, antenatal and delivery care. .... significant difference using p-value cut off point of 0.05. Results .... International Journal of Family Planning Perspectives 21, 64-74. Foreit.

  18. Marketers hone their skills to reach target markets.

    White, D; Christensen, M


    New challenges lie ahead for health care marketers. Marketers must communicate with several important groups: their own administration, the general public, employers, hospital employees, and, of course, physicians. And as budgets tighten, the methods used to communicate must become more creative and more efficient.

  19. A review of health literacy: Definitions, interpretations, and implications for policy initiatives.

    Malloy-Weir, Leslie J; Charles, Cathy; Gafni, Amiram; Entwistle, Vikki


    Definitions and interpretations of 'health literacy' have important implications for the delivery of health care and for health policy-related initiatives. We conducted a systematic review and critical analysis to determine the extent to which definitions of health literacy differ in the academic literature, the similarities and differences across definitions, and possible interpretations for the most commonly used definitions. We identified 250 different definitions of health literacy and grouped them into three categories: (i) most commonly used definitions (n=6), (ii) modified versions of these most commonly used definitions (n=133), and (iii) 'other' definitions (n=111). We found the most commonly used definitions to be open to multiple interpretations and to reflect underlying assumptions that are not always justifiable. Attention is needed to the ways in which differing definitions and interpretations of health literacy may affect patient care and the delivery of health literacy-related policy initiatives.Journal of Public Health Policy advance online publication, 19 May 2016; doi:10.1057/jphp.2016.18.

  20. Background of REACH in EU regulations on evaluation of chemicals.

    Foth, H; Hayes, Aw


    Industrial chemicals are needed for chemical synthesis or technical purposes. These beneficial effects are counterbalanced by the potential health risks for all who come into contact with them. The new chemical legislation of the EU, Registration, Evaluation and Authorization of Chemicals (REACH) will force the responsibility of manufacturers and importers of chemical substances to gather the right information needed to decide on the right circumstances of use and control of chemical substances and products. In order to understand the roots of REACH, experiences gained with regard to existing chemicals legislation, particularly in Germany, will be reviewed. Since Council Directive 67/548/EEC all chemicals placed on the market need a set of standard information and provisions for safe transportation. This directive and its amendments (Council Directive(s) 79/831/EEC and 92/32/EEC) have established for new substances a sound information data basis for classification of dangerous properties. Under Council Regulation 793/93/EEC, regulations and administrative provisions have established the requirement to assess the risk to man and the environment of existing substances. So far, only 119 substances have been evaluated under the forces of this regulation. This separation has led to a substantial imbalance between existing substances and new substances with respect to available data needed to recognize hazards for health. The register of produced and imported chemical substances under REACH should eliminate some of this separation and will also be the key for selection of substances of very high concern by the authorization process to restrict the use and distribution accordingly.

  1. Identification of consistency in rating curve data: Bidirectional Reach (BReach)

    Van Eerdenbrugh, Katrien; Van Hoey, Stijn; Verhoest, Niko E. C.


    Before calculating rating curve discharges, it is crucial to identify possible interruptions in data consistency. In this research, a methodology to perform this preliminary analysis is developed and validated. This methodology, called Bidirectional Reach (BReach), evaluates in each data point results of a rating curve model with randomly sampled parameter sets. The combination of a parameter set and a data point is classified as non-acceptable if the deviation between the accompanying model result and the measurement exceeds observational uncertainty. Moreover, a tolerance degree that defines satisfactory behavior of a sequence of model results is chosen. This tolerance degree equals the percentage of observations that are allowed to have non-acceptable model results. Subsequently, the results of the classification is used to assess the maximum left and right reach for each data point of a chronologically sorted time series. This maximum left and right reach in a gauging point represent the data points in the direction of the previous respectively the following observations beyond which none of the sampled parameter sets both are satisfactory and result in an acceptable deviation. This analysis is repeated for a variety of tolerance degrees. Plotting results of this analysis for all data points and all tolerance degrees in a combined BReach plot enables the detection of changes in data consistency. Moreover, if consistent periods are detected, limits of these periods can be derived. The methodology is validated with various synthetic stage-discharge data sets and proves to be a robust technique to investigate temporal consistency of rating curve data. It provides satisfying results despite of low data availability, large errors in the estimated observational uncertainty, and a rating curve model that is known to cover only a limited part of the observations.

  2. Quality of Care and Disparities in Obstetrics.

    Howell, Elizabeth A; Zeitlin, Jennifer


    Growing attention is being paid to obstetric quality of care as patients are pressing the health care system to measure and improve quality. There is also an increasing recognition of persistent racial and ethnic disparities prevalent in obstetric outcomes. Yet few studies have linked obstetric quality of care with racial and ethnic disparities. This article reviews definitions of quality of care, health disparities, and health equity as they relate to obstetric care and outcomes; describes current efforts and challenges in obstetric quality measurement; and proposes 3 steps in an effort to develop, track, and improve quality and reduce disparities in obstetrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Reaching a consensus: a discrete nonlinear time-varying case

    Saburov, M.; Saburov, K.


    In this paper, we have considered a nonlinear protocol for a structured time-varying and synchronous multi-agent system. By means of cubic triple stochastic matrices, we present an opinion sharing dynamics of the multi-agent system as a trajectory of a non-homogeneous system of cubic triple stochastic matrices. We show that the multi-agent system eventually reaches to a consensus if either of the following two conditions is satisfied: (1) every member of the group people has a positive subjective distribution on the given task after some revision steps or (2) all entries of some cubic triple stochastic matrix are positive.

  4. Interaction torque contributes to planar reaching at slow speed

    Hoshi Fumihiko


    Full Text Available Abstract Background How the central nervous system (CNS organizes the joint dynamics for multi-joint movement is a complex problem, because of the passive interaction among segmental movements. Previous studies have demonstrated that the CNS predictively compensates for interaction torque (INT which is arising from the movement of the adjacent joints. However, most of these studies have mainly examined quick movements, presumably because the current belief is that the effects of INT are not significant at slow speeds. The functional contribution of INT for multijoint movements performed in various speeds is still unclear. The purpose of this study was to examine the contribution of INT to a planer reaching in a wide range of motion speeds for healthy subjects. Methods Subjects performed reaching movements toward five targets under three different speed conditions. Joint position data were recorded using a 3-D motion analysis device (50 Hz. Torque components, muscle torque (MUS, interaction torque (INT, gravity torque (G, and net torque (NET were calculated by solving the dynamic equations for the shoulder and elbow. NET at a joint which produces the joint kinematics will be an algebraic sum of torque components; NET = MUS - G - INT. Dynamic muscle torque (DMUS = MUS-G was also calculated. Contributions of INT impulse and DMUS impulse to NET impulse were examined. Results The relative contribution of INT to NET was not dependent on speed for both joints at every target. INT was additive (same direction to DMUS at the shoulder joint, while in the elbow DMUS counteracted (opposed to INT. The trajectory of reach was linear and two-joint movements were coordinated with a specific combination at each target, regardless of motion speed. However, DMUS at the elbow was opposed to the direction of elbow movement, and its magnitude varied from trial to trial in order to compensate for the variability of INT. Conclusion Interaction torque was important at

  5. Defining a controller architecture for the Long-Reach Manipulator

    Ford, W.E. [Sandia National Labs., Albuquerque, NM (United States). Intelligent Systems Dept. III


    To draft a procurement specification for the Long-Reach Manipulator (LRM), the benefits and limitations of the various robotic control system architectures available need to be determined. This report identifies and describes the advantages and potential disadvantages of using an open control system versus a closed (or proprietary) system, focusing on integration of interfaces for sensors, end effectors, tooling, and operator interfaces. In addition, the various controls methodologies of several recent systems are described. Finally, the reasons behind the recommendation to procure an open control system are discussed.

  6. Near IR observations of η Car: Reaching its critical rotation?

    Ishibashi, Kazunori; Mehner, Andrea; Nagayama, Takahiro


    We report a preliminary result in the monitoring of η Carinae in JHKs bands through the “spectroscopic” event of 2014.5 at InfraRed Survey Facility (IRSF) located in South African Astronomical Observatory (SAAO). The latest photometric data, combined with the data taken with the MK-II photometer [1], show a sign of the same cyclic variation in the J-H vs. H-K diagram reported by Mehner et al.[2]. The change can still be attributed to an apparent increase in black-body temperature, potentially reaching 3,000 to 6,000K as of March 2015.

  7. Family (oikos Evangelism for reaching forward caste Hindus in India

    DW Fowlkes


    Full Text Available This article acknowledges the need for Church Planting Movements among the unreached peoples of India. Of particular concern to this study is the application of Church Planting Movement strategy to forward caste Hindus of India. It is shown that evangelizing households (family or �oikos� evangelism is a New Testament strategy and the most appropriate strategy for reaching forward caste Hindus. It is concluded that Christian disciples remaining within Hindu culture and familial systems hold the potential for the most indigenous approach to evangelizing forward caste Hindus.

  8. Optical fiber reach extended FMCW radar for remote respiratory tracking

    Suhr, Lau Frejstrup; Tafur Monroy, Idelfonso; Vegas Olmos, Juan José


    Wireless monitoring of human vital signs such as breathing rate is a nonintrusive alternative to contemporary solutions relying on physical contact. To ease the installment, fiber optical transmission is used to extend the reach from the transmitter and receiver circuitry to the antenna subsystem....... In this paper, a frequency modulated carrier wave radar, operating at 25.7–26.6 GHz and utilizing optical fiber extension, was experimentally demonstrated to accurately recover the breathing rate of a human placed 1 m away from the radar antennas....

  9. The reach of INO for atmospheric neutrino oscillation parameters

    Thakore, Tarak; Ghosh, Anushree; Choubey, Sandhya; Dighe, Amol


    The India-based Neutrino Observatory (INO) will host a 50 kt magnetized iron calorimeter (ICAL@INO) for the study of atmospheric neutrinos. Using the detector resolutions and efficiencies obtained by the INO collaboration from a full-detector GEANT4-based simulation, we determine the reach of this experiment for the measurement of the atmospheric neutrino mixing parameters ( {sin^2 {θ_{23 }}and| {\\varDelta m_{32}^2} |} ) . We also explore the sensitivity of this experiment to the octant of θ 23, and its deviation from maximal mixing.

  10. The Reach of INO for Atmospheric Neutrino Oscillation Parameters

    Thakore, Tarak; Choubey, Sandhya; Dighe, Amol


    The India-based Neutrino Observatory (INO) will host a 50 kt magnetized iron calorimeter (ICAL@INO) for the study of atmospheric neutrinos. Using the detector resolutions and efficiencies obtained by the INO collaboration from a full-detector GEANT4-based simulation, we determine the reach of this experiment for the measurement of the atmospheric neutrino mixing parameters ($\\sin^2 \\theta_{23}$ and $|\\Delta m_{32}^2 |$). We also explore the sensitivity of this experiment to the deviation of $\\theta_{23}$ from maximal mixing, and its octant.

  11. Beyond abortion: the potential reach of a human life amendment.

    Westfall, D


    In Roe v. Wade, the Supreme Court held that the constitutionally protected right to privacy includes a woman's right to terminate pregnancy. Following the decision, anti-abortion groups turned to Congress to limit or negate that right. As a result of their efforts, several "human life" statutes and constitutional amendments have been proposed. This Article focuses on the implications of proposed amendments that seek to ban or limit the availability of abortions indirectly by broadening the definition of "person" to include unborn individuals. The Article discusses the potentially serious effects such an amendment would have in areas unrelated to abortion. It finds that the resulting chaos and uncertainty would have great social costs, and concludes that if abortions are to be banned or restricted, a human life amendment that directly deals with abortion is preferable to one that defines "person" to include the unborn.

  12. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

    Surekha Kishore


    Full Text Available Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, health care delivered at household level has definitely   gone down due to financial constraints and increasing cost of living, thus posing a problem for the elderly.  Aims & Objective: To find out the prevalence of chronic morbidity and health care seeking behaviour amongst the elderly in rural areas of Uttarakhand. Material and Methods: A cross-sectional study was carried out in rural areas of Uttarakhand to assess the chronic morbidity amongst elderly population. All the persons above the age group of 60 years of the eight villages were interviewed using a pre-defined, pre-tested, semi-structured and indigenously developed questionnaire. Results: The study group suffered from various chronic morbidities like hypertension, diabetes, cardiovascular diseases. Men were greater in number (158, 62.2%. Participants belonging mostly to nuclear families (156, 61.9%. Below the poverty line were (98, 38.9%. Half of the study population had one or the other chronic morbid condition. Majority of the elderly men contacted the health care facility whereas majority of the elderly women chose to use remedies. Conclusion: There is definitely a need of   provision of health care services for poor geriatric population. In addition to this government should take up some program for social security of this population along with creating an awareness about the same.

