WorldWideScience

Sample records for reach definitive care

  1. Improving exposure scenario definitions within REACH

    DEFF Research Database (Denmark)

    Lee, Jihyun; Pizzol, Massimo; Thomsen, Marianne

    In recent years, the paradigm of chemical management system has changed from being toxicity oriented and media based to being risk oriented and receptor based. This trend is evident not only regarding environmental quality standards, but also for industrial chemical regulations. Political...... 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...... and managing the risks posed by industrial chemicals and providing appropriate safety information to their users (EC, 2007). However, to ensure a high level of protection of human health and the environment, there is a need to consider ‘aggregate exposure’ including background exposures from environment which...

  2. Pharmaceutical care: the PCNE definition 2013.

    Science.gov (United States)

    Allemann, Samuel S; van Mil, J W Foppe; Botermann, Lea; Berger, Karin; Griese, Nina; Hersberger, Kurt E

    2014-06-01

    Twenty-three years after Hepler and Strand published their well-known definition of Pharmaceutical Care (PhC), confusion remains about what the term includes and how to differentiate it from other terms. The board of the Pharmaceutical Care Network Europe (PCNE) felt the need to redefine PhC and to answer the question: "What is Pharmaceutical Care in 2013". The aims of this paper were to review existing definitions of PhC and to describe the process of developing a redefined definition. A literature search was conducted in the MEDLINE database (1964-January 2013). Keywords included "Pharmaceutical Care", "Medication (Therapy) Management", "Medicine Management", and "Pharmacist Care" in the title or abstract together with the term "defin*". To ease comparison between definitions, we developed a standardised syntax to paraphrase the definitions. During a dedicated meeting, a moderated discussion about the definition of PhC was organised. The initial literature search produced 186 hits, with eight unique PhC definitions. Hand searching identified a further 11 unique definitions. These 19 definitions were paraphrased using the standardised syntax (provider, recipient, subject, outcome, activities). Fourteen members of PCNE and 10 additional experts attended the moderated discussion. Working groups of increasing size developed intermediate definitions, which had similarities and differences to those retrieved in the literature search. At the end of the session, participants reached a consensus on a "PCNE definition of Pharmaceutical Care" reading: "Pharmaceutical Care is the pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes". It was possible to paraphrase definitions of PhC using a standardised syntax focusing on the provider, recipient, subject, outcomes, and activities included in PhC practice. During a one-day workshop, experts in PhC research agreed on a definition, intended to be applicable for the

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

    Directory of Open Access Journals (Sweden)

    Abby Swanson Kazley

    2012-03-01

    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

  4. RiverCare communication strategy for reaching beyond

    Science.gov (United States)

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

    2017-04-01

    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

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

    Science.gov (United States)

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

    2007-08-01

    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.

  6. Reaching the Millennium Development Goals : Mauritania Should Care

    OpenAIRE

    Magnoli Bocchi, Alessandro; Pontara, Nicola; Fall, Khayar; Tejada, Catalina M.; Gallego Cuervo, Pablo

    2008-01-01

    Mauritania is a resource-rich developing country. As many other African nations, it will not reach most of the Millennium Development Goals, unless the authorities commit to accelerating progress. To succeed by 2015, the government needs to: mobilize additional financial resources, introduce policy changes at the sector level, and strengthen the links between strategic objectives and the b...

  7. Automated River Reach Definition Strategies: Applications for the Surface Water and Ocean Topography Mission

    Science.gov (United States)

    Frasson, Renato Prata de Moraes; Wei, Rui; Durand, Michael; Minear, J. Toby; Domeneghetti, Alessio; Schumann, Guy; Williams, Brent A.; Rodriguez, Ernesto; Picamilh, Christophe; Lion, Christine; Pavelsky, Tamlin; Garambois, Pierre-André

    2017-10-01

    The upcoming Surface Water and Ocean Topography (SWOT) mission will measure water surface heights and widths for rivers wider than 100 m. At its native resolution, SWOT height errors are expected to be on the order of meters, which prevent the calculation of water surface slopes and the use of slope-dependent discharge equations. To mitigate height and width errors, the high-resolution measurements will be grouped into reaches (˜5 to 15 km), where slope and discharge are estimated. We describe three automated river segmentation strategies for defining optimum reaches for discharge estimation: (1) arbitrary lengths, (2) identification of hydraulic controls, and (3) sinuosity. We test our methodologies on 9 and 14 simulated SWOT overpasses over the Sacramento and the Po Rivers, respectively, which we compare against hydraulic models of each river. Our results show that generally, height, width, and slope errors decrease with increasing reach length. However, the hydraulic controls and the sinuosity methods led to better slopes and often height errors that were either smaller or comparable to those of arbitrary reaches of compatible sizes. Estimated discharge errors caused by the propagation of height, width, and slope errors through the discharge equation were often smaller for sinuosity (on average 8.5% for the Sacramento and 6.9% for the Po) and hydraulic control (Sacramento: 7.3% and Po: 5.9%) reaches than for arbitrary reaches of comparable lengths (Sacramento: 8.6% and Po: 7.8%). This analysis suggests that reach definition methods that preserve the hydraulic properties of the river network may lead to better discharge estimates.

  8. [Primary care: A definition of the field to develop research].

    Science.gov (United States)

    Verga-Gérard, A

    2018-03-01

    Research in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l'offre de soins). The RECaP (Research in Clinical Epidemiology and Public Health) network is a French research network supported by Inserm, which recently implemented a specific working group focusing on research in primary care, based on a multidisciplinary approach. Researchers from different specialties participate in this group. The first aim of the group was to reach a common definition of the perimeter and of the panel of healthcare professionals and structures potentially involved in the field of primary care. For this purpose, a selection of different data sets of sources defining primary care was analyzed by the group, each participant collecting a set of sources, from which a synthesis was made and discussed. A definition of primary care at different levels (international, European and French) was summarized. A special attention was given to the French context in order to adapt the perimeter to the characteristics of the French healthcare system, notably by illustrating the different key elements of the definition with the inclusion of primary care actors and the type of practice premises. In conclusion, this work illustrates the diversity of primary care in France and the potential offered for research purposes. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Glossary of Managed Care Definitions

    Science.gov (United States)

    ... or treatment provided to a plan member. Coverage : decision making process that identifies what services or products are ... themselves and pay a monthly premium for it. Mental health care : medical ... abuse. Mixed model or network HMO : a managed care plan that ...

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

    Science.gov (United States)

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

    2014-01-01

    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. Copyright © 2013 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  11. Reaching common ground: a patient-family-based conceptual framework of quality EOL care.

    Science.gov (United States)

    Howell, Doris; Brazil, Kevin

    2005-01-01

    Improvement in the quality of end-of-life (EOL) care is a priority health care issue since serious deficiencies in quality of care have been reported across care settings. Increasing pressure is now focused on Canadian health care organizations to be accountable for the quality of palliative and EOL care delivered. Numerous domains of quality EOL care upon which to create accountability frameworks are now published, with some derived from the patient/family perspective. There is a need to reach common ground on the domains of quality EOL care valued by patients and families in order to develop consistent performance measures and set priorities for health care improvement. This paper describes a meta-synthesis study to develop a common conceptual framework of quality EOL care integrating attributes of quality valued by patients and their families.

  12. Reviewing the definition of crisis in dementia care

    NARCIS (Netherlands)

    MacNeil-Vroomen, J.L.; Bosmans, J.E.; van Hout, H.P.J.; de Rooij, S.E.

    2013-01-01

    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.

  13. Reviewing the definition of crisis in dementia care

    NARCIS (Netherlands)

    Vroomen, Janet MacNeil; Bosmans, Judith E.; van Hout, Hein P. J.; de Rooij, Sophia E.

    2013-01-01

    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. We systematically

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

    Science.gov (United States)

    Finau, Sitaleki A; Finau, Eseta

    2007-09-01

    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.

  15. Reaching Out’: international models for transitional care for teenage and young adult cancer patients

    Directory of Open Access Journals (Sweden)

    Charlotte Weston

    2018-05-01

    Full Text Available Background: This article will give an overview of ‘Reaching Out’, a project to identify international models of transitional care for adolescent and young adult (AYA cancer patients. Aims: •\tExplore provision of AYA cancer care in a different cultural context •\tIdentify new models of care for supporting transition between paediatric, AYA and adult care, and between acute and primary care •\tIdentify relevant resources and service designs that could be adapted for use in AYA services in the UK Methods: Three-week observational visit in a range of international healthcare settings. Findings: Similarities and differences between Australian and UK healthcare systems were observed. Models of care using a range of resources, including structured health and wellbeing programmes, were identified to support transitional care. Models of collaborative working across organisations were observed. The implementation of innovative programmes to improve efficiency of services and limit unnecessary impact on patient time and finances were identified, including the use of Skype for collaborative consultations between acute and community healthcare providers. Conclusions: Recommendations to benefit AYA patients with an improved range of supportive, holistic services and improved person-centred care include: •\tJoint AYA nursing posts between AYA centres to support transition •\tStructured AYA post-treatment health and wellbeing programme •\tProgramme of creative wellbeing projects to support transition at the end of treatment Scope use of Skype appointments within the AYA service Implications for practice: Observing service provision and healthcare practice in an international setting provides the opportunity to improve cross-cultural competence, which is essential to culturally competent care. Cross-cultural competence supports the improvement of patient care through experiential learning, sharing of ideas and connecting with others. The

  16. Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

    Science.gov (United States)

    Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas

    2017-03-01

    Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

  17. Need, access, and the reach of integrated care: A typology of patients.

    Science.gov (United States)

    Bridges, Ana J; Villalobos, Bianca T; Anastasia, Elizabeth A; Dueweke, Aubrey R; Gregus, Samantha J; Cavell, Timothy A

    2017-06-01

    This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. Understanding the reasons for delay to definitive surgical care of ...

    African Journals Online (AJOL)

    Understanding the reasons for delay to definitive surgical care of patients with acute appendicitis in rural South Africa. V Y Kong,1 MB ChB; C Aldous,2 PhD; D L Clarke,1 FCS ... Acute appendicitis in rural South Africa is associated with significant morbidity due to prolonged delays before definitive .... telemedicine support.

  19. Vertical integration and diversification of acute care hospitals: conceptual definitions.

    Science.gov (United States)

    Clement, J P

    1988-01-01

    The terms vertical integration and diversification, although used quite frequently, are ill-defined for use in the health care field. In this article, the concepts are defined--specifically for nonuniversity acute care hospitals. The resulting definitions are more useful than previous ones for predicting the effects of vertical integration and diversification.

  20. Definition of supportive care: does the semantic matter?

    Science.gov (United States)

    Hui, David

    2014-07-01

    'Supportive care' is a commonly used term in oncology; however, no consensus definition exists. This represents a barrier to communication in both the clinical and research settings. In this review, we propose a unifying conceptual framework for supportive care and discuss the proper use of this term in the clinical and research settings. A recent systematic review revealed several themes for supportive care: a focus on symptom management and improvement of quality of life, and care for patients on treatments and those with advanced stage disease. These findings are consistent with a broad definition for supportive care: 'the provision of the necessary services for those living with or affected by cancer to meet their informational, emotional, spiritual, social, or physical needs during their diagnostic, treatment, or follow-up phases encompassing issues of health promotion and prevention, survivorship, palliation, and bereavement.' Supportive care can be classified as primary, secondary, and tertiary based on the level of specialization. For example, palliative care teams provide secondary supportive care for patients with advanced cancer. Until a consensus definition is available for supportive care, this term should be clearly defined or cited whenever it is used.

  1. Understanding the reasons for delay to definitive surgical care of ...

    African Journals Online (AJOL)

    Background. Acute appendicitis in rural South Africa is associated with significant morbidity due to prolonged delays before definitive surgical care. Objective. This audit aimed to quantify the delay in our healthcare system. Methods. From September 2010 to September 2012, all patients with confirmed acute appendicitis ...

  2. Reaching everyone: Promoting the inclusion of youth with disabilities in evaluating foster care outcomes

    OpenAIRE

    Blakeslee, Jennifer E.; Quest, A. Del; Powers, Jennifer; Powers, Laurie E.; Geenen, Sarah; Nelson, May; Dalton, Lawrence D.; McHugh, Elizabeth

    2013-01-01

    Efforts to evaluate foster care outcomes must avoid systematic exclusion of particular groups. Although often unrecognized as such, youth with disabilities are highly overrepresented in the U.S. foster care system, and yet youth with some disabilities, including those with intellectual, serious emotional, and physical impairments may be underrepresented in research and evaluation studies evaluating foster care outcomes. The recruitment and retention of youth with various disabilities in such ...

  3. Reaching out to the forgotten: providing access to medical care for the homeless in Italy.

    Science.gov (United States)

    De Maio, Gianfranco; Van den Bergh, Rafael; Garelli, Silvia; Maccagno, Barbara; Raddi, Freja; Stefanizzi, Alice; Regazzo, Costantina; Zachariah, Rony

    2014-06-01

    A program for outpatient and intermediate inpatient care for the homeless was pioneered by the humanitarian organization Médecins Sans Frontières (MSF) in Milan, Italy, during the winter of 2012-2013. We aimed to document the characteristics and clinical management of inpatients and outpatients seen during this program. A clinic providing outpatient and intermediate inpatient care (24 bed capacity) was set up in an existing homeless hostel. Patients were admitted for post-hospitalization intermediate care or for illnesses not requiring secondary care. This study was a retrospective audit of the routine program data. Four hundred and fifty four individuals presented for outpatient care and 123 patients were admitted to inpatient intermediary care. On average one outpatient consultation was conducted per patient per month, most for acute respiratory tract infections (39.8%; 522/1311). Eleven percent of all outpatients suffered from an underlying chronic condition and 2.98% (38/1311) needed referral to emergency services or secondary care facilities. Most inpatients were ill patients referred through public reception centers (72.3%; 89/123), while 27.6% (34/123) were post-hospitalization patients requiring intermediate care. Out of all inpatients, 41.4% (51/123) required more than 1 week of care and 6.5% (8/123) needed counter-referral to secondary care. The observed service usage, morbidity patterns, relatively long lengths of stay, high referral completion and need for counter-referrals, all reflect the important gap-filling role played by an intermediate care facility for this vulnerable population. We recommend that in similar contexts, medical non-governmental organizations (NGOs) focus on the setup of inpatient intermediary care services; while outpatient services are covered by the public health system. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  4. The High Cost of Child Care Puts Quality Care out of Reach for Many Families. Issue Brief.

    Science.gov (United States)

    Schulman, Karen

    This issue brief presents data on the cost of child care, collected from local child care resource and referral agencies (CCR&Rs) surveyed by the Children's Defense Fund. The report's key findings on the high cost of child care are: (1) child care for a 4-year-old in a child care center averages $4,000 to $6,000 a year in cities and states…

  5. A matter of definition--key elements identified in a discourse analysis of definitions of palliative care.

    Science.gov (United States)

    Pastrana, T; Jünger, S; Ostgathe, C; Elsner, F; Radbruch, L

    2008-04-01

    For more than 30 years, the term "palliative care" has been used. From the outset, the term has undergone a series of transformations in its definitions and consequently in its tasks and goals. There remains a lack of consensus on a definition. The aim of this article is to analyse the definitions of palliative care in the specialist literature and to identify the key elements of palliative care using discourse analysis: a qualitative methodology. The literature search focused on definitions of the term 'palliative medicine' and 'palliative care' in the World Wide Web and medical reference books in English and German. A total of 37 English and 26 German definitions were identified and analysed. Our study confirmed the lack of a consistent meaning concerning the investigated terms, reflecting on-going discussion about the nature of the field among palliative care practitioners. Several common key elements were identified. Four main categories emerged from the discourse analysis of the definition of palliative care: target groups, structure, tasks and expertise. In addition, the theoretical principles and goals of palliative care were discussed and found to be key elements, with relief and prevention of suffering and improvement of quality of life as main goals. The identified key elements can contribute to the definition of the concept 'palliative care'. Our study confirms the importance of semantic and ethical influences on palliative care that should be considered in future research on semantics in different languages.

  6. Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia.

    Science.gov (United States)

    MacWilliams, Judy; Bramwell, Michael; Brown, Sally; O'Connor, Margaret

    2014-02-01

    Most terminally ill people express a preference for dying at home. Within established models of palliative care, achieving death at home is a particular challenge for homeless people. This paper describes a quality-improvement project undertaken by a community-based palliative care service in Melbourne, Australia, to understand homeless people's palliative care needs and the challenges that workers face. Six semi-structured interviews with workers in hospital and community-based settings were undertaken and a case study documented. The results were used to initiate discussion about how policy and protocols for the community-based palliative care service might serve this population more effectively. The findings confirmed that homeless people have complex psychosocial and medical needs. They may be periodically uncontactable or living in unsafe settings, experience isolation from social support networks, and have issues of compliance with treatment protocols exacerbated by mental health problems and/or substance abuse. Service providers had particular challenges in meeting the palliative care needs of homeless people. A flexible, compassionate, and coordinated response is required, and more work is needed to explore how the needs of this particular group can be met.

  7. Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic Disease Care Versus a Traditional Fee-for-Service Approach.

    Science.gov (United States)

    Sanders, Jim; Guse, Clare E

    2016-08-09

    There is a significant disparity in hypertensive treatment rates between those with and without health insurance. If left untreated, hypertension leads to significant morbidity and mortality. The uninsured face numerous barriers to access chronic disease care. We developed the Community-based Chronic Disease Management (CCDM) clinics specifically for the uninsured with hypertension utilizing nurse-led teams, community-based locations, and evidence-based clinical protocols. All services, including laboratory and medications, are provided on-site and free of charge. In order to ascertain if the CCDM model of care was as effective as traditional models of care in achieving blood pressure goals, we compared CCDM clinics' hypertensive care outcomes with 2 traditional fee-for-service physician-led clinics. All the clinics are located near one another in poor urban neighborhoods of Milwaukee, Wisconsin. Patients seen at the CCDM clinics and at 1 of the 2 traditional clinics showed a statistically significant improvement in reaching blood pressure goal at 6 months (P fee-for-service clinics when compared with the CCDM clinics. The CCDM model of care is at least as effective in controlling hypertension as more traditional fee-for-service models caring for the same population. The CCDM model of care to treat hypertension may offer another approach for engaging the urban poor in chronic disease care. © The Author(s) 2016.

  8. Reaching everyone: Promoting the inclusion of youth with disabilities in evaluating foster care outcomes

    Science.gov (United States)

    Blakeslee, Jennifer E.; Quest, A. Del; Powers, Jennifer; Powers, Laurie E.; Geenen, Sarah; Nelson, May; Dalton, Lawrence D.; McHugh, Elizabeth

    2013-01-01

    Efforts to evaluate foster care outcomes must avoid systematic exclusion of particular groups. Although often unrecognized as such, youth with disabilities are highly overrepresented in the U.S. foster care system, and yet youth with some disabilities, including those with intellectual, serious emotional, and physical impairments may be underrepresented in research and evaluation studies evaluating foster care outcomes. The recruitment and retention of youth with various disabilities in such studies can be impeded by under-identification of disability and relatively high placement and school mobility. Furthermore, youth with various disabilities may experience more disappointing outcomes than foster youth overall, underscoring the importance of including these youth in outcome tracking efforts. This is especially relevant given the recent implementation of the National Youth in Transition Database (NYTD), which requires that state child welfare agencies gather baseline information about youth in foster care at age 17, and then survey outcomes at 19 and 21. To promote the full participation of foster youth with disabilities in such outcome evaluation, this paper describes successful strategies for identifying and retaining participants that were used in three separate longitudinal intervention studies. These strategies include the systematic recruitment of foster youth by special education status, and creative use of validated tracking and retention strategies incorporating minor accommodations as needed. PMID:24273364

  9. [Research within the reach of Osakidetza professionals: Primary Health Care Research Program].

    Science.gov (United States)

    Grandes, Gonzalo; Arce, Verónica; Arietaleanizbeaskoa, María Soledad

    2014-04-01

    To provide information about the process and results of the Primary Health Care Research Program 2010-2011 organised by the Primary Care Research Unit of Bizkaia. Descriptive study. Osakidetza primary care. The 107 health professionals who applied for the program from a total of 4,338 general practitioners, nurses and administrative staff who were informed about it. Application level, research topics classification, program evaluation by participants, projects funding and program costs. Percentage who applied, 2.47%; 95% CI 2.41-2.88%. Of the 28 who were selected and 19 completed. The research topics were mostly related to the more common chronic diseases (32%), and prevention and health promotion (18%). Over 90% of participants assessed the quality of the program as good or excellent, and half of them considered it as difficult or very difficult. Of the18 new projects generated, 12 received funding, with 16 grants, 10 from the Health Department of the Basque Government, 4 from the Carlos III Institute of Health of the Ministry of Health of Spain, and 2 from Kronikgune. A total of €500,000 was obtained for these projects. This program cost €198,327. This experience can be used by others interested in the promotion of research in primary care, as the program achieved its objectives, and was useful and productive. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  10. Reaching Agreement: The Structure & Pragmatics of Critical Care Nurses' Informal Argument

    Science.gov (United States)

    Hagler, Debra A.; Brem, Sarah K.

    2008-01-01

    The hospital critical care unit provides an authentic, high-stakes setting for studying reasoning, argumentation, and discourse. In particular, it allows examination of structural and pragmatic features of informal collaborative argument created while participants are engaged in familiar, meaningful activities central to their work. The nursing…

  11. The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review.

    Science.gov (United States)

    Lebeau, Jean-Pierre; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Mercier, Alain; Pasquet, Thomas; Rusch, Emmanuel; Hendrickx, Kristin; Vermeire, Etienne

    2014-07-02

    Therapeutic inertia has been defined as the failure of health-care provider to initiate or intensify therapy when therapeutic goals are not reached. It is regarded as a major cause of uncontrolled hypertension. The exploration of its causes and the interventions to reduce it are plagued by unclear conceptualizations and hypothesized mechanisms. We therefore systematically searched the literature for definitions and discussions on the concept of therapeutic inertia in hypertension in primary care, to try and form an operational definition. A systematic review of all types of publications related to clinical inertia in hypertension was performed. Medline, EMbase, PsycInfo, the Cochrane library and databases, BDSP, CRD and NGC were searched from the start of their databases to June 2013. Articles were selected independently by two authors on the basis of their conceptual content, without other eligibility criteria or formal quality appraisal. Qualitative data were extracted independently by two teams of authors. Data were analyzed using a constant comparative qualitative method. The final selection included 89 articles. 112 codes were grouped in 4 categories: terms and definitions (semantics), "who" (physician, patient or system), "how and why" (mechanisms and reasons), and "appropriateness". Regarding each of these categories, a number of contradictory assertions were found, most of them relying on little or no empirical data. Overall, the limits of what should be considered as inertia were not clear. A number of authors insisted that what was considered deleterious inertia might in fact be appropriate care, depending on the situation. Our data analysis revealed a major lack of conceptualization of therapeutic inertia in hypertension and important discrepancies regarding its possible causes, mechanisms and outcomes. The concept should be split in two parts: appropriate inaction and inappropriate inertia. The development of consensual and operational definitions

  12. Extending the reach of health care for obesity and diabetes using virtual worlds.

    Science.gov (United States)

    Morie, Jacquelyn Ford; Chance, Eric

    2011-03-01

    Today's epidemic of obesity and diabetes poses challenges to health care similar to those facing soldiers who return with postdeployment mental health issues. These include geographic barriers, social stigma, and the need for behavioral change. Researchers at University of Southern California's Institute for Creative Technologies are adapting their extensive experience in technological solutions for training to techniques that can aid veterans in need. These techniques show promise for concerns in the growing crisis of "diabesity." Virtual reality (VR) has already demonstrated itself as an impactful treatment method for several behavioral and mental health domains. Virtual worlds, the successor technology of original VR, inherited many of its predecessor's strengths but also presents the new affordances of accessibility, social connectivity, and avatar usage, which pave the way toward future treatment options on a broader scale. © 2011 Diabetes Technology Society.

  13. Prison mental health in-reach teams in England: the care programme approach and sexual abuse/violence.

    Science.gov (United States)

    Brooker, Charles G D; Forrester, Andrew

    2017-12-01

    Prison mental health in-reach teams have doubled in size over the past decade and case-loads have reduced. Since 2010 it has been mandatory for keyworkers to ask whether prisoners with serious mental illness being treated under the care programme approach have experienced sexual or physical abuse. This is known as routine enquiry and should take place for these prisoners but NHS England, the commissioners, do not audit this activity. It is time to review current interventions and their associated outcomes. © The Royal College of Psychiatrists 2017.

  14. Reaching a Consensus on the Definition of Genetic Literacy that Is Required from a Twenty-First-Century Citizen

    Science.gov (United States)

    Boerwinkel, Dirk Jan; Yarden, Anat; Waarlo, Arend Jan

    2017-12-01

    To determine what knowledge of genetics is needed for decision-making on genetic-related issues, a consensus-reaching approach was used. An international group of 57 experts, involved in teaching, studying, or developing genetic education and communication or working with genetic applications in medicine, agriculture, or forensics, answered the questions: "What knowledge of genetics is relevant to those individuals not professionally involved in science?" and "Why is this knowledge relevant?" The answers were classified in different knowledge components following the PISA 2015 science framework. During a workshop with the participants, the results were discussed and applied to seven cases in which genetic knowledge is relevant for decision-making. The analysis of these discussions resulted in a revised framework consisting of nine conceptual knowledge components, three sociocultural components, and four epistemic components. The framework can be used in curricular decisions; its open character allows for including new technologies and applications and facilitates comparisons of different cases.

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

    Science.gov (United States)

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

    2016-10-21

    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

  16. Community Engagement in a complex intervention to improve access to primary mental health care for hard-to-reach groups.

    Science.gov (United States)

    Lamb, Jonathan; Dowrick, Christopher; Burroughs, Heather; Beatty, Susan; Edwards, Suzanne; Bristow, Kate; Clarke, Pam; Hammond, Jonathan; Waheed, Waquas; Gabbay, Mark; Gask, Linda

    2015-12-01

    Despite the availability of effective evidence-based treatments for depression and anxiety, many 'harder-to-reach' social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model. Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered. A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom. Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open-ended investment are a barrier. The time-limited nature of a CE intervention provides an impetus to 'do it now', allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement. CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology. © 2014 John Wiley & Sons Ltd.

  17. International definition of a point-of-care test in family practice: a modified e-Delphi procedure.

    Science.gov (United States)

    Schols, Angel M R; Dinant, Geert-Jan; Hopstaken, Rogier; Price, Christopher P; Kusters, Ron; Cals, Jochen W L

    2018-01-29

    The use of point-of-care tests (POCTs) in family practice is increasing, and the term POCT is often used in medical literature and clinical practice. Yet, no widely supported definition by several professional fields exists. To reach consensus on an international definition of a POCT in family practice. We performed a modified international e-Delphi procedure of four rounds among expert panel members from different professional backgrounds-family practitioners, laboratory specialists, policymakers, researchers and manufacturers. Of 27 panel members from seven different countries, 26 participated in all rounds. Most panel members were active in POCT research or policymaking and 70% worked in family medicine. After choosing important components, structuring of answers and feedback, the following definition was chosen as the best or second best definition by 81% of panel members: a point-of-care test in family practice is a test to support clinical decision making, which is performed by a qualified member of the practice staff nearby the patient and on any part of the patient's body or its derivatives, during or very close to the time of consultation, to help the patient and physician to decide upon the best suited approach, and of which the results should be known at the time of the clinical decision making. The definition emerging from this study can inform family practitioners, laboratory specialists, policymakers and manufacturers on the most widely supported and recognized definition and could act as a clear starting point for the organization and execution of professional point-of-care testing in family practice worldwide. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Conscience in health care and the definitions of death.

    Science.gov (United States)

    Kato, Yutaka

    2013-02-01

    Brain death or neurologic death has gradually become recognized as human death over the past decades worldwide. Nevertheless, in Japan, the New York State, and the State of New Jersey, death is declared based not on brain death criteria, but on cardio-pulmonary criteria. In Japan, the 1997 Organ Transplant Law legalized brain death determination exclusively when organs were to be procured from brain-dead patients. Even after 2009 law revision, the default definition of death continued to be based on cardio-pulmonary criteria, despite the criticism. The cases of Japan and the United States provide a good reference as social experiments of appreciating conscientious or religio-cultural dimensions in health care. This text theoretically examines the 1997 organ transplant law of Japan and its 2009 revision, presenting some characteristics of Japan's case compared to American cases and the implications its approach has for the rest of the world. This is an example in which a foreign idea that did not receive widespread support from Japanese citizens was transformed to fit the religio-cultural landscape.

  19. Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks.

    Science.gov (United States)

    Hui, David; De La Cruz, Maxine; Mori, Masanori; Parsons, Henrique A; Kwon, Jung Hye; Torres-Vigil, Isabel; Kim, Sun Hyun; Dev, Rony; Hutchins, Ronald; Liem, Christiana; Kang, Duck-Hee; Bruera, Eduardo

    2013-03-01

    Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.

  20. In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Nelson Sara

    2008-12-01

    Full Text Available Abstract Background A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT to four residential care homes has been evaluated. The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods Data captured prospectively (July 2005 to June 2007 included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support; length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion Introduction of a specialist nursing in-reach

  1. Prenatal care: reaching mothers, reaching infants

    National Research Council Canada - National Science Library

    Brown, Sarah S

    1988-01-01

    ... Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1988 i Copyrightthe cannot be not from book, paper however, version for formatting, original authoritative the typesetting-specific the as from created publication files XML from other this and of recomposed styles, version heading print the breaks, use ...

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

    NARCIS (Netherlands)

    van Mil, J.W F

    1996-01-01

    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

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

    Science.gov (United States)

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

    2011-01-01

    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.

  4. How do we reach the girls and women who are the hardest to reach? Inequitable opportunities in reproductive and maternal health care services in armed conflict and forced displacement settings in Colombia.

    Directory of Open Access Journals (Sweden)

    Juan Carlos Rivillas

    Full Text Available This paper assesses inequalities in access to reproductive and maternal health services among females affected by forced displacement and sexual and gender-based violence in conflict settings in Colombia. This was accomplished through the following approaches: first, we assessed the gaps and gradients in three selected reproductive and maternal health care services. Second, we analyzed the patterns of inequalities in reproductive and maternal health care services and changes over time. And finally, we identified challenges and strategies for reaching girls and women who are the hardest to reach in conflict settings, in order to accelerate progress towards universal health coverage and to contribute to meeting the Sustainable Development Goals of good health and well-being and gender equality by 2030.Three types of data were required: data about health outcomes (relating to rates of females affected by conflict, information about reproductive and maternal health care services to provide a social dimension to unmask inequalities (unmet needs in family planning, antenatal care and skilled births attendance; and data on the female population. Data sources used include the National Information System for Social Protection, the National Registry of Victims, the National Administrative Department of Statistics, and Demographic Health Survey at three specific time points: 2005, 2010 and 2015. We estimated the slope index of inequality to express absolute inequality (gaps and the concentration index to expresses relative inequality (gradients, and to understand whether inequality was eliminated over time.Our findings show that even though absolute health care service-related inequalities dropped over time, relative inequalities worsened or remain unchanged. All summary measures still indicated the existence of inequalities as well as common patterns. Our findings suggest that there is a pattern of marginal exclusion and incremental patterns of inequality

  5. How do we reach the girls and women who are the hardest to reach? Inequitable opportunities in reproductive and maternal health care services in armed conflict and forced displacement settings in Colombia.

    Science.gov (United States)

    Rivillas, Juan Carlos; Devia Rodriguez, Raul; Song, Gloria; Martel, Andréanne

    2018-01-01

    This paper assesses inequalities in access to reproductive and maternal health services among females affected by forced displacement and sexual and gender-based violence in conflict settings in Colombia. This was accomplished through the following approaches: first, we assessed the gaps and gradients in three selected reproductive and maternal health care services. Second, we analyzed the patterns of inequalities in reproductive and maternal health care services and changes over time. And finally, we identified challenges and strategies for reaching girls and women who are the hardest to reach in conflict settings, in order to accelerate progress towards universal health coverage and to contribute to meeting the Sustainable Development Goals of good health and well-being and gender equality by 2030. Three types of data were required: data about health outcomes (relating to rates of females affected by conflict), information about reproductive and maternal health care services to provide a social dimension to unmask inequalities (unmet needs in family planning, antenatal care and skilled births attendance); and data on the female population. Data sources used include the National Information System for Social Protection, the National Registry of Victims, the National Administrative Department of Statistics, and Demographic Health Survey at three specific time points: 2005, 2010 and 2015. We estimated the slope index of inequality to express absolute inequality (gaps) and the concentration index to expresses relative inequality (gradients), and to understand whether inequality was eliminated over time. Our findings show that even though absolute health care service-related inequalities dropped over time, relative inequalities worsened or remain unchanged. All summary measures still indicated the existence of inequalities as well as common patterns. Our findings suggest that there is a pattern of marginal exclusion and incremental patterns of inequality in the

  6. The care unit in nursing home research: evidence in support of a definition.

    Science.gov (United States)

    Estabrooks, Carole A; Morgan, Debra G; Squires, Janet E; Boström, Anne-Marie; Slaughter, Susan E; Cummings, Greta G; Norton, Peter G

    2011-04-14

    Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A

  7. Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life.