  13. HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities

    Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis


    HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection. PMID:24592330

  14. HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities

    Jaime Galindo-Quintero


    Full Text Available HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1 and the other by CLS and community leaders (BAFI-2. Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.

  15. Hospice care

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

  16. Palliative Care

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

  17. 7 CFR 51.1315 - Carefully hand-picked.


    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Carefully hand-picked. 51.1315 Section 51.1315... STANDARDS) United States Standards for Winter Pears 1 Definitions § 51.1315 Carefully hand-picked. Carefully hand-picked means that the pears do not show evidence of rough handling or of having been on the ground....

  18. 7 CFR 51.1274 - Carefully hand-picked.


    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Carefully hand-picked. 51.1274 Section 51.1274... STANDARDS) United States Standards for Summer and Fall Pears 1 Definitions § 51.1274 Carefully hand-picked. Carefully hand-picked means that the pears do not show evidence of rough handling or of having been on...

  19. Evolving Systems of Care with Total Clinical Outcomes Management

    Lyons, John S.; Epstein, Richard A.; Jordan, Neil


    The current article proposes that further specification of the system of care concept is required. Based on the assertions that the system of care concept (a) refers to an ideal as opposed to an observable phenomenon, and (b) is engaged in offering transformational experiences, the authors propose that the system of care definition must be…

  20. Healthcare service quality: towards a broad definition.

    Mosadeghrad, Ali Mohammad


    The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

  1. Integrated testing strategy (ITS) for bioaccumulation assessment under REACH.

    Lombardo, Anna; Roncaglioni, Alessandra; Benfentati, Emilio; Nendza, Monika; Segner, Helmut; Fernández, Alberto; Kühne, Ralph; Franco, Antonio; Pauné, Eduard; Schüürmann, Gerrit


    REACH (registration, evaluation, authorisation and restriction of chemicals) regulation requires that all the chemicals produced or imported in Europe above 1 tonne/year are registered. To register a chemical, physicochemical, toxicological and ecotoxicological information needs to be reported in a dossier. REACH promotes the use of alternative methods to replace, refine and reduce the use of animal (eco)toxicity testing. Within the EU OSIRIS project, integrated testing strategies (ITSs) have been developed for the rational use of non-animal testing approaches in chemical hazard assessment. Here we present an ITS for evaluating the bioaccumulation potential of organic chemicals. The scheme includes the use of all available data (also the non-optimal ones), waiving schemes, analysis of physicochemical properties related to the end point and alternative methods (both in silico and in vitro). In vivo methods are used only as last resort. Using the ITS, in vivo testing could be waived for about 67% of the examined compounds, but bioaccumulation potential could be estimated on the basis of non-animal methods. The presented ITS is freely available through a web tool. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. CP-violation reach of an electron capture neutrino beam

    Orme, Christopher


    This article extends the work of Bernabeu and Espinoza by examining the CP-violation reach of a $^{150}$Dy electron capture beam through the variation of the two Lorentz boosts, the number of useful electron capture decays, the relative run time of each boost and the number of atmospheric backgrounds. The neutrinos are assumed to be sourced at CERN with an upgraded SPS and are directed towards a 440 kton Water Cerenkov detector located at the Canfranc laboratory. Two large `CP-coverage' choices for the boost pairings are found; a $\\delta$-symmetrical coverage for $(\\gamma_{1}, \\gamma_{2})$ = (280, 160) and an $\\delta$-asymmetric coverage for $(\\gamma_{1}, \\gamma_{2})$ = (440,150). With a nominal useful decay rate of $N_{\\rm ions} = 10^{18}$ per year, the $\\delta$-symmetric setup can rule out CP-conservation down to $\\sin^{2}2\\theta_{13} = 3\\cdot 10^{-4}$. To reach $\\sin^{2}2\\theta_{13} = 1\\cdot 10^{-3}$ for both $\\delta 0$ requires a useful decay rate of $N_{\\rm ions} = 6\\cdot 10^{17}$ per year.

  3. CP-violation reach of an electron capture neutrino beam

    Orme, Christopher


    This article extends the work of Bernabeu and Espinoza by examining the CP-violation reach of a 150Dy electron capture beam through the variation of the two Lorentz boosts, the number of useful electron capture decays, the relative run time of each boost and the number of atmospheric backgrounds. The neutrinos are assumed to be sourced at CERN with an upgraded SPS and are directed towards a 440 kton Water Cerenkov detector located at the Canfranc laboratory. Two large ‘CP-coverage’ choices for the boost pairings are found; a δ-symmetrical coverage for ( γ 1, γ 2) = (280, 160) and an δ-asymmetric coverage for ( γ 1 , γ 2) = (440,150). With a nominal useful decay rate of N ions = 1018 ions per year, the δ-symmetric setup can rule out CP-conservation down to sin2 2 θ 13 = 3•10-4. To reach sin2 2 θ 13 =1•10-3 for both δ 0 requires a useful decay rate of N ions = 6•1017 ions per year.

  4. Reaching the hip-hop generation: Final (symposium proceedings) report


    The goal of this final (closing) report is to capture the flavor of the symposium held March 1 and 2, 1993 in New York City convened by Motivational Educational Entertainment, Inc. (MEE), a black-owned communications research, consulting, and video production company based in Philadelphia, Pennsylvania. The mission of MEE is to understand, reach, and positively affect inner-city youth. Traditional communication approaches from mainstream sources to at-risk youth often don`t account for the unique way youth communicate among themselves and how they relate to the media. This understanding, however, is crucial. To understand youth communication, the people who create and send both entertaining and educational messages to urban youth must be brought into the dialogue. The meeting in New York was intended to provide an important opportunity for senders to meet and evaluate the appropriateness and effectiveness of their messages. In addition, the MEE symposium provided a forum for the continuing public debate about what needs to be done to reach today`s urban teens. Included in this document is a description of symposium goals/objectives, symposium activities, the reaction to and analysis of the symposium, recommendations for future MEE courses of action, and an appendix containing copies of press articles.

  5. Google Hangouts: Leveraging Social Media to Reach the Education Community

    Eisenhamer, Bonnie; Summers, Frank; McCallister, Dan; Ryer, Holly


    Research shows that educator professional development is most effective when it is sustained and/or when a follow-on component is included to support the learning process. In order to create more comprehensive learning experiences for our workshop participants, the education team at the Space Telescope Science Institute is working collaboratively with scientific staff and other experts to create a follow-on component for our professional development program. The new component utilizes video conferencing platforms, such as Google's Hangouts On Air, to provide educators with content updates and extended learning opportunities in between in-person professional development experiences. The goal is to enhance our professional development program in a cost-effective way while reaching a greater cross-section of educators. Video broadcasts go live on Google+, YouTube, and our website - thus providing access to any user with a web browser. Additionally, the broadcasts are automatically recorded and archived for future viewing on our YouTube channel. This provides educators with anywhere, anytime training that best suits their needs and schedules. This poster will highlight our new Hangouts for educators as well as our cross-departmental efforts to expand the reach of our Hubble Hangouts for the public through a targeted recruitment strategy.

  6. Fluvial geomorphology of the Middle Reach of the Huai River

    Bang-yi YU; Peng WU; Jue-yi SUI; Xing-ju YANG; Jin NI


    The Middle Reach of the Huai River (MRHR) flows northeast into the Hongzehu Lake. Before entering the Hongzehu Lake, the Huai River has a braided channel which is shallow and wide, and the riverbed has a negative slope. Based on the characteristics of the MRHR, this river reach can be divided into the following sections: a quasi-straight (or mildly curved) section, a bend section, and a braided section. The majority of the MRHR is quasi-straight. In this paper, several parameters are used to assess the geomorphology of the MRHR. Statistical analyses are performed to establish a relationship between the span length“L”and channel width“B”for different channel patterns. The relationship between the meandering length “S” and bankfull channel width “B” is also derived. Results indicate that the bankfull channel width “B”, the bankfull cross sectional area “A” and the average flow depth“H”are mainly dependent on the dominant discharge in the channel. A relationship is derived that describes the dependency of the curvature radius“R”on the dominant discharge“Q”, water surface slope“J”and the turning angle“α”.

  7. Bionics Solution to Learn the Arm Reaching with Collision Avoidance

    P. Gorce


    Full Text Available This article presents a learning model that simulates the control of an anthropomorphic arm kinematics motion. The objective is to reach and grasp a static prototypic object placed behind different kinds of obstacle in size and position. The network, composed of two generic neural network modules, learns to combine multi-modal arm-related information (trajectory parameters as well as obstacle-related information (obstacle size and location. Our simulation was based on the notion of Via Point, which postulates that the motion planning that is divided into specific successive position of the arm. In order to determine these special points, an experimental protocol has been built and pertinent parameters have been integrated to the model. According to these studies, we propose an original method that takes into account the previous learning modules to determine the entire trajectory of the wrist in order to reach the same object placed behind two successive obstacles. The aim of this approach is to understand better the impact of experience in a task realisation and show that learning can be performed from previous initiation. Some results (applied to obstacle avoidance task show the efficiency of the proposed method.

  8. An optically trapped mirror for reaching the standard quantum limit

    Matsumoto, Nobuyuki; Aso, Yoichi; Tsubono, Kimio


    The preparation of a mechanical oscillator driven by quantum back-action is a fundamental requirement to reach the standard quantum limit (SQL) for force measurement, in optomechanical systems. However, thermal fluctuating force generally dominates a disturbance on the oscillator. In the macroscopic scale, an optical linear cavity including a suspended mirror has been used for the weak force measurement, such as gravitational-wave detectors. This configuration has the advantages of reducing the dissipation of the pendulum (i.e., suspension thermal noise) due to a gravitational dilution by using a thin wire, and of increasing the circulating laser power. However, the use of the thin wire is weak for an optical torsional anti-spring effect in the cavity, due to the low mechanical restoring force of the wire. Thus, there is the trade-off between the stability of the system and the sensitivity. Here, we describe using a triangular optical cavity to overcome this limitation for reaching the SQL. The triangular cav...

  9. The multiple process model of goal-directed reaching revisited.

    Elliott, Digby; Lyons, James; Hayes, Spencer J; Burkitt, James J; Roberts, James W; Grierson, Lawrence E M; Hansen, Steve; Bennett, Simon J


    Recently our group forwarded a model of speed-accuracy relations in goal-directed reaching. A fundamental feature of our multiple process model was the distinction between two types of online regulation: impulse control and limb-target control. Impulse control begins during the initial stages of the movement trajectory and involves a comparison of actual limb velocity and direction to an internal representation of expectations about the limb trajectory. Limb-target control involves discrete error-reduction based on the relative positions of the limb and the target late in the movement. Our model also considers the role of eye movements, practice, energy optimization and strategic behavior in limb control. Here, we review recent work conducted to test specific aspects of our model. As well, we consider research not fully incorporated into our earlier contribution. We conclude that a slightly modified and expanded version of our model, that includes crosstalk between the two forms of online regulation, does an excellent job of explaining speed, accuracy, and energy optimization in goal-directed reaching.

  10. Reaching Conversation Through Play: A Qualitative Change of Activity.

    Teixeira R.


    Full Text Available This article illustrates the process of reaching conversation in the case of Anna, a 10- year-old girl, in a countryside Portuguese primary school, through neuropsychological habilitation and psychotherapy. This case identifies the theoretical and methodological concepts from Vygotsky’s cultural historical conceptualization in psychotherapy practice. Vygotsky introduced a new form of thinking in psychology, the concept of play, as a cultural and relational tool on a child’s (consciousness development. During psychotherapy, Anna progressed through the following stages: 1 not playing (deploying the toys, with no relations between them or awareness of social rules; 2 worldplay (building worlds using wooden blocks and other toys, establishing relations between the characters and their possessions; and 3 imaginary situation (with no toys. At the end of this process, she was able to talk about her issues, communicating in a more adaptive way, especially in a schooled society. When she reached conversation, Anna’s activity was also changed. Therefore, there was a qualitative change regarding her needs, motives and ways of acting and reacting to herself, others, and cultural tools or events.

  11. Recovery of Three Arctic Stream Reaches From Experimental Nutrient Enrichment.

    Green, A. C.; Benstead, J. P.; Deegan, L. A.; Peterson, B. J.; Bowden, W. B.; Huryn, A. D.; Slavik, K.; Hershey, A. E.


    We examined multi-year patterns in community recovery from experimental low-concentration nutrient (N+P and P only) enrichment in three reaches of two Arctic tundra streams (Kuparuk River and Oksrukuyik Creek) on the North Slope of Alaska (USA). Rates of recovery varied among community components and depended on duration of enrichment (2 to 13 consecutive growing seasons). Biomass and C:P ratio of epilithic algae returned to reference levels rapidly (within 2 years), regardless of enrichment duration. Bryophyte cover, which increased greatly after long-term enrichment (>8 years), recovered to reference levels only after 7 years, when a storm scoured most remnant moss in the recovering reach. Persistence of bryophytes slowed recovery rates of insect taxa that had either been positively (e.g., Ephemerella, most chironomid taxa) or negatively (e.g., Orthocladius rivulorum) affected by this shift in dominant primary producer and its consequence for benthic habitat. Growth of Arctic grayling (adults and young-of-year), the top predator, returned to reference rates within two years. Recovery of these Arctic stream ecosystems from nutrient enrichment was consequently controlled largely by interactions between duration of enrichment and physical disturbance, mediated through physical habitat shifts caused by bryophytes.

  12. Livestock First Reached Southern Africa in Two Separate Events.

    Karim Sadr

    Full Text Available After several decades of research on the subject, we now know when the first livestock reached southern Africa but the question of how they got there remains a contentious topic. Debate centres on whether they were brought with a large migration of Khoe-speakers who originated from East Africa; or whether the livestock were traded down-the-line among hunter-gatherer communities; or indeed whether there was a long history of diverse small scale population movements in this part of the world, one or more of which 'infiltrated' livestock into southern Africa. A new analysis of the distribution of stone toolkits from a sizeable sample of sub-equatorial African Later Stone Age sites, coupled with existing knowledge of the distribution of the earliest livestock remains and ceramics vessels, has allowed us to isolate two separate infiltration events that brought the first livestock into southern Africa just over 2000 years ago; one infiltration was along the Atlantic seaboard and another entered the middle reaches of the Limpopo River Basin. These findings agree well with the latest results of genetic research which together indicate that multiple, small-scale infiltrations probably were responsible for bringing the first livestock into southern Africa.

  13. How do antimalarial drugs reach their intracellular targets?

    Katherine eBasore


    Full Text Available Drugs represent the primary treatment available for human malaria, as caused by Plasmodium spp. Currently approved drugs and antimalarial drug leads generally work against parasite enzymes or activities within infected erythrocytes. To reach their specific targets, these chemicals must cross at least three membranes beginning with the host cell membrane. Uptake at each membrane may involve partitioning and diffusion through the lipid bilayer or facilitated transport through channels or carriers. Here, we review the features of available antimalarials and examine whether transporters may be required for their uptake. Our computational analysis suggests that most antimalarials have high intrinsic membrane permeability, obviating the need for uptake via transporters; a subset of compounds appear to require facilitated uptake. We also review parasite and host transporters that may contribute to drug uptake. Broad permeability channels at the erythrocyte and parasitophorous vacuolar membranes of infected cells relax permeability constraints on antimalarial drug design; however, this uptake mechanism is prone to acquired resistance as the parasite may alter channel activity to reduce drug uptake. A better understanding of how antimalarial drugs reach their intracellular targets is critical to prioritizing drug leads for antimalarial development and may reveal new targets for therapeutic intervention.

  14. Apache The Definitive Guide

    Laurie, Ben


    Apache is far and away the most widely used web server platform in the world. This versatile server runs more than half of the world's existing web sites. Apache is both free and rock-solid, running more than 21 million web sites ranging from huge e-commerce operations to corporate intranets and smaller hobby sites. With this new third edition of Apache: The Definitive Guide, web administrators new to Apache will come up to speed quickly, and experienced administrators will find the logically organized, concise reference sections indispensable, and system programmers interested in customizin

  15. Jenkins The Definitive Guide

    Smart, John


    Streamline software development with Jenkins, the popular Java-based open source tool that has revolutionized the way teams think about Continuous Integration (CI). This complete guide shows you how to automate your build, integration, release, and deployment processes with Jenkins-and demonstrates how CI can save you time, money, and many headaches. Ideal for developers, software architects, and project managers, Jenkins: The Definitive Guide is both a CI tutorial and a comprehensive Jenkins reference. Through its wealth of best practices and real-world tips, you'll discover how easy it is

  16. Cassandra the definitive guide

    Hewitt, Eben


    What could you do with data if scalability wasn't a problem? With this hands-on guide, you'll learn how Apache Cassandra handles hundreds of terabytes of data while remaining highly available across multiple data centers -- capabilities that have attracted Facebook, Twitter, and other data-intensive companies. Cassandra: The Definitive Guide provides the technical details and practical examples you need to assess this database management system and put it to work in a production environment. Author Eben Hewitt demonstrates the advantages of Cassandra's nonrelational design, and pays special

  17. Hadoop The Definitive Guide

    White, Tom


    Hadoop: The Definitive Guide helps you harness the power of your data. Ideal for processing large datasets, the Apache Hadoop framework is an open source implementation of the MapReduce algorithm on which Google built its empire. This comprehensive resource demonstrates how to use Hadoop to build reliable, scalable, distributed systems: programmers will find details for analyzing large datasets, and administrators will learn how to set up and run Hadoop clusters. Complete with case studies that illustrate how Hadoop solves specific problems, this book helps you: Use the Hadoop Distributed

  18. Competing definitions of contextual environments

    Jerrett Michael


    Full Text Available Abstract Background The growing interest in the effects of contextual environments on health outcomes has focused attention on the strengths and weaknesses of alternate contextual unit definitions for use in multilevel analysis. The present research examined three methods to define contextual units for a sample of children already enrolled in a respiratory health study. The Inclusive Equal Weights Method (M1 and Inclusive Sample Weighted Method (M2 defined communities using the boundaries of the census blocks that incorporated the residences of the CHS participants, except that the former estimated socio-demographic variables by averaging the census block data within each community, while the latter used weighted proportion of CHS participants per block. The Minimum Bounding Rectangle Method (M3 generated minimum bounding rectangles that included 95% of the CHS participants and produced estimates of census variables using the weighted proportion of each block within these rectangles. GIS was used to map the locations of study participants, define the boundaries of the communities where study participants reside, and compute estimates of socio-demographic variables. The sensitivity of census variable estimates to the choice of community boundaries and weights was assessed using standard tests of significance. Results The estimates of contextual variables vary significantly depending on the choice of neighborhood boundaries and weights. The choice of boundaries therefore shapes the community profile and the relationships between its components (variables. Conclusion Multilevel analysis concerned with the effects of contextual environments on health requires careful consideration of what constitutes a contextual unit for a given study sample, because the alternate definitions may have differential impact on the results. The three alternative methods used in this research all carry some subjectivity, which is embedded in the decision as to what

  19. Developing Caring Relationships in Schools: A Review of the Research on Caring and Nurturing Pedagogies

    Velasquez, Andrea; West, Richard; Graham, Charles; Osguthorpe, Richard


    Education has been criticized for a disproportionate focus on the technical aspects of teaching with less focus on its "human" aspects. Consequently, many researchers and theorists have expressed a need to answer what role care plays in education. Our purpose in this review is to examine the definition of caring pedagogies and synthesize…

  20. 42 CFR 440.2 - Specific definitions; definitions of services for FFP purposes.


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Specific definitions; definitions of services for... Definitions § 440.2 Specific definitions; definitions of services for FFP purposes. (a) Specific definitions...) Definitions of services for FFP purposes. Except as limited in part 441, FFP is available in...

  1. “Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap

    Hughes, Tom; Yu, Jonathan T.S.; Wong, Kai Yuen; Malata, Charles M.


    INTRODUCTION Necrotising fasciitis (NF) is a rare, severe, rapidly progressing and life-threatening synergistic infection primarily affecting the superficial fascia. A novel method of definitive and aesthetic reconstruction of NF thigh defects by using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap without recourse to temporising skin grafts is presented. PRESENTATION OF CASE A 30-year-old parous woman presented in extremis with fulminant NF of her left anteromedial thigh. Following emergency radical debridement and intensive care stabilisation she was reconstructed 48 h later in a single stage with a pedicled TRAM flap islanded on the ipsilateral deep inferior epigastric vessels. There was excellent contour restoration of her thigh and coverage of the exposed femoral vessels. DISCUSSION Pedicled flaps based on the rectus abdominis muscle provide a large, readily available reconstructive option for correction of substantial regional defects as herein illustrated. They are robust when based on dominant inferior vascular pedicle with a long reach and wide arc of rotation when designed transversely (as a TRAM flap). CONCLUSION This case also illustrates that definitive flap reconstruction of NF can be successfully undertaken in the emergent setting, thereby negating the need for large areas of skin grafting which can lead to contractures with consequent functional impairment and suboptimal aesthetic results. PMID:23548707

  2. Critical Care Implications of the Affordable Care Act.

    Dogra, Anjali P; Dorman, Todd


    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.

  3. Reaching is Better When You Get What You Want: Realtime Feedback of Intended Reaching Trajectory Despite an Unstable Environment

    Justin eHorowitz


    Full Text Available Improvements in human-machine interaction may help overcome the unstable and uncertain environments that cause problems in everyday living. Here we experimentally evaluated intent feedback (IF, which estimates and displays the human operator's underlying intended trajectory in real-time. IF is a filter that combines a model of the arm with position and force data to determine the intended position. Subjects performed targeted reaching motions while seeing either their actual hand position or their estimated intent as a cursor while they experienced white noise forces rendered by a robotic handle. We found significantly better reaching performance during force exposure using the estimated intent. Additionally, in a second set of subjects with a reduced modeled stiffness, IF reduced estimated arm stiffness to about half that without IF, indicating a more relaxed state of operation. While visual distortions typically degrade performance and require an adaptation period to overcome, this particular distortion immediately enhanced performance. In the future, this method could provide novel insights into the nature of control. IF might also be applied in driving and piloting applications to best follow a person's desire in unpredictable or turbulent conditions.

  4. Does Having More Options Mean Harder to Reach Consensus?

    Wu, Degang


    We generalize a binary majority-vote model on adaptive networks to a plurality-vote counterpart. When opinions are uniformly distributed in the population of voters in the initial state, it is found that having more available opinions in the initial state actually accelerate the time to consensus. In particular, we investigate the three-state plurality-vote model. While time to consensus in two state model scales exponentially with population size $N$, for finite-size system, there is a non-zero probability that either the population reaches the consensus state in a time that is very short and independent of $N$ (in the heterophily regime), or in a time that scales exponentially with $N$ but is still much faster than two-state model.

  5. Integrated testing strategy (ITS) for bioaccumulation assessment under REACH

    Lombardo, Anna; Roncaglioni, Alessandra; Benfentati, Emilio


    in a dossier. REACH promotes the use of alternative methods to replace, refine and reduce the use of animal (eco)toxicity testing. Within the EU OSIRIS project, integrated testing strategies (ITSs) have been developed for the rational use of non-animal testing approaches in chemical hazard assessment. Here we...... methods are used only as last resort. Using the ITS, in vivo testing could be waived for about 67% of the examined compounds, but bioaccumulation potential could be estimated on the basis of non-animal methods. The presented ITS is freely available through a web tool. © 2014 Elsevier Ltd....... present an ITS for evaluating the bioaccumulation potential of organic chemicals. The scheme includes the use of all available data (also the non-optimal ones), waiving schemes, analysis of physicochemical properties related to the end point and alternative methods (both in silico and in vitro). In vivo...

  6. The contributions of vision and haptics to reaching and grasping

    Kayla Dawn Stone


    Full Text Available This review aims to provide a comprehensive outlook on the sensory (visual and haptic contributions to reaching and grasping. The focus is on studies in developing children, normal and neuropsychological populations, and in sensory-deprived individuals. Studies have suggested a right-hand/left-hemisphere specialization for visually-guided grasping and a left-hand/right-hemisphere specialization for haptically-guided object recognition. This poses the interesting possibility that when vision is not available and grasping relies heavily on the haptic system, there is an advantage to use the left hand. We review the evidence for this possibility and dissect the unique contributions of the visual and haptic systems to grasping. We ultimately discuss how the integration of these two sensory modalities shape hand preference.