    Science.gov (United States)

    Chavez, Laura J; Grannis, Connor; Dolce, Millie; Chisolm, Deena J

    2018-03-15

    Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care-related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). The study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0-100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. Among 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31-77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92-67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. Teen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  8. Managed Care, Distance Traveled, and Hospital Market Definition

    OpenAIRE

    Frech, Ted E

    1998-01-01

    Most scholars and antitrust cases have defined hospital service markets as primarily local. But, two recent decisions have greatly expanded geographic markets, incorporating hospitals as far as 100 miles apart. Managed care plans, now important in most markets, were believed to shift patients to distant hospitals to capture lower prices. We examine distance traveled and its connection to managed care penetration. In contrast to earlier literature, we examine both direct and indirect effects. ...

  9. The HIV care cascade in Switzerland: reaching the UNAIDS/WHO targets for patients diagnosed with HIV.

    Science.gov (United States)

    Kohler, Philipp; Schmidt, Axel J; Cavassini, Matthias; Furrer, Hansjakob; Calmy, Alexandra; Battegay, Manuel; Bernasconi, Enos; Ledergerber, Bruno; Vernazza, Pietro

    2015-11-28

    To describe the HIV care cascade for Switzerland in the year 2012. Six levels were defined: (i) HIV-infected, (ii) HIV-diagnosed, (iii) linked to care, (iv) retained in care, (v) on antiretroviral treatment (ART), and (vi) with suppressed viral load. We used data from the Swiss HIV Cohort Study (SHCS) complemented by a nationwide survey among SHCS physicians to estimate the number of HIV-patients not registered in the cohort. We also used Swiss ART sales data to estimate the number of patients treated outside the SHCS network. Based on the number of patients retained in care, we inferred the estimates for levels (i) to (iii) from previously published data. We estimate that (i) 15 200 HIV-infected individuals lived in Switzerland in 2012 (margins of uncertainty, 13 400-19 300). Of those, (ii) 12 300 (81%) were diagnosed, (iii) 12 200 (80%) linked, and (iv) 11 900 (79%) retained in care. Broadly based on SHCS network data, (v) 10 800 (71%) patients were receiving ART, and (vi) 10 400 (68%) had suppressed (Switzerland is substantially lower than previously reported, halving previous national HIV prevalence estimates to 0.2%. In Switzerland in 2012, 91% of patients in care were receiving ART, and 96% of patients on ART had suppressed viral load, meeting recent UNAIDS/WHO targets.

  10. Early definitive treatment rate as a quality indicator of care in acute gallstone pancreatitis.

    Science.gov (United States)

    Green, R; Charman, S C; Palser, T

    2017-11-01

    Early definitive treatment (cholecystectomy or endoscopic sphincterotomy in the same admission or within 2 weeks after discharge) of gallstone disease after a biliary attack of acute pancreatitis is standard of care. This study investigated whether compliance with early definitive treatment for acute gallstone pancreatitis can be used as a care quality indicator for the condition. A retrospective cohort study was conducted using the Hospital Episode Statistics database. All emergency admissions to National Health Service hospitals in England with a first time diagnosis of acute gallstone pancreatitis in the financial years 2008, 2009 and 2010 were examined. Trends in early definitive treatment between hospital trusts were examined and patient morbidity outcomes were determined. During the study interval there were 19 510 patients with an overall rate of early definitive treatment at 34·7 (range 9·4-84·7) per cent. In the 1-year follow-up period, 4661 patients (23·9 per cent) had one or more emergency readmissions for complications related to gallstone pancreatitis. Of these, 2692 (57·8 per cent) were readmissions for acute pancreatitis; 911 (33·8 per cent) were within the first 2 weeks of discharge, with the remaining 1781 (66·2 per cent) occurring after the point at which definitive treatment should have been received. Early definitive treatment resulted in a 39 per cent reduction in readmission risk (adjusted risk ratio (RR) 0·61, 95 per cent c.i. 0·58 to 0·65). The risk was further reduced for acute pancreatitis readmissions to 54 per cent in the early definitive treatment group (adjusted RR 0·46, 0·42 to 0·51). In acute gallstone pancreatitis, compliance with recommended early definitive treatment varied considerably, with associated variation in outcomes. Compliance should be used as a quality indicator to improve care. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  11. Needs assessments in palliative care: an appraisal of definitions and approaches used.

    Science.gov (United States)

    Higginson, Irene J; Hart, Sam; Koffman, Jonathan; Selman, Lucy; Harding, Richard

    2007-05-01

    We report a systematic appraisal of definitions and approaches to needs assessment in palliative care. Electronic databases were searched, and relevant individuals and organizations were contacted to identify needs assessments in palliative care. Over 200 articles were identified giving general information on needs assessment, and 77 articles comprised palliative care-related needs assessment reports. The reports originated from Africa (37), Australia (1), Europe (including former central/eastern European states) (35), USA (1), Latin America (5), and Asia (7). Two underpinning definitions of need were identified, that of Maslow from the field of psychology, and that of Bradshaw from sociology. However, in conducting needs assessments, these definitions were operationalized, and here the National Health Service Executive definition of need as "the ability to benefit from health care" is helpful. We identified three main categories of approach to needs assessment--epidemiological, corporate, and comparative--that can be used in combination. Careful consideration must be paid to any needs assessment data to ensure that the assessment is implemented.

  12. Primary care patients in the emergency department: who are they? A review of the definition of the 'primary care patient' in the emergency department.

    Science.gov (United States)

    Bezzina, Andrew J; Smith, Peter B; Cromwell, David; Eagar, Kathy

    2005-01-01

    To review the definition of 'primary care' and 'inappropriate' patients in ED and develop a generally acceptable working definition of a 'primary care' presentation in ED. A Medline review of articles on primary care in ED and the definitions used. A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential 'primary care', 'general practice', or 'inappropriate' patients in ED. A representative definition was developed premised on the common factors in these papers: low urgency/acuity--triage categories four or five in the Australasian Triage Scale, self-referred--by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on, presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred), unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted. This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.

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

    Science.gov (United States)

    Bultz, Barry D

    2017-06-01

    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.

  14. [FRC measurement in intensive care patients. A definition of standards].

    Science.gov (United States)

    Wauer, H J; Lorenz, B A; Kox, W J

    1998-10-01

    Determination of Functional Residual Capacity (FRC) can be performed through washout methods, indicator gas dilution or bodyplethysmography. Some of these techniques have been adapted for use in intensive care patients whilst being mechanically ventilated. However, most measurement setups are bulky, cumbersome to use and their running costs are high. Hence FRC measurement has not become a routine method in intensive care although it offers considerable advantages in the management of ventilated patients such as the determination of "best PEEP", the detection of progressive alveolar collapse in the course of acute lung injury and during weaning from mechanical ventilation. Up to now most efforts to improve and simplify FRC measurement were made at the expense of accuracy. An ideal method ought to be accurate, easy to handle and cost-effective. It should supply not only FRC data but also information about intrapulmonary gas distribution and dead space. These demands can be met using modern data acquisition software. The pros and cons of all methods available for FRC measurement are discussed in view of their suitability for intensive care patients. A conventional nitrogen washout using emission spectroscopy for measurement of nitrogen concentration gives satisfying exact values for the determination of the parameters mentioned above. The measurement error can be lowered under 5% by special corrections for flow and nitrogen signal (delay and rise times, changes of gas viscosity). For flow measurement a normal pneumotachograph can be used. Using a laptop computer for data acquisition the bed-side monitor fulfills most of the demands in intensive care. It is then also possible to measure indices of intrapulmonary gas distribution such as Alveolar Mixing Efficiency and Lung Clearance Index.

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

    NARCIS (Netherlands)

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

    2011-01-01

    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

  16. Remission of rheumatoid arthritis: should we care about definitions?

    Science.gov (United States)

    Aletaha, D; Smolen, J S

    2006-01-01

    A state of remission can be achieved in more and more rheumatoid arthritis (RA) patients. The combination of several RA disease activity measures seems to be important to provide an overall view of disease activity. Remission can be defined by two different approaches: one using a categorical model, requiring criteria for multiple variables to be fulfilled, each with its own threshold value (remission "criteria"); the other using a dimensional model, providing single measures of activity, which allow definition of remission by a single cut point (remission cut points for composite indices). The face validity of remission as defined by composite indices surpasses the one for the "criteria". Likewise, the ones that are not weighted seem to surpass the weighted ones, as can be seen by the significant proportion of patients that continues to have considerable swollen joint counts despite being in Disease Activity Score (DAS)-28 remission. All composite indices seem to perform similarly well as tests for remission using expert judgments as the gold standard.

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

    Science.gov (United States)

    Bhaumik, Soumyadeep; Mathew, Rebecca J

    2015-01-01

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

    Directory of Open Access Journals (Sweden)

    Soumyadeep Bhaumik

    2015-01-01

    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.

  19. A literature review on self-care of chronic illness: definition, assessment and related outcomes.

    Science.gov (United States)

    Ausili, Davide; Masotto, Matteo; Dall'Ora, Chiara; Salvini, Lorena; Di Mauro, Stefania

    2014-01-01

    Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients. A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies. Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed.

  20. [Dignity in the care of terminal ill and dying patients. Definitions and supportive interventions in palliative care].

    Science.gov (United States)

    Mehnert, A; Schröder, A S; Puhlmann, K; Müllerleile, U; Koch, U

    2006-11-01

    Most patients, family members, health care professional as well as volunteers would agree that dignified care and being allowed to die with dignity are superior and unquestionable goals of palliative care. Although the majority of people have a more or less vague concept of dignity and despite its significance for palliative care, only a few empirical approaches to describe the sense of dignity from patients' and health care professionals' perspectives have been undertaken. However, individual descriptions of the dignity concept and definitions can serve as an impetus to improve the current palliative care practice by the development and evaluation of psychotherapeutic interventions for patients near the end of life and the allocation of resources. This article considers an internationally developed empirical-based model of dignity in severe and terminal ill patients by Chochinov et al. Furthermore, it illustrates the understanding of dignity as well as self-perceived exertions of influence on a patient's dignity from the perspective of health care professionals and volunteers. Psychotherapeutic interventions and strategies are introduced that can help conserve the sense of dignity of patients during palliative care.

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

    Science.gov (United States)

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

    2017-01-01

    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

  2. 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.

    Science.gov (United States)

    Amirkhanian, Yuri; Kelly, Jeffrey; Kuznetsova, Anna; Meylakhs, Anastasia; Yakovlev, Alexey; Musatov, Vladimir; Chaika, Nikolay

    2014-01-01

    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. 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. 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. Implementation of treatment cascade goals requires complementing conventional paths of identifying PLH with feasible and effective community-based approaches

  3. Prison mental health in-reach teams, serious mental illness and the Care Programme Approach in England.

    Science.gov (United States)

    Brooker, Charlie; Webster, Russell

    2017-08-01

    The delivery of prison mental health services in England is examined over the last 12 years. Resources for services have grown significantly during this period and improved organisational models for the delivery of services are now in place. During this period however the challenges of working in the prison environment have increased. The paper argues that a history of sexual abuse or violence are common amongst prisoners and the Care Programme Approach (CPA) provides the vehicle to assess these histories through the use of routine enquiry. Commissioners of prison mental health services now need to ensure that teams are delivering cogent trauma-based interventions where relevant and the outcomes are measured. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  4. Reaching the hard to reach.

    Science.gov (United States)

    Bhiwandi, P; Campbell, M; Potts, M

    1994-01-01

    The 1994 International Conference on Population and Development proposed increasing contraceptive couple protection from 550 million in 1995 to 880 million in 2015. The task for family planning (FP) programs is to provide access to services for, sometimes, inaccessible rural populations. FP need based on desire for no more children has ranged from under 20% in Senegal to almost 80% in Peru. Socioeconomic development was found not to be a prerequisite for fertility change. Gender inequalities in education and social autonomy must be changed. FP access is very important among women with a disadvantaged background or among women unsure about FP. Bangladesh is a good example of a country with increased contraceptive prevalence despite low income. The rule of thumb is that contraception increases of 15% contribute to a drop in family size of about one child. Program effectiveness is related to a variety of factors: contraceptive availability at many locations, acceptable price of contraception, delivery of the oral contraceptives without prescriptions, and other strategies. FP is a service not a medical treatment. A range of methods must be promoted and available from a range of facilities. Contraceptive use is dependent on the woman's stage in her lifecycle and is dependent on informed choice. Community-based distribution systems are effective, whereas free distribution by poorly-trained field workers is not always very effective because patient payment of all or part of the cost assures quality and freedom of choice. Effective programs for underprivileged groups involve aggressive, easy to manage programs that can be replicated rapidly. FP serves a useful function in depressing maternal mortality among the poor in Africa, who have no access to quality health services. Social marketing is an effective strategy for reaching remote areas. Political will and robust management are necessary commodities.

  5. Who to include in palliative care research? Consequences of different population definitions in palliative care epidemiology.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Deliens, L.; Francke, A.L.; Stalman, W.A.B.; Willems, D.L.; Eijk, T.T.M. van; Wal, G. van der

    2003-01-01

    Object of the study: Epidemiological research into palliative care faces the problem of defining an adequate research population. Subjects in studies are alternately defined as patients receiving 'palliative care' , 'palliative treatment' or 'end of life care'. So far, it is not known how

  6. Bolivia programme evaluation of a package to reach an underserved population: Community-based maternal and newborn care economic analysis.

    Science.gov (United States)

    Barger, Diana; Pooley, Bertha; Dupuy, Julien Roger; Cardenas, Norma Amparo; Wall, Steve; Owen, Helen; Daviaud, Emmanuelle

    2017-10-01

    To address inequitable access to health services of indigenous communities in the Bolivian highlands, the Bolivian Ministry of Health, with the support of Save the Children-Saving Newborn Lives, conducted operational research to identify, implement and test a package of maternal and newborn interventions using locally recruited, volunteer Community Health Workers (vCHW) between 2008 and 2010. The additional annual economic and financial costs of the intervention were estimated from the perspective of the Bolivian Ministry of Health in two municipalities. The cost of intervention-stimulated increases in facility attendance was estimated with national surveillance data using a pre-post comparison, adjusted for secular trends in facility attendance. Three scale-up scenarios were modelled by varying the levels of coverage and the number (per mother and child pair) and frequency of home visits. Average cost per mother and average cost per home visit are presented in constant 2015 US$. Eighteen per cent of expectant mothers in the catchment area were visited at least once. The annualized additional financial cost of the community-based intervention across both municipalities was $43 449 of which 3% ($1324) was intervention design, 20% ($8474) set-up and 77% ($33 651) implementation. Drivers of additional costs were additional paid staff (68%), 81% of which was for management and support by local implementing partner and 19% of which was for vCHW supervision. The annual financial cost per vCHW was $595. Modelled scale-up scenarios highlight potential efficiency gains. Recognizing local imperatives to reduce inequalities by targeting underserved populations, the observed low coverage by vCHWs resulted in a high cost per mother and child pair ($296). This evaluation raises important questions about this model's ability to achieve its ultimate goals of reducing neonatal mortality and inequalities through behaviour change and increased care seeking and has served to

  7. Women’s Health Care Utilization among Harder-to-Reach HIV-Infected Women ever on Antiretroviral Therapy in British Columbia

    Directory of Open Access Journals (Sweden)

    Xuetao Wang

    2012-01-01

    Full Text Available Background. HIV-infected women are disproportionately burdened by gynaecological complications, psychological disorders, and certain sexually transmitted infections that may not be adequately addressed by HIV-specific care. We estimate the prevalence and covariates of women’s health care (WHC utilization among harder-to-reach, treatment-experienced HIV-infected women in British Columbia (BC, Canada. Methods. We used survey data from 231 HIV-infected, treatment-experienced women enrolled in the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA study, which recruited harder-to-reach populations, including aboriginal people and individuals using injection drugs. Independent covariates of interest included sociodemographic, psychosocial, behavioural, individual health status, structural factors, and HIV clinical variables. Logistic regression was used to generate adjusted estimates of associations between use of WHC and covariates of interest. Results. Overall, 77% of women reported regularly utilizing WHC. WHC utilization varied significantly by region of residence (P value <0.01. In addition, women with lower annual income (AOR (95% CI = 0.14 (0.04–0.54, who used illicit drugs (AOR (95% CI = 0.42 (0.19–0.92 and who had lower provider trust (AOR (95% CI = 0.97 (0.95–0.99, were significantly less likely to report using WHC. Conclusion. A health service gap exists along geographical and social axes for harder-to-reach HIV-infected women in BC. Women-centered WHC and HIV-specific care should be streamlined and integrated to better address women’s holistic health.

  8. Implementing the Institute of Medicine definition of disparities: an application to mental health care.

    Science.gov (United States)

    McGuire, Thomas G; Alegria, Margarita; Cook, Benjamin L; Wells, Kenneth B; Zaslavsky, Alan M

    2006-10-01

    In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

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

    Science.gov (United States)

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

    2016-01-01

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

  10. What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review.

    Science.gov (United States)

    Rotter, Thomas; Plishka, Christopher; Lawal, Adegboyega; Harrison, Liz; Sari, Nazmi; Goodridge, Donna; Flynn, Rachel; Chan, James; Fiander, Michelle; Poksinska, Bonnie; Willoughby, Keith; Kinsman, Leigh

    2018-01-01

    Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

  11. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction.

    Science.gov (United States)

    Olivier, Jill; Tsimpo, Clarence; Gemignani, Regina; Shojo, Mari; Coulombe, Harold; Dimmock, Frank; Nguyen, Minh Cong; Hines, Harrison; Mills, Edward J; Dieleman, Joseph L; Haakenstad, Annie; Wodon, Quentin

    2015-10-31

    At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Reaching the hard-to-reach.

    Science.gov (United States)

    Valdes, C

    1992-01-01

    Guatemala's family planning (FP) programs are innovative but contraceptive use is only 23%. Total fertility is 5.3 children/woman, and the 9.5 million population will double in 23 years. The problem is poverty and illiteracy among rural residents removed from health services. 80% live in poverty and 80% are illiterate. Government effort is devoted to combating diseases such as diarrhea so there are few funds for implementing a comprehensive population policy. There is support within the national government but FP lacks priority status. APROFAM's goals are to use innovative marketing methods to inform the rural population who lack access to and knowledge about FP. Service delivery is constrained by the difficulty in reaching remote areas where 4 out of 10 indigenous Guatemalans live. Infant mortality can reach as high as 200/1000 live births. Population growth has slowed, and APROFAM plans to reach 16,000 more in the future. Promotions are conducted in several languages and aired on radio, television, and in the print media. It has been found that market research is the most effective strategy in reaching indigenous families. APROFAM has also been effective in upgrading service facilities through training, client surveys, and setting improved clinic standards. Breastfeeding, training, and voluntary sterilization programs contribute to the primary care effort. The example is given of Paulina Lebron from a very poor area who has learned how to space her children and thus improve the standard of living for her family. Eventually, she convinced herself and her family that sterilization was necessary, and now the couple enjoy the bliss of newlyweds without fear of pregnancy.

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

    Science.gov (United States)

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

    2017-03-24

    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

  14. Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition.

    Science.gov (United States)

    Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J G; Javouhey, Etienne; Peters, Mark J; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

    2016-12-01

    Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS. We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality). From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89-0.94), and 0.956 (95 % CI 0.93-0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality. This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock.

  15. The impact of a primary care e-communication intervention on the participation of chronic disease patients who had not reached guideline suggested treatment goals.

    Science.gov (United States)

    Lussier, Marie-Thérèse; Richard, Claude; Glaser, Emma; Roberge, Denis

    2016-04-01

    To evaluate the efficacy of two web-based educational approaches on doctor-patient communication. The study focused on chronic disease (CD) patients in a lengthy relationship with their family physician (FP) who had not reached guideline suggested treatment goals (off-target) for their CDs. 322 hypertensive, diabetic, or dyslipidemic patients of 18 FPs were randomised into three groups: Usual Care (UC), e-Learning (e-L) and e-Learning+Workshop (e-L+W). Interventions were based on Cegala's PACE system: Prepare, Ask questions, Check understanding, Express concerns. Communication was evaluated using the Roter Interaction Analysis System (RIAS), MEDICODE and questionnaires. Encounter length was similar across groups. RIAS showed that e-L+W group engaged in more socio-emotional talk and PACE-like utterances. MEDICODE showed that interventions increased frequency, initiative and dialogue for selected CD medication themes. Quality of communication was perceived as satisfactory at baseline and did not change. Following interventions, CD patients were more activated even in well-established doctor-patient relationships. PACE web-based interventions are accessible and effective at increasing CD patients' participation. They increase legitimacy to express the patient experience. FPs should present this type of training to CD patients as an integral part of their routine practice and consider referring patients to complete it. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. 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".

    Science.gov (United States)

    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

    2017-04-01

    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

  17. Adherence to tuberculosis care in Canadian Aboriginal populations, Part 1: definition, measurement, responsibility, barriers.

    Science.gov (United States)

    Orr, Pamela

    2011-04-01

    In a 2-part series, the current literature with respect to adherence to tuberculosis care among Canadian Aboriginal populations is reviewed. In the current paper, which comprises part 1 of this review, adherence is defined, and methods of measurement, issues of responsibility and potential barriers to adherence are explored. Study design. Literature review. A systematic search and analytic review of relevant studies was undertaken, including an online search of electronic databases (PubMed, PsychINFO, MEDLINE, Native Health Database, Scopus, Social Science Citation Index) and publications by governmental and non-governmental agencies. Poor adherence to therapy for TB disease is the most common cause of initial treatment failure and of disease relapse worldwide. Adherence to care for TB disease is necessary for the health of both the affected individual and society as a whole. Adherence is a task-specific behaviour that is not inherent to ethnic identity. The term applies only when common agreement over a care plan has been reached between patient and provider. The International Standards for Tuberculosis Care and the Patients Charter outline the responsibilities for adherence on the part of both patients and providers. For Canadian Aboriginals, barriers to adherence may derive from a complex interaction between the health system, personal factors and social factors, which may include dysfunctional acute and public health systems, dissonant (between health care provider and patient) belief systems, concurrent co-morbidities and life stressors, poverty and social stigma. Adherence is a task-specific behaviour, not a personality trait. It is influenced by the interaction of systemic, personal and societal factors. These factors must be understood within the historical experience of TB and the cultural meaning of health and illness among Indigenous Canadians.

  18. Constructing definitions of safety risks while nurses care for hospitalised older people: Secondary analysis of qualitative data.

    Science.gov (United States)

    Dahlke, Sherry; Hall, Wendy A; Baumbusch, Jennifer

    2017-09-01

    The aim of this secondary qualitative descriptive analysis was to examine how nurses construct a definition of older peoples' safety risks and provide care while working within organisational contexts that are focused on diminishing patient risks. Numbers of older patients are increasing in acute hospital contexts-contexts that place their focus on patient safety. Nurses need to manage tensions between older peoples' risks, evidence-informed practice decisions, limited resources and organisational emphases on patient falls. To date, their practice dilemmas have not been well examined. A secondary qualitative descriptive analysis was conducted using data that were collected between June 2010 and May 2011 to examine nursing practice with hospitalised older people. All field notes and transcribed data were reviewed to generate themes representing 18 Registered Nurses' perceptions about safe care for hospitalised older people. The first author generated categories that described how nurses construct definitions of safety risks for older people. All authors engaged in an iterative analytic process that resulted in themes capturing nurses' efforts to provide care in limited resource environments while considering older peoples' safety risks. Nurses constructed definitions of patient safety risks in the context of institutional directives. Nurses provided care using available resources as efficiently as possible and accessing co-worker support. They also minimised the importance of older people's functional abilities by setting priorities for medically delegated tasks and immobilising their patients to reduce their risks. Nurses' definitions of patient risk, which were shaped by impoverished institutional resources and nurses' lack of valuing of functional abilities, contributed to suboptimal care for older adults. Nurses' definitions of risk as physical injury reduced their attention to patients' functional abilities, which nurses reported suffered declines as a result

  19. Reaching the unreached.

    Science.gov (United States)

    Ariyaratne, A T

    1989-01-01

    Embodied in the child survival revolution are ideological, methodological, and organizational innovations aimed at radical change in the condition of the world's children as rapidly as possible. In countries such as Sri Lanka, child survival and health for all by the year 2000 often seem to be impossible goals, given the tumultuous socioeconomic and political conditions. In Sri Lanka, the quality of life has been eroded, not enhanced, by the importation of Western technology and managerial capitalism and the destruction of indigenous processes. The chaos and violence that have been brought into the country have made it difficult to reach the poor children, women, and refugees in rural areas with primary health care interventions. Sri Lanka's unreachable--the decision making elites--have blocked access to the unreached--the urban and rural poor. If governments are to reach the unreached, they must remove the obstacles to a people-centered, community development process. It is the people themselves, and the institutions of their creation, that can reach the children amidst them in greatest need. To achieve this task, local communities must be provided with basic human rights, the power to make decisions that affect their lives, necessary resources, and appropriate technologies. Nongovernmental organizations can play a crucial role as bridges between the unreached and the unreachable by promoting community empowerment, aiding in the formation of networks of community organizations, and establishing linkages with government programs. If the ruling elites in developing countries can be persuaded to accommodate the needs and aspirations of those who, to date, have been excluded from the development process, the child survival revolution can be a nonviolent one.

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

    Science.gov (United States)

    Evans, Natalie; Meñaca, Arantza; Koffman, Jonathan; Harding, Richard; Higginson, Irene J; Pool, Robert; Gysels, Marjolein

    2012-07-01

    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. Our aim was to appraise cultural competency approaches described in the British literature on EoL care and minority ethnic groups. This is a critical review. Articles on cultural competency were identified from a systematic review of the literature on minority ethnic groups and EoL care in the United Kingdom. Terms, definitions, and conceptual models of cultural competency approaches were identified and situated according to purpose, components, and origin. Content analysis of definitions and models was carried out to identify key components. One-hundred thirteen articles on minority ethnic groups and EoL care in the United Kingdom were identified. Over half (n=60) contained a term, definition, or model for cultural competency. In all, 17 terms, 17 definitions, and 8 models were identified. The most frequently used term was "culturally sensitive," though "cultural competence" was defined more often. Definitions contained one or more of the components: "cognitive," "implementation," or "outcome." Models were categorized for teaching or use in patient assessment. Approaches were predominantly of American origin. The variety of terms, definitions, and models underpinning cultural competency approaches demonstrates a lack of conceptual clarity, and potentially complicates implementation. Further research is needed to compare the use of cultural competency approaches in diverse cultures and settings, and to assess the impact of such approaches on patient outcomes.

  1. The effects of intraoperative positioning on patients undergoing early definitive care for femoral shaft fractures.

    Science.gov (United States)

    Apostle, K L; Lefaivre, K A; Guy, P; Broekhuyse, H M; Blachut, P A; O'Brien, P J; Meek, R N

    2009-10-01

    To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position. Retrospective cohort study, single centered. One level 1 trauma center. Nine hundred eighty-eight patients representing 1027 femoral shaft fractures treated with IM nails were identified through a prospectively gathered database between 1987 and 2006. Antegrade IM nail insertion with reaming of the femoral canal in either the supine or lateral position. Mortality was the primary outcome. Admission to intensive care unit (ICU) was the secondary outcome measure and a surrogate measure of morbidity. Literature review was performed to identify factors shown to contribute to morbidity and mortality in orthopaedic trauma patients. Intraoperative position in either the supine or lateral position was added to this list. Logistic regression analysis was performed to determine the magnitude and effect of the independent variables on each of the study end points. To determine if a more significant trend toward less favorable outcomes was observed with increasing severity of injury, particularly injuries of the chest and thorax, subgroup analysis was performed for all those with a femur fracture and an Injury Severity Score > or =18 and all those with a femur fracture and an Abbreviated Injury Score chest > or =3. Intraoperative position in either the supine or lateral position was not a significant predictor of mortality or ICU admission for the original cohort or the subgroup of Injury Severity Score > or =18. However, for the subgroup of Abbreviated Injury Score chest > or =3, intraoperative positioning in the lateral position had a statistically significant protective effect against ICU admission (P = 0.044). For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in

  2. Reach Address Database (RAD)

    Data.gov (United States)

    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,...

  3. GAP-REACH

    Science.gov (United States)

    Lewis-Fernández, Roberto; Raggio, Greer A.; Gorritz, Magdaliz; Duan, Naihua; Marcus, Sue; Cabassa, Leopoldo J.; Humensky, Jennifer; Becker, Anne E.; Alarcón, Renato D.; Oquendo, María A.; Hansen, Helena; Like, Robert C.; Weiss, Mitchell; Desai, Prakash N.; Jacobsen, Frederick M.; Foulks, Edward F.; Primm, Annelle; Lu, Francis; Kopelowicz, Alex; Hinton, Ladson; Hinton, Devon E.

    2015-01-01

    Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-itemGAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article. PMID:24080673

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

    Science.gov (United States)

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

    2012-05-01

    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.

  5. REACH: impact on the US cosmetics industry?

    Science.gov (United States)

    Pouillot, Anne; Polla, Barbara; Polla, Ada

    2009-03-01

    The Registration, Evaluation, Authorization and restriction of Chemicals (REACH) is a recent European regulation on chemical substances meant to protect human health and the environment. REACH imposes the "precautionary principle" where additional data and definitive action are required when uncertainty is identified. The cosmetics industry is only partially concerned by REACH: while the stages of registration and evaluation apply to cosmetics, those of authorization and restriction most likely will not, as cosmetic ingredients are already subject to regulation by various agencies and directives. REACH has potential benefits to the industry including the possibility of reassuring consumers and improving their image of chemicals and cosmetics. However, REACH also has potential disadvantages, mainly with regard to impeding innovation. The American cosmetics industry will be affected by REACH, because all US manufacturers who export substances to Europe will have to fully comply with REACH.

  6. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care: Who do we reach?

    NARCIS (Netherlands)

    Stoop, C.H.; Nefs, G.M.; Pop, V.J.M.; Pouwer, F.

    2017-01-01

    AIMS: This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. METHODS: People with

  7. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care : Who do we reach?

    NARCIS (Netherlands)

    Stoop, C.H.; Nefs, G.M.; Pop, V.J.M.; Pouwer, François

    2017-01-01

    Aims: This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. Methods: People with

  8. Applying systems biology to biomedical research and health care: a précising definition of systems medicine.

    Science.gov (United States)

    Schleidgen, Sebastian; Fernau, Sandra; Fleischer, Henrike; Schickhardt, Christoph; Oßa, Ann-Kristin; Winkler, Eva C

    2017-11-21

    Systems medicine has become a key word in biomedical research. Although it is often referred to as P4-(predictive, preventive, personalized and participatory)-medicine, it still lacks a clear definition and is open to interpretation. This conceptual lack of clarity complicates the scientific and public discourse on chances, risks and limits of Systems Medicine and may lead to unfounded hopes. Against this background, our goal was to develop a sufficiently precise and widely acceptable definition of Systems Medicine. In a first step, PubMed was searched using the keyword "systems medicine". A data extraction tabloid was developed putting forward a means/ends-division. Full-texts of articles containing Systems Medicine in title or abstract were screened for definitions. Definitions were extracted; their semantic elements were assigned as either means or ends. To reduce complexity of the resulting list, summary categories were developed inductively. In a second step, we applied six criteria for adequate definitions (necessity, non-circularity, non-redundancy, consistency, non-vagueness, and coherence) to these categories to derive a so-called précising definition of Systems Medicine. We identified 185 articles containing the term Systems Medicine in title or abstract. 67 contained at least one definition of Systems Medicine. In 98 definitions, we found 114 means and 132 ends. From these we derived the précising definition: Systems Medicine is an approach seeking to improve medical research (i.e. the understanding of complex processes occurring in diseases, pathologies and health states as well as innovative approaches to drug discovery) and health care (i.e. prevention, prediction, diagnosis and treatment) through stratification by means of Systems Biology (i.e. data integration, modeling, experimentation and bioinformatics). Our study also revealed the visionary character of Systems Medicine. Our insights, on the one hand, allow for a realistic identification of

  9. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model

    OpenAIRE

    Moore, Julia E.; Grouchy, Michelle; Graham, Ian D.; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E.

    2016-01-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. F...

  10. Project Engage: Snowball Sampling and Direct Recruitment to Identify and Link Hard-to-Reach HIV-Infected Persons Who Are Out of Care.