  7. Reaching Quantum Supremacy with a Boson Sampling Experiment

    Latmiral, Ludovico


    Boson Sampling represents a promising witness of the supremacy of quantum systems as a resource for the solution of computational problems. The classical hardness of Boson Sampling has been related to the so called Permanent-of-Gaussians Conjecture and has been extended to some generalizations such as scattershot Boson Sampling, approximate and lossy sampling under some reasonable constraints. However, it is still unclear how demanding these bounds are for a quantum experimental sampler. Starting from a state of the art analysis and focusing on the foreseeable practical conditions needed to reach quantum supremacy, we look at different techniques and present a more general and effective solution. We apply our approach to both the experimental suggestions presented to date and we eventually find in both cases a new threshold that is less error sensitive and experimentally more feasible.

  8. Study on New Approaches for extended chemical management and REACH

    Lee, Jihyun


    For several decades, the use of chemicals has been rapidly increasing and widely spread in our daily life. To cope with this trend, the paradigm of chemical management system has changed: from hazard criteria which is based on their intrinsic hazardous properties, to the actual risk of chemicals...... which is based on both the hazard of the substance and the possible exposure level of human to the substance, and from single substance-oriented to multiple chemical (e.g. mixture toxicity)–oriented management system (EC, 2012; Moeller and Biwer, 2014). This study aims to examine the limitations...... of existing chemical regulations in view of protecting vulnerable populations from “excessive total risk” and to explore the possibilities for improvement. Firstly, the completeness of the REACH exposure scenario was reviewed with the finding that the current scenario does not take into account territorial...

  9. Reaching Nonlinear Consensus via Non-Autonomous Polynomial Stochastic Operators

    Saburov, Mansoor; Saburov, Khikmat


    This paper is a continuation of our previous studies on nonlinear consensus which unifies and generalizes all previous results. We consider a nonlinear protocol for a structured time-varying synchronous multi-agent system. We present an opinion sharing dynamics of the multi-agent system as a trajectory of non-autonomous polynomial stochastic operators associated with multidimensional stochastic hyper-matrices. We show that the multi-agent system eventually reaches to a nonlinear consensus if either one of the following two conditions is satisfied: (i) every member of the group people has a positive subjective distribution on the given task after some revision steps or (ii) all entries of some multidimensional stochastic hyper-matrix are positive.

  10. QSPR prediction of physico-chemical properties for REACH.

    Dearden, J C; Rotureau, P; Fayet, G


    For registration of a chemical, European Union REACH legislation requires information on the relevant physico-chemical properties of the chemical. Predicted property values can be used when the predictions can be shown to be valid and adequate. The relevant physico-chemical properties that are amenable to prediction are: melting/freezing point, boiling point, relative density, vapour pressure, surface tension, water solubility, n-octanol-water partition coefficient, flash point, flammability, explosive properties, self-ignition temperature, adsorption/desorption, dissociation constant, viscosity, and air-water partition coefficient (Henry's law constant). Published quantitative structure-property relationship (QSPR) methods for all of these properties are discussed, together with relevant property prediction software, as an aid for those wishing to use predicted property values in submissions to the European Chemicals Agency (ECHA).

  11. The contributions of vision and haptics to reaching and grasping.

    Stone, Kayla D; Gonzalez, Claudia L R


    This review aims to provide a comprehensive outlook on the sensory (visual and haptic) contributions to reaching and grasping. The focus is on studies in developing children, normal, and neuropsychological populations, and in sensory-deprived individuals. Studies have suggested a right-hand/left-hemisphere specialization for visually guided grasping and a left-hand/right-hemisphere specialization for haptically guided object recognition. This poses the interesting possibility that when vision is not available and grasping relies heavily on the haptic system, there is an advantage to use the left hand. We review the evidence for this possibility and dissect the unique contributions of the visual and haptic systems to grasping. We ultimately discuss how the integration of these two sensory modalities shape hand preference.

  12. Reaching for the stars: SLPs shine on literacy teams.

    Staskowski, Maureen; Zagaiski, Kelley


    Speech-language pathologists (SLPs) who work with school-age children have the opportunity to contribute to the literacy development of specific students as well as the literacy instruction and intervention programs in their district. These efforts are made in collaboration with other professionals and parents and may be referred to as participation on literacy teams. This article describes successful literacy teams in elementary schools including the variety of possible members as well as common characteristics of successful literacy teams. We describe how SLPs participate by developing collegial relationships with their team, using best practices for literacy, and supporting children as they progress in the general curriculum. Finally, we discuss some strategies for SLPs to take stock of their own literacy team participation, identify new goals, and map out a plan to reach new heights in literacy as integral members of literacy teams.

  13. Reaching Rural Canadian Communities in the Yukon and Alberta

    Van Laerhoven, Christa L.


    Canada is very large geographically, so many rural communities are very far from major centers. People in such communities are at a severe disadvantage when it comes to in-person interaction with science or scientists because resources tend to be directed at large population centers, where more people can be reached for the same amount of effort. While this geographic distance can be mitigated by doing outreach over the internet, there is at some level no substitute for showing up in person with e.g. meteorites in hand. Due to where various members of my family are located, I have occasion to visit Whitehorse, YT and Andrew, AB (~1.5 hour drive north-east of Edmonton) and have taken advantage of trips to these locations to do astronomy outreach in both schools and public libraries. I will discuss how I arranged school and library visits and general observations from my experience doing outreach in rural Canadian communities.

  14. Rapid Automatic Motor Encoding of Competing Reach Options

    Jason P. Gallivan


    Full Text Available Mounting neural evidence suggests that, in situations in which there are multiple potential targets for action, the brain prepares, in parallel, competing movements associated with these targets, prior to implementing one of them. Central to this interpretation is the idea that competing viewed targets, prior to selection, are rapidly and automatically transformed into corresponding motor representations. Here, by applying target-specific, gradual visuomotor rotations and dissociating, unbeknownst to participants, the visual direction of potential targets from the direction of the movements required to reach the same targets, we provide direct evidence for this provocative idea. Our results offer strong empirical support for theories suggesting that competing action options are automatically represented in terms of the movements required to attain them. The rapid motor encoding of potential targets may support the fast optimization of motor costs under conditions of target uncertainty and allow the motor system to inform decisions about target selection.

  15. Reaching Synchronization in Networked Harmonic Oscillators With Outdated Position Data.

    Song, Qiang; Yu, Wenwu; Cao, Jinde; Liu, Fang


    This paper studies the synchronization problem for a network of coupled harmonic oscillators by proposing a distributed control algorithm based only on delayed position states, i.e., outdated position states stored in memory. The coupling strength of the network is conveniently designed according to the absolute values and the principal arguments of the nonzero eigenvalues of the network Laplacian matrix. By analyzing a finite number of stability switches of the network with respect to the variation in the time delay, some necessary and sufficient conditions are derived for reaching synchronization in networked harmonic oscillators with positive and negative coupling strengths, respectively, and it is shown that the time delay should be taken from a set of intervals bounded by some critical values. Simulation examples are given to illustrate the effectiveness of the theoretical analysis.

  16. Dendritic mitochondria reach stable positions during circuit development.

    Faits, Michelle C; Zhang, Chunmeng; Soto, Florentina; Kerschensteiner, Daniel


    Mitochondria move throughout neuronal dendrites and localize to sites of energy demand. The prevailing view of dendritic mitochondria as highly motile organelles whose distribution is continually adjusted by neuronal activity via Ca(2+)-dependent arrests is based on observations in cultured neurons exposed to artificial stimuli. Here, we analyze the movements of mitochondria in ganglion cell dendrites in the intact retina. We find that whereas during development 30% of mitochondria are motile at any time, as dendrites mature, mitochondria all but stop moving and localize stably to synapses and branch points. Neither spontaneous nor sensory-evoked activity and Ca(2+) transients alter motility of dendritic mitochondria; and pathological hyperactivity in a mouse model of retinal degeneration elevates rather than reduces motility. Thus, our findings indicate that dendritic mitochondria reach stable positions during a critical developmental period of high motility, and challenge current views about the role of activity in regulating mitochondrial transport in dendrites.

  17. Extending the reach of compressed gluinos at the LHC

    Delgado, Antonio; Martin, Adam; Raj, Nirmal


    Conventional supersymmetry searches rely on large missing momentum and, on that account, are unsuitable for discovering superpartners nearly degenerate with the LSP. Such "compressed regions" are best probed by dedicated strategies that exploit their unique kinematic features. We consider a case study of a compressed gluino-bino simplified spectrum, motivated by its ability to set the dark matter relic abundance via coannihilation. A kinematic variable suited to this spectrum is introduced, by which, for a gluino-bino mass splitting of 100 GeV, the discovery reach is extendable to mg ˜=850 GeV (1370 GeV) at LHC center-of-mass energy 8 TeV (13 TeV) with luminosity 20 fb-1 (3000 fb-1 ). The nontrivial role played by soft triggers is also discussed.

  18. Reach the Bottom Line of the Sbottom Search

    Alvarez, Ezequiel


    We propose a new search strategy for directly-produced sbottoms at the LHC with a small mass splitting between the sbottom and its decayed stable neutralino. Our search strategy is based on boosting sbottoms through an energetic initial state radiation jet. In the final state, we require a large missing transverse energy and one or two b-jets besides the initial state radiation jet. We also define a few kinematic variables to further increase the discovery reach. For the case that the sbottom mainly decays into the bottom quark and the stable neutralino, we have found that even for a mass splitting as small as 10 GeV sbottoms with masses up to around 400 GeV can be excluded at the 95% confidence level with 20 inverse femtobarn data at the 8 TeV LHC.

  19. Promoting early literacy in pediatric practice: twenty years of reach out and read.

    Zuckerman, Barry


    Reach Out and Read (ROR) is the first pediatric, evidence-based strategy to prevent problems of early childhood development and learning. With a start in a single clinic in Boston City Hospital in 1989, doctors working in >4000 clinics and practices gave approximately 5.7 million new books to >3.5 million children in all 50 states in 2008. ROR also has become a model for a different way of thinking about parent education during primary care encounters, based less on telling and more on creating real-time learning experiences. ROR flourished because of (1) the growth of pediatric interest in child development, (2) local leadership of pediatric champions as well as nonmedical supporters, coordinators, and volunteers, (3) evidence of effectiveness, and (4) public financial support attributable to strong bipartisan support in Congress, led by Senator Edward Kennedy. Since ROR started, an increasing amount of research confirms the importance of reading aloud for the development of language and other emergent literacy skills, which in turn helps children get ready for school and leads to later success in reading. Future goals include continued growth until all low-income children are reached with pediatric advice and books, a national campaign led by physicians encouraging all parents to read to their children every day, additional evidence-based, parent information to increase the effectiveness of parents reading to children, quality-improvement efforts to achieve the full potential, and global expansion.

  20. Screening difficult-to-reach populations for tuberculosis using a mobile medical unit, Punjab India

    Binepal, G.; Agarwal, P.; Kaur, N.; Singh, B.; Bhagat, V.; Verma, R. P.; Satyanarayana, S.; Oeltmann, J. E.


    Background: In India, the National Health Mission has provided one mobile medical unit (MMU) per district in the state of Punjab to provide primary health care services for difficult-to-reach populations. Objectives: To determine the number of patients with presumptive tuberculosis (TB) and the number of TB cases detected and treated among patients who used the MMU services from May to December 2012 in Mohali district, Punjab, India. Methods: A cross-sectional study was conducted and registers of the out-patient, laboratory, radiology, and TB departments of the MMU were reviewed to determine the number of persons presumed to have TB and the number of persons diagnosed with TB. Results: Of 8346 patients who attended the MMUs, 663 (8%) had symptoms suggestive of TB. Among those with TB symptoms, 540 (81%) were evaluated for pulmonary TB using sputum examination or chest X-ray. In total, 58 (11%) patients had clinical or laboratory evidence of pulmonary TB, of whom 21 (36%) started anti-tuberculosis treatment. Conclusion: As MMUs are an integral part of the general public health system, these units have the potential to detect TB cases among difficult-to-reach populations. Additional research is required to optimise the diagnosis of TB at MMUs and to increase rates of TB treatment initiation. PMID:26767177

  1. Care in context: Becoming an STS researcher.

    Atkinson-Graham, Melissa; Kenney, Martha; Ladd, Kelly; Murray, Cameron Michael; Simmonds, Emily Astra-Jean


    This collaborative article, written by graduate students who attended the Politics of Care in Technoscience Workshop, brings the themes in this volume to bear on their own developing science and technology study projects and research practices. Exploring the contours of five specific moments where questions of care have arisen in the course of their everyday research, they do not find a single or untroubled definition of care; instead, care is often a site of ambivalence, tension, and puzzlement. However, despite this uneasiness, they argue that taking the time to reflect on the multiple, sometimes conflicting, forms and definitions of care within a specific research context can inform the way that science and technology studies scholars envision and conduct their work.