    Science.gov (United States)

    Wohl, Amy Rock; Ludwig-Barron, Natasha; Dierst-Davies, Rhodri; Kulkarni, Sonali; Bendetson, Jesse; Jordan, Wilbert; Bolan, Robert; Smith, Terry; Cunningham, William; Pérez, Mario J

    2017-06-01

    Innovative strategies are needed to identify and link hard-to-find persons living with HIV (PLWH) who are out of care (OOC). Project Engage, a health department-based project in Los Angeles County, used a mixed-methods approach to locate and provide linkage for PLWH who have limited contact with HIV medical and nonmedical services. Incentivized social network recruitment (SNR) and direct recruitment (DR) was used to identify eligible OOC alters for a linkage intervention that included HIV clinic selection, appointment and transportation support, reminder calls/texts, and clinic navigation. Between 2012 and 2015, 112 alters were identified using SNR (n = 74) and DR (n = 38). Most alters were male (80%), African American (38%), and gay (60%). Sizable percentages were homeless (78%), had engaged in sex work (32%) in the previous 6 months, had injected drugs (47%), were incarcerated in the previous 12 months (50%), and had only received HIV care during the previous 5 years while incarcerated (24%). SNR alters were more likely than DR alters to be African American, uninsured, unemployed, homeless, sex workers, injection drug users, recently incarcerated, and have unmet service needs. Alters linked to care within 3 (69%), 4-6 (5%), and 7-12 months (8%), and 72% were retained at 6-12 months. The percent virally suppressed increased (27% vs. 41%) and the median viral load decreased (P = 0.003) between linkage and follow-up at 6-12 months. The alternative approaches presented were effective at locating marginalized HIV-positive persons who are OOC for linkage and retention. The SNR approach was most successful at identifying alters with serious social challenges and gaps in needed medical/ancillary services.

  11. Health and beyond…strategies for a better India: using the “prison window” to reach disadvantaged groups in primary care

    Science.gov (United States)

    Bhaumik, Soumyadeep; Mathew, Rebecca J.

    2015-01-01

    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. PMID:26288765

  12. Teratology testing under REACH.

    Science.gov (United States)

    Barton, Steve

    2013-01-01

    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.

  13. Global reach and engagement

    Science.gov (United States)

    2016-09-01

    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?

  14. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model.

    Science.gov (United States)

    Moore, Julia E; Grouchy, Michelle; Graham, Ian D; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E

    2016-05-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. Copyright © 2016 Longwoods Publishing.

  15. A longitudinal evaluation of persons with disabilities: does a longitudinal definition help define who receives necessary care?

    Science.gov (United States)

    Chan, Leighton; Ciol, Marcia A; Shumway-Cook, Anne; Yorkston, Kathryn M; Dudgeon, Brian J; Asch, Steven M; Hoffman, Jeanne M

    2008-06-01

    To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators. Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient's disability status in activities of daily living (ADLs). Assessment of the health care indicators commenced after the second interview and continued throughout the survey period (an additional 1-3y). National survey. Participants (N=29,074) of the Medicare Current Beneficiary Survey (1992-2001) with no, increasing, decreasing, and stable ADL disability. Not applicable. The incidence of 5 avoidable outcomes, receipt of 3 preventive care measures, and adherence to 32 diagnostically based indicators assessing the quality of treatment for acute myocardial infarction [AMI], angina, breast cancer, cerebrovascular accident, transient ischemic attack, cholelithiasis, chronic obstructive pulmonary disease [COPD], congestive heart failure, depression, gastrointestinal bleeding, diabetes, and hypertension. For most indicators, less than 75% of eligible patients received necessary care, regardless of disability status. For 5 indicators, less than 50% of patients received appropriate treatment. In a logistic regression analysis that controlled for patient age, sex, race, and income, disability status was a significant factor in 7 quality measures (AMI, breast cancer, COPD, diabetes, angina, pneumonia, annual visits). Using a longitudinal definition of disability and objective health quality indicators, we found that disability status can be an important factor in determining receipt of quality health care in a broad range of diagnostic categories. However, the impact of disability status varies depending on the indicator measured. In this cohort of patients, the changing nature of a person's disability seems to have less impact than whether they ever have had any functional deficits.

  16. Suitability of current definitions of ambulatory care sensitive conditions for research in emergency department patients: a secondary health data analysis.

    Science.gov (United States)

    Frick, Johann; Möckel, Martin; Muller, Reinhold; Searle, Julia; Somasundaram, Rajan; Slagman, Anna

    2017-10-22

    The aim of this study was to investigate the suitability of existing definitions of ambulatory care sensitive conditions (ACSC) in the setting of an emergency department (ED) by assessing ACSC prevalence in patients admitted to hospital after their ED stay. The secondary aim was to identify ACSC suitable for specific application in the ED setting. Observational clinical study with secondary health data. Two EDs of the Charité-Universitätsmedizin Berlin. All medical ED patients of the 'The Charité Emergency Medicine Study' (CHARITEM) study, who were admitted as inpatients during the 1-year study period (n=13 536). Prevalence of ACSC. Prevalence of ACSC in the study population differed significantly depending on the respective ACSC set used. Prevalence ranged between 19.1% (95% CI 18.4% to 19.8%; n=2586) using the definition by Albrecht et al and 36.6% (95% CI 35.8% to 37.5%; n=4960) using the definition of Naumann et al . (pdefinitions) was 48.1% (95% CI 47.2% to 48.9%; n=6505). Some frequently observed diagnoses such as ' convulsion and epilepsy ' (prevalence: 3.4%, 95% CI 3.1% to 3.7%; n=455), ' diseases of the urinary system ' (prevalence: 1.4%; 95% CI 1.2% to 1.6%; n=191) or ' atrial fibrillation and flutter ' (prevalence: 1.0%, 95% CI 0.8% to 1.2%, n=134) are not included in all of the current ACSC definitions. The results highlight the need for an optimised, ED-specific ACSC definition. Particular ACSC diagnoses (such as ' convulsion and epilepsy ' or ' diseases of the urinary system ' and others) seem to be of special relevance in an ED population but are not included in all available ACSC definitions. Further research towards the development of a suitable and specific ACSC definition for research in the ED setting seems warranted. German Clinical Trials Register Deutsches Register für Klinische Studien: DRKS-ID: DRKS00000261. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved

  17. Racial/Ethnic Disparities in Mental Health Care Utilization among U.S. College Students: Applying the Institution of Medicine Definition of Health Care Disparities.

    Science.gov (United States)

    Hunt, Justin B; Eisenberg, Daniel; Lu, Liya; Gathright, Molly

    2015-10-01

    The authors apply the Institute of Medicine's definition of health care disparities to college students. The analysis pools data from the first two waves of the Healthy Minds Study, a multicampus survey of students' mental health (N = 13,028). A probit model was used for any past-year service utilization, and group differences in health status were adjusted by transforming the entire distribution for each minority population to approximate the white distribution. Disparities existed between whites and all minority groups. Compared to other approaches, the predicted service disparities were greater because this method included the effects of mediating SES variables. Health care disparities persist in the college setting despite improved access and nearly universal insurance coverage. Our findings emphasize the importance of investigating potential sources of disparities beyond geography and coverage.

  18. Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

    NARCIS (Netherlands)

    Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J. G.; Javouhey, Etienne; Peters, Mark J.; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

    2016-01-01

    Purpose Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and

  19. Underinsurance in children with special health care needs: the impact of definition on findings.

    Science.gov (United States)

    Preskitt, Julie K; McEldowney, Rene P; Mulvihill, Beverly A; Wingate, Martha S; Menachemi, Nir

    2013-10-01

    To identify differences in groups of children with special healthcare needs (CSHCN) identified as underinsured by two alternate definitions and discuss implications for policy decisions based on using one definition over another. Secondary data from the National Survey of CSHCN 2005/2006 were analyzed. Only CSHCN who were continuously-insured for 12 months were included in analyses. We identified groups of underinsured CSHCN using two general definitions ("economic" and "attitudinal") and three mutually-exclusive groups (identified by both definitions, identified by attitudinal but not economic, and identified by economic but not attitudinal). Key variables included demographics and condition characteristics. Different underinsurance rates were identified [attitudinal = 30.9 % (n = 11,470); economic = 22.7 % (n = 8,447)] with fair agreement by kappa score (κ = 0.3194; Z = 65.91; p > 0.0001). Differences across mutually-exclusive groups included family income ≥400 % FPL (attitudinal only = 34.2 %, economic only = 16.3 %, both = 18.4 %; p needed equipment/supplies/home health (OR = 1.31, p needs.

  20. Refractory septic shock in children : a European Society of Paediatric and Neonatal Intensive Care definition

    NARCIS (Netherlands)

    Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J. G.; Javouhey, Etienne; Peters, Mark J.; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

    2016-01-01

    Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal

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

    Science.gov (United States)

    2013-01-01

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

  2. Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator

    National Research Council Canada - National Science Library

    Gallagher, Brian; Cen, Liyi; Hannan, Edward L

    2005-01-01

    Objective: Evaluate the Agency for Healthcare Research and Quality's Patient Safety Indicator that identifies patients with selected infections that result from medical care during hospital inpatient treatment...

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

    Science.gov (United States)

    Pitt, Catherine; Roberts, Bayard; Checchi, Francesco

    2012-01-10

    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. 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. 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. 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-specific evidence becomes available. Decision analytic modelling

  4. ASPEN-AND-ESPEN: A postacute-care comparison of the basic definition of malnutrition from the American Society of Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics with the European Society for Clinical Nutrition and Metabolism definition.

    Science.gov (United States)

    Sánchez-Rodríguez, Dolores; Marco, Ester; Ronquillo-Moreno, Natalia; Maciel-Bravo, Liev; Gonzales-Carhuancho, Abel; Duran, Xavier; Guillén-Solà, Anna; Vázquez-Ibar, Olga; Escalada, Ferran; Muniesa, Josep M

    2018-01-25

    The aim of this study was to assess the prevalence of malnutrition by applying the ASPEN/AND definition and the ESPEN consensus definition in a postacute-care population, and secondly, to determine the metrological properties of the set of six clinical characteristics that constitute the ASPEN/AND basic diagnosis, compared to the ESPEN consensus, based mostly on objective anthropometric measurements. Prospective study of 84 consecutive deconditioned older inpatients (85.4 ± 6.2; 59.5% women) admitted for rehabilitation in postacute care. ASPEN/AND diagnosis of malnutrition was considered in presence of at least two of the following: low energy intake, fluid accumulation, diminished handgrip strength, and loss of weight, muscle mass, or subcutaneous fat. Sensitivity, specificity, positive and negative predictive values, accuracy, likelihood ratios, and kappa statistics were calculated for ASPEN/AND criteria and compared with ESPEN consensus. The prevalence of malnutrition by ASPEN/AND criteria was 63.1% and by ESPEN consensus, 20.2%; both diagnoses were associated with significantly longer length of stay, but the ESPEN definition was significantly associated with poorer functional outcomes after the rehabilitation program. Compared to ESPEN consensus, ASPEN/AND diagnosis showed fair validity (sensitivity = 94.1%; specificity = 44.8%); kappa statistic was 2.217. Applying the ASPEN/AND definition obtained a higher prevalence of malnutrition in a postacute-care population than was identified by the ESPEN definition. ASPEN/AND criteria had fair validity and agreement compared with the ESPEN definition. A simple, evidence-based, unified malnutrition definition might improve geriatric care. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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

    Science.gov (United States)

    Read, Marilyn A.

    2003-01-01

    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…

  6. Adolescent and Adult HIV Providers' Definitions of HIV-Infected Youths' Successful Transition to Adult Care in the United States.

    Science.gov (United States)

    Philbin, Morgan M; Tanner, Amanda E; Ma, Alice; Chambers, Brittany D; Ware, Samuella; Kinnard, Elizabeth N; Hussen, Sophia A; Lee, Sonia; Fortenberry, J Dennis

    2017-10-01

    It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.

  7. Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations.

    Science.gov (United States)

    Sawtell, Mary; Sweeney, Lorna; Wiggins, Meg; Salisbury, Cathryn; Eldridge, Sandra; Greenberg, Lauren; Hunter, Rachael; Kaur, Inderjeet; McCourt, Christine; Hatherall, Bethan; Findlay, Gail; Morris, Joanne; Reading, Sandra; Renton, Adrian; Adekoya, Ruth; Green, Belinda; Harvey, Belinda; Latham, Sarah; Patel, Kanta; Vanlessen, Logan; Harden, Angela

    2018-03-05

    The provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care. The Community REACH trial will assess the effectiveness and cost-effectiveness of engaging communities in the co-production and delivery of an intervention that addresses this issue. The study design is a matched cluster randomised controlled trial with integrated process and economic evaluations. The unit of randomisation is electoral ward. The intervention will be delivered in 10 wards; 10 comparator wards will have normal practice. The primary outcome is the proportion of pregnant women attending their antenatal booking appointment by the 12th completed week of pregnancy. This and a number of secondary outcomes will be assessed for cohorts of women (n = approximately 1450 per arm) who give birth 2-7 and 8-13 months after intervention delivery completion in the included wards, using routinely collected maternity data. Eight hospitals commissioned to provide maternity services in six NHS trusts in north and east London and Essex have been recruited to the study. These trusts will provide anonymised routine data for randomisation and outcomes analysis. The process evaluation will examine intervention implementation, acceptability, reach and possible causal pathways. The economic evaluation will use a cost-consequences analysis and decision model to evaluate the intervention. Targeted community engagement in the research process was a priority. Community REACH aims to increase early initiation of antenatal care using an intervention that is co-produced and

  8. Outcome in elderly patients undergoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution

    International Nuclear Information System (INIS)

    Mohan, Dasarahally S.; Suh, John H.; Phan, Jennifer L.; Kupelian, Patrick A.; Cohen, Bruce H.; Barnett, Gene H.

    1998-01-01

    Purpose: To determine the efficacy of definitive surgery and radiation in patients aged 70 years and older with supratentorial glioblastoma multiforme. Methods and Materials: We selected elderly patients (≥ 70 years) who had primary treatment for glioblastoma multiforme at our tertiary care institution from 1977 through 1996. The study group (n = 102) included 58 patients treated with definitive radiation, 19 treated with palliative radiation, and 25 who received no radiation. To compare our results with published findings, we grouped our patients according to the applicable prognostic categories developed by the Radiation Therapy Oncology Group (RTOG): RTOG group IV (n = 6), V (n = 70), and VI (n = 26). Patients were retrospectively assigned to prognostic group IV, V, or VI based on age, performance status, extent of surgery, mental status, neurologic function, and radiation dose. Treatment included surgical resection and radiation (n 49), biopsy alone (n = 25), and biopsy followed by radiation (n = 28). Patients were also stratified according to whether they were optimally treated (gross total or subtotal resection with postoperative definitive radiation) or suboptimally treated (biopsy, biopsy + radiation, surgery alone, or surgery + palliative radiation). Patients were considered to have a favorable prognosis (n = 39) if they were optimally treated and had a Karnofsky Performance Status (KPS) score of at least 70. Results: The median survival for patients according to RTOG groups IV, V, and VI was 9.2, 6.6, and 3.1 months, respectively (log-rank, p < 0.0004). The median overall survival was 5.3 months. The definitive radiation group (n = 58) had a median survival of 7.3 months compared to 4.5 months in the palliative radiation group (n = 19) and 1.2 months in the biopsy-alone group (p < 0.0001). Optimally treated patients had a median survival of 7.4 months compared to 2.4 months in those suboptimally treated (p < 0.0001). The favorable prognosis group had an

  9. Constipation in specialized palliative care: factors related to constipation when applying different definitions.

    Science.gov (United States)

    Erichsén, E; Milberg, A; Jaarsma, T; Friedrichsen, M

    2016-02-01

    For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied. The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation. Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios. Patients with hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both constipated, MC & PC, (n = 78) had higher odds of having cancer- disease. There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.

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

    Science.gov (United States)

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

    2014-09-19

    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.

  11. Solar Hydrogen Reaching Maturity

    Directory of Open Access Journals (Sweden)

    Rongé Jan

    2015-09-01

    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.

  12. Escalating energy costs threaten health care for critically ill and homebound seniors: home care nurses, aides and therapists drive 4.8 billion miles per year to reach shut-in patients.

    Science.gov (United States)

    2008-08-01

    The rapidly rising cost of fuel has had a profound impact on the home care and hospice industry. In an effort to quantify the increased burden, the National Association for Home Care & Hospice's (NAHC) Foundation for Hospice and Home Care conducted a study showing that home care and hospice providers drive over 5 billion miles per year to deliver services --about two-and-a-half times the number driven by United Parcel Service, the international delivery service. The findings garnered significant interest by the media and elected officials. Reprinted in this issue of CARING Magazine are the press release that NAHC issued regarding the study, as well as a graphic representation of the study's findings that was circulated to the National Conference of State Legislatures at its most recent meeting in July. Also represented on these pages is a reprint from the Congressional Record of July 11, 2008, in which Senator Debbie Stabenow (D-MI), one of the highest ranking Democrats in the US. Senate, entered into the record an article from the front page of the New York Times of July 5, 2008, that covered the mileage study.

  13. Measurement of the potential geographic accessibility from call to definitive care for patient with acute stroke.

    Science.gov (United States)

    Freyssenge, J; Renard, F; Schott, A M; Derex, L; Nighoghossian, N; Tazarourte, K; El Khoury, C

    2018-01-12

    The World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility. The aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car. The method proposed analyses the potential geographic accessibility of stroke care infrastructure in different scenarios. The study allows better considering of the issues inherent to an area: difficult weather conditions, traffic congestion and failure to respect the distance limits of emergency transport. Depending on the scenario, access times vary considerably within the same commune. For example, between the first and the second scenario for cities in the north of Rhône county, there is a 10 min difference to the nearest Primary Stroke Center (PSC). For the first scenario, 90% of the population is 20 min away of the PSC and 96% for the second scenario. Likewise, depending on the modal vector (fire brigade or emergency medical service), overall accessibility from the emergency call to admission to a Comprehensive Stroke Center (CSC) can vary by as much as 15 min. The setting up of the various scenarios and modal comparison based on the calculation of overall accessibility makes this a new method for calculating potential access to care facilities. It is important to take into account the specific pathological features and the availability of care facilities for modelling. This method is innovative and recommendable for measuring accessibility in the field of health care. This study makes possible to highlight the patients' extension of care delays. Thus, this can impact the improvement of patient care and rethink the

  14. BROOKHAVEN: Proton goal reached

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

    On March 30 the 35-year old Alternating Gradient Synchrotron (AGS) exceeded its updated design goal of 6 x 10 13 protons per pulse (ppp), by accelerating 6.3 x 10 13 ppp, a world record intensity. This goal was set 11 years ago and achieving it called for the construction of a new booster and the reconstruction of much of the AGS. The booster was completed in 1991, and reached its design intensity of 1.5 x 10 13 ppp in 1993. The AGS reconstruction was finished in 1994, and by July of that year the AGS claimed a new US record intensity for a proton synchrotron of 4 x 10 13 ppp, using four booster pulses. Reaching the design intensity was scheduled for 1995. In 1994, the AGS had seemed to be solidly limited to 4 x 10 13 ppp, but in 1995 the operations crew, working on their own in the quiet of the owl shift, steadily improved the intensity, regularly setting new records, much to the bemusement of the machine physicists. The physicists, however, did contribute. A second harmonic radiofrequency cavity in the booster increased the radiofrequency bucket area for capture, raising the booster intensity from 1.7 to 2.1 x 10 13 ppp. In the AGS, new radiofrequency power supplies raised the available voltage from 8 to 13 kV, greatly enhancing the beam loading capabilities of the system. A powerful new transverse damping system successfully controlled instabilities that otherwise would have destroyed the beam in less than a millisecond. Also in the AGS, 35th harmonic octupole resonances were found

  15. BROOKHAVEN: Proton goal reached

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1995-09-15

    On March 30 the 35-year old Alternating Gradient Synchrotron (AGS) exceeded its updated design goal of 6 x 10{sup 13} protons per pulse (ppp), by accelerating 6.3 x 10{sup 13} ppp, a world record intensity. This goal was set 11 years ago and achieving it called for the construction of a new booster and the reconstruction of much of the AGS. The booster was completed in 1991, and reached its design intensity of 1.5 x 10{sup 13} ppp in 1993. The AGS reconstruction was finished in 1994, and by July of that year the AGS claimed a new US record intensity for a proton synchrotron of 4 x 10{sup 13} ppp, using four booster pulses. Reaching the design intensity was scheduled for 1995. In 1994, the AGS had seemed to be solidly limited to 4 x 10{sup 13} ppp, but in 1995 the operations crew, working on their own in the quiet of the owl shift, steadily improved the intensity, regularly setting new records, much to the bemusement of the machine physicists. The physicists, however, did contribute. A second harmonic radiofrequency cavity in the booster increased the radiofrequency bucket area for capture, raising the booster intensity from 1.7 to 2.1 x 10{sup 13} ppp. In the AGS, new radiofrequency power supplies raised the available voltage from 8 to 13 kV, greatly enhancing the beam loading capabilities of the system. A powerful new transverse damping system successfully controlled instabilities that otherwise would have destroyed the beam in less than a millisecond. Also in the AGS, 35th harmonic octupole resonances were found.

  16. Optimising self-care support for people with heart failure and their caregivers: development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping.

    Science.gov (United States)

    Greaves, Colin J; Wingham, Jennifer; Deighan, Carolyn; Doherty, Patrick; Elliott, Jennifer; Armitage, Wendy; Clark, Michelle; Austin, Jackie; Abraham, Charles; Frost, Julia; Singh, Sally; Jolly, Kate; Paul, Kevin; Taylor, Louise; Buckingham, Sarah; Davis, Russell; Dalal, Hasnain; Taylor, Rod S

    2016-01-01

    We aimed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life. We used intervention mapping to guide the development of our intervention. We identified "targets for change" by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We then used behaviour change theory, expert opinion and a taxonomy of behaviour change techniques, to identify barriers to and facilitators of change and to match intervention strategies to each target. A patient and public involvement group helped to identify patient and caregiver needs, refine the intervention objectives and strategies and deliver training to the intervention facilitators. A feasibility study (ISRCTN25032672) involving 23 patients, 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention. The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention is a comprehensive self-care support programme comprising the "Heart Failure Manual", a choice of two exercise programmes for patients, a "Family and Friends Resource" for caregivers, a "Progress Tracker" tool and a facilitator training course. The main targets for change are engaging in exercise training, monitoring for symptom deterioration, managing stress and anxiety, managing medications and understanding heart failure. Secondary targets include managing low mood and smoking cessation. The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks, via home and telephone contacts. The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators, patients and caregivers. Intervention fidelity analysis and stakeholder feedback suggested

  17. An evaluation of the diagnostic accuracy of the 1991 American College of Chest Physicians/Society of Critical Care Medicine and the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society sepsis definition.

    Science.gov (United States)

    Zhao, Huifang; Heard, Stephen O; Mullen, Marie T; Crawford, Sybil; Goldberg, Robert J; Frendl, Gyorgy; Lilly, Craig M

    2012-06-01

    Limited research has been conducted to compare the test characteristics of the 1991 and 2001 sepsis consensus definitions. This study assessed the accuracy of the two sepsis consensus definitions among adult critically ill patients compared to sepsis case adjudication by three senior clinicians. Observational study of patients admitted to intensive care units. Seven intensive care units of an academic medical center. A random sample of 960 patients from all adult intensive care unit patients between October 2007 and December 2008. None. Sensitivity, specificity, and the area under the receiver operating characteristic curve for the two consensus definitions were calculated by comparing the number of patients who met or did not meet consensus definitions vs. the number of patients who were or were not diagnosed with sepsis by adjudication. The 1991 sepsis definition had a high sensitivity of 94.6%, but a low specificity of 61.0%. The 2001 sepsis definition had a slightly increased sensitivity but a decreased specificity, which were 96.9% and 58.3%, respectively. The areas under the receiver operating characteristic curve for the two definitions were not statistically different (0.778 and 0.776, respectively). The sensitivities and areas under the receiver operating characteristic curve of both definitions were lower at the 24-hr time window level than those of the intensive care unit stay level, though their specificities increased slightly. Fever, high white blood cell count or immature forms, low Glasgow coma score, edema, positive fluid balance, high cardiac index, low PaO2/FIO2 ratio, and high levels of creatinine and lactate were significantly associated with sepsis by both definitions and adjudication. Both the 1991 and the 2001 sepsis definition have a high sensitivity but low specificity; the 2001 definition has a slightly increased sensitivity but a decreased specificity compared to the 1991 definition. The diagnostic performances of both definitions were

  18. Older persons' worries expressed during home care visits: exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences.

    NARCIS (Netherlands)

    Hafskjold, L.; Eide, T.; Holmström, I.K.; Sundling, V.; Dulmen, S. van; Eide, H.

    2016-01-01

    Objective: Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims

  19. Reaching Beyond The Stars

    Science.gov (United States)

    Baker, Mariah; Rosenthal, L.; Gaughan, A.; Hopkins, E.

    2014-01-01

    Strawbridge Observatory at Haverford College is home to a undergraduate-led public observing program. Our program holds ~once monthly public events throughout the academic year that take advantage of eyepiece observing on our 16-inch and 12-inch telescopes as well as of the classroom, library, and projection system. These resources allow us to organize a variety of astronomy related activities that are engaging for individuals of all ages: accessible student talks, current film screenings and even arts and crafts for the families who attend with young children. These events aim to spark curiosity in others about scientific discovery and about the remarkable nature of the world in which we live. In addition to exciting local families about astronomy, this program has excited Haverford students from a range of disciplines about both science and education. Being entirely student led means that we are able to take the initiative in planning, coordinating and running all events, fostering an atmosphere of collaboration, experimentation and commitment amongst our volunteers. Additionally, this program is one of the few at Haverford that regularly reaches beyond the campus walls to promote and build relationships with the outside community. In light of this, our program presents a distinctive and enlightening opportunity for student volunteers: we get to use our scientific backgrounds to educate a general audience, while also learning from them about how to communicate and inspire in others the excitement we feel about the subject of astronomy. The work on this project has been supported by NSF AST-1151462.

  20. UX-15 Reaches LEP

    CERN Multimedia

    2001-01-01

    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...

  1. Reaching out to retirees.

    Science.gov (United States)

    Adigozel, Ozgur; Huber, Celia; Lewis, Greg; Singhal, Shubham

    2006-01-01

    The numbers pertaining to the approaching demographic boom in health-care-related expenditures are eye-popping: Health-related financial products to help retiring baby boomers deal with out-of-pocket costs alone will generate up to 80 billion dollars in revenues and 8-12 billion dollars in pre-tax profits by 2014. But health insurers will have to refocus their efforts if they want to take full advantage of this opportunity. (For more, see "Turning Subscribers Into Customers: The Future Is Now" in the July/August issue, the first in this two-part series.) Two areas are critical: product innovation to provide comprehensive solutions that meet seniors' needs more effectively, and advice-based distribution that creates privileged customer relationships.

  2. Data capture and communication during transfers to definitive care in an inclusive trauma system.

    Science.gov (United States)

    Bradley, Nori L; Garraway, Naisan; Bell, Nathaniel; Lakha, Nasira; Hameed, S Morad

    2017-05-01

    Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer. We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243). Completion rates of paramedic form and ATLS primary survey variables were extracted. Nominal and interval descriptives were calculated. Documentation rates were considered deficient at system-wide information transfer. Copyright © 2016. Published by Elsevier Ltd.

  3. Prevalence of malnutrition and sarcopenia in a post-acute care geriatric unit: Applying the new ESPEN definition and EWGSOP criteria.

    Science.gov (United States)

    Sánchez-Rodríguez, Dolores; Marco, Ester; Ronquillo-Moreno, Natalia; Miralles, Ramón; Vázquez-Ibar, Olga; Escalada, Ferran; Muniesa, Josep M

    2017-10-01

    The European Society of Clinical Nutrition and Metabolism (ESPEN) consensus definition of malnutrition has been applied in hospitalized older diabetics and middle-aged patients, geriatric outpatients, and healthy elderly and young individuals. In a post-acute care setting, our aim was to assess malnutrition (ESPEN definition) and determine its relationship with sarcopenia in older in-patients deconditioned due to an acute process. Eighty-eight in-patients aged ≥70 years with body mass index (BMI) malnutrition risk using biochemical markers and Mini-Nutritional Assessment-Short Form (MNA-SF). The ESPEN definition was applied: 1) BMI Malnutrition prevalence was 4.5%, 7.9%, and 17% using ESPEN definitions 1, 2a, and 2b, respectively; 19.3% were malnourished. Prevalence of sarcopenia was 37.5%, of which 90.9% fulfilled ESPEN malnutrition criteria, a significant association (p = 0.02). No differences in biochemical markers were observed between patients with or without malnutrition or sarcopenia. ESPEN criteria constitute an appropriate tool to establish a malnutrition diagnosis in post-acute care. Sarcopenia, as defined by EWGSOP, was present in 37.5% of patients, of which 90.9% fulfilled ESPEN criteria; therefore, malnutrition was significantly related to sarcopenia. Additional work is needed to determine further implications of the ESPEN consensus definition. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  4. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report

    Science.gov (United States)

    Salins, Naveen; Gursahani, Roop; Mathur, Roli; Iyer, Shivakumar; Macaden, Stanley; Simha, Nagesh; Mani, Raj Kumar; Rajagopal, M. R.

    2018-01-01

    Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date. Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research. The consensus statement was created using Nominal Group and Delphi Method. Results: Twenty-five definitions related to the limitations of treatment and providing palliative care at the end of life were created by reviewing existing international documents and suitably modifying it to the Indian sociocultural context by achieving national consensus. Twenty-five terminologies defined within the scope of this document are (1) terminal illness, (2) actively dying, (3) life-sustaining treatment, (4) potentially inappropriate treatment, (5) cardiopulmonary resuscitation (CPR), (6) do not attempt CPR, (7) withholding life-sustaining treatment, (8) withdrawing life-sustaining treatment, (9) euthanasia (10) active shortening of the dying process, (11) physician-assisted suicide, (12) palliative care, (13) EOLC, (14) palliative sedation, (15) double effect, (16) death, (17) best interests, (18) health-care decision-making capacity, (19) shared decision-making, (20) advance directives, (21) surrogates, (22) autonomy, (23) beneficence, (24) nonmaleficence, and (25) justice.

  5. Do working environment interventions reach shift workers?

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...

  6. 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.

    Science.gov (United States)

    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

    2011-08-04

    , 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. Clinicaltrials.gov NCT00866619.

  7. Animal hypnosis: an attempt to reach a definition.

    Science.gov (United States)

    Carli, G

    1982-05-01

    Animal hypnosis is a prolonged immobility response which may be defined according to several physiological parameters. In the rabbit, EEG, hyppocampal rhythmic activity, spinal reflexes and local cerebral glucose utilization are modified during this condition. The duration of the response is affected by persistent nociceptive stimuli. Corticosterone plasma levels are correlated with individual susceptibility and elevated when habituation to hypnosis occurs. Testosterone metabolism in the hypothalamus is found decreased after a single trial and increased following repeated trials. The possible importance of these modifications is discussed.

  8. Development of a validated clinical case definition of generalized tonic-clonic seizures for use by community-based health care providers.

    Science.gov (United States)

    Anand, Krishnan; Jain, Satish; Paul, Eldho; Srivastava, Achal; Sahariah, Sirazul A; Kapoor, Suresh K

    2005-05-01

    To develop and test a clinical case definition for identification of generalized tonic-clonic seizures (GTCSs) by community-based health care providers. To identify symptoms that can help identify GTCSs, patients with history of a jerky movements or rigidity in any part of the body ever in life were recruited from three sites: the community, secondary care hospital, and tertiary care hospital. These patients were administered a 14-item structured interview schedule focusing on the circumstances surrounding the seizure. Subsequently, a neurologist examined each patient and, based on available investigations, classified them as GTCS or non-GTCS cases. A logistic regression analysis was performed to select symptoms that were to be used for case definition of GTCSs. Validity parameters for the case definition at different cutoff points were calculated in another set of subjects. In total, 339 patients were enrolled in the first phase of the study. The tertiary care hospital contributed the maximal number of GTCS cases, whereas cases of non-GTCS were mainly from the community. At the end of phase I, the questionnaire was shortened from 14 to eight questions based on statistical association and clinical judgment. After phase II, which was conducted among 170 subjects, three variables were found to be significantly related to the presence of GTCSs by logistic regression: absence of stress (13.1; 4.1-41.3), presence of frothing (13.7; 4.0-47.3), and occurrence in sleep (8.3; 2.0-34.9). As a case definition using only three variables did not provide sufficient specificity, three more variables were added based on univariate analysis of the data (incontinence during the episode and unconsciousness) and review of literature (injury during episode). A case definition consisting of giving one point to an affirmative answer for each of the six questions was tested. At a cutoff point of four, sensitivity was 56.9 (47.4-66.0) and specificity, 96.3 (86.2-99.4). Among the 197 GTCS

  9. Do working environment interventions reach shift workers?

    Science.gov (United States)

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

    2016-01-01

    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. We used questionnaire data from 5361 female care workers in the Danish eldercare sector. The questions concerned usual working hours, quality of leadership, and self-reported implementation of workplace activities aimed at stress reduction, reorganization of the working hours, and participation in improvements of working procedures or qualifications. Compared with day workers, shift 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 to some extent explained the lack of reach of interventions especially among fixed evening workers. In the light of the evidence of shift workers' stressful working conditions, we suggest that future studies focus on the generalizability of results of the present study and on how to reach this group and meet their needs when designing and implementing workplace interventions.

  10. Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs.

    Science.gov (United States)

    Bethell, Christina D; Read, Debra; Brockwood, Krista

    2004-05-01

    National health goals include ensuring that all children have a medical home. Historically, medical home has been determined by the presence of a usual or primary source of care, such as a pediatrician or a family physician. More recent definitions expand on this simplistic notion of medical home. A definition of medical home set forth by the American Academy of Pediatrics (AAP) includes 7 dimensions and 37 discrete concepts for determining the presence of a medical home for a child. Standardized methods to operationalize these definitions for purposes of national, state, health plan, or medical practice level reporting on the presence of medical homes for children are essential to assessing and improving health care system performance in this area. The objective of this study was to identify methods to measure the presence of medical homes for all children and for children with special health care needs (CSHCN) using existing population-based data sets. Methods were developed for using existing population-based data sets to assess the presence of medical homes, as defined by the AAP, for children with and without special health care needs. Data sets evaluated included the National Survey of Children With Special Health Care Needs, the National Medical Expenditures Panel Survey, the Consumer Assessment of Health Plans Study Child Survey (CAHPS), and the Consumer Assessment of Health Plans Study Child Survey--Children With Chronic Conditions (CAHPS-CCC2.0H). Alternative methods for constructing measures using existing data were compared and results used to inform the design of a new method for use in the upcoming National Survey of Children's Health. Data from CAHPS-CCC2.0H are used to illustrate measurement options and variations in the overall presence of medical homes for children across managed health care plans as well as to evaluate in which areas of the AAP definition of medical home improvements may be most needed for all CSHCN. Existing surveys vary in

  11. Editor's Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function.

    Science.gov (United States)

    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

    2018-02-01

    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

  12. Reaching ignition in the tokamak

    International Nuclear Information System (INIS)

    Furth, H.P.

    1985-06-01

    This review covers the following areas: (1) the physics of burning plasmas, (2) plasma physics requirements for reaching ignition, (3) design studies for ignition devices, and (4) prospects for an ignition project

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

    Science.gov (United States)

    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…

  14. Evaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units.

    Science.gov (United States)

    Gaur, Aditya H; Miller, Marlene R; Gao, Cuilan; Rosenberg, Carol; Morrell, Gloria C; Coffin, Susan E; Huskins, W Charles

    2013-07-01

    To evaluate the application of the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce CLABSIs; to identify sources of variability in the application of the definition. Online survey using 18 standardized case scenarios. Each described a positive blood culture in a patient and required a yes- or-no answer to the question "Is this a CLABSI?" NHSN staff responses were the reference standard. Sixty-five US PICUs and PHOUs. Staff who routinely adjudicate CLABSIs using NHSN definitions. Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios evaluating application of 1 of the 3 criteria ("known pathogen," 78% [1.7%]; "skin contaminant, >1 year of age," 76% [SE, 2.5%]; "skin contaminant, ≤1 year of age," 81% [3.8%]; [Formula: see text]). The mean percentage of concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was present or incubating on admission (64% [4.6%]; [Formula: see text]) or to distinguish between primary and secondary bacteremia (65% [2.5%]; [Formula: see text]). The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary from secondary bloodstream infection are needed.

  15. Prostate cancer: experience with definitive irradiation in the aged

    International Nuclear Information System (INIS)

    Green, N.; Bodner, H.; Broth, E.

    1985-01-01

    When considering therapeutic options for localized prostate cancer, stage and grade of disease have been the most important determinants. In the elderly, the nominal age has assumed increasing importance in the final decision. A balanced judgment must be reached between the patient's normal life expectancy and the rapidity with which the cancer may be expected to express its malignant potential. By careful attention to patient selection and the details of treatment, definitive irradiation can improve quality of life and survival. Of 63 patients aged seventy-three to ninety years referred for irradiation, 56 were found medically suitable for definitive treatment. A review of the authors experience is presented

  16. Older persons' worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences.

    Science.gov (United States)

    Hafskjold, Linda; Eide, Tom; Holmström, Inger K; Sundling, Vibeke; van Dulmen, Sandra; Eide, Hilde

    2016-12-01

    Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons' worries and (2) the content of these expressions. An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. The two-step approach provides an in-depth knowledge of older persons' worries, causes of worries, and their related emotions. The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-07-01

    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

  18. Definition of successful defibrillation

    NARCIS (Netherlands)

    Koster, Rudolph W.; Walker, Robert G.; van Alem, Anouk P.

    2006-01-01

    OBJECTIVES: The definition of defibrillation shock "success" endorsed by the International Liaison Committee on Resuscitation since the publication of Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care has been removal of ventricular fibrillation at 5 secs after shock

  19. RECORDS REACHING RECORDING DATA TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    G. W. L. Gresik

    2013-07-01

    Full Text Available The goal of RECORDS (Reaching Recording Data Technologies is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.

  20. Records Reaching Recording Data Technologies

    Science.gov (United States)

    Gresik, G. W. L.; Siebe, S.; Drewello, R.

    2013-07-01

    The goal of RECORDS (Reaching Recording Data Technologies) is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.

  1. Efficacy, cost-utility and reach of an eHealth self-management application 'Oncokompas' that helps cancer survivors to obtain optimal supportive care: study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    van der Hout, Anja; van Uden-Kraan, Cornelia F; Witte, Birgit I; Coupé, Veerle M H; Jansen, Femke; Leemans, C René; Cuijpers, Pim; van de Poll-Franse, Lonneke V; Verdonck-de Leeuw, Irma M

    2017-01-01

    BACKGROUND: Cancer survivors have to deal with a wide range of physical symptoms, psychological, social and existential concerns, and lifestyle issues related to cancer and its treatment. Therefore, it is essential that they have access to optimal supportive care services. The eHealth

  2. Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

    Science.gov (United States)

    Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David

    2014-11-01

    Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision

  3. Children's mental health emergencies-part 1: challenges in care: definition of the problem, barriers to care, screening, advocacy, and resources.

    Science.gov (United States)

    Baren, Jill M; Mace, Sharon E; Hendry, Phyllis L; Dietrich, Ann M; Grupp-Phelan, Jacqueline; Mullin, Jacqueline

    2008-06-01

    At a time when there has been a reduction in mental health resources nationwide, the incidence of mental health disorders in children has seen a dramatic increase for many reasons. A review of the literature was done to identify the epidemiology, barriers to care, useful emergency department (ED) screening methods, and resources regarding pediatric mental health disorders in the ED. Although there are many challenges to the provision of care for children with mental health emergencies, some resources are available. Furthermore, ED screening and intervention may be effective in improving patient outcomes. Collaborative efforts with multidisciplinary services can create a continuum of care, promote better identification of children and adolescents with mental health disorders, and promote early recognition and intervention, which are key to effective referral and treatment.

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

    Science.gov (United States)

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

    2012-01-01

    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…

  5. Deriving Prostate Alpha-Beta Ratio Using Carefully Matched Groups, Long Follow-Up and the Phoenix Definition of Biochemical Failure

    International Nuclear Information System (INIS)

    Shaffer, Richard; Pickles, Tom; Lee, Richard; Moiseenko, Vitali

    2011-01-01

    Purpose: Prior studies have derived low values of alpha-beta ratio (a/ss) for prostate cancer of approximately 1-2 Gy. These studies used poorly matched groups, differing definitions of biochemical failure, and insufficient follow-up. Methods and Materials: National Comprehensive Cancer Network low- or low-intermediate risk prostate cancer patients, treated with external beam radiotherapy or permanent prostate brachytherapy, were matched for prostate-specific antigen, Gleason score, T-stage, percentage of positive cores, androgen deprivation therapy, and era, yielding 118 patient pairs. The Phoenix definition of biochemical failure was used. The best-fitting value for a/ss was found for up to 90-month follow-up using maximum likelihood analysis, and the 95% confidence interval using the profile likelihood method. Linear quadratic formalism was applied with the radiobiological parameters of relative biological effectiveness = 1.0, potential doubling time = 45 days, and repair half-time = 1 hour. Bootstrap analysis was performed to estimate uncertainties in outcomes, and hence in a/ss. Sensitivity analysis was performed by varying the values of the radiobiological parameters to extreme values. Results: The value of a/ss best fitting the outcomes data was >30 Gy, with lower 95% confidence limit of 5.2 Gy. This was confirmed on bootstrap analysis. Varying parameters to extreme values still yielded best-fit a/ss of >30 Gy, although the lower 95% confidence interval limit was reduced to 0.6 Gy. Conclusions: Using carefully matched groups, long follow-up, the Phoenix definition of biochemical failure, and well-established statistical methods, the best estimate of a/ss for low and low-tier intermediate-risk prostate cancer is likely to be higher than that of normal tissues, although a low value cannot be excluded.

  6. After Katrina, Teachers Reaching Out

    Science.gov (United States)

    Perlmutter, David D.

    2005-01-01

    In this article, the author talks about teachers communicating with students to show willingness to listen and care. In cases of real emotional distress, he refers students to the proper campus counseling services, but after Hurricane Katrina, it broke the barriers of his disengagement from students' personal problem. He learned that in many…

  7. A Cross-Cultural Comparative Study of Undergraduate Health Care Professional Students’ Knowledge, Definitions, Education, and Training Experience of Domestic Violence in Northern Ireland and Jordan

    Directory of Open Access Journals (Sweden)

    Nahla Mansour Al-Ali

    2012-11-01

    Full Text Available The purpose of this study was to examine the cross-cultural differences in the knowledge, definitions, and current training and educational experiences of domestic violence (DV among third-year undergraduate nursing, dental, and medical students from two distinct universities in Northern Ireland and Jordan. A convenience sample of 774 undergraduate students was recruited. Analysis was based on gender, culture, and educational speciality, as seen through the integrated lens of a social ecological and feminist theory model. The results showed that a substantial percentage of all participants had never received any education or training on DV in their undergraduate programs. The majority of participants had good knowledge about DV, and half of the participants believed that DV is “common” in their respective countries. Significant gender and cultural differences in the definition of DV were also revealed, with Northern Irish students and female students in both cultures more likely to regard a range of behaviors as a form of DV. The research findings suggest several potential directions for change, emphasizing the importance of establishing a systematic evidence-based multidisciplinary and interagency approach to teaching and learning for student health care professionals on the topic of DV in their undergraduate programs.

  8. Defending definitions of life.

    Science.gov (United States)

    Mix, Lucas John

    2015-01-01

    Over the past 10 years, it has become unpopular to talk about definitions of life, under the assumption that attempts at a precise definition are counterproductive. Recent attempts have failed to meet strict philosophical criteria for definitions and have failed to reach consensus. I argue that provisional definitions are necessary for clear communications. Our current knowledge of biology justifies a number of universal claims about the category of life. Whether or not "life" represents a natural category, it maps to a number of important, observable processes. Given the importance of those processes and the extent of our knowledge, plural explicit definitions of life (and related categories) will be necessary for progress in astrobiology and origin-of-life studies as well as biology in general. I propose concrete categories related to, but not necessarily coextensive with, life for clear communication and hypothesis formation: Woese life, Darwin life, Haldane life.

  9. REACH and nanomaterials: current status

    International Nuclear Information System (INIS)

    Alessandrelli, Maria; Di Prospero Fanghella, Paola; Polci, Maria Letizia; Castelli, Stefano; Pettirossi, Flavio

    2015-01-01

    New challenges for regulators are emerging about a specific assessment and appropriate management of the potential risks of nanomaterials. In the framework of European legislation on chemicals, Regulation (EC) No. 1907/2006 REACH aims to ensure the safety of human health and the environment through the collection of information on the physico-chemical characteristics of the substances and on their profile (eco) toxicological and the identification of appropriate risk management linked to 'exposure to these substances without impeding scientific progress and the competitiveness of industry. In order to cover the current shortage of information on the safety of nanomaterials and tackle the acknowledged legal vacuum, are being a rich activities, carried out both by regulators both by stake holders, and discussions on the proposals for adapting the European regulatory framework for chemicals . The European Commission is geared to strengthen the REACH Regulation by means of updates of its annexes. The importance of responding to the regulatory requirements has highlighted the need for cooperation between European organizations, scientists and industries to promote and ensure the safe use of nanomaterials. [it

  10. Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

    Science.gov (United States)

    2014-01-01

    Background Providing scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care. Methods We extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases’ compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data. Results We successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for

  11. Objectivity applied to embodied subjects in health care and social security medicine: definition of a comprehensive concept of cognitive objectivity and criteria for its application.

    Science.gov (United States)

    Solli, Hans Magnus; Barbosa da Silva, António

    2018-03-02

    The article defines a comprehensive concept of cognitive objectivity (CCCO) applied to embodied subjects in health care. The aims of this study were: (1) to specify some necessary conditions for the definition of a CCCO that will allow objective descriptions and assessments in health care, (2) to formulate criteria for application of such a CCCO, and (3) to investigate the usefulness of the criteria in work disability assessments in medical certificates from health care provided for social security purposes. The study design was based on a philosophical conceptual analysis of objectivity and subjectivity, the phenomenological notions 'embodied subject', 'life-world', 'phenomenological object' and 'empathy', and an interpretation of certificates as texts. The study material consisted of 18 disability assessments from a total collection of 86 medical certificates provided for social security purposes, written in a Norwegian hospital-based mental health clinic. Four necessary conditions identified for defining a CCCO were: (A) acknowledging the patient's social context and life-world, (B) perceiving patients as cognitive objects providing a variety of meaningful data (clinical, psychometric, and behavioural data - i.e. activities and actions, meaningful expressions and self-reflection), (C) interpreting data in context, and (D) using general epistemological principles. The criteria corresponding to these conditions were: (a) describing the patient's social context and recognizing the patient's perspective, (b) taking into consideration a variety of quantitative and qualitative data drawn from the clinician's perceptions of the patient as embodied subject, (c) being aware of the need to interpret the data in context, and (d) applying epistemological principles (professional expertise, dialogical intersubjectivity, impartiality, accuracy and correctness). Genuine communication is presupposed. These criteria were tested in the work disability assessments of medical

  12. Palliative Care

    Science.gov (United States)

    ... for Patients and Families What Is Palliative Care? Definition Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to ...

  13. Reaching remote areas in Latin America.

    Science.gov (United States)

    Jaimes, R

    1994-01-01

    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

  14. Unified communication to reach vulnerable mothers.

    Science.gov (United States)

    Tezcan, B; Von Rege, I; Henkson, H; Oteng-Ntim, E

    2011-01-01

    The feasibility of using a mobile text to reach vulnerable patient groups was assessed in this study. A total of 121 pregnant or postnatal women were randomly asked to complete a questionnaire. The questionnaire was given to them in the antenatal clinic, postnatal ward, antenatal ward or in the day assessment unit at St Thomas' Hospital, London. The forms were collected and analysed using an Excel database. The results of this survey show that mobile technology is readily available for 97% of the obstetric population. In mothers from vulnerable groups and in mothers from deprived areas, 61% possessed 3rd generation mobile technology. The majority of mothers surveyed wanted their care supplemented by the use of their mobile phones.

  15. Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study.

    Science.gov (United States)

    Woringer, Maria; Cecil, Elizabeth; Watt, Hillary; Chang, Kiara; Hamid, Fozia; Khunti, Kamlesh; Dubois, Elizabeth; Evason, Julie; Majeed, Azeem; Soljak, Michael

    2017-06-14

    Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.

  16. Transcatheter aortic valve replacement and vascular complications definitions.

    Science.gov (United States)

    Van Mieghem, Nicolas M; Généreux, Philippe; van der Boon, Robert M A; Kodali, Susheel; Head, Stuart; Williams, Matthew; Daneault, Benoit; Kappetein, Arie-Pieter; de Jaegere, Peter P; Leon, Martin B; Serruys, Patrick W

    2014-03-20

    Transcatheter aortic valve replacement (TAVR) requires large calibre catheters and is therefore associated with increased vascular complications. The aim of this study was to illustrate the impact of the different definitions of major vascular complications on their incidence and to underscore the importance of uniform reporting. We pooled dedicated databases of consecutive patients undergoing TAVR from two tertiary care facilities and looked for the incidence of major vascular complications using various previously reported definitions. The level of agreement (Kappa statistic) between the respective definitions and the Valve Academic Research Consortium (VARC) consensus definition of vascular complications was assessed. A total of 345 consecutive patients underwent transfemoral TAVR and were included in this analysis. A completely percutaneous access and closure technique was applied in 96% of cases. Arterial sheath size ranged between 18 and 24 Fr, the majority being 18 Fr (60%). Procedural success was reached in 94.5%. Depending on the definition used, major vascular complications occurred in 5.2-15.9% of patients. According to the VARC definitions, the rate of major and minor vascular complications was 9.0% and 9.6%, respectively. Major vascular complications according to VARC criteria demonstrated at least a substantial level of agreement with the SOURCE registry (k 0.80), the UK registry (k 0.82) the Italian registry (k 0.72) and "FRANCE" registry (k 0.70) definitions, compared to a moderate level of agreement with the definitions used in the German registry ( 0.47) and the 18 Fr Safety and Efficacy study (k 0.42). Minor complications according to VARC demonstrated a moderate agreement only with vascular complications using the German registry definition (k 0.54). Non-uniformity in how vascular complications are defined precludes any reliable comparison between previously reported TAVR registries. The VARC consensus document offers standardised endpoint

  17. Reaching for the red planet

    Science.gov (United States)

    David, L

    1996-05-01

    The distant shores of Mars were reached by numerous U.S. and Russian spacecraft throughout the 1960s to mid 1970s. Nearly 20 years have passed since those successful missions which orbited and landed on the Martian surface. Two Soviet probes headed for the planet in July, 1988, but later failed. In August 1993, the U.S. Mars Observer suddenly went silent just three days before it was to enter orbit around the planet and was never heard from again. In late 1996, there will be renewed activity on the launch pads with three probes departing for the red planet: 1) The U.S. Mars Global Surveyor will be launched in November on a Delta II rocket and will orbit the planet for global mapping purposes; 2) Russia's Mars '96 mission, scheduled to fly in November on a Proton launcher, consists of an orbiter, two small stations which will land on the Martian surface, and two penetrators that will plow into the terrain; and finally, 3) a U.S. Discovery-class spacecraft, the Mars Pathfinder, has a December launch date atop a Delta II booster. The mission features a lander and a microrover that will travel short distances over Martian territory. These missions usher in a new phase of Mars exploration, setting the stage for an unprecedented volley of spacecraft that will orbit around, land on, drive across, and perhaps fly at low altitudes over the planet.

  18. Metasurface holograms reaching 80% efficiency.

    Science.gov (United States)

    Zheng, Guoxing; Mühlenbernd, Holger; Kenney, Mitchell; Li, Guixin; Zentgraf, Thomas; Zhang, Shuang

    2015-04-01

    Surfaces covered by ultrathin plasmonic structures--so-called metasurfaces--have recently been shown to be capable of completely controlling the phase of light, representing a new paradigm for the design of innovative optical elements such as ultrathin flat lenses, directional couplers for surface plasmon polaritons and wave plate vortex beam generation. Among the various types of metasurfaces, geometric metasurfaces, which consist of an array of plasmonic nanorods with spatially varying orientations, have shown superior phase control due to the geometric nature of their phase profile. Metasurfaces have recently been used to make computer-generated holograms, but the hologram efficiency remained too low at visible wavelengths for practical purposes. Here, we report the design and realization of a geometric metasurface hologram reaching diffraction efficiencies of 80% at 825 nm and a broad bandwidth between 630 nm and 1,050 nm. The 16-level-phase computer-generated hologram demonstrated here combines the advantages of a geometric metasurface for the superior control of the phase profile and of reflectarrays for achieving high polarization conversion efficiency. Specifically, the design of the hologram integrates a ground metal plane with a geometric metasurface that enhances the conversion efficiency between the two circular polarization states, leading to high diffraction efficiency without complicating the fabrication process. Because of these advantages, our strategy could be viable for various practical holographic applications.

  19. 42 CFR 1000.10 - General definitions.

    Science.gov (United States)

    2010-10-01

    ... 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 chapter...

  20. The definite article in Romance expletives and long weak definites

    Directory of Open Access Journals (Sweden)

    M.Teresa Espinal

    2017-03-01

    Full Text Available This paper focuses on some issues involving expletive articles and long weak definites in Romance (mainly Spanish, Brazilian Portuguese and Catalan, in comparison to DPs that elicit a strong reading. We show the similarities between expletive definites and long weak definites, and we argue for an analysis in common to other polarity items in terms of polarity sensitivity. We reach the conclusion that the definite article in Romance comes in two variants: the referentially unique variant (to be translated as the semantic 'iota 'operator and the polar variant, formally characterized with an abstract [+σ] feature, that encodes a weak bound reading (to be semantically translated by an existential operator.

  1. Broadening of Generalized Anxiety Disorders Definition Does not Affect the Response to Psychiatric Care: Findings from the Observational ADAN Study

    Science.gov (United States)

    Álvarez, Enrique; Carrasco, Jose L; Olivares, José M; López-Gómez, Vanessa; Vilardaga, Inma; Perez, María

    2012-01-01

    Objective: To elucidate the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD), we examined prospectively the evolution of GAD symptoms in two groups of patients; one group diagnosed according to DSM-IV criteria and the other, according to broader criteria. Method: Multicentre, prospective and observational study conducted on outpatient psychiatric clinics. Patients were selected from October 2007 to January 2009 and diagnosed with GAD according to DSM-IV criteria (DSM-IV group) or broader criteria. Broader criteria were considered 1-month of excessive or non-excessive worry and only 2 of the associated symptoms listed on DSM-IV for GAD diagnosis. Socio-demographic data, medical history and functional outcome measures were collected three times during a 6-month period. Results: 3,549 patients were systematically recruited; 1,815 patients in DSM-IV group (DG) and 1,264 in broad group (BG); 453 patients did not fulfil inclusion criteria and were excluded. Most patients (87.9% in DG, 82.0% in BG) were currently following pharmacological therapies (mainly benzodiazepines) to manage their anxiety symptoms. The changes observed during the study were: 49.0% and 58.0%, respectively of patients without anxiety symptoms as per HAM-A scale at the 6 month visit (p=0.261) and 59.7% and 67.7%, respectively (p=0.103) of responder rates (> 50% reduction of baseline scoring). Conclusion: Broadening of GAD criteria does not seem to affect psychiatric care results in subjects with GAD, is able to identify the core symptoms of the disease according to the DSM-IV criteria and could lead to an earlier diagnosis. PMID:23173012

  2. ALMA Telescope Reaches New Heights

    Science.gov (United States)

    2009-09-01

    ball at a distance of nine miles, and to keep their smooth reflecting surfaces accurate to less than the 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 fiber optics -- and positioned it with an accuracy of a small fraction of an inch. The transporter is guided by a laser steering system and, just like some cars, 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 11.5 miles 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. 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 millimeter and submillimeter wavelengths, between infrared light and radio waves in the electromagnetic spectrum. Light at these wavelengths comes from some of the coldest, and from some of the most distant objects in the cosmos. These include cold clouds of gas and dust where new stars are being born, or remote galaxies towards the edge of the observable universe. The Universe is relatively unexplored at submillimeter wavelengths, as the telescopes need extremely dry atmospheric conditions, such as those at Chajnantor, and advanced detector technology. The Atacama Large Millimeter/submillimeter Array

  3. Operational Reach: Is Current Army Doctrine Adequate?

    National Research Council Canada - National Science Library

    Heintzelman, Scott

    2003-01-01

    The term operational reach, an element of operational design, is new to U.S. Army doctrine. Operational reach is not found in the previous edition of the Army's basic operational doctrine, Field Manual...

  4. Stream Habitat Reach Summary - NCWAP [ds158

    Data.gov (United States)

    California Natural Resource Agency — 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...

  5. Important ATLAS Forward Calorimeter Milestone Reached

    CERN Document Server

    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...

  6. Wee Care: Reaching Teenage Mothers and Changing Their Lives.

    Science.gov (United States)

    Rosenwald, Priscilla R.; Porter, Gwen

    1989-01-01

    Describes an intervention program for pregnant teenagers and teen mothers. Topics include program development and implementation, staffing, and content. Also discussed are adjustments that a mother must make in order to break the chain of poverty and welfare. (RJC)

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

    NARCIS (Netherlands)

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

    2015-01-01

    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

  8. 48 CFR 873.102 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... SUPPLEMENTARY REGULATIONS SIMPLIFIED ACQUISITION PROCEDURES FOR HEALTH-CARE RESOURCES 873.102 Definitions...-care providers include health-care plans and insurers and any organizations, institutions, or other entities or individuals who furnish health-care resources. (38 U.S.C. 8153) Health-care resource includes...

  9. The long reach of Alzheimer's disease: patients, practice, and policy.

    Science.gov (United States)

    Bynum, Julie P W

    2014-04-01

    The impact of Alzheimer's disease and related dementias reaches well beyond the health care needs of the person with dementia. As dementia inexorably progresses, the patient becomes increasingly dependent on others for basic daily care and routine tasks, a physically safe environment, and protection from exploitation or abuse. Addressing the diverse medical and social care needs of the burgeoning US population with Alzheimer's disease and related dementias requires the adoption of a broad-based policy framework and agenda that explicitly acknowledge the complex and unique needs of people with dementia and the impacts of dementia on caregivers and society at large. Public policies related to social service providers, agencies that provide appropriate housing, financial and legal services, and law enforcement must complement other policies focused on prevention and risk reduction, effective treatment development, and efficient health care delivery.

  10. Impact of a change in surveillance definition on performance assessment of a catheter-associated urinary tract infection prevention program at a tertiary care medical center.

    Science.gov (United States)

    Sopirala, Madhuri M; Syed, Asma; Jandarov, Roman; Lewis, Margaret

    2018-03-16

    In January 2015, the Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) changed the definition of catheter-associated urinary tract infection (CAUTI). We evaluated the outcomes of a robust CAUTI prevention program when we performed surveillance using the old definition (before 2015) versus the new definition (after 2015). This is the first study to evaluate how the change in CDC/NHSN definitions affected the outcomes of a CAUTI reduction program. Baseline was from January 2012 to September 2014; the intervention period was from October 2014 to February 2016. Staff nurses were trained to be liaisons of infection prevention (Link Nurses) with clearly defined CAUTI prevention goals and with ongoing monthly activities. CAUTI incidence per 1000 catheter days was compared between the baseline and intervention periods, using the 2 definitions. With the new definition, CAUTIs decreased by 33%, from 2.69 to 1.81 cases per 1000 catheter days (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI]: 0.48-0.93; P definition, CAUTIs increased by 12%, from 3.38 to 3.80 cases per 1000 catheter days (IRR = 1.12; 95% CI: 0.88-1.43; P = .348). We aggressively targeted CAUTI prevention, but a reduction was observed only with the new definition. Our findings stress the importance of having a reasonably accurate surveillance definition to monitor infection prevention initiatives. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Peer Support for the Hardly Reached: A Systematic Review.

    Science.gov (United States)

    Sokol, Rebeccah; Fisher, Edwin

    2016-07-01

    Health disparities are aggravated when prevention and care initiatives fail to reach those they are intended to help. Groups can be classified as hardly reached according to a variety of circumstances that fall into 3 domains: individual (e.g., psychological factors), demographic (e.g., socioeconomic status), and cultural-environmental (e.g., social network). Several reports have indicated that peer support is an effective means of reaching hardly reached individuals. However, no review has explored peer support effectiveness in relation to the circumstances associated with being hardly reached or across diverse health problems. To conduct a systematic review assessing the reach and effectiveness of peer support among hardly reached individuals, as well as peer support strategies used. Three systematic searches conducted in PubMed identified studies that evaluated peer support programs among hardly reached individuals. In aggregate, the searches covered articles published from 2000 to 2015. Eligible interventions provided ongoing support for complex health behaviors, including prioritization of hardly reached populations, assistance in applying behavior change plans, and social-emotional support directed toward disease management or quality of life. Studies were excluded if they addressed temporally isolated behaviors, were limited to protocol group classes, included peer support as the dependent variable, did not include statistical tests of significance, or incorporated comparison conditions that provided appreciable social support. We abstracted data regarding the primary health topic, categorizations of hardly reached groups, program reach, outcomes, and strategies employed. We conducted a 2-sample t test to determine whether reported strategies were related to reach. Forty-seven studies met our inclusion criteria, and these studies represented each of the 3 domains of circumstances assessed (individual, demographic, and cultural-environmental). Interventions

  12. REACH: Evaluation Report and Executive Summary

    Science.gov (United States)

    Sibieta, Luke

    2016-01-01

    REACH is a targeted reading support programme designed to improve reading accuracy and comprehension in pupils with reading difficulties in Years 7 and 8. It is based on research by the Centre for Reading and Language at York and is delivered by specially trained teaching assistants (TAs). This evaluation tested two REACH interventions, one based…

  13. LD Definition.

    Science.gov (United States)

    Learning Disability Quarterly, 1987

    1987-01-01

    The position paper (1981) of the National Joint Committee on Learning Disabilities presents a revised definition of learning disabilities and identifies issues and concerns (such as the limitation to children and the exclusion clause) associated with the definition included in P.L. 94-142, the Education for All Handicapped Children Act. (DB)

  14. The database for reaching experiments and models.

    Directory of Open Access Journals (Sweden)

    Ben Walker

    Full Text Available Reaching is one of the central experimental paradigms in the field of motor control, and many computational models of reaching have been published. While most of these models try to explain subject data (such as movement kinematics, reaching performance, forces, etc. from only a single experiment, distinct experiments often share experimental conditions and record similar kinematics. This suggests that reaching models could be applied to (and falsified by multiple experiments. However, using multiple datasets is difficult because experimental data formats vary widely. Standardizing data formats promises to enable scientists to test model predictions against many experiments and to compare experimental results across labs. Here we report on the development of a new resource available to scientists: a database of reaching called the Database for Reaching Experiments And Models (DREAM. DREAM collects both experimental datasets and models and facilitates their comparison by standardizing formats. The DREAM project promises to be useful for experimentalists who want to understand how their data relates to models, for modelers who want to test their theories, and for educators who want to help students better understand reaching experiments, models, and data analysis.

  15. Enhancing US Operational Reach in Southeast Asia

    National Research Council Canada - National Science Library

    Hitchcock, David

    2003-01-01

    .... While this treat continues to exist, the US Pacific Command (PACOM) must also pursue a neat term methodology to expand its operational reach and ability to respond to contingencies throughout the East Asian littoral, especially within Southeast Asia...

  16. Reaching the Overlooked Student in Physical Education

    Science.gov (United States)

    Esslinger, Keri; Esslinger, Travis; Bagshaw, Jarad

    2015-01-01

    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.

  17. Compact muon solenoid magnet reaches full field

    CERN Multimedia

    2006-01-01

    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)

  18. Caring Science or Science of Caring.

    Science.gov (United States)

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

    2018-01-01

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

  19. Goal Definition

    DEFF Research Database (Denmark)

    Bjørn, Anders; Laurent, Alexis; Owsianiak, Mikołaj

    2018-01-01

    The goal definition is the first phase of an LCA and determines the purpose of a study in detail. This chapter teaches how to perform the six aspects of a goal definition: (1) Intended applications of the results, (2) Limitations due to methodological choices, (3) Decision context and reasons...... for carrying out the study, (4) Target audience , (5) Comparative studies to be disclosed to the public and (6) Commissioner of the study and other influential actors. The instructions address both the conduct and reporting of a goal definition and are largely based on the ILCD guidance document (EC...

  20. Scope Definition

    DEFF Research Database (Denmark)

    Bjørn, Anders; Owsianiak, Mikołaj; Laurent, Alexis

    2018-01-01

    The scope definition is the second phase of an LCA. It determines what product systems are to be assessed and how this assessment should take place. This chapter teaches how to perform a scope definition. First, important terminology and key concepts of LCA are introduced. Then, the nine items...... making up a scope definition are elaborately explained: (1) Deliverables. (2) Object of assessment, (3) LCI modelling framework and handling of multifunctional processes, (4) System boundaries and completeness requirements, (5) Representativeness of LCI data, (6) Preparing the basis for the impact...... assessment, (7) Special requirements for system comparisons, (8) Critical review needs and (9) Planning reporting of results. The instructions relate both to the performance and reporting of a scope definition and are largely based on ILCD....

  1. 42 CFR 1000.20 - Definitions specific to Medicare.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Definitions specific to Medicare. 1000.20 Section 1000.20 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS INTRODUCTION; GENERAL DEFINITIONS Definitions § 1000.20 Definitions specific to...