  2. Size definitions for particle sampling


    The recommendations of an ad hoc working group appointed by Committee TC 146 of the International Standards Organization on size definitions for particle sampling are reported. The task of the group was to collect the various definitions of 'respirable dust' and to propose a practical definition on recommendations for handling standardization on this matter. One of two proposed cut-sizes in regard to division at the larynx will be adopted after a ballot.

  3. Effects of aging on interjoint coordination during arm reaching

    Marcus Vinicius da Silva

    Full Text Available Abstract Introduction Moving the arm towards an object is a complex task. Movements of the arm joints must be well coordinated in order to obtain a smooth and accurate hand trajectory. Most studies regarding reaching movements address young subjects. Coordination differences in the neural mechanism underlying motor control throughout the life stages is yet unknown. The understanding of these changes can lead to a better comprehension of neuromotor pathologies and therefore to more suitable therapies. Methods Our purpose was to investigate interjoint coordination in three different aging groups (children, young, elderly. Kinematics and kinetics specific variables were analyzed focusing on defined parameters to get insight into arm coordination. Intersegmental dynamics was used to calculate shoulder and elbow torques assuming a 2-link segment model of the upper extremity (upper arm and forearm with two friction-less joints (shoulder and elbow. A virtual reality environment was used to examine multidirectional planar reaching in three different directions (randomly presented. Results Seven measures were computed to investigate group interlimb differences: shoulder and elbow muscle torques (peak and impulse, work performed by shoulder and elbow joints, maximum velocity, movement distance, distance error at final position, movement duration and acceleration duration. Our data analysis showed differences between movement performances for all analyzed variables, at all ages. Conclusion We found that the intersegmental dynamics for the interlimb (left/right comparisons were similar for the elderly and children groups as compared to the young. In addition, the coordination and control of motor tasks changes during life, becoming less effective in old age.

  4. Walking is not like reaching: evidence from periodic mechanical perturbations.

    Jooeun Ahn

    Full Text Available The control architecture underlying human reaching has been established, at least in broad outline. However, despite extensive research, the control architecture underlying human locomotion remains unclear. Some studies show evidence of high-level control focused on lower-limb trajectories; others suggest that nonlinear oscillators such as lower-level rhythmic central pattern generators (CPGs play a significant role. To resolve this ambiguity, we reasoned that if a nonlinear oscillator contributes to locomotor control, human walking should exhibit dynamic entrainment to periodic mechanical perturbation; entrainment is a distinctive behavior of nonlinear oscillators. Here we present the first behavioral evidence that nonlinear neuro-mechanical oscillators contribute to the production of human walking, albeit weakly. As unimpaired human subjects walked at constant speed, we applied periodic torque pulses to the ankle at periods different from their preferred cadence. The gait period of 18 out of 19 subjects entrained to this mechanical perturbation, converging to match that of the perturbation. Significantly, entrainment occurred only if the perturbation period was close to subjects' preferred walking cadence: it exhibited a narrow basin of entrainment. Further, regardless of the phase within the walking cycle at which perturbation was initiated, subjects' gait synchronized or phase-locked with the mechanical perturbation at a phase of gait where it assisted propulsion. These results were affected neither by auditory feedback nor by a distractor task. However, the convergence to phase-locking was slow. These characteristics indicate that nonlinear neuro-mechanical oscillators make at most a modest contribution to human walking. Our results suggest that human locomotor control is not organized as in reaching to meet a predominantly kinematic specification, but is hierarchically organized with a semi-autonomous peripheral oscillator operating under

  5. Transdisciplinarity in Health Care: A Concept Analysis.

    Van Bewer, Vanessa


    To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.

  6. Spiritual nursing care: A concept analysis.

    Monareng, Lydia V


    Although the concept 'spiritual nursing care' has its roots in the history of the nursing profession, many nurses in practice have difficulty integrating the concept into practice. There is an ongoing debate in the empirical literature about its definition, clarity and application in nursing practice. The study aimed to develop an operational definition of the concept and its application in clinical practice. A qualitative study was conducted to explore and describe how professional nurses render spiritual nursing care. A purposive sampling method was used to recruit the sample. Individual and focus group interviews were audio-taped and transcribed verbatim. Trustworthiness was ensured through strategies of truth value, applicability, consistency and neutrality. Data were analysed using the NUD*IST power version 4 software, constant comparison, open, axial and selective coding. Tech's eight steps of analysis were also used, which led to the emergence of themes, categories and sub-categories. Concept analysis was conducted through a comprehensive literature review and as a result 'caring presence' was identified as the core variable from which all the other characteristics of spiritual nursing care arise. An operational definition of spiritual nursing care based on the findings was that humane care is demonstrated by showing caring presence, respect and concern for meeting the needs not only of the body and mind of patients, but also their spiritual needs of hope and meaning in the midst of health crisis, which demand equal attention for optimal care from both religious and nonreligious nurses.

  7. Formal Definition of Artificial Intelligence

    Dobrev, Dimiter


    * This publication is partially supported by the KT-DigiCult-Bg project. A definition of Artificial Intelligence (AI) was proposed in [1] but this definition was not absolutely formal at least because the word "Human" was used. In this paper we will formalize the definition from [1]. The biggest problem in this definition was that the level of intelligence of AI is compared to the intelligence of a human being. In order to change this we will introduce some parameters to which AI ...

  8. [Beneficence, definition and challenges].

    Rapoport, Danielle


    Much more than a mere neologism or concept which appeared in the 1990s, "well-treatment" is conveyed today through a proper attitude adopted in daily nursing practice. This form of care which consists in respecting others, dependant on the subjectivity and the experience of each person, constitutes a humanist approach. It requires the continuous training of caregivers.

  9. Fractal patterns applied to implant surface: definitions and perspectives.

    Dohan Ehrenfest, David M


    Fractal patterns are frequently found in nature, but they are difficult to reproduce in artificial objects such as implantable materials. In this article, a definition of the concept of fractals for osseointegrated surfaces is suggested, based on the search for quasi-self-similarity on at least 3 scales of investigation: microscale, nanoscale, and atomic/crystal scale. Following this definition, the fractal dimension of some surfaces may be defined (illustrated here with the Intra-Lock Ossean surface). However the biological effects of this architecture are still unknown and should be examined carefully in the future.

  10. The definition and natural history of severe exacerbation of hepatitis B

    GUO Wei


    Full Text Available Despite different opinions on its definition and classification in the past, a consensus has gradually been reached regarding the naming, classification, and clinical diagnosis of liver failure. The classification of liver failure is described, and the definition and natural history of severe exacerbation of hepatitis B are summarized. Antiviral treatment and artificial liver support in the early stage are beneficial for clinical outcomes and prognosis.

  11. Defining Occupational and Consumer Exposure Limits for Nanomaterials - First Experiences from REACH Registrations

    Aschberger, K.; Klöslova, Z.; Falck, G.; Christensen, F. M.


    nanosized materials, they were not derived from hazard data for the nanoform. Different methods for deriving the DNELs were applied and few dossiers derived DNELs by applying the default assessment factors in the REACH guidance. Several DNELs were based on available Occupational Exposure Limits (OELs) for inhalable and respirable dust or the nuisance dust levels, which have not been established for nanosized materials. In general lower (i.e. less strict) assessment factors were applied with different types of justification. All DNELs were expressed in the mass metrics. It is important to note that submission, identification and selection of the dossiers addressed in this study was done before the adoption of the EC recommendation (2011/696/EU) on a definition of nanomaterial and before the publication of the revised ECHA guidance documents that include recommendations for nanomaterials.

  12. Care strategies used by occupational therapists in psychosocial care centers

    Francine Baltazar Assad


    Full Text Available Introduction: The psychosocial rehabilitation centered care in experience with the suffering, thus breaking with the hegemonic logic of disease-focused care. Occupational therapy has supported this detachment, with actions targeting the daily life to achieve social inclusion and autonomy of people with a diagnosis of mental disorder. Objective: To identify the care strategies used by occupational therapists in psychosocial care centers and understand how these strategies contribute to psychosocial rehabilitation. Method: Descriptive Study of qualitative approach, with five occupational therapists of three psychosocial care centers that responded to an interview, which was recorded, transcribed and analyzed by thematic content analysis. Results: Were extracted the categories: Integral Care Strategies; Singular Care Strategies and Interdisciplinary Care Strategies. Another category, Understanding and expansion of everyday life, referred to the contribution in psychosocial rehabilitation. The specificity was diluted between the possibilities of actions, because the strategies are common to other professional groups, but are guided by a new conception of health care from the perspective of integrality and network. From the understanding and expansion of everyday life as a contribution of occupational therapy, emerged the specificity of the group and its contribution in psychosocial rehabilitation. Some strategies have been punctual and effectuated in the service itself; however, many have reached the territory. Conclusion: There is a need for reports of occupational therapists practices even if in care projects common to other groups, in order to keep up with the discussions on strengthening the professional institutionalization in country.

  13. Time for a neonatal–specific consensus definition for sepsis

    Wynn, James L.; Wong, Hector R.; Shanley, Thomas P.; Bizzarro, Matthew J.; Saiman, Lisa; Polin, Richard A.


    Objective To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. Study selection The review focused primarily on pediatric literature relevant to the topic of interest. Conclusions Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates. PMID:24751791

  14. Bullying by Definition: An Examination of Definitional Components of Bullying

    Goldsmid, Susan; Howie, Pauline


    Lack of definitional consensus remains an important unresolved issue within bullying research. This study examined the ability of definitional variables to predict overall level of victimisation (distress, power inequity, and provocation as predictors) and bullying (intention to harm, power inequity, and provocation as predictors) in 246…

  15. [Scientific evidence and the cost of innovations in the health-care system].

    Porzsolt, Franz; Schreyögg, Jonas


    When depicting the relationship between evidence and the cost of an innovation in the health-care system, the overall risks of assessment, the redistribution of risks in a regulated market, and the ethical consequences must first be taken into account. There are also evidence-based criteria and economic considerations which are relevant when calculating the cost of an innovation. These topics can indicate, but not exhaustively deal with the complicated relationship between scientific evidence and calculating the cost of an innovation in the health-care system. The following three statements summarize the current considerations in the continuing discussion of this topic: *Scientific evidence undoubtedly exists which should be taken into consideration when calculating the cost of an innovation in the health-care system. *The existing scientific evidence is, however, not sufficient to reach such a decision. Additional information about the benefit perceived by the patient is required. *No standardized method exists to measure this additional information. Therefore, a definition problem also exists in the health-care system when setting a price according to scientific evidence.