  2. Ações de saúde mental na atenção básica: caminho para ampliação da integralidade da atenção Mental health in primary care: ways to reach an integral care

    Directory of Open Access Journals (Sweden)

    Oswaldo Yoshimi Tanaka

    2009-04-01

    Full Text Available A atenção básica de saúde, impulsionada pela estratégia da saúde da família, tem o grande desafio de incorporar de ações de enfrentamento às situações de violência e problemas de saúde mental. O trabalho analisou a atenção prestada a 411 crianças de cinco a onze anos em uma UBS na cidade de São Paulo. Os dados clínicos foram comparados com um inventário de sintomas padronizados Child Behavior Checklist (CBCL. Entrevistas semi-estruturadas foram aplicadas complementarmente em pediatras. O trabalho mostra que os pediatras têm baixa capacidade de reconhecer problemas de saúde mental em crianças. Os principais fatores relacionados a este baixo desempenho foram: deficiência na formação, carência de possibilidade de atuação concreta frente à queixa ou hipótese diagnóstica. O processo de reorganização do trabalho na atenção básica deveria contemplar a oferta de apoio técnico específico em saúde mental, propiciando a incorporação de tecnologias de intervenção mais apropriadas, como acolhimento e escuta qualificada. A incorporação dos aspectos psicossociais na prática cotidiana da atenção básica possibilitará a ampliação do conceito saúde-doença e abrirá caminho para a abordagem das situações de violência às crianças atendidas na rede básica de serviços de saúde do SUS.A great challenge for the primary healthcare system, implemented by the strategy called the Family Health Program, is to incorporate actions for facing situations of violence and mental health problems. This study analyzed the care delivered to 411 children between five and eleven years of age in a primary care unit in the city of São Paulo. The clinical findings were compared to a standard inventory of symptoms (CBCL. In addition, semi-structured interviews were held with pediatricians. The study shows low capacity of the pediatricians to recognize mental health problems in children. This is mainly due to deficiencies in

  3. Guiding Warfare to Reach Sustainable Peace

    DEFF Research Database (Denmark)

    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......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 developing best practices in the education and implementation of IHL in capacity building of security forces....

  4. Taking family planning services to hard-to-reach populations.

    Science.gov (United States)

    Donovan, P

    1996-01-01

    Interviews were conducted in 1995 among 100 US family planning program personnel who serve hard-to-reach populations, such as drug abusers, prisoners, the disabled, homeless persons, and non-English speaking minorities. Findings indicate that a range of services is available for hard-to-reach groups. Most family planning agencies focus on drug abusers because of the severity of HIV infections and the availability of funding. This article describes the activities of various agencies in Michigan, Pennsylvania, and Massachusetts that serve substance abuse centers with family planning services. One recommendation for a service provider is to present services in an environment where it is safe to talk about a person's needs. One other program offered personal greetings upon arrival and the continuity of having a familiar face to oversee all reproductive and health needs. Programs for prisoners ranged from basic sex education classes to comprehensive reproductive health care. Some prisons offered individual counseling. Some programs were presented in juvenile offender facilities. Outreach to the homeless involved services at homeless shelters, outreach workers who recruited women into traditional family planning clinics, and establishment of nontraditional sites for the homeless and other hard-to-reach persons. One provider's suggestion was to offer services where high-risk women already go for other services. Most services to the disabled target the developmentally disabled rather than the physically disabled. Experience has shown that many professionals working with the disabled do not recognize their clients' sexual needs. Other hard-to-reach groups include women in housing projects and shelters for battered women, welfare applicants, and sex workers. Key to service provision is creating trust, overcoming language and cultural differences, and subsidizing the cost of care.

  5. Reaching Reluctant Students: Insights from Torey Hayden.

    Science.gov (United States)

    Marlowe, Mike

    1999-01-01

    Illustrates principles of reaching students who fight or avoid adults by using examples drawn from the writings of Torey Hayden. Presents ten concepts that can serve as guidelines for building relationships with resistant children, and gives excerpts from Hayden's works to illustrate each concept. Demonstrates how books provide teachers with…

  6. ATLAS Barrel Toroid magnet reached nominal field

    CERN Multimedia

    2006-01-01

     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

  7. Application of the new Sepsis-3 definition in a cohort of patients with severe sepsis and septic shock admitted to Intensive Care Unit from the Emergency Department.

    Science.gov (United States)

    García-Gigorro, Renata; Molina-Collado, Zaira; Sáez-de la Fuente, Ignacio; Sanchez-Izquierdo, José Ángel; Montejo González, Juan Carlos

    2018-04-18

    After the publication of the new definition for sepsis and septic shock, our objective is to analyse the evolution of patients admitted to ICU with an infection process using the previous and new recommendations. This is a sub-analysis of a previous observational prospective study. We included 98 patients admitted to ICU from the emergency department due to infection during an 18-month period. We studied the clinical evolution during ICU admission and hospital mortality. According to Sepsis-2 definition, 78% percent had septic shock and using Sepsis-3 criteria, 52%; hospital mortality was 29 and 41%, respectively. The RR of hospital mortality of septic shock was 10.3 (95% CI: 2.8-37.5) compared to patients without shock. The 30-day probability survival of patients with sepsis and septic shock were 78% and 68%, respectively (long rank definition could help improve the evaluation of risk of hospital death. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  8. 1. REACHING THE UNREACHED.cdr

    African Journals Online (AJOL)

    RICHY

    including attention to care givers or parental concerns. ... and not involving them in decisions about immunisation. But now, most of .... decision making and explore any specific concerns ... Ley P, Improving patients' understanding, recall, nd.

  9. Inactivation of Parietal Reach Region Affects Reaching But Not Saccade Choices in Internally Guided Decisions.

    Science.gov (United States)

    Christopoulos, Vassilios N; Bonaiuto, James; Kagan, Igor; Andersen, Richard A

    2015-08-19

    The posterior parietal cortex (PPC) has traditionally been considered important for awareness, spatial perception, and attention. However, recent findings provide evidence that the PPC also encodes information important for making decisions. These findings have initiated a running argument of whether the PPC is critically involved in decision making. To examine this issue, we reversibly inactivated the parietal reach region (PRR), the area of the PPC that is specialized for reaching movements, while two monkeys performed a memory-guided reaching or saccade task. The task included choices between two equally rewarded targets presented simultaneously in opposite visual fields. Free-choice trials were interleaved with instructed trials, in which a single cue presented in the peripheral visual field defined the reach and saccade target unequivocally. We found that PRR inactivation led to a strong reduction of contralesional choices, but only for reaches. On the other hand, saccade choices were not affected by PRR inactivation. Importantly, reaching and saccade movements to single instructed targets remained largely intact. These results cannot be explained as an effector-nonspecific deficit in spatial attention or awareness, since the temporary "lesion" had an impact only on reach choices. Hence, the PPR is a part of a network for reach decisions and not just reach planning. There has been an ongoing debate on whether the posterior parietal cortex (PPC) represents only spatial awareness, perception, and attention or whether it is also involved in decision making for actions. In this study we explore whether the parietal reach region (PRR), the region of the PPC that is specialized for reaches, is involved in the decision process. We inactivated the PRR while two monkeys performed reach and saccade choices between two targets presented simultaneously in both hemifields. We found that inactivation affected only the reach choices, while leaving saccade choices intact

  10. Does workplace health promotion reach shift workers?

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  11. Olefins and chemical regulation in Europe: REACH.

    Science.gov (United States)

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

    2015-11-05

    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

  12. Performance reach in the LHC for 2012

    International Nuclear Information System (INIS)

    Arduini, G.

    2012-01-01

    Based on the 2011 experience and Machine Development study results, the performance reach of the LHC with 25 and 50 ns beams will be addressed for operation at 3.5 and 4 TeV. The possible scrubbing scenarios and potential intensity limitations resulting from vacuum, heating will be taken into account wherever possible. The paper mainly covers the performance of the two high luminosity regions in IR1 and IR5. (author)

  13. Rethinking a women's health care agenda.

    Science.gov (United States)

    Palley, M L; Palley, H A

    2000-01-01

    The baby boom population has entered middle age. In addition many people, especially women, are living into old age. These are large population cohorts that are politically engaged. Also there is money to be made by commercial stakeholders in responding to the health risks of these women. The definition of women's health care needs has changed in the past decade. Traditionally the defining characteristics of women's health policy were reproduction, childbearing and a woman's role as a sexual partner. Today it also includes the way that different diseases affect women and the best way to reach women at risk for a wide range of conditions, e.g., heart disease, cancer and depression.

  14. 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

    Directory of Open Access Journals (Sweden)

    Neumann, Melanie

    2012-02-01

    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

  15. Toward a better definition of massive transfusion: focus on the interval of hemorrhage control.

    Science.gov (United States)

    Sharpe, John P; Weinberg, Jordan A; Magnotti, Louis J; Croce, Martin A; Fabian, Timothy C

    2012-12-01

    In clinical research, massive transfusion (MT) is commonly defined as transfusion of 10 or more red blood cell (RBC) units within 24 hours. However, the clinical relevance of this definition remains poorly understood. In this study, we evaluated whether patients who reach the MT threshold during hemorrhage control differ clinically from those who reach it after hemorrhage control (i.e., after intensive care unit [ICU] arrival) but before 24 hours. Prospective data were collected on all Level I trauma resuscitations within 5.5 years. Patients transfused 10 or more RBCs in the first 24 hours of hospitalization were identified and stratified according to when the MT threshold was achieved: before ICU arrival (Pre-ICU) versus after ICU arrival but before 24 hours of hospitalization (Post-ICU). Clinical characteristics between groups were compared. Three hundred five patients received 10 or more units before ICU arrival, and 46 reached the MT threshold after ICU arrival but before 24 hours. Both groups were clinically similar with respect to age, sex, and Injury Severity Score, but the Post-ICU group had a larger proportion of blunt injuries (71 vs. 53%, p definition. However, they have a significantly decreased mortality risk at 24 hours and the potential to dilute the study cohort. For research purposes, restricting the MT definition to 10 or more RBCs during hemorrhage control may result in study cohorts with relatively more uniform mortality risks. Prognostic study, level II.

  16. Palliative care and pediatric surgical oncology.

    Science.gov (United States)

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

    2016-10-01

    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.

  17. Riparian Vegetation Mapping Along the Hanford Reach

    International Nuclear Information System (INIS)

    FOGWELL, T.W.

    2003-01-01

    During the biological survey and inventory of the Hanford Site conducted in the mid-1990s (1995 and 1996), preliminary surveys of the riparian vegetation were conducted along the Hanford Reach. These preliminary data were reported to The Nature Conservancy (TNC), but were not included in any TNC reports to DOE or stakeholders. During the latter part of FY2001, PNNL contracted with SEE Botanical, the parties that performed the original surveys in the mid 1990s, to complete the data summaries and mapping associated with the earlier survey data. Those data sets were delivered to PNNL and the riparian mapping by vegetation type for the Hanford Reach is being digitized during the first quarter of FY2002. These mapping efforts provide the information necessary to create subsequent spatial data layers to describe the riparian zone according to plant functional types (trees, shrubs, grasses, sedges, forbs). Quantification of the riparian zone by vegetation types is important to a number of DOE'S priority issues including modeling contaminant transport and uptake in the near-riverine environment and the determination of ecological risk. This work included the identification of vegetative zones along the Reach by changes in dominant plant species covering the shoreline from just to the north of the 300 Area to China Bar near Vernita. Dominant and indicator species included Agropyron dasytachyudA. smithii, Apocynum cannabinum, Aristida longiseta, Artemisia campestris ssp. borealis var scouleriana, Artemisa dracunculus, Artemisia lindleyana, Artemisia tridentata, Bromus tectorum, Chrysothamnus nauseosus, Coreopsis atkinsoniana. Eleocharis palustris, Elymus cinereus, Equisetum hyemale, Eriogonum compositum, Juniperus trichocarpa, Phalaris arundinacea, Poa compressa. Salk exigua, Scirpus acutus, Solidago occidentalis, Sporobolus asper,and Sporobolus cryptandrus. This letter report documents the data received, the processing by PNNL staff, and additional data gathered in FY2002

  18. Long-reach manipulators for decommissioning

    International Nuclear Information System (INIS)

    Webster, D.A.; Challinor, S.F.

    1993-01-01

    A survey of redundant facilities at Sellafield has identified that in many cases the conventional means of deploying remote handling equipment are not appropriate and that novel means must be employed. However, decommissioning is not a value adding activity and so expensive one off designs must be avoided. The paper will describe BNFL's approach to the synthesis from proprietary parts of a manipulator which can lift 3 te at a horizontal reach of over 5 metres and yet can still perform the dextrous manipulation necessary to remove small items. It will also cover the development of the manipulator control systems and the adaption of commercial handtools to be manipulator friendly. (author)

  19. Luminosity performance reach after LS1

    International Nuclear Information System (INIS)

    Herr, W.

    2012-01-01

    Based on past experience (2010/2011), in particular expected limitations from beam-beam effects, and taking into account the expected beam quality from the LHC injectors, the peak and integrated luminosity at top energy is discussed for different scenarios (e.g. bunch spacing, beta*). In particular it will be shown which are the key parameters to reach the nominal luminosity and it is also shown that peak luminosities two times larger than nominal (or higher) are possible. Possible test in 2012 are discussed

  20. City Reach Code Technical Support Document

    Energy Technology Data Exchange (ETDEWEB)

    Athalye, Rahul A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Chen, Yan [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhang, Jian [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Liu, Bing [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Frankel, Mark [New Buildings Inst., Portland, OR (United States); Lyles, Mark [New Buildings Inst., Portland, OR (United States)

    2017-10-31

    This report describes and analyzes a set of energy efficiency measures that will save 20% energy over ASHRAE Standard 90.1-2013. The measures will be used to formulate a Reach Code for cities aiming to go beyond national model energy codes. A coalition of U.S. cities together with other stakeholders wanted to facilitate the development of voluntary guidelines and standards that can be implemented in stages at the city level to improve building energy efficiency. The coalition's efforts are being supported by the U.S. Department of Energy via Pacific Northwest National Laboratory (PNNL) and in collaboration with the New Buildings Institute.

  1. 45 CFR 60.3 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Definitions. 60.3 Section 60.3 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS General Provisions § 60.3 Definitions. Act means...

  2. Can donated media placements reach intended audiences?

    Science.gov (United States)

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

    2013-09-01

    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.

  3. Efficacy of REACH Forgiveness across cultures.

    Science.gov (United States)

    Lin, Yin; Worthington, Everett L; Griffin, Brandon J; Greer, Chelsea L; Opare-Henaku, Annabella; Lavelock, Caroline R; Hook, Joshua N; Ho, Man Yee; Muller, Holly

    2014-09-01

    This study investigates the efficacy of the 6-hour REACH Forgiveness intervention among culturally diverse undergraduates. Female undergraduates (N = 102) and foreign extraction (46.2%) and domestic (43.8%) students in the United States were randomly assigned to immediate treatment or waitlist conditions. Treatment efficacy and the effect of culture on treatment response were assessed using measures of emotional and decisional forgiveness across 3 time periods. Students in the treatment condition reported greater improvement in emotional forgiveness, but not decisional forgiveness, relative to those in the waitlist condition. Gains were maintained at a 1-week follow-up. Although culture did not moderate the effect of treatment, a main effect of culture on emotional forgiveness and marginally significant interaction effect of culture on decisional forgiveness were found. The REACH Forgiveness intervention was efficacious for college students from different cultural backgrounds when conducted in the United States. However, some evidence may warrant development of culturally adapted forgiveness interventions. © 2014 Wiley Periodicals, Inc.

  4. Common SIDS and SUID Terms and Definitions

    Science.gov (United States)

    ... media links Common SIDS and SUID Terms and Definitions Page Content Health care providers and others may ... NICHD Home Accessibility NICHD Contact Disclaimer NICHD Accounts: Facebook Twitter Pinterest YouTube NIH...Turning Discovery Into Health ® ...

  5. Tacit definitions of informal caregiving.

    Science.gov (United States)

    Wrubel, J; Richards, T A; Folkman, S; Acree, M C

    2001-01-01

    This study describes three tacit definitions of informal caregiving and explores the extent to which differences in these tacit definitions explain variation in caregivers' negative mood over time. There is a growing need to understand the sources of stress and gratification for informal caregivers. Tacit definitions of informal caregiving refer to caregivers' understanding of what caregiving entails. These definitions are tacit because they arise from caregivers' taken-for-granted understanding rather than formally articulated positions concerning caregiving. A random sample of 60 men, all of whom were caregiving partners of men with acquired immunodeficiency syndrome (AIDS), was drawn from a larger cohort of 253 participants in the University of California San Francisco (UCSF) Coping Project (1990-1997). The caregivers were assessed bimonthly for 2 years with procedures that included a semi-structured interview focusing on a recent stressful event involving caregiving, and quantitative measures of well-being. Interpretive phenomenological case studies of the narrative accounts of the 60 caregivers produced three tacit definitions of caregiving - engagement, conflict and distance. These three tacit definitions were distinguished by differences in learning about caregiving, involvement in health care decisions, caregiving activities and reported sources of stress. The three groups differed on measures of dyadic adjustment, depression, anger and anxiety. Better understanding of caregivers' tacit definitions can facilitate and enhance effective support and interventions for caregivers.

  6. Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data

    NARCIS (Netherlands)

    Waldinger, Marcel D.; Zwinderman, Aeilko H.; Olivier, Berend; Schweitzer, Dave H.

    2005-01-01

    Introduction. Consensus on a definition of premature ejaculation has not yet been reached because of debates based on subjective authority opinions and nonstandardized assessment methods to measure ejaculation time and ejaculation control. Aim. To provide a definition for lifelong premature

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

    Science.gov (United States)

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

    2014-12-01

    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. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  8. Riparian Vegetation Mapping Along the Hanford Reach

    Energy Technology Data Exchange (ETDEWEB)

    FOGWELL, T.W.

    2003-07-11

    During the biological survey and inventory of the Hanford Site conducted in the mid-1990s (1995 and 1996), preliminary surveys of the riparian vegetation were conducted along the Hanford Reach. These preliminary data were reported to The Nature Conservancy (TNC), but were not included in any TNC reports to DOE or stakeholders. During the latter part of FY2001, PNNL contracted with SEE Botanical, the parties that performed the original surveys in the mid 1990s, to complete the data summaries and mapping associated with the earlier survey data. Those data sets were delivered to PNNL and the riparian mapping by vegetation type for the Hanford Reach is being digitized during the first quarter of FY2002. These mapping efforts provide the information necessary to create subsequent spatial data layers to describe the riparian zone according to plant functional types (trees, shrubs, grasses, sedges, forbs). Quantification of the riparian zone by vegetation types is important to a number of DOE'S priority issues including modeling contaminant transport and uptake in the near-riverine environment and the determination of ecological risk. This work included the identification of vegetative zones along the Reach by changes in dominant plant species covering the shoreline from just to the north of the 300 Area to China Bar near Vernita. Dominant and indicator species included Agropyron dasytachyudA. smithii, Apocynum cannabinum, Aristida longiseta, Artemisia campestris ssp. borealis var scouleriana, Artemisa dracunculus, Artemisia lindleyana, Artemisia tridentata, Bromus tectorum, Chrysothamnus nauseosus, Coreopsis atkinsoniana. Eleocharis palustris, Elymus cinereus, Equisetum hyemale, Eriogonum compositum, Juniperus trichocarpa, Phalaris arundinacea, Poa compressa. Salk exigua, Scirpus acutus, Solidago occidentalis, Sporobolus asper,and Sporobolus cryptandrus. This letter report documents the data received, the processing by PNNL staff, and additional data gathered in FY

  9. Reach and get capability in a computing environment

    Science.gov (United States)

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

    2012-06-05

    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.

  10. Validity of an Interactive Functional Reach Test.

    Science.gov (United States)

    Galen, Sujay S; Pardo, Vicky; Wyatt, Douglas; Diamond, Andrew; Brodith, Victor; Pavlov, Alex

    2015-08-01

    Videogaming platforms such as the Microsoft (Redmond, WA) Kinect(®) are increasingly being used in rehabilitation to improve balance performance and mobility. These gaming platforms do not have built-in clinical measures that offer clinically meaningful data. We have now developed software that will enable the Kinect sensor to assess a patient's balance using an interactive functional reach test (I-FRT). The aim of the study was to test the concurrent validity of the I-FRT and to establish the feasibility of implementing the I-FRT in a clinical setting. The concurrent validity of the I-FRT was tested among 20 healthy adults (mean age, 25.8±3.4 years; 14 women). The Functional Reach Test (FRT) was measured simultaneously by both the Kinect sensor using the I-FRT software and the Optotrak Certus(®) 3D motion-capture system (Northern Digital Inc., Waterloo, ON, Canada). The feasibility of implementing the I-FRT in a clinical setting was assessed by performing the I-FRT in 10 participants with mild balance impairments recruited from the outpatient physical therapy clinic (mean age, 55.8±13.5 years; four women) and obtaining their feedback using a NASA Task Load Index (NASA-TLX) questionnaire. There was moderate to good agreement between FRT measures made by the two measurement systems. The greatest agreement between the two measurement system was found with the Kinect sensor placed at a distance of 2.5 m [intraclass correlation coefficient (2,k)=0.786; PNASA/TLX questionnaire. FRT measures made using the Kinect sensor I-FRT software provides a valid clinical measure that can be used with the gaming platforms.

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

    Directory of Open Access Journals (Sweden)

    Chien-Lung Chan

    2014-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Judith Tiao

    2014-01-01

    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.

  13. Reaching women in Egypt: a success story

    Directory of Open Access Journals (Sweden)

    Ahmed Mousa

    2009-06-01

    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

  14. Naturalness Reach of the Large Hadron Collider in Minimal Supergravity

    CERN Document Server

    Allanach, B.C.; Parker, Michael Andrew; Webber, B.R.

    2000-01-01

    We re-analyse the prospects of discovering supersymmetry at the LHC, in order to re-express coverage in terms of a fine-tuning parameter and to extend the analysis to scalar masses (m_0) above 2 TeV. We use minimal supergravity (mSUGRA) unification assumptions for the SUSY breaking parameters. Such high values of m_0 have recently been found to have a focus point, leading to relatively low fine-tuning. In addition, improvements in the simulations since the last study mean that this region no longer lacks radiative electroweak symmetry breaking. The best fine tuning reach is found in a mono-leptonic channel, where for mu>0, A_0=0 and tan beta=10 (corresponding to the focus point), all points in mSUGRA with m_0 < 4000 GeV, with a fine tuning measure up to 300 (570) are covered by the search, where the definition of fine-tuning excludes (includes) the contribution from the top Yukawa coupling. Even for arbitrarily high m_0, mSUGRA does not evade detection provided the gaugino mass parameter M_{1/2} < 460 G...

  15. Toxicological comments to the discussion about REACH.

    Science.gov (United States)

    Greim, Helmut; Arand, Michael; Autrup, Herman; Bolt, Hermann M; Bridges, James; Dybing, Erik; Glomot, Rémi; Foa, Vito; Schulte-Hermann, Rolf

    2006-03-01

    It is the ultimate goal of the intended REACH process (Registration, Evaluation and Authorization of Chemicals) of the European Union to identify substances of hazardous properties and to evaluate the risks of human and environmental exposure. During the last few months there has been a controversial discussion as to what extent in vitro studies and consideration of structure activity relationship provide sufficient information to waive repeated exposure studies. Industry as well as certain regulatory agencies or NGOs support this approach and propose that repeated dose studies may only be required beyond 100 t/a. From a toxicological point of view it has to be stressed that this discussion primarily considers the cost reduction and protection of animals, whereas protection of human health and the environment are secondary. In vitro studies only allow identification of specific hazardous properties which can be detected by the specific test system. Moreover, appropriate information on the dose response of adverse effects, identification of thresholds and NOELs that are essential for risk characterization cannot be obtained from these studies. Consequently, identification of all relevant hazardous properties and endpoints of adverse effects can only be determined in the intact animal by repeated dose studies such as 28-day or 90-day studies. In the absence of such information the hazard identification is incomplete and there is no basis for appropriate risk assessment of human exposure. Thus, any waiving of repeated dose studies in animals bears the probability of unforeseen effects in case of acute or continuous human exposure. From this the undersigning European Toxicologists conclude: 1. The intention of REACH is to identify hazardous properties in order that a reliable risk assessment can be made and measures taken to deal with chemicals posing a significant risk. 2. The recent debate has centered on ways in which the well established in vivo methods for risk

  16. Making metabolism accessible and meaningful: is the definition of a central metabolic dogma within reach?

    Science.gov (United States)

    LaRossa, Robert A

    2015-04-01

    Intermediary metabolism, a dominant research area before the emergence of molecular biology, is attracting renewed interest for fundamental and applied reasons as documented here. Nonetheless, the field may appear to be a thicket precluding entry to all but the most determined. Here we present a metabolic overview that makes this important and fascinating area accessible to a broad range of the molecular biological and biotechnological communities that are being attracted to biological problems crying out for metabolic solutions. This is accomplished by identifying seven key concepts, a so-called metabolic central dogma, that provide a core understanding analogous to the "Central Dogma of Molecular Biology" which focused upon maintenance and flow of genetic information.

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

    Science.gov (United States)

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

    2015-01-01

    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].

  18. ESO telbib: Linking In and Reaching Out

    Science.gov (United States)

    Grothkopf, U.; Meakins, S.

    2015-04-01

    Measuring an observatory's research output is an integral part of its science operations. Like many other observatories, ESO tracks scholarly papers that use observational data from ESO facilities and uses state-of-the-art tools to create, maintain, and further develop the Telescope Bibliography database (telbib). While telbib started out as a stand-alone tool mostly used to compile lists of papers, it has by now developed into a multi-faceted, interlinked system. The core of the telbib database is links between scientific papers and observational data generated by the La Silla Paranal Observatory residing in the ESO archive. This functionality has also been deployed for ALMA data. In addition, telbib reaches out to several other systems, including ESO press releases, the NASA ADS Abstract Service, databases at the CDS Strasbourg, and impact scores at Altmetric.com. We illustrate these features to show how the interconnected telbib system enhances the content of the database as well as the user experience.

  19. Using New Media to Reach Broad Audiences

    Science.gov (United States)

    Gay, P. L.

    2008-06-01

    The International Year of Astronomy New Media Working Group (IYA NMWG) has a singular mission: To flood the Internet with ways to learn about astronomy, interact with astronomers and astronomy content, and socially network with astronomy. Within each of these areas, we seek to build lasting programs and partnerships that will continue beyond 2009. Our weapon of choice is New Media. It is often easiest to define New Media by what it is not. Television, radio, print and their online redistribution of content are not New Media. Many forms of New Media start as user provided content and content infrastructures that answer that individual's creative whim in a way that is adopted by a broader audience. Classic examples include Blogs and Podcasts. This media is typically distributed through content specific websites and RSS feeds, which allow syndication. RSS aggregators (iTunes has audio and video aggregation abilities) allow subscribers to have content delivered to their computers automatically when they connect to the Internet. RSS technology is also being used in such creative ways as allowing automatically updating Google-maps that show the location of someone with an intelligent GPS system, and in sharing 100 word microblogs from anyone (Twitters) through a single feed. In this poster, we outline how the IYA NMWG plans to use New Media to reach target primary audiences of astronomy enthusiasts, image lovers, and amateur astronomers, as well as secondary audiences, including: science fiction fans, online gamers, and skeptics.

  20. Media perspective - new opportunities for reaching audiences

    Science.gov (United States)

    Haswell, Katy

    2007-08-01

    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.

  1. Has Athletic Performance Reached its Peak?

    Science.gov (United States)

    Berthelot, Geoffroy; Sedeaud, Adrien; Marck, Adrien; Antero-Jacquemin, Juliana; Schipman, Julien; Saulière, Guillaume; Marc, Andy; Desgorces, François-Denis; Toussaint, Jean-François

    2015-09-01

    Limits to athletic performance have long been a topic of myth and debate. However, sport performance appears to have reached a state of stagnation in recent years, suggesting that the physical capabilities of humans and other athletic species, such as greyhounds and thoroughbreds, cannot progress indefinitely. Although the ultimate capabilities may be predictable, the exact path for the absolute maximal performance values remains difficult to assess and relies on technical innovations, sport regulation, and other parameters that depend on current societal and economic conditions. The aim of this literature review was to assess the possible plateau of top physical capabilities in various events and detail the historical backgrounds and sociocultural, anthropometrical, and physiological factors influencing the progress and regression of athletic performance. Time series of performances in Olympic disciplines, such as track and field and swimming events, from 1896 to 2012 reveal a major decrease in performance development. Such a saturation effect is simultaneous in greyhound, thoroughbred, and frog performances. The genetic condition, exhaustion of phenotypic pools, economic context, and the depletion of optimal morphological traits contribute to the observed limitation of physical capabilities. Present conditions prevailing, we approach absolute physical limits and endure a continued period of world record scarcity. Optional scenarios for further improvements will mostly depend on sport technology and modification competition rules.

  2. LEP Dismantling Reaches Half-Way Stage

    CERN Multimedia

    2001-01-01

    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...

  3. CAST reaches milestone but keeps on searching

    CERN Multimedia

    CERN Courier (september 2011 issue)

    2011-01-01

    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 ...

  4. The European General Practice Research Network Presents the Translations of Its Comprehensive Definition of Multimorbidity in Family Medicine in Ten European Languages

    Science.gov (United States)

    Le Reste, Jean Yves; Nabbe, Patrice; Rivet, Charles; Lygidakis, Charilaos; Doerr, Christa; Czachowski, Slawomir; Lingner, Heidrun; Argyriadou, Stella; Lazic, Djurdjica; Assenova, Radost; Hasaganic, Melida; Munoz, Miquel Angel; Thulesius, Hans; Le Floch, Bernard; Derriennic, Jeremy; Sowinska, Agnieska; Van Marwijk, Harm; Lietard, Claire; Van Royen, Paul

    2015-01-01

    Background Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review. Objective To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research. Method Forward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached Results 229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved. Conclusion A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care. PMID:25607642

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

    1998-12-31

    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.)

  6. Adaptive mixed reality rehabilitation improves quality of reaching movements more than traditional reaching therapy following stroke.

    Science.gov (United States)

    Duff, Margaret; Chen, Yinpeng; Cheng, Long; Liu, Sheng-Min; Blake, Paul; Wolf, Steven L; Rikakis, Thanassis

    2013-05-01

    Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. We describe the first proof-of-concept study to compare outcomes of AMRR and traditional upper-extremity physical therapy. Two groups of participants with chronic stroke received either a month of AMRR therapy (n = 11) or matched dosing of traditional repetitive task therapy (n = 10). Participants were right handed, between 35 and 85 years old, and could independently reach to and at least partially grasp an object in front of them. Upper-extremity clinical scale scores and kinematic performances were measured before and after treatment. Both groups showed increased function after therapy, demonstrated by statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment (FMA) scores, with the traditional therapy group improving significantly more on the FMA. However, only participants who received AMRR therapy showed a consistent improvement in kinematic measurements, both for the trained task of reaching to grasp a cone and the untrained task of reaching to push a lighted button. AMRR may be useful in improving both functionality and the kinematics of reaching. Further study is needed to determine if AMRR therapy induces long-term changes in movement quality that foster better functional recovery.

  7. The Revised Academic Consensus Definition of Terrorism

    Directory of Open Access Journals (Sweden)

    Alex P. Schmid

    2012-05-01

    Full Text Available Terrorism is a contested concept. While there are many national and regional definitions, there is no universal legal definition approved by the General Assembly of the United Nations (the one proposed by the Security Council in Res. 1566 (2004 is non-binding, lacking legal authority in international law. The Ad Hoc Committee on Terrorism of the 6th (legal Committee of the General Assembly has, with some interruptions, been trying to reach a legal definition since 1972 - but in vain. In the absence of a legal definition, attempts have been made since the 1980s to reach agreement on an academic consensus definition. The latest outcome is the revised definition reprinted below. It is the result of three rounds of consultations among academics and other professionals. A description how it was arrived at can be found on pp. 39 - 98 of Alex P. Schmid (Ed.. The Routledge Handbook of Terrorism Research. London and New York: Routledge, 2011. The same volume also contains 260 other definitions compiled by Joseph J. Easson and Alex P. Schmid on pp. 99 -200.

  8. Can coronal hole spicules reach coronal temperatures?

    Science.gov (United States)

    Madjarska, M. S.; Vanninathan, K.; Doyle, J. G.

    2011-08-01

    Aims: The present study aims to provide observational evidence of whether coronal hole spicules reach coronal temperatures. Methods: We combine multi-instrument co-observations obtained with the SUMER/SoHO and with the EIS/SOT/XRT/Hinode. Results: The analysed three large spicules were found to be comprised of numerous thin spicules that rise, rotate, and descend simultaneously forming a bush-like feature. Their rotation resembles the untwisting of a large flux rope. They show velocities ranging from 50 to 250 kms-1. We clearly associated the red- and blue-shifted emissions in transition region lines not only with rotating but also with rising and descending plasmas. Our main result is that these spicules although very large and dynamic, are not present in the spectral lines formed at temperatures above 300 000 K. Conclusions: In this paper we present the analysis of three Ca ii H large spicules that are composed of numerous dynamic thin spicules but appear as macrospicules in lower resolution EUV images. We found no coronal counterpart of these and smaller spicules. We believe that the identification of phenomena that have very different origins as macrospicules is due to the interpretation of the transition region emission, and especially the He ii emission, wherein both chromospheric large spicules and coronal X-ray jets are present. We suggest that the recent observation of spicules in the coronal AIA/SDO 171 Å and 211 Å channels probably comes from the existence of transition region emission there. Movie is available in electronic form at http://www.aanda.org

  9. When Does the Warmest Water Reach Greenland?

    Science.gov (United States)

    Grist, J. P.; Josey, S. A.; Boehme, L.; Meredith, M. P.; Laidre, K. L.; Heide-Jørgensen, M. P.; Kovacs, K. M.; Lydersen, C.; Davidson, F. J. M.; Stenson, G. B.; Hammill, M. O.; Marsh, R.; Coward, A.

    2016-02-01

    The warmest water reaching the east and west coast of Greenland is found between 200 and 600 m, in the warm Atlantic Water Layer (WL). Temperature changes within the WL have been highlighted as a possible cause of accelerated melting of tidewater glaciers and therefore are an important consideration for understanding global sea level rise. However, a limited number of winter observations of the WL have prohibited determining its seasonal variability. To address this, temperature data from Argo profiling floats, a range of sources within the World Ocean Database, and unprecedented coverage from marine-mammal borne sensors have been analyzed for the period 2002-2011. A significant seasonal range in temperature ( 1-2°C) is found in the warm layer, in contrast to most of the surrounding ocean. The magnitude of the seasonal cycle is thus comparable with the 1990s warming that was associated with an increased melt rate in a marine terminating glacier of West Greenland. The phase of the seasonal cycle exhibits considerable spatial variability; with high-resolution ocean model trajectory analysis suggesting it is determined by the time taken for waters to be advected from the subduction site in the Irminger Basin. For western Greenland, the annual temperature maximum occurs near or after the turn of the calendar year. This is significant because a recent study suggested that it is in the non-summer months when fjord-shelf exchanges allow the WL to most strongly influence glacier melt rate. However this is also the time of the year when the WL is least well observed. It is therefore clear that year-round subsurface temperature measurements are still required for a complete description of the WL seasonality, and in particular to ensure that the ice-melting potential of the WL is not underestimated.

  10. Comparative effectiveness of linezolid versus vancomycin as definitive antibiotic therapy for heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococcal central-line-associated bloodstream infections in a neonatal intensive care unit.

    Science.gov (United States)

    Blanchard, A C; Fortin, E; Laferrière, C; Goyer, I; Moussa, A; Autmizguine, J; Quach, C

    2017-06-01

    Heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococci (hVICoNS) are emerging pathogens causing central-line-associated bloodstream infections (CLABSIs) in neonatal intensive care unit (NICU) patients. Given the burden of disease associated with CLABSI and the current lack of therapeutic guidelines, we aimed to compare the effectiveness of linezolid versus vancomycin used as the definitive antibiotic therapy for hVICoNS CLABSI. We performed a retrospective cohort study of infants with hVICoNS CLABSI from a single NICU between 2009 and 2014, treated with either linezolid or vancomycin as definitive antibiotic therapy. CLABSI duration, early and late recurrence and in-hospital mortality were compared using propensity score-adjusted proportional hazards and logistic regression models. Of 89 infants with hVICoNS CLABSI, 33 (37.1%) treated with linezolid were compared with 56 (62.9%) treated with vancomycin. The median duration of CLABSI was 5 (range 1-12) versus 4 days (range 0-14) ( P  =   0.11), early recurrences were 3.0% versus 7.1% ( P  =   0.42), late recurrences 0% versus 14.3% ( P  =   0.02) and mortality 27.3% versus 28.6% ( P  =   0.90), when treated with linezolid versus vancomycin, respectively. When adjusting using a continuous propensity score, linezolid had an HR of 0.78 (95% CI 0.48-1.27) for CLABSI duration, an OR of 0.23 (95% CI 0.02-2.56) for early recurrence and an OR of 0.9 (95% CI 0.3-2.67) for mortality, relative to vancomycin. There was no statistically significant difference between linezolid and vancomycin when used as definitive treatment for hVICoNS CLABSI in NICU patients, in terms of CLABSI duration, recurrence or all-cause mortality. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    Directory of Open Access Journals (Sweden)

    Sundby Johanne

    2005-05-01

    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

  12. Functional reach and lateral reach tests adapted for aquatic physical therapy

    Directory of Open Access Journals (Sweden)

    Ana Angélica Ribeiro de Lima

    Full Text Available Abstract Introduction: Functional reach (FR and lateral reach (LR tests are widely used in scientific research and clinical practice. Assessment tools are useful in assessing subjects with greater accuracy and are usually adapted according to the limitations of each condition. Objective: To adapt FR and LR tests for use in an aquatic environment and assess the performance of healthy young adults. Methods: We collected anthropometric data and information on whether the participant exercised regularly or not. The FR and LR tests were adapted for use in an aquatic environment and administered to 47 healthy subjects aged 20-30 years. Each test was repeated three times. Results: Forty-one females and six males were assessed. The mean FR test score for men was 24.06 cm, whereas the mean value for right lateral reach (RLR was 10.94 cm and for left lateral reach (LLR was 9.78 cm. For females, the mean FR score was 17.57 cm, while the mean values for RLR was 8.84cm and for LLR was 7.76 cm. Men performed better in the FR (p < 0.001 and RLR tests than women (p = 0.037. Individuals who exercised regularly showed no differences in performance level when compared with their counterparts. Conclusion: The FR and LR tests were adapted for use in an aquatic environment. Males performed better on the FR and RLR tests, when compared to females. There was no correlation between the FR and LR tests and weight, height, Body Mass Index (BMI, foot length or length of the dominant upper limb.

  13. Clinical application of the basic definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN): Comparison with classical tools in geriatric care.

    Science.gov (United States)

    Sánchez-Rodríguez, Dolores; Annweiler, Cédric; Ronquillo-Moreno, Natalia; Tortosa-Rodríguez, Andrea; Guillén-Solà, Anna; Vázquez-Ibar, Olga; Escalada, Ferran; Muniesa, Josep M; Marco, Ester

    Malnutrition is a prevalent condition related to adverse outcomes in older people. Our aim was to compare the diagnostic capacity of the malnutrition criteria of the European Society of Parenteral and Enteral Nutrition (ESPEN) with other classical diagnostic tools. Cohort study of 102 consecutive in-patients ≥70 years admitted for postacute rehabilitation. Patients were considered malnourished if their Mini-Nutritional Assessment-Short Form (MNA-SF) score was ≤11 and serum albumin <3 mg/dL or MNA-SF ≤ 11, serum albumin <3 mg/dL, and usual clinical signs and symptoms of malnutrition. Sensitivity, specificity, positive and negative predictive values, accuracy likelihood ratios, and kappa values were calculated for both methods: and compared with ESPEN consensus. Of 102 eligible in-patients, 88 fulfilled inclusion criteria and were identified as "at risk" by MNA-SF. Malnutrition diagnosis was confirmed in 11.6% and 10.5% of the patients using classical methods,whereas 19.3% were malnourished according to the ESPEN criteria. Combined with low albumin levels, the diagnosis showed 57.9% sensitivity, 64.5% specificity, 85.9% negative predictive value,0.63 accuracy (fair validity, low range), and kappa index of 0.163 (poor ESPEN agreement). The combination of MNA-SF, low albumin, and clinical malnutrition showed 52.6% sensitivity, 88.3% specificity, 88.3%negative predictive value, and 0.82 accuracy (fair validity, low range), and kappa index of 0.43 (fair ESPEN agreement). Malnutrition was almost twice as prevalent when diagnosed by the ESPEN consensus, compared to classical assessment methods: Classical methods: showed fair validity and poor agreement with the ESPEN consensus in assessing malnutrition in geriatric postacute care. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Classification of Infections in Intensive Care Units: A Comparison of Current Definition of Hospital-Acquired Infections and Carrier State Criterion

    Directory of Open Access Journals (Sweden)

    Jiří Žurek

    2012-06-01

    Full Text Available Background: The rate of nosocomial infection appears to depend on whether it is calculated using the Center for Disease Control (CDC or carrier state criteria. The objective of this study was to differentiate between primary endogenous (PE, secondary endogenous (SE and exogenous (EX infections, and to compare this classification with CDC criteria for nosocomial infections. Methods: Children hospitalized for more than 72 h at pediatric intensive care unit during 2004–2005 were enrolled. Children, who had the infection before the admission, and or did not develop an infection within the hospitalization were excluded. Surveillance samples were sampled on admission, and then twice a week. Diagnostic samples were obtained when infection was suspected based on the clinical condition and laboratory findings. Infections were evaluated as PE, SE and EX, and their incidences were compared with CDC criteria for nosocomial infections. Results: One hundred seventy eight patients were enrolled in the study. Forty-four patients (24.7% develop infection. Twenty-seven patients (61.3% had PE, 10 patients (22.7% had SE, and 7 patients (15.9% had EX infection. Secondary endogenous and EX infections are considered as nosocomial, thus 17 patients (38.6% had a nosocomial infection. Thirty-one patients (70.5% met CDC criteria for nosocomial infections. Seventeen patients (55% were classified as PE, and 14 patients (45% as SE or EX infections.Conclusion: Seventy percent of infections (31 out of 44 patients met the CDC criteria for nosocomial infections, but only 39% of infections (17 out of 44 patients were classified as nosocomial based on carrier state classification.

  15. Classification of infections in intensive care units: a comparison of current definition of hospital-acquired infections and carrier state criterion.

    Science.gov (United States)

    Zurek, Jiří; Fedora, Michal

    2012-06-01

    The rate of nosocomial infection appears to depend on whether it is calculated using the Center for Disease Control (CDC) or carrier state criteria. The objective of this study was to differentiate between primary endogenous (PE), secondary endogenous (SE) and exogenous (EX) infections, and to compare this classification with CDC criteria for nosocomial infections. Children hospitalized for more than 72 h at pediatric intensive care unit during 2004-2005 were enrolled. Children, who had the infection before the admission, and or did not develop an infection within the hospitalization were excluded. Surveillance samples were sampled on admission, and then twice a week. Diagnostic samples were obtained when infection was suspected based on the clinical condition and laboratory findings. Infections were evaluated as PE, SE and EX, and their incidences were compared with CDC criteria for nosocomial infections. One hundred seventy eight patients were enrolled in the study. Forty-four patients (24.7%) develop infection. Twenty-seven patients (61.3%) had PE, 10 patients (22.7%) had SE, and 7 patients (15.9%) had EX infection. Secondary endogenous and EX infections are considered as nosocomial, thus 17 patients (38.6%) had a nosocomial infection. Thirty-one patients (70.5%) met CDC criteria for nosocomial infections. Seventeen patients (55%) were classified as PE, and 14 patients (45%) as SE or EX infections. Seventy percent of infections (31 out of 44 patients) met the CDC criteria for nosocomial infections, but only 39% of infections (17 out of 44 patients) were classified as nosocomial based on carrier state classification.

  16. IAEA Patient Protection Effort Reaches Key Milestone

    International Nuclear Information System (INIS)

    2012-01-01

    scans when it can be avoided. An increasing number of infants and children are also getting repeated CT scans. In most cases, the medical benefits still outweigh the harm, but there is growing concern about unjustified CT scans with increased cumulative doses to patients that could be detrimental. The IAEA held its first Smart Card development meeting in 2009. Additional sessions in 2010 and 2012 led to the final draft of the Joint Position Statement, which outlines a number of major goals: 1. Supporting accountability for patient safety; 2. Strengthening of the process of justification (e.g. information available at the point-of-care for the referring practitioner); 3. Supporting optimization (e.g. use of diagnostic reference levels (DRLs)); 4. Providing information for assessment of radiation risks; and 5. Establishing a tool for use in research and epidemiology. (IAEA)

  17. Influences of definition ambiguity on hospital performance indicator scores: examples from The Netherlands

    NARCIS (Netherlands)

    Anema, Helen A.; van der Veer, Sabine N.; Kievit, Job; Krol-Warmerdam, Elly; Fischer, Claudia; Steyerberg, Ewout; Dongelmans, Dave A.; Reidinga, Auke C.; Klazinga, Niek S.; de Keizer, Nicolet F.

    2014-01-01

    Reliable and unambiguously defined performance indicators are fundamental to objective and comparable measurements of hospitals' quality of care. In two separate case studies (intensive care and breast cancer care), we investigated if differences in definition interpretation of performance

  18. Late presentation to HIV testing is overestimated when based on the consensus definition.

    Science.gov (United States)

    Sasse, A; Florence, E; Pharris, A; De Wit, S; Lacor, P; Van Beckhoven, D; Deblonde, J; Delforge, M-L; Fransen, K; Goffard, J-C; Legrand, J-C; Moutschen, M; Piérard, D; Ruelle, J; Vaira, D; Vandercam, B; Van Ranst, M; Van Wijngaerden, E; Vandekerckhove, L; Verhofstede, C

    2016-03-01

    In 2011, a consensus was reached defining "late presenters" (LPs) as individuals presenting for care with a CD4 count account. Case surveillance data for newly diagnosed patients in Belgium in 1998-2012 were analysed, including CD4 count at diagnosis, the presence of AIDS-defining events, and recent infections (definition. Secondly, LPs were reclassified as "nonlate" if infections were reported as recent. A total of 7949 HIV diagnoses were included in the study. Recent infections were increasingly reported over time, accounting for 8.2% of new infections in 1998 and 37.5% in 2012. The consideration of clinical stage significantly modified the proportion of LPs: 18.2% of men who have sex with men (MSM) diagnosed in 2012 would be classified as LPs instead of 30.9% using the consensus definition (P definition. The impact of transient CD4 count on late presentation estimates should be assessed and, if relevant, the introduction of clinical stage in the definition of late presentation should be considered. © 2015 British HIV Association.

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

    Science.gov (United States)

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

    2016-07-01

    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

  20. Guaranteed performance in reaching mode of sliding mode ...

    Indian Academy of Sciences (India)

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

    addresses the design of constant plus proportional rate reaching law-based SMC for second-order ... Reaching mode; sliding mode controlled systems; output tracking ... The uncertainty in the input distribution function g is expressed as.

  1. Nanomaterials under REACH. Nanosilver as a case study

    NARCIS (Netherlands)

    Pronk MEJ; Wijnhoven SWP; Bleeker EAJ; Heugens EHW; Peijnenburg WJGM; Luttik R; Hakkert BC; SEC; SIR; LER

    2009-01-01

    Om de risico's van nanomaterialen te kunnen inschatten en beheersen, zijn enkele aanpassingen nodig in de Europese chemicalienwetgeving REACH. De gegevens over stoffen waar REACH standaard om vraagt, zijn namelijk onvoldoende om de specifieke eigenschappen van nanomaterialen te bepalen. Hetzelfde

  2. Reaching Adolescents and Youth in Burkina Faso, Guinea-Bissau

    African Journals Online (AJOL)

    AJRH Managing Editor

    typical profile of individuals in contact with peer educators or attending youth ... being reached (versus not reached) by programs ... characteristics in order to serve groups that may be ... places for counseling services but the frequency of.

  3. Reaching Hard-to-Reach Individuals: Nonselective Versus Targeted Outbreak Response Vaccination for Measles

    Science.gov (United States)

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

    2014-01-01

    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. PMID:24131555

  4. Outcomes of senior reach gatekeeper referrals: comparison of the Spokane gatekeeper program, Colorado Senior Reach, and Mid-Kansas Senior Outreach.

    Science.gov (United States)

    Bartsch, David A; Rodgers, Vicki K; Strong, Don

    2013-01-01

    Outcomes of older adults referred for care management and mental health services through the senior reach gatekeeper model of case finding were examined in this study and compared with the Spokane gatekeeper model Colorado Senior Reach and the Mid-Kansas Senior Outreach (MKSO) programs are the two Senior Reach Gatekeeper programs modeled after the Spokane program, employing the same community education and gatekeeper model and with mental health treatment for elderly adults in need of support. The three mature programs were compared on seniors served isolation, and depression ratings. Nontraditional community gatekeepers were trained and referred seniors in need. Findings indicate that individuals served by the two Senior Reach Gatekeeper programs demonstrated significant improvements. Isolation indicators such as social isolation decreased and depression symptoms and suicide ideation also decreased. These findings for two Senior Reach Gatekeeper programs demonstrate that the gatekeeper approach to training community partners worked in referring at-risk seniors in need in meeting their needs, and in having a positive impact on their lives.

  5. The dipoles reach the half-way mark

    CERN Multimedia

    2006-01-01

    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. Health Care Provider Value Chain

    OpenAIRE

    Kawczynski , Lukasz; Taisch , Marco

    2009-01-01

    International audience; In every society there is a need for an efficient health care system. This paper aims to propose a value definition and a value chain model within the health care. In order to define value patients and experts were surveyed. The proposed definition offers a complex way of looking at the value within the health care sector. The proposal of the value chain model is anticipated with a value stream mapping activities and experts interviews. Proposed model offers consistent...

  7. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  8. Historical centres: changing definitions

    Directory of Open Access Journals (Sweden)

    Roberta Lazzarotti

    2014-02-01

    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.

  9. Action plans can interact to hinder or facilitate reach performance.

    Science.gov (United States)

    Fournier, Lisa R; Wiediger, Matthew D; Taddese, Ezana F

    2015-11-01

    Executing a reach action can be delayed while retaining another action in working memory (WM) if the two action plans partly overlap rather than do not overlap. This delay (partial repetition cost) occurs when reach responses are under cognitive control. In this study, we investigated whether facilitation (a partial repetition benefit) occurs when reach responses are automatic. We also examined whether the hemisphere controlling the limb or selection of the preferred limb (based on a free-reach task) influences reach performance when the actions partly overlap. Left- and right-handers reached to different stimulus locations to the left and right of body midline with their ipsilateral hand while maintaining an action plan in WM that required the same or the different hand. The results showed a partial repetition benefit for spatially compatible reaches to left and right stimulus locations far from the body midline, but not for those near the body midline. Also, no partial repetition cost was found at any of the stimulus-reach locations. This indicates that automatic reach responses that partly overlap with an action plan maintained in WM are not delayed, but instead can be facilitated (partial repetition benefit). The roles of hemisphere and reach-hand preference in action control and the importance of the degree of feature overlap in obtaining a partial repetition benefit (and cost) are discussed.

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

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    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.

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

    DEFF Research Database (Denmark)

    Mortensen, Peter Stendahl

    2000-01-01

    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 ...... and estiamtes from such models are shown to be closer to panel data. the problem, however, is to get valid input for such models from readership surveys. Means for this are discussed....

  12. CORRELATION OF LOW BACK PAIN WITH BODY MASS INDEX, FUNCTIONAL REACH TEST AMONG FEMALE NURSING PROFESSIONALS

    Directory of Open Access Journals (Sweden)

    Shameela .T .V

    2015-12-01

    Full Text Available Background: Among health care workers the highest level of work related back injuries are more affected in nurses. There were many studies done to assess low back pain by using different tools. So this study aimed to identify the prevalence low back pain disability among female nursing professionals and the association between BMI, functional reach test and low back pain, so that a better tool can be used during the clinical examination for the betterment of the patient. The objective of the study is to identify the prevalence of low back pain disability, the association of Low Back Pain(LBP with BMI and functional reach test among female nursing professionals. Methods: A total of 256 subjects were assessed for disability due to back pain using OswestryLBP Disability Questionnaire and the prevalence of disability was determined. The sit and reach test, forward reach test and their BMI were calculated for those who had a disability score of 20 and above (n=87. Results: Data was analyzed using Pearson’s correlation.The study result showed a significant correlation (p=0.03 of sit and reach test with low back pain disability scores. There was a negative correlationseen among BMI and LBP disability score forward reach test and LBP disability score, and BMI and no low back pain disability score. Conclusion: The prevalence of LBP disability among nursing professionals was 33.9%. This study suggest that sit and reach test can be used as an indicator of low back pain. Whereas BMI and forward reach test do not indicate low back pain.

  13. Cultural competence: a constructivist definition.

    Science.gov (United States)

    Blanchet Garneau, Amélie; Pepin, Jacinthe

    2015-01-01

    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. © The Author(s) 2014.

  14. On-Location Public Affairs Reach-Back System

    Science.gov (United States)

    2017-03-01

    INTENTIONALLY LEFT BLANK xxiii ACKNOWLEDGMENTS None of us is as smart as all of us. —Management expert Ken Blanchard It seems you can’t get much...requirements where other infrastructure is limited or non-existent. A. DEFINITION OF ULTRA HIGH DEFINITION VIDEO Digital images are displayed as a grid of...of typical personal computer hardware, including a fourth-generation Intel i7 quad-core processor , 16GB of random access memory (RAM), and multiple

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    (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...

  16. Acute respiratory distress syndrome: the Berlin Definition.

    Science.gov (United States)

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

    2012-06-20

    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 < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin 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 < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC 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

  17. Late presentation of HIV infection: a consensus definition

    DEFF Research Database (Denmark)

    Antinori, A; Coenen, T; Costagiola, D

    2010-01-01

    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....

  18. Analyzing differences in operational disease definitions using ontological modeling

    NARCIS (Netherlands)

    Peelen, Linda; Klein, Michel C.A.; Schlobach, Stefan; De Keizer, Nicolette F.; Peek, Niels

    2007-01-01

    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. 42 CFR 484.2 - Definitions.

    Science.gov (United States)

    2010-10-01

    ...-function health agency, such as the home care department of a hospital or the nursing division of a health... AND CERTIFICATION HOME HEALTH SERVICES General Provisions § 484.2 Definitions. As used in this part... governing the agency's operation. Branch office means a location or site from which a home health agency...

  20. 14 CFR 1251.503 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning... otherwise entitled by statute, regulation, or agency policy to receive education services from the agency... Aeronautics and Space Administration § 1251.503 Definitions. For purposes of this regulation, the term...

  1. 36 CFR 1208.103 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning... otherwise entitled by statute, regulation, or agency policy to receive education services from the agency... ARCHIVES AND RECORDS ADMINISTRATION § 1208.103 Definitions. For purposes of this regulation, the term...

  2. Consistency assessment of rating curve data in various locations using Bidirectional Reach (BReach)

    Science.gov (United States)

    Van Eerdenbrugh, Katrien; Van Hoey, Stijn; Coxon, Gemma; Freer, Jim; Verhoest, Niko E. C.

    2017-10-01

    When estimating discharges through rating curves, temporal data consistency is a critical issue. In this research, consistency in stage-discharge data is investigated using a methodology called Bidirectional Reach (BReach), which departs from a (in operational hydrology) commonly used definition of consistency. A period is considered to be consistent if no consecutive and systematic deviations from a current situation occur that exceed observational uncertainty. Therefore, the capability of a rating curve model to describe a subset of the (chronologically sorted) data is assessed in each observation by indicating the outermost data points for which the rating curve model behaves satisfactorily. These points are called the maximum left or right reach, depending on the direction of the investigation. This temporal reach should not be confused with a spatial reach (indicating a part of a river). Changes in these reaches throughout the data series indicate possible changes in data consistency and if not resolved could introduce additional errors and biases. In this research, various measurement stations in the UK, New Zealand and Belgium are selected based on their significant historical ratings information and their specific characteristics related to data consistency. For each country, regional information is maximally used to estimate observational uncertainty. Based on this uncertainty, a BReach analysis is performed and, subsequently, results are validated against available knowledge about the history and behavior of the site. For all investigated cases, the methodology provides results that appear to be consistent with this knowledge of historical changes and thus facilitates a reliable assessment of (in)consistent periods in stage-discharge measurements. This assessment is not only useful for the analysis and determination of discharge time series, but also to enhance applications based on these data (e.g., by informing hydrological and hydraulic model

  3. A Comprehensive Definition for Integrative Oncology.

    Science.gov (United States)

    Witt, Claudia M; Balneaves, Lynda G; Cardoso, Maria J; Cohen, Lorenzo; Greenlee, Heather; Johnstone, Peter; Kücük, Ömer; Mailman, Josh; Mao, Jun J

    2017-11-01

    Integrative oncology, which is generally understood to refer to the use of a combination of complementary medicine therapies in conjunction with conventional cancer treatments, has been defined in different ways, but there is no widely accepted definition. We sought to develop and establish a consensus for a comprehensive definition of the field of integrative oncology. We used a mixed-methods approach that included a literature analysis and a consensus procedure, including an interdisciplinary expert panel and surveys, to develop a comprehensive and acceptable definition for the term "integrative oncology." The themes identified in the literature and from the expert discussion were condensed into a two-sentence definition. Survey respondents had very positive views on the draft definition, and their comments helped to shape the final version. The final definition for integrative oncology is: "Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before,during, and beyond cancer treatment." This short and comprehensive definition for the term integrative oncology will facilitate a better understanding and communication of this emerging field. This definition will also drive focused and cohesive effort to advance the field of integrative oncology. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

    Directory of Open Access Journals (Sweden)

    Chiara eBegliomini

    2014-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Environmental stressors afflicting tailwater stream reaches across the United States

    Science.gov (United States)

    Miranda, Leandro E.; Krogman, R. M.

    2014-01-01

    The tailwater is the reach of a stream immediately below an impoundment that is hydrologically, physicochemically and biologically altered by the presence and operation of a dam. The overall goal of this study was to gain a nationwide awareness of the issues afflicting tailwater reaches in the United States. Specific objectives included the following: (i) estimate the percentage of reservoirs that support tailwater reaches with environmental conditions suitable for fish assemblages throughout the year, (ii) identify and quantify major sources of environmental stress in those tailwaters that do support fish assemblages and (iii) identify environmental features of tailwater reaches that determine prevalence of key fish taxa. Data were collected through an online survey of fishery managers. Relative to objective 1, 42% of the 1306 reservoirs included in this study had tailwater reaches with sufficient flow to support a fish assemblage throughout the year. The surface area of the reservoir and catchment most strongly delineated reservoirs maintaining tailwater reaches with or without sufficient flow to support a fish assemblage throughout the year. Relative to objective 2, major sources of environmental stress generally reflected flow variables, followed by water quality variables. Relative to objective 3, zoogeography was the primary factor discriminating fish taxa in tailwaters, followed by a wide range of flow and water quality variables. Results for objectives 1–3 varied greatly among nine geographic regions distributed throughout the continental United States. Our results provide a large-scale view of the effects of reservoirs on tailwater reaches and may help guide research and management needs.

  7. The role of diseases, risk factors and symptoms in the definition of multimorbidity – a systematic review

    Science.gov (United States)

    Willadsen, Tora Grauers; Bebe, Anna; Køster-Rasmussen, Rasmus; Jarbøl, Dorte Ejg; Guassora, Ann Dorrit; Waldorff, Frans Boch; Reventlow, Susanne; Olivarius, Niels de Fine

    2016-01-01

    Objective is to explore how multimorbidity is defined in the scientific literature, with a focus on the roles of diseases, risk factors, and symptoms in the definitions. Design: Systematic review. Methods: MEDLINE (PubMed), Embase, and The Cochrane Library were searched for relevant publications up until October 2013. One author extracted the information. Ambiguities were resolved, and consensus reached with one co-author. Outcome measures were: cut-off point for the number of conditions included in the definitions of multimorbidity; setting; data sources; number, kind, duration, and severity of diagnoses, risk factors, and symptoms. We reviewed 163 articles. In 61 articles (37%), the cut-off point for multimorbidity was two or more conditions (diseases, risk factors, or symptoms). The most frequently used setting was the general population (68 articles, 42%), and primary care (41 articles, 25%). Sources of data were primarily self-reports (56 articles, 42%). Out of the 163 articles selected, 115 had individually constructed multimorbidity definitions, and in these articles diseases occurred in all definitions, with diabetes as the most frequent. Risk factors occurred in 98 (85%) and symptoms in 71 (62%) of the definitions. The severity of conditions was used in 26 (23%) of the definitions, but in different ways. The definition of multimorbidity is heterogeneous and risk factors are more often included than symptoms. The severity of conditions is seldom included. Since the number of people living with multimorbidity is increasing there is a need to develop a concept of multimorbidity that is more useful in daily clinical work. Key pointsThe increasing number of multimorbidity patients challenges the healthcare system. The concept of multimorbidity needs further discussion in order to be implemented in daily clinical practice.Many definitions of multimorbidity exist and most often a cut-off point of two or more is applied to a range of 4–147 different conditions

  8. Proximal and distal adjustments of reaching behavior in preterm infants.

    Science.gov (United States)

    de Toledo, Aline Martins; Soares, Daniele de Almeida; Tudella, Eloisa

    2011-01-01

    The authors aimed to investigate proximal and distal adjustments of reaching behavior and grasping in 5-, 6-, and 7-month-old preterm infants. Nine low-risk preterm and 10 full-term infants participated. Both groups showed the predominance of unimanual reaching, an age-related increase in the frequency of vertical-oriented and open hand movement, and also an increase in successful grasping from 6 to 7 months. The frequency of open hand was higher in the preterm group at 6 months. Intrinsic restrictions imposed by prematurity did not seem to have impaired reaching performance of preterm infants throughout the months of age.

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

    Science.gov (United States)

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

    2017-06-01

    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.

  10. Ranking REACH registered neutral, ionizable and ionic organic chemicals based on their aquatic persistency and mobility.

    Science.gov (United States)

    Arp, H P H; Brown, T N; Berger, U; Hale, S E

    2017-07-19

    The contaminants that have the greatest chances of appearing in drinking water are those that are mobile enough in the aquatic environment to enter drinking water sources and persistent enough to survive treatment processes. Herein a screening procedure to rank neutral, ionizable and ionic organic compounds for being persistent and mobile organic compounds (PMOCs) is presented and applied to the list of industrial substances registered under the EU REACH legislation as of December 2014. This comprised 5155 identifiable, unique organic structures. The minimum cut-off criteria considered for PMOC classification herein are a freshwater half-life >40 days, which is consistent with the REACH definition of freshwater persistency, and a log D oc water distribution coefficient). Experimental data were given the highest priority, followed by data from an array of available quantitative structure-activity relationships (QSARs), and as a third resort, an original Iterative Fragment Selection (IFS) QSAR. In total, 52% of the unique REACH structures made the minimum criteria to be considered a PMOC, and 21% achieved the highest PMOC ranking (half-life > 40 days, log D oc freshwater persistency, which was also the parameter that QSARs performed the most poorly at predicting. Several prioritized drinking water contaminants in the EU and USA, and other contaminants of concern, were identified as PMOCs. This identification and ranking procedure for PMOCs can be part of a strategy to better identify contaminants that pose a threat to drinking water sources.

  11. Improving Posthospital Discharge Telephone Reach Rates Through Prehospital Discharge Face-to-Face Meetings.

    Science.gov (United States)

    Vergara, Franz H; Sheridan, Daniel J; Sullivan, Nancy J; Budhathoki, Chakra

    The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. Acute care adult medicine inpatient units. A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups. The framework of the study is the transitions theory. A convenience sampling technique was used, whereby 88 eligible patients on the intervention unit received face-to-face meetings prehospital discharge whereas 123 patients on the comparison unit received standard care (no face-to-face meetings). Cross-tabulation and chi-square tests were employed to examine the association of face-to-face meeting intervention and TFU reach rates. Implementing brief (face-to-face meetings by a telephonic case manager prehospital discharge resulted in a TFU reach rate of 87% on the intervention unit, whereas the comparison unit only had a 58% TFU reach rate (p communication with more patients posthospital discharge. A brief prehospital discharge face-to-face meeting with patients assisted them to understand the reasons for a posthospital discharge telephone call, identified the best times to call using accurate telephone numbers, and taught patients how best to prepare for the call. In addition, by meeting patients face-to-face, the telephonic case manager was no longer an unknown person on the telephone asking them questions about their medical condition. These factors combined may have significantly helped to increase TFU reach rates.

  12. Just caring.

    Science.gov (United States)

    Hussey, Trevor

    2012-01-01

    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.

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

    Data.gov (United States)

    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...

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

    Data.gov (United States)

    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...

  15. Stream Habitat Reach Summary - North Coast [ds63

    Data.gov (United States)

    California Natural Resource Agency — 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...

  16. LTRM Fish Sampling Strata, UMRS La Grange Reach

    Data.gov (United States)

    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...

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

    Data.gov (United States)

    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. Impact of measles supplementary immunization activities on reaching children missed by routine programs.