  16. Kerberos The Definitive Guide

    Garman, Jason


    Kerberos, the single sign-on authentication system originally developed at MIT, deserves its name. It's a faithful watchdog that keeps intruders out of your networks. But it has been equally fierce to system administrators, for whom the complexity of Kerberos is legendary. Single sign-on is the holy grail of network administration, and Kerberos is the only game in town. Microsoft, by integrating Kerberos into Active Directory in Windows 2000 and 2003, has extended the reach of Kerberos to all networks large or small. Kerberos makes your network more secure and more convenient for users by

  17. Nueva política europea en productos químicos. REACH New European policy on chemical products. REACH

    Francisco Vargas Marcos


    Full Text Available En febrero de 2001, la Comisión Europea publicó el Libro Blanco relativo a la estrategia para la futura política en materia de sustancias y preparados químicos, que se fundamenta en una revisión del sistema comunitario actual de regulación de las sustancias y preparados químicos. Como consecuencia, el 29 de octubre de 2003, la Comisión adoptó la propuesta de Reglamento sobre registro, evaluación, autorización y restricción de las sustancias químicas (REACH. Mediante esta propuesta, además de crearse la Agencia Europea de Sustancias Químicas, se establece el sistema REACH que consta de los siguientes elementos:Registro, que exige a la industria que facilite información sobre sus sustancias con el objeto de conseguir una utilización segura de las mismas.Evaluación, que garantiza que la industria cumple sus obligaciones y evita que se realicen ensayos innecesarios.Autorización de sustancias con propiedades extremadamente preocupantes (CMR, PBT, disruptores endocrinos, etc. para unos usos particulares.Restricción, como red de seguridad para la reducción de riesgos que no hayan sido abordados en las etapas anteriores.Este sistema de recogida de información en varias fases permitirá conocer y reducir los riesgos derivados del uso de unas 30.000 sustancias químicas que se producen/importan en la Unión Europea en cantidad superior a una tonelada/año. La información, una vez validada, se almacenará en una base de datos y podrá utilizarse para el establecimiento de un vínculo causal entre los factores medioambientales y los efectos negativos sobre la salud derivados de la producción y utilización de los productos químicos.In February 2001 the European Commission issued a White Paper on a “Strategy for a future Chemicals Policy” based on a review of the current European Union system for regulating the dangerous substances and preparations. As a result, on 29 October 2003, the Commission endorsed a Proposal for a

  18. How to find the sedimentary archive of fluvial pollution in a bedrock-confined river reach

    Elznicova, Jitka; Matys Grygar, Tomas; Kiss, Timea; Lelkova, Tereza; Balogh, Marton; Sikora, Martin


    The Ohre River springs in the Eastern Germany and it is a tributary of the Labe (Elbe) River in Northwest Bohemia. The river received pollution from several sources during the last five centuries. Most of the pollution sources located along the upper and middle reaches, where the depositional and erosional pattern of the river is highly variable. The upper part of the catchment consists of mainly felsic rocks and the river has a broad floodplain. The middle reach and its right-bank tributaries are deeply incised into the Doupovske Hory Mts., which consists of mafic volcanic rocks; whereas the left-bank tributaries are incised into intrusive and metamorphic rocks of the Krusne Hory Mts. (Ore mountains) with several local ore mines (Ag, Pb and U) in particular in around Olovi and Jachymov. Due to the geologic and geomorphologic complexity, deposition of historical sediments in the middle reach has been spatially limited and uneven, and anomalous background concentrations of risk elements are expected. As a consequence, in the middle reach of the Ohre River it is difficult to find a useful sedimentary archive of historical pollution, though it is desired for two main reasons: (1) to decipher the undocumented and poorly described pollution history from the Krusne Hory Mts. and (2) to better understand the retention of pollutants in the transport zones of a confined river system. Based on historical maps we identified a side-bar (35x320 m) in the middle reach of the river near Straz on Ohre and aimed to describe its formation, its recent erosion/deposition history and to evaluate its sedimentary archive value. In the first half of the 19th century it was an island separated from the valley edge by a side channel. Since then there has been no apparent lateral accretion of the bar (its shape has not been changed), but the upstream part of the side channel aggraded by a sediment plug. We evaluated the current bar topography and geomorphology by a detailed field survey

  19. Virtual care

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....... of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... the performance of specific home care services by means of video conversations rather than physical visits in the citizens’ homes. As scholars within the STS tradition maintain, technologies do not simply replace a human function; they rather transform care work, redistributing tasks between citizens, technology...

  20. Pin care

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. . Accessed May 13, 2016.

  1. Medical homes: "where you stand on definitions depends on where you sit".

    Vest, Joshua R; Bolin, Jane N; Miller, Thomas R; Gamm, Larry D; Siegrist, Thomas E; Martinez, Luis E


    The medical home is a potentially transformative strategy to address issues of access, quality, and efficiency in the delivery of health care in the United States. While numerous organizations support a physician-driven definition, it is by no means the universally accepted definition. Several professional groups, payers, and researchers have offered differing, or nuanced, definitions of medical homes. This lack of consensus has contributed to uncertainty among providers about the medical home. We conducted a systematic review of the literature on the medical home and identified 29 professional, government, and academic sources offering definitions. While consensus appears to exist around a core of selected features, the medical home means different things to different people. The variation in definitions can be partly explained by the obligation of organizations to their members and whether the focus is on the patient or provider. Differences in definitions have implications at both the policy and practice levels.

  2. Sociocultural definitions of risk

    Rayner, S.


    Public constituencies frequently are criticized by technical experts as being irrational in response to low-probability risks. This presentation argued that most people are concerned with a variety of risk attributes other than probability and that is rather irrational to exclude these from the definition and analysis of technological risk. Risk communication, which is at the heart of the right-to-know concept, is described as the creation of shared meaning rather than the mere transmission of information. A case study of utilities, public utility commissions, and public interest groups illustrates how the diversity of institutional cultures in modern society leads to problems for the creation of shared meanings in establishing trust, distributing liability, and obtaining consent to risk. This holistic approach to risk analysis is most appropriate under conditions of high uncertainty and/or decision stakes. 1 fig., 5 tabs.

  3. [Definition of shock types].

    Adams, H A; Baumann, G; Gänsslen, A; Janssens, U; Knoefel, W; Koch, T; Marx, G; Müller-Werdan, U; Pape, H C; Prange, W; Roesner, D; Standl, T; Teske, W; Werner, G; Zander, R


    Definitions of shock types. Hypovolaemic shock is a state of insufficient perfusion of vital organs with consecutive imbalance of oxygen supply and demand due to an intravascular volume deficiency with critically impaired cardiac preload. Subtypes are haemorrhagic shock, hypovolaemic shock in the narrow sense, traumatic-haemorrhagic shock and traumatic-hypovolaemic shock. Cardiac shock is caused by a primary critical cardiac pump failure with consecutive inadequate oxygen supply of the organism. Anaphylactic shock is an acute failure of blood volume distribution (distributive shock) and caused by IgE-dependent, type-I-allergic, classical hypersensibility, or a physically, chemically, or osmotically induced IgE-independent anaphylactoid hypersensibility. The septic shock is a sepsis-induced distribution failure of the circulating blood volume in the sense of a distributive shock. The neurogenic shock is a distributive shock induced by generalized and extensive vasodilatation with consecutive hypovolaemia due to an imbalance of sympathetic and parasympathetic regulation of vascular smooth muscles.

  4. Product definition data interface

    Birchfield, B.; Downey, P.


    The development and application of advanced Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) technology in aerospace industry is discussed. New CAD/CAM capabilities provide the engineer and production worker with tools to produce better products and significantly improve productivity. This technology is expanding in all phases of engineering and manufacturing with large potential for improvements in productivity. The integration of CAD and CAM systematically to insure maximum utility throughout the U.S. Aerospace Industry, its large community of supporting suppliers, and the Department of Defense aircraft overhaul and repair facilities is outlined. The need for a framework for exchange of digital product definition data, which serves the function of the conventional engineering drawing is emphasized.

  5. Grouping Synonyms by Definitions

    Falk, Ingrid; Jacquey, Evelyne; Venant, Fabienne


    We present a method for grouping the synonyms of a lemma according to its dictionary senses. The senses are defined by a large machine readable dictionary for French, the TLFi (Tr\\'esor de la langue fran\\c{c}aise informatis\\'e) and the synonyms are given by 5 synonym dictionaries (also for French). To evaluate the proposed method, we manually constructed a gold standard where for each (word, definition) pair and given the set of synonyms defined for that word by the 5 synonym dictionaries, 4 lexicographers specified the set of synonyms they judge adequate. While inter-annotator agreement ranges on that task from 67% to at best 88% depending on the annotator pair and on the synonym dictionary being considered, the automatic procedure we propose scores a precision of 67% and a recall of 71%. The proposed method is compared with related work namely, word sense disambiguation, synonym lexicon acquisition and WordNet construction.

  6. Viruses, definitions and reality

    Libia Herrero-Uribe


    Full Text Available Viruses are known to be abundant, ubiquitous, and to play a very important role in the health and evolution of life organisms. However, most biologists have considered them as entities separate from the realm of life and acting merely as mechanical artifacts that can exchange genes between different organisms. This article reviews some definitions of life organisms to determine if viruses adjust to them, and additionally, considers new discoveries to challenge the present definition of viruses. Definitions of life organisms have been revised in order to validate how viruses fit into them. Viral factories are discussed since these mini-organelles are a good example of the complexity of viral infection, not as a mechanical usurpation of cell structures, but as a driving force leading to the reorganization and modification of cell structures by viral and cell enzymes. New discoveries such as the Mimivirus, its virophage and viruses that produce filamentous tails when outside of their host cell, have stimulated the scientific community to analyze the current definition of viruses. One way to be free for innovation is to learn from life, without rigid mental structures or tied to the past, in order to understand in an integrated view the new discoveries that will be unfolded in future research. Life processes must be looked from the complexity and trans-disciplinarity perspective that includes and accepts the temporality of the active processes of life organisms, their interdependency and interrelation among them and their environment. New insights must be found to redefine life organisms, especially viruses, which still are defined using the same concepts and knowledge of the fifties. Rev. Biol. Trop. 59 (3: 993-998. Epub 2011 September 01.Los virus son abundantes, ubicuos, y juegan un papel muy importante en la salud y en la evolución de los organismos vivos. Sin embargo, la mayoría de los biólogos los siguen considerado como entidades separadas

  7. Partial Remission Definition

    Andersen, Marie Louise Max; Hougaard, Philip; Pörksen, Sven


    of type 1 diabetes (T1D). Receiver operating characteristic curve (ROC) analysis was used to evaluate the predictive value of IDAA1c and age on partial C-peptide remission (stimulated C-peptide, SCP > 300 pmol/L). RESULTS: PR (IDAA1c ≤ 9) in the Danish and Hvidoere cohorts occurred in 62 vs. 61% (3 months......OBJECTIVE: To validate the partial remission (PR) definition based on insulin dose-adjusted HbA1c (IDAA1c). SUBJECTS AND METHODS: The IDAA1c was developed using data in 251 children from the European Hvidoere cohort. For validation, 129 children from a Danish cohort were followed from the onset...

  8. Meteorite and meteoroid: New comprehensive definitions

    Rubin, A.E.; Grossman, J.N.


    Meteorites have traditionally been defined as solid objects that have fallen to Earth from space. This definition, however, is no longer adequate. In recent decades, man-made objects have fallen to Earth from space, meteorites have been identified on the Moon and Mars, and small interplanetary objects have impacted orbiting spacecraft. Taking these facts and other potential complications into consideration, we offer new comprehensive definitions of the terms "meteorite,""meteoroid," and their smaller counterparts: A meteoroid is a 10-??m to 1-m-size natural solid object moving in interplanetary space. A micrometeoroid is a meteoroid 10 ??m to 2 mm in size. A meteorite is a natural, solid object larger than 10 ??m in size, derived from a celestial body, that was transported by natural means from the body on which it formed to a region outside the dominant gravitational influence of that body and that later collided with a natural or artificial body larger than itself (even if it is the same body from which it was launched). Weathering and other secondary processes do not affect an object's status as a meteorite as long as something recognizable remains of its original minerals or structure. An object loses its status as a meteorite if it is incorporated into a larger rock that becomes a meteorite itself. A micrometeorite is a meteorite between 10 ??m and 2 mm in size. Meteorite- "a solid substance or body falling from the high regions of the atmosphere" (Craig 1849); "[a] mass of stone and iron that ha[s] been directly observed to have fallen down to the Earth's surface" (translated from Cohen 1894); "[a] solid bod[y] which came to the earth from space" (Farrington 1915); "A mass of solid matter, too small to be considered an asteroid; either traveling through space as an unattached unit, or having landed on the earth and still retaining its identity" (Nininger 1933); "[a meteoroid] which has reached the surface of the Earth without being vaporized" (1958

  9. Recovery of three arctic stream reaches from experimental nutrient enrichment

    Benstead, J.P.; Green, A.C.; Deegan, Linda A.; Peterson, B.J.; Slavik, K.; Bowden, W.B.; Hershey, A.E.