    Science.gov (United States)

    Portnoy, Allison; Jit, Mark; Helleringer, Stéphane; Verguet, Stéphane

    2018-01-02

    Measles supplementary immunization activities (SIAs) are vaccination campaigns that supplement routine vaccination programs with a recommended second dose opportunity to children of different ages regardless of their previous history of measles vaccination. They are conducted every 2-4 years and over a few weeks in many low- and middle-income countries. While SIAs have high vaccination coverage, it is unclear whether they reach the children who miss their routine measles vaccine dose. Determining who is reached by SIAs is vital to understanding their effectiveness, as well as measure progress towards measles control. We examined SIAs in low- and middle-income countries from 2000 to 2014 using data from the Demographic and Health Surveys. Conditional on a child's routine measles vaccination status, we examined whether children participated in the most recent measles SIA. The average proportion of zero-dose children (no previous routine measles vaccination defined as no vaccination date before the SIA) reached by SIAs across 14 countries was 66%, ranging from 28% in São Tomé and Príncipe to 91% in Nigeria. However, when also including all children with routine measles vaccination data, this proportion decreased to 12% and to 58% when imputing data for children with vaccination reported by the mother and vaccination marks on the vaccination card across countries. Overall, the proportions of zero-dose children reached by SIAs declined with increasing household wealth. Some countries appeared to reach a higher proportion of zero-dose children using SIAs than others, with proportions reached varying according to the definition of measles vaccination (e.g., vaccination dates on the vaccination card, vaccination marks on the vaccination card, and/or self-reported data). This suggests that some countries could improve their targeting of SIAs to children who miss other measles vaccine opportunities. Across all countries, SIAs played an important role in reaching

  19. Decoding natural reach-and-grasp actions from human EEG

    Science.gov (United States)

    Schwarz, Andreas; Ofner, Patrick; Pereira, Joana; Ioana Sburlea, Andreea; Müller-Putz, Gernot R.

    2018-02-01

    Objective. Despite the high number of degrees of freedom of the human hand, most actions of daily life can be executed incorporating only palmar, pincer and lateral grasp. In this study we attempt to discriminate these three different executed reach-and-grasp actions utilizing their EEG neural correlates. Approach. In a cue-guided experiment, 15 healthy individuals were asked to perform these actions using daily life objects. We recorded 72 trials for each reach-and-grasp condition and from a no-movement condition. Main results. Using low-frequency time domain features from 0.3 to 3 Hz, we achieved binary classification accuracies of 72.4%, STD  ±  5.8% between grasp types, for grasps versus no-movement condition peak performances of 93.5%, STD  ±  4.6% could be reached. In an offline multiclass classification scenario which incorporated not only all reach-and-grasp actions but also the no-movement condition, the highest performance could be reached using a window of 1000 ms for feature extraction. Classification performance peaked at 65.9%, STD  ±  8.1%. Underlying neural correlates of the reach-and-grasp actions, investigated over the primary motor cortex, showed significant differences starting from approximately 800 ms to 1200 ms after the movement onset which is also the same time frame where classification performance reached its maximum. Significance. We could show that it is possible to discriminate three executed reach-and-grasp actions prominent in people’s everyday use from non-invasive EEG. Underlying neural correlates showed significant differences between all tested conditions. These findings will eventually contribute to our attempt of controlling a neuroprosthesis in a natural and intuitive way, which could ultimately benefit motor impaired end users in their daily life actions.

  20. 32 CFR 564.37 - Medical care.

    Science.gov (United States)

    2010-07-01

    ... 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 which...

  1. REACH: next step to a sound chemicals management.

    Science.gov (United States)

    Van der Wielen, Arnold

    2007-12-01

    REACH is the new European Regulation for Registration, Evaluation, Authorisation and Restriction of Chemicals. It entered into force on 1st June 2007 to streamline and improve the former legislative framework on new and on existing chemical substances of the European Union. Companies which manufacture or import more than 1 tonne of a substance per year will be required to register the substance at the new EU Chemicals Agency located in Helsinki. REACH places greater responsibility on industry to manage the risks that chemicals may pose to the health and the environment and to provide safety information that will be passed down the supply chain. In principle, REACH applies to all chemicals as such, as components in preparations and as used in articles. REACH is a radical step forward in the EU chemicals management. The onus will move from the authorities to industry. In addition, REACH will allow the further evaluation of substances where there are grounds for concern, foresees an authorisation system for the use of substances of very high concern and a system of restrictions, where applicable, for substances of concern. The Authorisation system will require companies to switch progressively to safer alternatives where a suitable alternative exists. Current use restrictions will remain under REACH system.

  2. Definition of Videogames

    Directory of Open Access Journals (Sweden)

    Grant Tavinor

    2008-01-01

    Full Text Available Can videogames be defined? The new field of games studies has generated three somewhat competing models of videogaming that characterize games as new forms of gaming, narratives, and interactive fictions. When treated as necessary and sufficient condition definitions, however, each of the three approaches fails to pick out all and only videogames. In this paper I argue that looking more closely at the formal qualities of definition helps to set out the range of definitional options open to the games theorist. A disjunctive definition of videogaming seems the most appropriate of these definitional options. The disjunctive definition I offer here is motivated by the observation that there is more than one characteristic way of being a videogame.

  3. Measuring progress towards a primary care-led NHS.

    Science.gov (United States)

    Miller, P; Craig, N; Scott, A; Walker, A; Hanlon, P

    1999-07-01

    The push towards a 'primary care-led' National Health Service (NHS) has far-reaching implications for the future structure of the NHS. The policy involves both a growing emphasis on the role of primary care practitioners in the commissioning of health services, and a change from hospital to primary and community settings for a range of services and procedures. Although the terminology has changed, this emphasis remains in the recent Scottish Health Service White Paper and its English counterpart. To consider three questions in relation to this policy goal. First, does the evidence base support the changes? Secondly, what is the scale of the changes that have occurred? Thirdly, what are the barriers to the development of a primary care-led NHS? Programme budgets were compiled to assess changes over time in the balance of NHS resource allocation with respect to primary and secondary care. Total NHS revenue expenditure for the 15 Scottish health boards was grouped into four blocks or 'programmes': primary care, secondary care, community services, and a residual. The study period was 1991/2 to 1995/6. Expenditure data were supplied by the Scottish Office. Ambiguity of definitions and the absence of good data cause methodological difficulties in evaluating the scale and the appropriateness of the shift. The data that are available suggest that, at the aggregate level, there have been changes over time in the balance of resource allocation between care settings: relative investment into primary care has increased. It would appear that this investment is relatively small and from growth money rather than a 'shift' from secondary care. In addition, the impact of GP-led commissioning is variable but limited. General practitioners' (GPs') attitudes to the policy suggest that progress towards a primary care-led NHS will continue to be patchy. The limited shift to date, alongside evidence of ambivalent attitudes to the shift on the part of GPs, suggest that this is a policy

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

    Science.gov (United States)

    Cornelsen, Sonja; Rennig, Johannes; Himmelbach, Marc

    2016-06-01

    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. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Delays in using chromatic and luminance information to correct rapid reaches.

    Science.gov (United States)

    Kane, Adam; Wade, Alex; Ma-Wyatt, Anna

    2011-09-07

    People can use feedback to make online corrections to movements but only if there is sufficient time to integrate the new information and make the correction. A key variable in this process is therefore the speed at which the new information about the target location is coded. Conduction velocities for chromatic signals are lower than for achromatic signals so it may take longer to correct reaches to chromatic stimuli. In addition to this delay, the sensorimotor system may prefer achromatic information over the chromatic information as delayed information may be less valuable when movements are made under time pressure. A down-weighting of chromatic information may result in additional latencies for chromatically directed reaches. In our study, participants made online corrections to reaches to achromatic, (L-M)-cone, and S-cone stimuli. Our chromatic stimuli were carefully adjusted to minimize stimulation of achromatic pathways, and we equated stimuli both in terms of detection thresholds and also by their estimated neural responses. Similar stimuli were used throughout the subjective adjustments and final reaching experiment. Using this paradigm, we found that responses to achromatic stimuli were only slightly faster than responses to (L-M)-cone and S-cone stimuli. We conclude that the sensorimotor system treats chromatic and achromatic information similarly and that the delayed chromatic responses primarily reflect early conduction delays.

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

    Science.gov (United States)

    Brand, T; Böttcher, S; Jahn, I

    2015-12-01

     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. [The REACH legislation: the consumer and environment protection perspective].

    Science.gov (United States)

    Gundert-Remy, Ursula

    2008-12-01

    REACH has been initiated with the aim of improving existing legislation. In order to assist in the interpretation of the REACH legislation, guidance documents have been developed, which have only lately become available. According to the REACH annexes and supported by guidance documents, waiving of test requirements will be possible, thus, opening the possibility that under REACH no new (eco)toxicological data will be required. Concerning products, a guidance document was released in April 2008 stating that the substance concentration threshold of 0.1 % (w/w) applies to the article as produced or imported and it does not relate to the homogeneous materials or parts of an article, but relates to the article as such (i.e., as produced or imported). Hence, notification will not be required for many products containing chemicals with properties which place them on the candidate list for authorization. In summary, it is at present not foreseeable whether the expected benefit of the REACH legislation will materialise for the environment and for the health of consumers and at the work place.

  8. Integrative health care - Toward a common understanding: A mixed method study.

    Science.gov (United States)

    Leach, Matthew J; Wiese, Marlene; Thakkar, Manisha; Agnew, Tamara

    2018-02-01

    To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and policy makers. In recognising the need for a clearer description, we propose a scientifically-grounded, multi-disciplinary stakeholder-informed definition of IHC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Local lymph node assay: how testing laboratories apply OECD TG 429 for REACH purposes.

    Science.gov (United States)

    Rovida, Costanza

    2011-01-01

    The Local Lymph Node Assay (LLNA) is the official method for assessing the allergic contact dermatitis potential of chemicals for the purposes of REACH regulation. The LLNA went through a validation process that allowed the delineation of a robust protocol for performing new tests. The OECD accepted this method in 2002 and published OECD TG 429. The European Chemical Agency (ECHA) recently published data that were submitted in the registration dossiers of chemicals. This database was analysed to determine how testing laboratories apply OECD TG 429. This analysis comes after a detailed analysis of four full study reports that were also prepared for REACH purposes. Although the majority of the tests are fully compliant with OECD TG 429, some showed major deviations, and a number of others used more animals than necessary. This suggests that in vivo tests need to be planned more carefully and consciously to obtain meaningful results with the minimum animal number necessary.

  10. Status report - FoodReach Toronto: lowering food costs for social agencies and community groups

    Directory of Open Access Journals (Sweden)

    Paul Coleman

    2018-01-01

    Full Text Available Toronto has the largest absolute number of food insecure households for any metropolitan census area in Canada: of its 2.1 million households, roughly 252 000 households (or 12% experience some level of food insecurity. Community organizations (including social agencies, school programs, and child care centres serve millions of meals per year to the city’s most vulnerable citizens, but often face challenges accessing fresh produce at affordable prices. Therefore in 2015, Toronto Public Health, in collaboration with public- and private-sector partners, launched the FoodReach program to improve the efficiency of food procurement among community organizations by consolidating their purchasing power. Since being launched, FoodReach has been used by more than 50 community organizations to provide many of Toronto’s most marginalised groups with regular access to healthy produce.

  11. REACH-related substitution within the Danish printing industry

    DEFF Research Database (Denmark)

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

    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......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...... 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....

  12. Definition of postprandial lipaemia

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...

  13. Productivity of Stream Definitions

    NARCIS (Netherlands)

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

    2007-01-01

    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

  14. Productivity of stream definitions

    NARCIS (Netherlands)

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

    2008-01-01

    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

  15. Engineering Definitional Interpreters

    DEFF Research Database (Denmark)

    Midtgaard, Jan; Ramsay, Norman; Larsen, Bradford

    2013-01-01

    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...

  16. Dynamics of Situation Definition

    Science.gov (United States)

    Park, Dongseop; Moro, Yuji

    2006-01-01

    Situation definition is the process and product of actors' interpretive activities toward a given situation. By reviewing a number of psychological studies conducted in experimental settings, we found that the studies have only explicated a part of the situation definition process and have neglected its dynamic aspects. We need to focus on the…

  17. Composite Coiled Tubing for Extended Reach in Horizontal Oil Wells

    DEFF Research Database (Denmark)

    Costache, Andrei; Berggreen, Christian

    2017-01-01

    Conventional steel coiled tubing cannot reach along the entire length of very long horizontal oil wells. A lighter and more buoyant coiled tube is made possible using composite materials. The high stiffness to weight ratio of fiber reinforced polymers, coupled with a lower coefficient of friction......, has the potential of greatly extending the reach in horizontal oil wells. This study shows how to design composite coiled tubing and gives a comprehensive discussion about the most influential parameters. Several solutions, using glass-fiber and carbon are considered. Finite element models are used...

  18. Telerobotic operation of structurally flexible, long-reach manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.; Hwang, D.H.; Babcock, S.M.

    1994-01-01

    As a part of the Department of Energy's Environmental Restoration and Waste Management Program, long-reach manipulators are being considered for the retrieval of waste from large storage tanks. Long-reach manipulators may have characteristics significantly different from those of typical industrial robots because of the flexibility of long links needed to cover the large workspace. To avoid structural vibrations during operation, control algorithms employing various types of shaping filters were investigated. A new approach that uses embedded simulation was developed and compared with others. In the new approach, generation of joint trajectories considering link flexibility was also investigated

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

    Science.gov (United States)

    Mason, Linda

    2000-01-01

    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…

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

    Science.gov (United States)

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

    2017-01-01

    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.

  1. The definition of cross polarization

    DEFF Research Database (Denmark)

    Ludwig, Arthur

    1973-01-01

    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....

  2. Preconception Care and Prenatal Care

    Science.gov (United States)

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

  3. Task-dependent vestibular feedback responses in reaching

    NARCIS (Netherlands)

    Keyser, J.; Medendorp, W.P.; Selen, L.P.J.

    2017-01-01

    When reaching for an earth-fixed object during self-rotation, the motor system should appropriately integrate vestibular signals and sensory predictions to compensate for the intervening motion and its induced inertial forces. While it is well established that this integration occurs rapidly, it is

  4. Reaching the Unreached - Special Emphasis on the Communication ...

    African Journals Online (AJOL)

    This paper provides an overview of the existing communication component in the Expanded Program on Immunisation (EPI) training in Zambia and critically analyses the need for a humane touch in the communication process so as to reach the target audience effectively. Interpersonal Communication (IPC) in Zambia has ...

  5. Shaping of Reach-to-Grasp Kinematics by Intentions

    DEFF Research Database (Denmark)

    Egmose, Ida; Køppe, Simo

    2017-01-01

    is primarily associated with transporting the hand to the object (i.e., extrinsic object properties), the decelerating part of the reach is used as a preparation for object manipulation (i.e., prepare the grasp or the subsequent action), and the grasp is associated with manipulating the object's intrinsic...

  6. Recognition for reaching the most vulnerable populations in Burkina ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Recognition for reaching the most vulnerable populations in Burkina Faso. 07 novembre 2016. An IDRC supported project was recognized for its efforts to improve health service provision and the monitoring of pregnant women, new mothers, children, and people living with HIV in Burkina Faso's Nouna district. Dr Maurice ...

  7. Object Permanence, Reaching, and Locomotion in Infants Who Are Blind.

    Science.gov (United States)

    Ross, S.; Tobin, M. J.

    1997-01-01

    The literature on the effects of congenital blindness on infants' development of motor functions and concepts of object permanence is reviewed. The article questions the idea that infants must first develop an object concept before sound clues alone will elicit reaching. Possible interventions to redress the effects of congenital blindness on…

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

    CERN Document Server

    Sabatini, John; O'Reilly, Tenaha

    2012-01-01

    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.

  9. Nanshan Aluminum Reached Strategic Cooperation with CSR Corporation Limited

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    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

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

    Science.gov (United States)

    Colak, Mehmet Selman; Ege, Aylin

    2013-01-01

    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. Development of postural adjustments during reaching in infants with CP

    NARCIS (Netherlands)

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

    1999-01-01

    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

  12. Evaluation of the Implementation of the Reaching Every District ...

    African Journals Online (AJOL)

    46987.2

    ABSTRACT. Background: In 2003, the Government of Zambia in collaboration with implementing partners in immunisation introduced the Reaching Every District. (RED) strategy to improve immunization coverage. The aim of this study is to evaluate the implementation of the. RED strategy in Lusaka district. Methods: A ...

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

    Science.gov (United States)

    DeFord, Diane

    2012-01-01

    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…

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

    NARCIS (Netherlands)

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

    2011-01-01

    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.

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

    Science.gov (United States)

    Bourne-Firl, Bridgetta

    2016-01-01

    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…

  16. Patterns of arm muscle activation involved in octopus reaching movements.

    Science.gov (United States)

    Gutfreund, Y; Flash, T; Fiorito, G; Hochner, B

    1998-08-01

    The extreme flexibility of the octopus arm allows it to perform many different movements, yet octopuses reach toward a target in a stereotyped manner using a basic invariant motor structure: a bend traveling from the base of the arm toward the tip (Gutfreund et al., 1996a). To study the neuronal control of these movements, arm muscle activation [electromyogram (EMG)] was measured together with the kinematics of reaching movements. The traveling bend is associated with a propagating wave of muscle activation, with maximal muscle activation slightly preceding the traveling bend. Tonic activation was occasionally maintained afterward. Correlation of the EMG signals with the kinematic variables (velocities and accelerations) reveals that a significant part of the kinematic variability can be explained by the level of muscle activation. Furthermore, the EMG level measured during the initial stages of movement predicts the peak velocity attained toward the end of the reaching movement. These results suggest that feed-forward motor commands play an important role in the control of movement velocity and that simple adjustment of the excitation levels at the initial stages of the movement can set the velocity profile of the whole movement. A simple model of octopus arm extension is proposed in which the driving force is set initially and is then decreased in proportion to arm diameter at the bend. The model qualitatively reproduces the typical velocity profiles of octopus reaching movements, suggesting a simple control mechanism for bend propagation in the octopus arm.

  17. How infants' reaches reveal principles of sensorimotor decision making

    Science.gov (United States)

    Dineva, Evelina; Schöner, Gregor

    2018-01-01

    In Piaget's classical A-not-B-task, infants repeatedly make a sensorimotor decision to reach to one of two cued targets. Perseverative errors are induced by switching the cue from A to B, while spontaneous errors are unsolicited reaches to B when only A is cued. We argue that theoretical accounts of sensorimotor decision-making fail to address how motor decisions leave a memory trace that may impact future sensorimotor decisions. Instead, in extant neural models, perseveration is caused solely by the history of stimulation. We present a neural dynamic model of sensorimotor decision-making within the framework of Dynamic Field Theory, in which a dynamic instability amplifies fluctuations in neural activation into macroscopic, stable neural activation states that leave memory traces. The model predicts perseveration, but also a tendency to repeat spontaneous errors. To test the account, we pool data from several A-not-B experiments. A conditional probabilities analysis accounts quantitatively how motor decisions depend on the history of reaching. The results provide evidence for the interdependence among subsequent reaching decisions that is explained by the model, showing that by amplifying small differences in activation and affecting learning, decisions have consequences beyond the individual behavioural act.

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

  19. On stiffening cables of a long reach manipulator

    International Nuclear Information System (INIS)

    Wang, S.L.; Santiago, P.

    1996-01-01

    A long reach manipulator will be used for waste remediation in large underground storage tanks. The manipulator's slenderness makes it flexible and difficult to control. A low-cost and effective method to enhance the manipulator's stiffness is proposed in this research by using suspension cables. These cables can also be used to accurately measure the position of the manipulator's wrist

  20. Challenges of extension workers in reaching rural women farmers in ...

    African Journals Online (AJOL)

    The study examined the challenges of extension workers in reaching rural women farmers in Enugu State Nigeria. Questionnaire was used to collect data from a sample size of 52 extension workers. Data were analyzed using percentage, mean statistic, chart and factor analysis. Results revealed that training and visit ...

  1. Quality, Reach, and Impact of Open Scholarly Publishing in Latin ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Quality, Reach, and Impact of Open Scholarly Publishing in Latin America. Better understanding Open Access of scholarly research will help determine how it contributes to the greater circulation of knowledge and disseminating research in Latin America. Open Access (defined as unrestricted access to articles published in ...

  2. The Internet and the Global Reach of EU law

    DEFF Research Database (Denmark)

    Kuner, Christopher Barth

    and learning; international negotiation; coercion and conditionality; and blocking recognition of third country legal measures. The EU’s actions in exercising its global reach implicate important normative issues, such as distinguishing between the furtherance of core EU legal values and the advancement...

  3. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

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

  4. Amplified Erosion above Waterfalls and Oversteepened Bedrock Reaches

    Science.gov (United States)

    Haviv, I.; Enzel, Y.; Whipple, K. X.; Zilberman, E.; Stone, J.; Matmon, A.; Fifield, K. L.

    2005-12-01

    Although waterfalls are abundant along steep bedrock channels, none of the conventional erosion laws can predict incision at the lip of a waterfall where flow is non-uniform and bed slope can be vertical. Considering the expected increase in flow velocity and shear stress at the lip of a vertical waterfall we determine erosion amplification at a waterfall lip as: Elip/Enormal= (1+0.4/Fr2)3n, where Fr is the Froude number and n ranges between 0.5-1.7. This amplification expression suggests that erosion at the lip could be as much as 2-5 times higher than normally expected in a setting with identical hydraulic geometry. It also demonstrates that a freefall is expected to amplify upstream incision rates even when the flow approaching the waterfall is highly supercritical. Utilizing this erosion amplification expression in numerical simulations in conjunction with a standard detachment-limited incision model we demonstrate its impact on reach-scale morphology above waterfalls. These simulations indicate that amplified erosion at the lip of a waterfall can trigger the formation of an oversteepened reach whose length is longer than the flow acceleration zone, provided incision velocity (Vi) at the edge of the flow acceleration zone is higher than the retreat velocity of the waterfall face. Such an oversteepened reach is expected to be more pronounced when Vi increases with increasing slope. The simulations also suggest that oversteepening can eventually lead to quasi steady-state gradients upstream from a waterfall provided Vi decreases with increasing slope. Flow acceleration above waterfalls can thus account, at least partially, for oversteepened bedrock reaches that are prevalent above waterfalls. Such reaches have been reported for the escarpments of southeast Australia, western Dead Sea, and at Niagara Falls. Using the cosmogenic isotope 36Cl we demonstrate that Vi upstream of a waterfall at the Dead Sea western escarpment is high enough for freefall

  5. Task-dependent vestibular feedback responses in reaching.

    Science.gov (United States)

    Keyser, Johannes; Medendorp, W Pieter; Selen, Luc P J

    2017-07-01

    When reaching for an earth-fixed object during self-rotation, the motor system should appropriately integrate vestibular signals and sensory predictions to compensate for the intervening motion and its induced inertial forces. While it is well established that this integration occurs rapidly, it is unknown whether vestibular feedback is specifically processed dependent on the behavioral goal. Here, we studied whether vestibular signals evoke fixed responses with the aim to preserve the hand trajectory in space or are processed more flexibly, correcting trajectories only in task-relevant spatial dimensions. We used galvanic vestibular stimulation to perturb reaching movements toward a narrow or a wide target. Results show that the same vestibular stimulation led to smaller trajectory corrections to the wide than the narrow target. We interpret this reduced compensation as a task-dependent modulation of vestibular feedback responses, tuned to minimally intervene with the task-irrelevant dimension of the reach. These task-dependent vestibular feedback corrections are in accordance with a central prediction of optimal feedback control theory and mirror the sophistication seen in feedback responses to mechanical and visual perturbations of the upper limb. NEW & NOTEWORTHY Correcting limb movements for external perturbations is a hallmark of flexible sensorimotor behavior. While visual and mechanical perturbations are corrected in a task-dependent manner, it is unclear whether a vestibular perturbation, naturally arising when the body moves, is selectively processed in reach control. We show, using galvanic vestibular stimulation, that reach corrections to vestibular perturbations are task dependent, consistent with a prediction of optimal feedback control theory. Copyright © 2017 the American Physiological Society.

  6. Bimanual reach to grasp movements after cervical spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Laura Britten

    Full Text Available Injury to the cervical spinal cord results in bilateral deficits in arm/hand function reducing functional independence and quality of life. To date little research has been undertaken to investigate control strategies of arm/hand movements following cervical spinal cord injury (cSCI. This study aimed to investigate unimanual and bimanual coordination in patients with acute cSCI using 3D kinematic analysis as they performed naturalistic reach to grasp actions with one hand, or with both hands together (symmetrical task, and compare this to the movement patterns of uninjured younger and older adults. Eighteen adults with a cSCI (mean 61.61 years with lesions at C4-C8, with an American Spinal Injury Association (ASIA grade B to D and 16 uninjured younger adults (mean 23.68 years and sixteen uninjured older adults (mean 70.92 years were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, and had longer deceleration phases than uninjured participants. These differences were exacerbated during bimanual reach-to-grasp tasks. Maximal grasp aperture was no different between groups, but reached earlier by people with cSCI. Participants with a cSCI were less synchronous than younger and older adults but all groups used the deceleration phase for error correction to end the movement in a synchronous fashion. Overall, this study suggests that after cSCI a level of bimanual coordination is retained. While there seems to be a greater reliance on feedback to produce both the reach to grasp, we observed minimal disruption of the more impaired limb on the less impaired limb. This suggests that bimanual movements should be integrated into therapy.

  7. Towards a practical definition of professional behaviour.

    Science.gov (United States)

    Rogers, Wendy; Ballantyne, Angela

    2010-04-01

    Professionalism remains a challenging part of the medical curriculum to define, teach and evaluate. We suggest that one way to meet these challenges is to clarify the definition of professionalism and distinguish this from medical ethics. Our analysis is two staged. First, we reviewed influential definitions of professionalism and separated elements relating to (a) ethico-legal competencies, (b) clinical competence and (c) professionalism. In reference to professionalism, we then distinguished between aspirational virtues/values and specific behaviours. From these, we develop a working definition of medical professional behaviour consisting of six domains of behaviour: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection; collaboration and team work; and care of colleagues. Second, we tested this working definition against empirical data concerning disciplinary action against practising doctors using (a) sources in the literature and (b) an original analysis of complaints received by the Medical Board of South Australia. Our empirical analysis supports the relevance of four of the six potential domains: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection. There are additional reasons for retaining 'collaboration and team work' in the medical professional behaviour curriculum but 'care of colleagues' may be better addressed in the ethico-legal curriculum. Our definition of professional behaviour is consistent with the theoretical literature, captures behaviours that predict future complaints against practitioners and is consistent with current complaints about professionalism in South Australian practitioners. This definition can further the teaching and assessing of professional behaviour in medical schools.

  8. The importance of reaching lipid targets: statins and the prevention of atherosclerosis.

    Science.gov (United States)

    Schwandt, P

    2003-06-01

    To help prevent the development of coronary heart disease (CHD), the European and NCEP guidelines have recommended target cholesterol levels for all individuals. Lifestyle changes are advocated for individuals not achieving these targets. Intervention with lipid-modifying agents may be required for patients at high risk of a cardiovascular event and statins are generally recognised as first-line therapy. Unfortunately, large numbers of patients at risk of cardiovascular events are not being treated to the guideline targets. Primary care physicians are in a good position to improve lipid management by assessing risk factors, implementing lipid management strategies, monitoring whether targets are being reached and amending treatment appropriately. Furthermore, by educating and motivating patients,primary care physicians may improve compliance with lifestyle changes and medication. These approaches may help more patients to achieve recommended lipid levels and prevent the development of cardiovascular disease.

  9. Role of salvage esophagectomy after definitive chemoradiotherapy

    International Nuclear Information System (INIS)

    Tachimori, Yuji

    2009-01-01

    Chemoradiotherapy has become a popular definitive therapy among many patients and oncologists for potentially resectable esophageal carcinoma. Although the complete response rates are high and short-term survival is favorable after chemoradiotherapy, persistent or recurrent locoregional disease is quite frequent. Salvage surgery is the sole curative intent treatment option for this course. As experience with definitive chemoradiotherapy grows, the number of salvage surgeries may increase. Selected articles about salvage esophagectomy after definitive chemoradiotherapy for esophageal carcinoma are reviewed. The number of salvage surgeries was significantly lower than the number of expected candidates. To identify candidates for salvage surgery, patients undergoing definitive chemoradiotherapy should be followed up carefully. Salvage esophagectomy is difficult when dissecting fibrotic masses from irradiated tissues. Patients who underwent salvage esophagectomy had increased morbidity and mortality. Pulmonary complications such as pneumonia and acute respiratory distress syndrome were common. The anastomotic leak rate was significantly increased because of the effects of the radiation administered to the tissues used as conduits. The most significant factor associated with long-term survival appeared to be complete resection. However, precise evaluation of resectability before operation was difficult. Nevertheless, increased morbidity and mortality will be acceptable in exchange for potential long-term survival after salvage esophagectomy. Such treatment should be considered for carefully selected patients at specialized centers. (author)

  10. Innovations are bringing better health within reach | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2018-01-29

    Jan 29, 2018 ... The project delivered better quality care to women and men suffering ... to foster communication at all levels: in the home, between spouses, in villages, ... This helps build more accountable and responsive health services.

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

    Medline Plus

    Full Text Available ... Crisis Centers About Be There Show You Care Find Resources Graphic Generator Toolkit Signs of Crisis Identifying ... or a Veteran you know is in crisis, find a facility near you. Spread the Word Download ...

  12. Translating the REACH Caregiver Intervention for Use by Area Agency on Aging Personnel: the REACH OUT Program

    Science.gov (United States)

    Burgio, Louis D.; Collins, Irene B.; Schmid, Bettina; Wharton, Tracy; McCallum, Debra; DeCoster, Jamie

    2009-01-01

    Purpose: The aim of this study was to translate the evidence-based Resources for Enhancing Alzheimer's Caregiver Health (REACH) II intervention for use in 4 Area Agencies on Aging (AAAs). A secondary aim was to examine possible moderators of treatment outcome. Design and Methods: We used a quasi-experimental pre-post treatment design with no…

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

    Science.gov (United States)

    Barrett, Sharon Kebschull

    2012-01-01

    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…

  14. Perceiver as polar planimeter: Direct perception of jumping, reaching, and jump-reaching affordances for the self and others.

    Science.gov (United States)

    Thomas, Brandon J; Hawkins, Matthew M; Nalepka, Patrick

    2017-03-30

    Runeson (Scandanavian Journal of Psychology 18:172-179, 1977) suggested that the polar planimeter might serve as an informative model system of perceptual mechanism. The key aspect of the polar planimeter is that it registers a higher order property of the environment without computational mediation on the basis of lower order properties, detecting task-specific information only. This aspect was posited as a hypothesis for the perception of jumping and reaching affordances for the self and another person. The findings supported this hypothesis. The perception of reaching while jumping significantly differed from an additive combination of jump-without-reaching and reach-without-jumping perception. The results are consistent with Gibson's (The senses considered as perceptual systems, Houghton Mifflin, Boston, MA; Gibson, The senses considered as perceptual systems, Houghton Mifflin, Boston, MA, 1966; The ecological approach to visual perception, Houghton Mifflin, Boston, MA; Gibson, The ecological approach to visual perception, Houghton Mifflin, Boston, MA, 1979) theory of information-that aspects of the environment are specified by patterns in energetic media.

  15. Simulation of Columbia River Floods in the Hanford Reach

    Energy Technology Data Exchange (ETDEWEB)

    Waichler, Scott R.; Serkowski, John A.; Perkins, William A.; Richmond, Marshall C.

    2017-01-30

    Columbia River water elevations and flows in the Hanford Reach affect the environment and facilities along the shoreline, including movement of contaminants in groundwater, fish habitat, and infrastructure subject to flooding. This report describes the hydraulic simulation of hypothetical flood flows using the best available topographic and bathymetric data for the Hanford Reach and the Modular Aquatic Simulation System in 1 Dimension (MASS1) hydrodynamic model. The MASS1 model of the Hanford Reach was previously calibrated to field measurements of water surface elevations. The current model setup can be used for other studies of flow, water levels, and temperature in the Reach. The existing MASS1 channel geometry and roughness and other model configuration inputs for the Hanford Reach were used for this study, and previous calibration and validation results for the model are reprinted here for reference. The flood flows for this study were simulated by setting constant flow rates obtained from the U.S. Army Corps of Engineers (USACE) for the Columbia, Snake, and Yakima Rivers, and a constant water level at McNary Dam, and then running the model to steady state. The discharge levels simulated were all low-probability events; for example, a 100-year flood is one that would occur on average every 100 years, or put another way, in any given year there is a 1% chance that a discharge of that level or higher will occur. The simulated floods and their corresponding Columbia River discharges were 100-year (445,000 cfs), 500-year (520,000 cfs), and the USACE-defined Standard Project Flood (960,000 cfs). The resulting water levels from the steady-state floods can be viewed as “worst case” outcomes for the respective discharge levels. The MASS1 output for water surface elevations was converted to the North American Vertical Datum of 1988 and projected across the channel and land surface to enable mapping of the floodplain for each scenario. Floodplain maps show that for

  16. Reach-to-grasp movement as a minimization process.

    Science.gov (United States)

    Yang, Fang; Feldman, Anatol G

    2010-02-01

    It is known that hand transport and grasping are functionally different but spatially coordinated components of reach-to-grasp (RTG) movements. As an extension of this notion, we suggested that body segments involved in RTG movements are controlled as a coherent ensemble by a global minimization process associated with the necessity for the hand to reach the motor goal. Different RTG components emerge following this process without pre-programming. Specifically, the minimization process may result from the tendency of neuromuscular elements to diminish the spatial gap between the actual arm-hand configuration and its virtual (referent) configuration specified by the brain. The referent configuration is specified depending on the object shape, localization, and orientation. Since the minimization process is gradual, it can be interrupted and resumed following mechanical perturbations, at any phase during RTG movements, including hand closure. To test this prediction of the minimization hypothesis, we asked subjects to reach and grasp a cube placed within the reach of the arm. Vision was prevented during movement until the hand returned to its initial position. As predicted, by arresting wrist motion at different points of hand transport in randomly selected trials, it was possible to halt changes in hand aperture at any phase, not only during hand opening but also during hand closure. Aperture changes resumed soon after the wrist was released. Another test of the minimization hypothesis was made in RTG movements to an object placed beyond the reach of the arm. It has previously been shown (Rossi et al. in J Physiol 538:659-671, 2002) that in such movements, the trunk motion begins to contribute to hand transport only after a critical phase when the shifts in the referent arm configuration have finished (at about the time when hand velocity is maximal). The minimization rule suggests that when the virtual contribution of the arm to hand transport is completed

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

    Science.gov (United States)

    Dubov, Alex

    2015-06-01

    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.