    1. Nutrient enrichment and resulting eutrophication is a widespread anthropogenic influence on freshwater ecosystems, but recovery from nutrient enrichment is poorly understood, especially in stream environments. We examined multi-year patterns in community recovery from experimental low-concentration nutrient enrichment (N + P or P only) in three reaches of two Arctic tundra streams (Kuparuk River and Oksrukuyik Creek) on the North Slope of Alaska (U.S.A.). 2. Rates of recovery varied among community components and depended on duration of enrichment (2-13 consecutive growing seasons). Biomass of epilithic algae returned to reference levels rapidly (within 2 years), regardless of nutrients added or enrichment duration. Aquatic bryophyte cover, which increased greatly in the Kuparuk River only after long-term enrichment (8 years), took 8 years of recovery to approach reference levels, after storms had scoured most remnant moss in the recovering reach. 3. Multi-year persistence of bryophytes in the Kuparuk River appeared to prevent recovery of insect populations that had either been positively (e.g. the mayfly Ephemerella, most chironomid midge taxa) or negatively (e.g. the tube-building chironomid Orthocladius rivulorum) affected by this shift in dominant primary producer. These lags in recovery (of >3 years) were probably driven by the persistent effect of bryophytes on physical benthic habitat. 4. Summer growth rates of Arctic grayling (both adults and young-of-year) in Oksrukuyik Creek (fertilised for 6 years with no bryophyte colonisation), which were consistently increased by nutrient addition, returned to reference rates within 1-2 years. 5. Rates of recovery of these virtually pristine Arctic stream ecosystems from low-level nutrient enrichment appeared to be controlled largely by duration of enrichment, mediated through physical habitat shifts caused by eventual bryophyte colonisation, and subsequent physical disturbance that removed bryophytes. Nutrient

  10. Far-Reaching Impacts of African Dust- A Calipso Perspective

    Yu, Hongbin; Chin, Mian; Yuan, Tianle; Bian, Huisheng; Prospero, Joseph; Omar, Ali; Remer, Lorraine; Winker, David; Yang, Yuekui; Zhang, Yan; Zhang, Zhibo


    African dust can transport across the tropical Atlantic and reach the Amazon basin, exerting far-reaching impacts on climate in downwind regions. The transported dust influences the surface-atmosphere interactions and cloud and precipitation processes through perturbing the surface radiative budget and atmospheric radiative heating and acting as cloud condensation nuclei and ice nuclei. Dust also influences biogeochemical cycle and climate through providing nutrients vital to the productivity of ocean biomass and Amazon forests. Assessing these climate impacts relies on an accurate quantification of dust transport and deposition. Currently model simulations show extremely large diversity, which calls for a need of observational constraints. Kaufman et al. (2005) estimated from MODIS aerosol measurements that about 144 Tg of dust is deposited into the tropical Atlantic and 50 Tg of dust into the Amazon in 2001. This estimated dust import to Amazon is a factor of 3-4 higher than other observations and models. However, several studies have argued that the oversimplified characterization of dust vertical profile in the study would have introduced large uncertainty and very likely a high bias. In this study we quantify the trans-Atlantic dust transport and deposition by using 7 years (2007-2013) observations from CALIPSO lidar. CALIPSO acquires high-resolution aerosol extinction and depolarization profiles in both cloud-free and above-cloud conditions. The unique CALIPSO capability of profiling aerosols above clouds offers an unprecedented opportunity of examining uncertainties associated with the use of MODIS clear-sky data. Dust is separated from other types of aerosols using the depolarization measurements. We estimated that on the basis of 7-year average, 118142 Tg of dust is deposited into the tropical Atlantic and 3860 Tg of dust into the Amazon basin. Substantial interannual variations are observed during the period, with the maximum to minimum ratio of about 1

  11. Late presentation of chronic viral hepatitis for medical care

    Mauss, Stefan; Pol, Stanislas; Buti, Maria


    INTRODUCTION: We present two consensus definitions of advanced and late stage liver disease being used as epidemiological tools. These definitions can be applied to assess the morbidity caused by liver diseases in different health care systems. We focus is on hepatitis B and C virus infections, b...

  12. Comparing Care

    Evert Pommer; Isolde Woittiez; John Stevens


    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  13. Barriers to emergency obstetric care services

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique


    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...... was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching...

  14. 5 CFR 210.102 - Definitions.


    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Definitions. 210.102 Section 210.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS BASIC CONCEPTS AND DEFINITIONS (GENERAL) Applicability of Regulations; Definitions § 210.102 Definitions. (a) The definitions in paragraph...

  15. [Introduction to palliative care for the oncologist-history and basic principles of palliative care].

    Shima, Yasuo


    The basic principle of palliative care has evolved over time and is the historical origin of the modern hospice. WHO proposed the first definition of palliative care in 1989, and the definition was revised in 2002. These definitions have something in common. Both relieve the pain and suffering to improve QOL. Palliative care is also good for any kind of life-threatening disease, regardless of whether it requires short or long term recuperation. That also need to be able to accept equally all the people of the community. The provision of general palliative care is the responsibility of all medical, nursing, and health professionals for the welfare of all patients with life-threatening disease. Specialist palliative care is based on the basic principles of palliative care, intensive clinical training, and systematic acquisition of knowledge and skills training to support palliative care education, clinical research and training provided by the profession. It has been established by nursing and medical experts in palliative care that palliative care can provide expertise in interdisciplinary teams in different settings. It is necessary that the medical system.

  16. The need for performance governance to reach sustainable transport

    Gudmundsson, Henrik

    The objective to set transport on a course towards sustainability is a complex and long term aspiration that is likely to meet, and have already met, several market and governance failures. While many market failures can be countered through careful design of appropriate policy instruments......, the governance failures need a ‘second order’ approach; an approach that involves the re-design of processes and institutional frameworks for anticipation, decision making, implementation, and learning; in short a framework for performance governance. According to the policy scientists Bouckaert and Halligan......, ‘Performance governance’ is what they call the most advanced form of public performance management. In simple models a government collects only sporadic information on performance to satisfy internal reporting. In the performance governance model, performance management is systematic, continuous...


    Krasimir Davchev


    Full Text Available The article deals with the connection between the historical development of the marketing concept and the impact this development has on the precise definition of the marketing concept. The author proposes his own version of the definition based on the current state of socio-economic reality.

  18. An Operational Definition of Learning

    Harel, Guershon; Koichu, Boris


    An operational definition offered in this paper posits learning as a multi-dimensional and multi-phase phenomenon occurring when individuals attempt to solve what they view as a problem. To model someone's learning accordingly to the definition, it suffices to characterize a particular sequence of that person's disequilibrium-equilibrium phases in…

  19. 46 CFR Section 1 - Definitions.



  20. Omani Students' Definitions of Geography

    Al-Nofli, Mohammed Abdullah


    Very few studies have been conducted on students' definitions of geography. The purpose of the present study was to add to the existing literature by exploring Omani students' definitions of geography. Participants were 477 students of grade 6 (ages 11-12) and grade 10 (ages 15-16) in one school district in Oman. They had been taught geography…


    Krasimir Davchev


    The article deals with the connection between the historical development of the marketing concept and the impact this development has on the precise definition of the marketing concept. The author proposes his own version of the definition based on the current state of socio-economic reality.

  2. Reaching men: at work and in social settings.

    Robinson, E T


    Targeting men with the message of AIDS prevention is vital because men are the major sexual decision makers in developing countries; reaching them at work and social settings is an effective way to intervene. Men who work as truckers, police, miners and other migrant workers, soldiers and seamen are highly mobile, spend time away from home and are likely to engage in high risk behavior. A targeted intervention operated by the African Medical and Research Foundation (AMREF) with the assistance of AIDSTECH has trained peer educators, usually barmaids, bar owners and health workers, to talk to transport workers driving between Dar es Salaam, Tanzania and Zambia. Thousands of AIDS prevention posters, stickers and flyers, and 130,000 condoms per month have been distributed. KAP surveys have been conducted on the project by graduate students from University of Dar es Salaam. Condom distribution points were opened in offices of 2 major trucking companies, a fat in Tanzania where condoms are only supplied by medical outlets. AIDSTECH has also helped set up AIDS interventions for the Ghana Armed Forces, involving HIV testing, condom distribution and education. The military is a conducive milieu for communicating AIDS health messages because of the authoritarian structure.

  3. The chemical and environmental property space of REACH chemicals.

    Öberg, Tomas; Iqbal, M Sarfraz


    The European regulation on chemicals, REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals), came into force on 1 June 2007. With pre-registration complete in 2008, data for these substances may provide an overview of the expected chemical space and its characteristics. In this paper, using various in silico computation tools, we evaluate 48782 neutral organic compounds from the list to identify hazardous and safe compounds. Two different classification schemes (modified Verhaar and ECOSAR) identified between 17% and 25% of the compounds as expressing only baseline toxicity (narcosis). A smaller portion could be identified as reactive (19%) or specifically acting (2.7%), while the majority were non-assigned (61%). Overall environmental persistence, bioaccumulation and long-range transport potential were evaluated using structure-activity relationships and a multimedia fugacity-based model. A surprisingly high proportion of compounds (20%), mainly aromatic and halogenated, had a very high estimated persistence (>195 d). The proportion of compounds with a very high estimated bioconcentration or bioaccumulation factor (>5000) was substantially less (6.9%). Finally, a list was compiled of those compounds within the applicability domain of the models used, meeting both persistence and bioaccumulation criteria, and with a long-range transport potential comparable to PCB. This list of 68 potential persistent organic pollutants contained many well-known compounds (all halogenated), but notably also five fluorinated compounds that were not included in the EINECS inventory. This study demonstrates the usability of in silico tools for identification of potentially environmentally hazardous chemicals.

  4. Milestone reached for the Big Wheels of the Muon Spectrometer

    Sandro Palestini

    The assembly and integration of the Big Wheels sectors of the Muon Spectrometer is reaching its conclusion, with only a few sectors of Wheel TGC-A-3 remaining on the assembly stations in building 180. The six trigger chambers (TGCs) wheels and two precision chambers wheels (MDTs) contain in total 104 sectors, which were assembled, equipped with detectors and fully tested over a period of two years. The few remaining Big Wheel sectors still stored in building 180 Most of the sectors left building 180 over the last twelve months, and form the six Wheels currently installed in the ATLAS detector. The remaining two will be installed before the end of the summer. The commitment of the personnel from the many teams who contributed to different parts of the project was essential to its success. In particular, teams coming from countries of different traditions and languages, such as China, Israel, Japan, Pakistan, Russia and USA contributed and collaborated very effectively to the timely completion of the p...

  5. Reaching the quantum limit of sensitivity in electron spin resonance

    Bienfait, A.; Pla, J. J.; Kubo, Y.; Stern, M.; Zhou, X.; Lo, C. C.; Weis, C. D.; Schenkel, T.; Thewalt, M. L. W.; Vion, D.; Esteve, D.; Julsgaard, B.; Mølmer, K.; Morton, J. J. L.; Bertet, P.


    The detection and characterization of paramagnetic species by electron spin resonance (ESR) spectroscopy is widely used throughout chemistry, biology and materials science, from in vivo imaging to distance measurements in spin-labelled proteins. ESR relies on the inductive detection of microwave signals emitted by the spins into a coupled microwave resonator during their Larmor precession. However, such signals can be very small, prohibiting the application of ESR at the nanoscale (for example, at the single-cell level or on individual nanoparticles). Here, using a Josephson parametric microwave amplifier combined with high-quality-factor superconducting microresonators cooled at millikelvin temperatures, we improve the state-of-the-art sensitivity of inductive ESR detection by nearly four orders of magnitude. We demonstrate the detection of 1,700 bismuth donor spins in silicon within a single Hahn echo with unit signal-to-noise ratio, reduced to 150 spins by averaging a single Carr-Purcell-Meiboom-Gill sequence. This unprecedented sensitivity reaches the limit set by quantum fluctuations of the electromagnetic field instead of thermal or technical noise, which constitutes a novel regime for magnetic resonance. The detection volume of our resonator is ˜0.02 nl, and our approach can be readily scaled down further to improve sensitivity, providing a new versatile toolbox for ESR at the nanoscale.

  6. Assessment of Suited Reach Envelope in an Underwater Environment

    Kim, Han; Benson, Elizabeth; Bernal, Yaritza; Jarvis, Sarah; Meginnis, Ian; Rajulu, Sudhakar


    Predicting the performance of a crewmember in an extravehicular activity (EVA) space suit presents unique challenges. The kinematic patterns of suited motions are difficult to reproduce in gravity. Additionally, 3-D suited kinematics have been practically and technically difficult to quantify in an underwater environment, in which crewmembers are commonly trained and assessed for performance. The goal of this study is to develop a hardware and software system to predictively evaluate the kinematic mobility of suited crewmembers, by measuring the 3-D reach envelope of the suit in an underwater environment. This work is ultimately aimed at developing quantitative metrics to compare the mobility of the existing Extravehicular Mobility Unit (EMU) to newly developed space suit, such as the Z-2. The EMU has been extensively used at NASA since 1981 for EVA outside the Space Shuttle and International Space Station. The Z-2 suit is NASA's newest prototype space suit. The suit is comprised of new upper torso and lower torso architectures, which were designed to improve test subject mobility.

  7. Breakthrough Capability for UVOIR Space Astronomy: Reaching the Darkest Sky

    Greenhouse, Matthew A.; Benson, Scott W.; Englander, Jacob; Falck, Robert D.; Fixsen, Dale J.; Gardner, Jonathan P.; Kruk, Jeffery W.; Oleson, Steven R.; Thronson, Harley A.


    We describe how availability of new solar electric propulsion (SEP) technology can substantially increase the science capability of space astronomy missions working within the near-UV to far-infrared (UVOIR) spectrum by making dark sky orbits accessible for the first time. We present two case studies in which SEP is used to enable a 700 kg Explorer-class and 7000 kg flagship-class observatory payload to reach an orbit beyond where the zodiacal dust limits observatory sensitivity. The resulting scientific performance advantage relative to a Sun-Earth L2 point (SEL2) orbit is presented and discussed. We find that making SEP available to astrophysics Explorers can enable this small payload program to rival the science performance of much larger long development-time systems. Similarly, we find that astrophysics utilization of high power SEP being developed for the Asteroid Redirect Robotics Mission (ARRM) can have a substantial impact on the sensitivity performance of heavier flagship-class astrophysics payloads such as the UVOIR successor to the James Webb Space Telescope.

  8. Hypothesis: origin of life in deep-reaching tectonic faults.

    Schreiber, Ulrich; Locker-Grütjen, Oliver; Mayer, Christian


    The worldwide discussion on the origin of life encounters difficulties when it comes to estimate the conditions of the early earth and to define plausible environments for the development of the first complex organic molecules. Until now, the role of the earth's crust has been more or less ignored. In our opinion, deep-reaching open, interconnected tectonic fault systems may provide possible reaction habitats ranging from nano- to centimetre and even larger dimensions for the formation of prebiotic molecules. In addition to the presence of all necessary raw materials including phosphate, as well as variable pressure and temperature conditions, we suggest that supercritical CO2 as a nonpolar solvent could have played an important role. A hypothetical model for the origin of life is proposed which will be used to design crucial experiments for the model's verification. Because all proposed processes could still occur in tectonic faults at the present time, it may be possible to detect and analyse the formation of prebiotic molecules in order to assess the validity of the proposed hypothesis.

  9. Higher harmonics increase LISA's mass reach for supermassive black holes

    Arun, K G; Sathyaprakash, B S; Sinha, Siddhartha


    Current expectations on the signal to noise ratios and masses of supermassive black holes which the Laser Interferometer Space Antenna (LISA) can observe are based on using in matched filtering only the dominant harmonic of the inspiral waveform at twice the orbital frequency. Other harmonics will affect the signal-to-noise ratio of systems currently believed to be observable by LISA. More significantly, inclusion of other harmonics in our matched filters would mean that more massive systems that were previously thought to be {\\it not} visible in LISA should be detectable with reasonable SNRs. Our estimates show that we should be able to significantly increase the mass reach of LISA and observe the more commonly occurring supermassive black holes of masses $\\sim 10^8M_\\odot.$ More specifically, with the inclusion of all known harmonics LISA will be able to observe even supermassive black hole coalescences with total mass $\\sim 10^8 M_\\odot (10^9M_\\odot)$ (and mass-ratio 0.1) for a low frequency cut-off of $10...

  10. Over one million followers reached in CERN TweetUp

    Katherine Chapman


    More than a million followers were reached on Twitter during CERN’s first ever “TweetUp”. On 25 July, 5 lucky Twitter followers, or "Tweeps" as they are known, visited CERN to take part in events held on the same day with the STS-134 astronauts. The Tweetup gave the online community a chance to ask questions and explore areas of CERN through the eyes of the tweeps, prompting over 1,000 tweets and re-tweets between them in 24 hours.   Loic Bommersbach, Lucy McKenna, Astrid Chantelauze (KIT), Nick Howes, Angeliki Kanellopoulou, Maud Ali-Cherif (ESA), Julien Harrod (ESA), Katherine Chapman (CERN), and Simon Bierwald outside the CERN Control Centre. Five winners of a competition announced on Twitter were invited to come to CERN and spend a day behind the scenes, taking part in events organised to celebrate the AMS experiment that was launched in May 2011. The aim was to give tweeps the opportunity to explore CERN and share their experiences, allowi...

  11. How Physics World reaches out in a digital age

    Durrani, Matin

    Physics World is an award-winning international magazine that exists in print and digital formats. Exploiting the opportunities available with digital publishing and apps, our output has expanded hugely in recent years to include technology-linked focus issues, regional special reports on the likes of China, India, Mexico and Brazil, plus audio, video and interactive material too. This growth in content - and new media for presenting physics - reflects wider changes in communication. People increasingly want to access content in a manner and time of their choosing, seeking out information presented in a way that suits them and their needs. That can be challenging for physics communicators because it means tailoring your message to different audiences and the medium they are using. But it's exciting too as you can reach out to many more people into physics - and in many different ways - than was possible in the past. This talk outlines some principles of good communication, including telling a good story, bearing the reader, viewer or listener in mind, using appropriate media, keeping up with social media, and exploiting the power of video. But with new forms of communication constantly emerging, it's worth remembering there is no one ``right answer''.

  12. Reaching the Students: A New Approach to Enhancing Science Literacy

    McNamara, B. J.; Burnham, C. C.


    Most NSF supported programs directed at improving science literacy among university students who are not majoring in SMET normally target instruction in introductory science or math classes. Unfortunately these efforts seldom reach the vast majority of students at a university because students can fulfil their science requirement by taking several other classes or class sections that are not impacted by the NSF program. Ideally it would be desirable to address the issues of science literacy and science anxiety among non-science majors in a single class that is required of essentially all undergraduates. We describe such a program which is being tested at NMSU. The targeted class is the university's freshman level English class. The idea behind this effort is to provide students with the skills they will need to be successful in their science classes in a less threatening humanities environment. We describe the problems that this approach raises, suggest solutions to these problems, and then discuss the overall status of this effort.

  13. Real-Time Fall Risk Assessment Using Functional Reach Test

    Brian Williams


    Full Text Available Falls are common and dangerous for survivors of stroke at all stages of recovery. The widespread need to assess fall risk in real time for individuals after stroke has generated emerging requests for a reliable, inexpensive, quantifiable, and remote clinical measure/tool. In order to meet these requests, we explore the Functional Reach Test (FRT for real-time fall risk assessment and implement the FRT function in mStroke, a real-time and automatic mobile health system for poststroke recovery and rehabilitation. mStroke is designed, developed, and delivered as an Application (App running on a hardware platform consisting of an iPad and one or two wireless body motion sensors based on different mobile health functions. The FRT function in mStroke is extensively tested on healthy human subjects to verify its concept and feasibility. Preliminary performance will be presented to justify the further exploration of the FRT function in mStroke through clinical trials on individuals after stroke, which may guide its ubiquitous exploitation in the near future.

  14. TQM in health care: mistaken identity?

    Rose, E A


    Total Quality Management is a powerful tool in health care today. The definition of quality improvement in the medical literature focuses on improving patient outcomes. However, most quality initiatives in the health care field focus on improving productivity, cost-effectiveness, market share, employee morale, and efficiencies of processes. This disparity between the medical definition of quality and the actual application of quality improvement may have the effect of alienating many physicians, the very people who must be involved. The semantics are important to address in a TQM initiative.

  15. Team-Based Care: A Concept Analysis.

    Baik, Dawon


    The purpose of this concept analysis is to clarify and analyze the concept of team-based care in clinical practice. Team-based care has garnered attention as a way to enhance healthcare delivery and patient care related to quality and safety. However, there is no consensus on the concept of team-based care; as a result, the lack of common definition impedes further studies on team-based care. This analysis was conducted using Walker and Avant's strategy. Literature searches were conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, with a timeline from January 1985 to December 2015. The analysis demonstrates that the concept of team-based care has three core attributes: (a) interprofessional collaboration, (b) patient-centered approach, and (c) integrated care process. This is accomplished through understanding other team members' roles and responsibilities, a climate of mutual respect, and organizational support. Consequences of team-based care are identified with three aspects: (a) patient, (b) healthcare professional, and (c) healthcare organization. This concept analysis helps better understand the characteristics of team-based care in the clinical practice as well as promote the development of a theoretical definition of team-based care. © 2016 Wiley Periodicals, Inc.

  16. [Ethical and political diversity in the right to health care in Brazilian municipalities along the MERCOSUR border].

    Nogueira, Vera Maria Ribeiro; Dal Prá, Keli Regina; Fermiano, Sabrina


    This article presents the results of a study in Brazilian municipalities along the border with the other Southern Cone Common Market (MERCOSUR) countries, identifying health care patterns and showing ethical and political diversity in the guarantee and use of the right to health care, characterizing demands on (and responses by) local health systems. The main variable was whether non-Brazilians had access to Brazilian health services. Data were collected using forms in municipalities with more than 10 thousand inhabitants, field diaries, meetings, and interviews. The definition of the right to health care varied greatly, indicating lack of common ethical and political principles and weak institutionality, with incapacity to absorb the demand by non-Brazilian patients. Agreements between the respective Federal governments of MERCOSUR countries had failed to reach the local level and were ignored by local health services managers and professionals. The foreign population remains uncertain about receiving care. In Brazil, the lack of uniform standards of care lead to ad hoc personal decisions by health services managers and professionals, thus hindering integrated action.

  17. Controversies in terminal cancer care.

    Diehl, V


    In the long term, about 75% of all cancer patients will need palliative care, but the curricula in courses of study leading to qualifications in the caring professions take no account of this, being concerned exclusively with curative strategies. Precise definition of palliative care as a medical discipline is needed, followed by an insistence on proper funding and instruction. In addition, palliation should be integrated into the early stages of patient contact, e.g., prevention, diagnosis, treatment planning, and not only implemented when attempts at curative therapy have failed. Public and political awareness must be promoted; in particular it should be recognized that the care givers themselves need support. There is a growing need for well-run hospices with purpose-trained staff. While "mercy killing" might be considered out of charity and humanity, the death of a terminally ill patient should be neither hastened nor postponed.

  18. Definition of the characteristic impedance

    徐云生; Abbas Sayed OMAR


    Currently available definitions of the characteristic impedance are ambiguous andior inaccurate.A general definition,based on the description of discontinuities between adjacent waveguides,is given.This definition is accurate and independent of the structure concerned.So it can be applied to the design of passive components in any type of transmission lines.Using this definition,a given structure can be uniquely characterized,but the absolute value of the characteristic impedance has no sense any more.As an example,the design of a microstrip impedance transformer using this new definition is presented.Numerical results using the mode-matching method prove the accuracy of the theory.

  19. Self reference in word definitions

    Levary, David; Moses, Elisha; Tlusty, Tsvi


    Dictionaries are inherently circular in nature. A given word is linked to a set of alternative words (the definition) which in turn point to further descendants. Iterating through definitions in this way, one typically finds that definitions loop back upon themselves. The graph formed by such definitional relations is our object of study. By eliminating those links which are not in loops, we arrive at a core subgraph of highly connected nodes. We observe that definitional loops are conveniently classified by length, with longer loops usually emerging from semantic misinterpretation. By breaking the long loops in the graph of the dictionary, we arrive at a set of disconnected clusters. We find that the words in these clusters constitute semantic units, and moreover tend to have been introduced into the English language at similar times, suggesting a possible mechanism for language evolution.

  20. The importance of being earnest when crafting definitions: science and scientism are not the same thing.

    Nash, Michael R


    The APA Division 30 definition of hypnosis is laudable in some respects. For instance, the committee rightly defines the "induction" as nothing more or less than the first suggestion after the introduction. However, the definition stumbles over its nonposition on whether the word hypnosis must be uttered during the procedure. This equivocation invites research designs that preemptively define a hypnotic group and a control group in terms of whether or not the word hypnosis is used in the protocol. These designs represent a backslide into naive operationism; they reveal little new about human nature or hypnosis. The field deserves an optimally heuristic definition that preserves pluralism and is relatively resistant to the teflon shield of preemptive definition. Researchers and practioners require a definition that recognizes the incompleteness of our concepts, generates a level epistemological playing field, and enables hypnosis theories to "reach."