  18. Dengue disease outbreak definitions are implicitly variable

    Directory of Open Access Journals (Sweden)

    Oliver J. Brady

    2015-06-01

    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.

  19. Genomic definition of species

    Energy Technology Data Exchange (ETDEWEB)

    Crkvenjakov, R.; Drmanac, R.

    1991-07-01

    The subject of this paper is the definition of species based on the assumption that genome is the fundamental level for the origin and maintenance of biological diversity. For this view to be logically consistent it is necessary to assume the existence and operation of the new law which we call genome law. For this reason the genome law is included in the explanation of species phenomenon presented here even if its precise formulation and elaboration are left for the future. The intellectual underpinnings of this definition can be traced to Goldschmidt. We wish to explore some philosophical aspects of the definition of species in terms of the genome. The point of proposing the definition on these grounds is that any real advance in evolutionary theory has to be correct in both its philosophy and its science.

  20. Distribution definition of path integrals

    International Nuclear Information System (INIS)

    Kerler, W.

    1979-01-01

    By starting from quantum mechanics it turns out that a rather general definition of quantum functional integrals can be given which is based on distribution theory. It applies also to curved space and provides clear rules for non-linear transformations. The refinements necessary in usual definitions of path integrals are pointed out. Since the quantum nature requires special care with time sequences, it is not the classical phase space which occurs in the phase-space form of the path integral. Feynman's configuration-space form only applies to a highly specialized situation, and therefore is not a very advantageous starting point for general investigations. It is shown that the commonly used substitutions of variables do not properly account for quantum effects. The relation to the traditional ordering problem is clarified. The distribution formulation has allowed to treat constrained systems directly at the quantum level, to complete the path integral formulation of the equivalence theorem, and to define functional integrals also for space translation after the transition to fields. (orig.)

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

    DEFF Research Database (Denmark)

    Lombardo, Anna; Roncaglioni, Alessandra; Benfentati, Emilio

    2014-01-01

    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......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...... 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...

  2. Key Design Requirements for Long-Reach Manipulators

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, D.S.

    2001-01-01

    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.

  3. Key design requirements for long-reach manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.; March-Leuba, S.; Babcock, S.M.; Hamel, W.R.

    1993-09-01

    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

  4. Key Design Requirements for Long-Reach Manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.

    2001-01-01

    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

  5. Using Facebook to Reach People Who Experience Auditory Hallucinations

    OpenAIRE

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

    2016-01-01

    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...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

    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.

  7. The processing of visual and auditory information for reaching movements.

    Science.gov (United States)

    Glazebrook, Cheryl M; Welsh, Timothy N; Tremblay, Luc

    2016-09-01

    Presenting target and non-target information in different modalities influences target localization if the non-target is within the spatiotemporal limits of perceptual integration. When using auditory and visual stimuli, the influence of a visual non-target on auditory target localization is greater than the reverse. It is not known, however, whether or how such perceptual effects extend to goal-directed behaviours. To gain insight into how audio-visual stimuli are integrated for motor tasks, the kinematics of reaching movements towards visual or auditory targets with or without a non-target in the other modality were examined. When present, the simultaneously presented non-target could be spatially coincident, to the left, or to the right of the target. Results revealed that auditory non-targets did not influence reaching trajectories towards a visual target, whereas visual non-targets influenced trajectories towards an auditory target. Interestingly, the biases induced by visual non-targets were present early in the trajectory and persisted until movement end. Subsequent experimentation indicated that the magnitude of the biases was equivalent whether participants performed a perceptual or motor task, whereas variability was greater for the motor versus the perceptual tasks. We propose that visually induced trajectory biases were driven by the perceived mislocation of the auditory target, which in turn affected both the movement plan and subsequent control of the movement. Such findings provide further evidence of the dominant role visual information processing plays in encoding spatial locations as well as planning and executing reaching action, even when reaching towards auditory targets.

  8. Definition of tolerable soil erosion values

    Directory of Open Access Journals (Sweden)

    G. Sparovek

    1997-09-01

    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.

  9. International reach of tobacco marketing among young children.

    Science.gov (United States)

    Borzekowski, Dina L G; Cohen, Joanna E

    2013-10-01

    Prosmoking messages, delivered through marketing and the media, can reach very young children and influence attitudes and behaviors around smoking. This study examined the reach of tobacco marketing to 5 and 6 year olds in 6 low- and middle-income countries. Researchers worked one-on-one with 5 and 6 year olds in Brazil, China, India, Nigeria, Pakistan, and Russia (N = 2423). The children were asked to match logos with pictures of products, including 8 logos for cigarette brands. Analyses examined, overall and by country, whether gender, age, location, household use of tobacco, and knowledge of media characters were associated with awareness of cigarette brand logos. Additional analyses considered the relationship between cigarette brand logo awareness and intentions to smoke. Overall, 68% of 5 and 6 year olds could identify at least 1 cigarette brand logo, ranging from 50% in Russia to 86% in China. Across countries, being slightly older and having someone in the household who used tobacco, were significantly associated with greater odds of being able to identify at least 1 cigarette brand logo. The majority of young children from low- and middle-income countries are familiar with cigarette brands. This study's findings suggest that more effective measures are needed to restrict the reach of tobacco marketing.

  10. The German REACH Congress 2016: a workshop report.

    Science.gov (United States)

    Reihlen, Antonia; Jepsen, Dirk; Broschinski, Lutz; Luch, Andreas; Schulte, Agnes

    2018-03-01

    In October 2016, the German REACH Congress was held at the German Federal Institute for Risk Assessment (BfR) in Berlin. Here, the associated improvement made in the fields of consumer protection and the progress in and experiences gained from the implementation of the authorisation procedure were discussed. Several speakers from EU institutions, German authorities, industry, and civil society organisations were invited to present their views. There was a shared consensus that REACH contributes to the advancement of consumer protection against chemical risks, mainly because more and higher quality information on substance-related hazards and potential exposures becomes available. In addition, risk management measures, particularly regarding restrictions on uses, scale down consumer exposures to chemicals. Opportunities for improvements identified at the congress include the quality of registration dossiers and the management of and communication on substances of very high concern (SVHC) that may be present in consumer articles. Although regarded as being in an early implementation phase, the authorisation process was generally found to be operational and progressing well. Criticism was expressed with regard to the consistency of authorisation decisions and the costs and uncertainties related to authorisation applications. Consumer protection legislation consists of several legal provisions which are interlinked. The congress participants agreed that REACH is an important element of this legal framework as it enhances and complements other legal provisions.

  11. Do older adults perceive postural constraints for reach estimation?

    Science.gov (United States)

    Cordova, Alberto; Gabbard, Carl

    2014-01-01

    BACKGROUND/STUDY CONTEXT: Recent evidence indicates that older persons have difficulty mentally representing intended movements. Furthermore, in an estimation of reach paradigm using motor imagery, a form of mental representation, older persons significantly overestimated their ability compared with young adults. The authors tested the notion that older adults may also have difficulty perceiving the postural constraints associated with reach estimation. The authors compared young (Mage = 22 years) and older (Mage = 67) adults on reach estimation while seated and in a more postural demanding standing and leaning forward position. The expectation was a significant postural effect with the standing condition, as evidenced by reduced overestimation. Whereas there was no difference between groups in the seated condition (both overestimated), older adults underestimated whereas the younger group once again overestimated in the standing condition. From one perspective, these results show that older adults do perceive postural constraints in light of their own physical capabilities. That is, that group perceived greater postural demands with the standing posture and elected to program a more conservative strategy, resulting in underestimation.

  12. Distractor interference during a choice limb reaching task.

    Directory of Open Access Journals (Sweden)

    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.

  13. The International Glossary on Infertility and Fertility Care, 2017.

    Science.gov (United States)

    Zegers-Hochschild, Fernando; Adamson, G David; Dyer, Silke; Racowsky, Catherine; de Mouzon, Jacques; Sokol, Rebecca; Rienzi, Laura; Sunde, Arne; Schmidt, Lone; Cooke, Ian D; Simpson, Joe Leigh; van der Poel, Sheryl

    2017-09-01

    representatives of international/regional scientific and patient organizations. A consensus-based and evidence-driven set of 283 terminologies used in infertility and fertility care was generated to harmonize communication among health professionals and scientists as well as the lay public, patients and policy makers. Definitions such as 'fertility care' and 'fertility awareness' together with terminologies used in embryology and andrology have been introduced in the glossary for the first time. Furthermore, the definition of 'infertility' has been expanded in order to cover a wider spectrum of conditions affecting the capacity of individuals and couples to reproduce. The definition of infertility remains as a disease characterized by the failure to establish a clinical pregnancy; however, it also acknowledges that the failure to become pregnant does not always result from a disease, and therefore introduces the concept of an impairment of function which can lead to a disability. Additionally, subfertility is now redundant, being replaced by the term infertility so as to standardize the definition and avoid confusion. All stakeholders agreed to the vast majority of terminologies included in this glossary. In cases where disagreements were not resolved, the final decision was reached after a vote, defined before the meeting as consensus if passed with 75%. Over the following months, an external expert group, which included representatives from non-governmental organizations, reviewed and provided final feedback on the glossary. Some terminologies have different definitions, depending on the area of medicine, for example demographic or clinical as well as geographic differences. These differences were taken into account and this glossary represents a multinational effort to harmonize terminologies that should be used worldwide. None. N/A. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights

  14. The International Glossary on Infertility and Fertility Care, 2017.

    Science.gov (United States)

    Zegers-Hochschild, Fernando; Adamson, G David; Dyer, Silke; Racowsky, Catherine; de Mouzon, Jacques; Sokol, Rebecca; Rienzi, Laura; Sunde, Arne; Schmidt, Lone; Cooke, Ian D; Simpson, Joe Leigh; van der Poel, Sheryl

    2017-09-01

    representatives of international/regional scientific and patient organizations. A consensus-based and evidence-driven set of 283 terminologies used in infertility and fertility care was generated to harmonize communication among health professionals and scientists as well as the lay public, patients and policy makers. Definitions such as 'fertility care' and 'fertility awareness' together with terminologies used in embryology and andrology have been introduced in the glossary for the first time. Furthermore, the definition of 'infertility' has been expanded in order to cover a wider spectrum of conditions affecting the capacity of individuals and couples to reproduce. The definition of infertility remains as a disease characterized by the failure to establish a clinical pregnancy; however, it also acknowledges that the failure to become pregnant does not always result from a disease, and therefore introduces the concept of an impairment of function which can lead to a disability. Additionally, subfertility is now redundant, being replaced by the term infertility so as to standardize the definition and avoid confusion. All stakeholders agreed to the vast majority of terminologies included in this glossary. In cases where disagreements were not resolved, the final decision was reached after a vote, defined before the meeting as consensus if passed with 75%. Over the following months, an external expert group, which included representatives from non-governmental organizations, reviewed and provided final feedback on the glossary. Some terminologies have different definitions, depending on the area of medicine, for example demographic or clinical as well as geographic differences. These differences were taken into account and this glossary represents a multinational effort to harmonize terminologies that should be used worldwide. None. N/A. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Out-reach in-space technology experiments program: Control of flexible robot manipulators in zero gravity, experiment definition phase

    Science.gov (United States)

    Phillips, Warren F.

    1989-01-01

    The results obtained show that it is possible to control light-weight robots with flexible links in a manner that produces good response time and does not induce unacceptable link vibrations. However, deflections induced by gravity cause large static position errors with such a control system. For this reason, it is not possible to use this control system for controlling motion in the direction of gravity. The control system does, on the other hand, have potential for use in space. However, in-space experiments will be needed to verify its applicability to robots moving in three dimensions.

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

    Energy Technology Data Exchange (ETDEWEB)

    Loevgren, Linnea; Wik, Ola

    2009-10-15

    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

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

    Science.gov (United States)

    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

    2013-12-01

    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

  18. Exploring Mathematical Definition Construction Processes

    Science.gov (United States)

    Ouvrier-Buffet, Cecile

    2006-01-01

    The definition of "definition" cannot be taken for granted. The problem has been treated from various angles in different journals. Among other questions raised on the subject we find: the notions of "concept definition" and "concept image", conceptions of mathematical definitions, redefinitions, and from a more axiomatic point of view, how to…

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

    Directory of Open Access Journals (Sweden)

    Pratik Banerjee

    2009-01-01

    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.

  20. Becoming Care Helper

    DEFF Research Database (Denmark)

    Jensen, Anne Winther

    ‘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......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...

  1. 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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-11-15

    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.)

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

    Science.gov (United States)

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

    2016-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Sangay Wangmo

    2016-09-01

    Full Text Available Abstract Background 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. Method 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. Results 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

  4. Simulating stream response to floodplain connectivity, reforestation and wetland restoration from reach to catchment scales

    Science.gov (United States)

    Singh, N.; Bomblies, A.; Wemple, B. C.; Ricketts, T.

    2017-12-01

    Natural infrastructure (e.g., floodplains, forests) can offer multiple ecosystem services (ES), including flood resilience and water quality improvement. In order to maintain these ES, state, federal and non-profit organizations may consider various interventions, such as increased floodplain connectivity, reforestation, and wetland restoration to minimize flood peaks and erosion during events. However, the effect of these interventions on hydro-geomorphic responses of streams from reach to catchment scales (>100 km2) are rarely quantified. We used stream geomorphic assessment datasets with a hydraulic model to investigate the influence of above mentioned interventions on stream power (SP), water depth (WD) and channel velocity (VEL) during floods of 2yr and 100yr return periods for three catchments in the Lake Champlain basin, Vermont. To simulate the effect of forests and wetlands, we changed the Manning's coefficient in the model, and to simulate the increased connectivity of the floodplain, we edited the LIDAR data to lower bank elevations. We find that the wetland scenario resulted in the greatest decline in WD and SP, whereas forested scenario exhibited maximum reduction in VEL. The connectivity scenario showed a decline in almost all stream responses, but the magnitude of change was relatively smaller. On average, 35% (2yr) and 50% (100yr) of altered reaches demonstrated improvement over baseline, and 39% (2yr) and 31% (100yr) of altered reaches showed degradation over baseline, across all interventions. We also noted changes in stream response along unaltered reaches (>30%), where we did not make interventions. Overall, these results point to the complexity related to stream interventions and suggest careful evaluation of spatially explicit tradeoffs of these interventions on river-floodplain ecosystem. The proposed approach of simulating and understanding stream's response to interventions, prior to the implementation of restoration activities, may lead to

  5. Impact of a community based implementation of REACH II program for caregivers of Alzheimer's patients.

    Directory of Open Access Journals (Sweden)

    Kristine Lykens

    Full Text Available BACKGROUND: In 2009 an estimated 5.3 million people in the United States were afflicted with Alzheimer's disease, a degenerative form of dementia. The impact of this disease is not limited to the patient but also has significant impact on the lives and health of their family caregivers. The Resources for Enhancing Alzheimer's Caregiver Health (REACH II program was developed and tested in clinical studies. The REACH II program is now being delivered by community agencies in several locations. This study examines the impact of the REACH II program on caregiver lives and health in a city in north Texas. STUDY DESIGN: Family caregivers of Alzheimer's patients were assessed using an instrument covering the multi-item domains of Caregiver Burden, Depression, Self-Care, and Social Support upon enrollment in the program and at the completion of the 6 month intervention. The domain scores were analyzed using a multivariate paired t-test and Bonferroni confidence interval for the differences in pre- and post-service domain scores. RESULTS: A total of 494 families were enrolled in the program during the period January 1, 2011 through June 30, 2012. Of these families 177 completed the 6 month program and have pre - and post service domain scores. The median age for the caregivers was 62 years. The domain scores for Depression and Caregiver Burden demonstrated statistically significant improvements upon program completion. CONCLUSION: The REACH II intervention was successfully implemented by a community agency with comparable impacts to those of the clinical trial warranting wider scale implementation.

  6. REACH MUSC: A Telemedicine Facilitated Network for Stroke: Initial Operational Experience

    Science.gov (United States)

    Adams, Robert J.; Debenham, Ellen; Chalela, Julio; Chimowitz, Marc; Hays, Angela; Hill, Cody; Holmstedt, Christine; Jauch, Edward; Kitch, Alec; Lazaridis, Christos; Turan, Tanya N.

    2012-01-01

    REACH Medical University of South Carolina (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 MUSC including 42 for intra-arterial revascularization [with or without IV tissue plasminogen activator (tPA)]. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al., 2011). 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 tPA, time milestones (in minutes) were: Onset to Door: 62 (mean), 50 (median); Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7, Consult Start to tPA Decision: 31 and 25; Decision to Infusion: 20 and 14, and total Door to Needle: 98 and 87. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75; Door to REACH Consult: 61 and 41; Consult Request to Consult Start: 9 and 7, Consult Start to tPA Decision: 27 and 23. While the consultants respond to consult requests in <10, 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. 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. PMID:22435064

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

    Directory of Open Access Journals (Sweden)

    Robert J. Adams

    2012-03-01

    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.

  8. [Acute schizophrenia concept and definition: investigation of a French psychiatrist population].

    Science.gov (United States)

    Baylé, F J; Misdrahi, D; Llorca, P M; Lançon, C; Olivier, V; Quintin, P; Azorin, J M

    2005-01-01

    For schizophrenic disorders, the clinical conception of "acute state" is widely used in clinical settings to assess the effectiveness of therapeutic programs as well as epidemiological studies. Schizophrenic-specific symptomatology modification, need for hospitalization, significant change in care, disturbances in social behavior or suicide attempts were all used to define acute schizophrenic state. The decision to hospitalize is frequently used to define acute state but refers to multiple factors such as mood disorder, suicide attempts, drug abuse or social and environmental problems. Indeed, several and distinct definitions in a criteria basis form are available but no one has reached consensus. Because recognition of acute schizophrenic state remains based on the subjective clinician's advice, epidemiological and therapeutic studies fail in validity and reliability. The aim of the study was to evaluate how a population of French psychiatrists define criteria and therapeutic targets of acute schizophrenic state in their clinical practice. Psychiatrists filled out a self administered interview. At the time the interview was given, clinicians were notified that they were participating in a clinical consensus survey about schizophrenia. Six major indicators for acute state definition based on the literature data were proposed: general schizophrenic symptomatology modification (depression, anxiety, agitation, impulsivity/aggressiveness), specific schizophrenic symptomatology modification (positive symptoms, negative symptoms, disorganization), need for hospitalization, significant change in care, disturbance in social behavior and lastly, suicidal behavior. Minimal duration (1.2 or 4 weeks) of general and specific schizophrenic symptomatology modification required to define acute state were evaluated. The booklet included the 30 PANSS symptoms listed with their definitions. Among this symptom list, clinicians were instructed to select the ten criteria which they

  9. Restoring Maximum Vertical Browsing Reach in Sauropod Dinosaurs.

    Science.gov (United States)

    Paul, Gregory S

    2017-10-01

    The ongoing controversy centered on neck posture and function in sauropod dinosaurs is misplaced for a number of reasons. Because of an absence of pertinent data it is not possible to accurately restore the posture and range of motion in long necked fossil animals, only gross approximations are possible. The existence of a single "neutral posture" in animals with long, slender necks may not exist, and its relationship to feeding habits is weak. Restorations of neutral osteological neck posture based on seemingly detailed diagrams of cervical articulations are not reliable because the pictures are not sufficiently accurate due to a combination of illustration errors, and distortion of the fossil cervicals. This is all the more true because fossil cervical series lack the critical inter-centra cartilage. Maximum vertical reach is more readily restorable and biologically informative for long necked herbivores. Modest extension of 10° between each caudal cervical allowed high shouldered sauropods to raise the cranial portion of their necks to vertical postures that allowed them to reach floral resources far higher than seen in the tallest mammals. This hypothesis is supported by the dorsally extended articulation of the only known co-fused sauropod cervicals. Many sauropods appear to have been well adapted for rearing in order to boost vertical reach, some possessed retroverted pelves that may have allowed them to walk slowly while bipedal. A combination of improved high browsing abilities and sexual selection probably explains the unusually long necks of tall ungulates and super tall sauropods. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:1802-1825, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. Vestibular feedback maintains reaching accuracy during body movement

    Science.gov (United States)

    Reynolds, Raymond F.

    2016-01-01

    Key points Reaching movements can be perturbed by vestibular input, but the function of this response is unclear.Here, we applied galvanic vestibular stimulation concurrently with real body movement while subjects maintained arm position either fixed in space or fixed with respect to their body.During the fixed‐in‐space conditions, galvanic vestibular stimulation caused large changes in arm trajectory consistent with a compensatory response to maintain upper‐limb accuracy in the face of body movement.Galvanic vestibular stimulation responses were absent during the body‐fixed task, demonstrating task dependency in vestibular control of the upper limb.The results suggest that the function of vestibular‐evoked arm movements is to maintain the accuracy of the upper limb during unpredictable body movement, but only when reaching in an earth‐fixed reference frame. Abstract When using our arms to interact with the world, unintended body motion can introduce movement error. A mechanism that could detect and compensate for such motion would be beneficial. Observations of arm movements evoked by vestibular stimulation provide some support for this mechanism. However, the physiological function underlying these artificially evoked movements is unclear from previous research. For such a mechanism to be functional, it should operate only when the arm is being controlled in an earth‐fixed rather than a body‐fixed reference frame. In the latter case, compensation would be unnecessary and even deleterious. To test this hypothesis, subjects were gently rotated in a chair while being asked to maintain their outstretched arm pointing towards either earth‐fixed or body‐fixed memorized targets. Galvanic vestibular stimulation was applied concurrently during rotation to isolate the influence of vestibular input, uncontaminated by inertial factors. During the earth‐fixed task, galvanic vestibular stimulation produced large polarity‐dependent corrections in arm

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    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....

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

    Directory of Open Access Journals (Sweden)

    DW Fowlkes

    2006-09-01

    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.

  13. THE REACH OF TWITTER AS A POLITICAL TOOL

    Directory of Open Access Journals (Sweden)

    Vanessa González Mendoza

    2010-07-01

    Full Text Available The massive growth of Internet and all the possibilities that it offers, have made us beings of instant gratification. The need to know, to be informed, and to communicate at all times, stands above many other things, and rules our daily life. Tools like Twitter provide the citizen a way in which they can express their ideas, either to be heard or to make a change even in the political atmosphere. This article searches to determine the influence and the reach of Twitter in the political activism of a country.

  14. Interaction torque contributes to planar reaching at slow speed

    Directory of Open Access Journals (Sweden)

    Hoshi Fumihiko

    2008-10-01

    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

  15. Marketers hone their skills to reach target markets.

    Science.gov (United States)

    White, D; Christensen, M

    1990-08-05

    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.

  16. Interprofessionals' definitions of moral resilience.

    Science.gov (United States)

    Holtz, Heidi; Heinze, Katherine; Rushton, Cynda

    2018-02-01

    To describe common characteristics and themes of the concept of moral resilience as reported by interprofessional clinicians in health care. Research has provided an abundance of data on moral distress with limited research to resolve and help negate the detrimental effects of moral distress. This reveals a critical need for research on how to mitigate the negative consequences of moral distress that plague nurses and other healthcare providers. One promising direction is to build resilience as an individual strategy concurrently with interventions to build a culture of ethical practice. Qualitative descriptive methods were used to analyse descriptive definitions provided by 184 interprofessional clinicians in health care attending educational programmes in various locations as well as a small group of 23 professionals with backgrounds such as chaplaincy and nonhealthcare providers. Three primary themes and three subthemes emerged from the data. The primary themes are integrity-personal and relational, and buoyancy. The subthemes are self-regulation, self-stewardship and moral efficacy. Individual healthcare providers and healthcare systems can use this research to help negate the detrimental effects of moral distress by finding ways to develop interventions to cultivate moral resilience. Moral resilience involves not only building and fostering the individual's capacity to navigate moral adversity but also developing systems that support a culture of ethical practice for healthcare providers. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Sadr, Karim

    2015-01-01

    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.

  18. Record reach : ExxonMobil extends its own world record

    Energy Technology Data Exchange (ETDEWEB)

    Wells, P.

    2008-06-15

    Extended reach drilling (ERD) records are now regularly being broken by ExxonMobil Corporation's Sakhalin project on Russia's east coast. In 2008, an oil well on the coast established a new record by achieving a measured depth of 11,680 meters. The well was punched out by a Texas-based drilling company using the world's largest land-based drilling rig. The use of ERD has reduced the capital and operating costs of the project in addition to reducing its environmental impacts. ERD has been used to drill onshore beneath the seafloor and has eliminated the need for additional offshore structure and pipelines. The horizontal reach of the wells has improved productivity while also avoiding disturbing whale migrations in the region. The rig features a 1.5 million pound load capacity, 3000 horsepower draw-works. The top-drive drilling systems were used to transmit real time data to external locations for further evaluation. Oil and gas is also produced from a gravity-based offshore platform. It was concluded that longer wellbore are now being developed by the corporation in order to drill under the Beaufort Sea. 2 figs.

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

    Energy Technology Data Exchange (ETDEWEB)

    1993-05-01

    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.

  20. Ricin A chain reaches the endoplasmic reticulum after endocytosis

    International Nuclear Information System (INIS)

    Liu Qiong; Zhan Jinbiao; Chen Xinhong; Zheng Shu

    2006-01-01

    Ricin is a potent ribosome inactivating protein and now has been widely used for synthesis of immunotoxins. To target ribosome in the mammalian cytosol, ricin must firstly retrograde transport from the endomembrane system to reach the endoplasmic reticulum (ER) where the ricin A chain (RTA) is recognized by ER components that facilitate its membrane translocation to the cytosol. In the study, the fusion gene of enhanced green fluorescent protein (EGFP)-RTA was expressed with the pET-28a (+) system in Escherichia coli under the control of a T7 promoter. The fusion protein showed a green fluorescence. The recombinant protein can be purified by metal chelated affinity chromatography on a column of NTA. The rabbit anti-GFP antibody can recognize the fusion protein of EGFP-RTA just like the EGFP protein. The cytotoxicity of EGFP-RTA and RTA was evaluated by the MTT assay in HeLa and HEP-G2 cells following fluid-phase endocytosis. The fusion protein had a similar cytotoxicity of RTA. After endocytosis, the subcellular location of the fusion protein can be observed with the laser scanning confocal microscopy and the immuno-gold labeling Electro Microscopy. This study provided important evidence by a visualized way to prove that RTA does reach the endoplasmic reticulum

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

    Science.gov (United States)

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

    2005-05-01

    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.

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

    Science.gov (United States)

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

    2015-01-01

    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.

  3. Adaptation to delayed force perturbations in reaching movements.

    Directory of Open Access Journals (Sweden)

    Noa Levy

    Full Text Available Adaptation to deterministic force perturbations during reaching movements was extensively studied in the last few decades. Here, we use this methodology to explore the ability of the brain to adapt to a delayed velocity-dependent force field. Two groups of subjects preformed a standard reaching experiment under a velocity dependent force field. The force was either immediately proportional to the current velocity (Control or lagged it by 50 ms (Test. The results demonstrate clear adaptation to the delayed force perturbations. Deviations from a straight line during catch trials were shifted in time compared to post-adaptation to a non-delayed velocity dependent field (Control, indicating expectation to the delayed force field. Adaptation to force fields is considered to be a process in which the motor system predicts the forces to be expected based on the state that a limb will assume in response to motor commands. This study demonstrates for the first time that the temporal window of this prediction needs not to be fixed. This is relevant to the ability of the adaptive mechanisms to compensate for variability in the transmission of information across the sensory-motor system.

  4. Generalization of unconstrained reaching with hand-weight changes.

    Science.gov (United States)

    Yan, Xiang; Wang, Qining; Lu, Zhengchuan; Stevenson, Ian H; Körding, Konrad; Wei, Kunlin

    2013-01-01

    Studies of motor generalization usually perturb hand reaches by distorting visual feedback with virtual reality or by applying forces with a robotic manipulandum. Whereas such perturbations are useful for studying how the central nervous system adapts and generalizes to novel dynamics, they are rarely encountered in daily life. The most common perturbations that we experience are changes in the weights of objects that we hold. Here, we use a center-out, free-reaching task, in which we can manipulate the weight of a participant's hand to examine adaptation and generalization following naturalistic perturbations. In both trial-by-trial paradigms and block-based paradigms, we find that learning converges rapidly (on a timescale of approximately two trials), and this learning generalizes mostly to movements in nearby directions with a unimodal pattern. However, contrary to studies using more artificial perturbations, we find that the generalization has a strong global component. Furthermore, the generalization is enhanced with repeated exposure of the same perturbation. These results suggest that the familiarity of a perturbation is a major factor in movement generalization and that several theories of the neural control of movement, based on perturbations applied by robots or in virtual reality, may need to be extended by incorporating prior influence that is characterized by the familiarity of the perturbation.

  5. Definitions A-Z

    Science.gov (United States)

    ... and effective products reach the market in a timely way and monitoring products for continued safety after ... findings without any clinical findings associated. spinal cord stimulation (SCS): Electrical device implanted in the spine to ...

  6. High-Definition Medicine.

    Science.gov (United States)

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

    2017-08-24

    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.

  7. ITER definition phase

    International Nuclear Information System (INIS)

    1989-01-01

    The International Thermonuclear Experimental Reactor (ITER) is envisioned as a fusion device which would demonstrate the scientific and technological feasibility of fusion power. As a first step towards achieving this goal, the European Community, Japan, the Soviet Union, and the United States of America have entered into joint conceptual design activities under the auspices of the International Atomic Energy Agency. A brief summary of the Definition Phase of ITER activities is contained in this report. Included in this report are the background, objectives, organization, definition phase activities, and research and development plan of this endeavor in international scientific collaboration. A more extended technical summary is contained in the two-volume report, ''ITER Concept Definition,'' IAEA/ITER/DS/3. 2 figs, 2 tabs

  8. Variation in Definition of Prolonged Mechanical Ventilation.

    Science.gov (United States)

    Rose, Louise; McGinlay, Michael; Amin, Reshma; Burns, Karen Ea; Connolly, Bronwen; Hart, Nicholas; Jouvet, Philippe; Katz, Sherri; Leasa, David; Mawdsley, Cathy; McAuley, Danny F; Schultz, Marcus J; Blackwood, Bronagh

    2017-10-01

    Consistency of definitional criteria for terminology applied to describe subject cohorts receiving mechanical ventilation within ICU and post-acute care settings is important for understanding prevalence, risk stratification, effectiveness of interventions, and projections for resource allocation. Our objective was to quantify the application and definition of terms for prolonged mechanical ventilation. We conducted a scoping review of studies (all designs except single-case study) reporting a study population (adult and pediatric) using the term prolonged mechanical ventilation or a synonym. We screened 5,331 references, reviewed 539 full-text references, and excluded 120. Of the 419 studies (representing 38 countries) meeting inclusion criteria, 297 (71%) reported data on a heterogeneous subject cohort, and 66 (16%) included surgical subjects only (46 of those 66, 70% cardiac surgery). Other studies described COPD (16, 4%), trauma (22, 5%), neuromuscular (17, 4%), and sepsis (1, 0.2%) cohorts. A total of 741 terms were used to refer to the 419 study cohorts. The most common terms were: prolonged mechanical ventilation (253, 60%), admission to specialized unit (107, 26%), and long-term mechanical ventilation (79, 19%). Some authors (282, 67%) defined their cohorts based on duration of mechanical ventilation, with 154 studies (55%) using this as the sole criterion. We identified 37 different durations of ventilation ranging from 5 h to 1 y, with > 21 d being the most common (28 of 282, 7%). For studies describing a surgical cohort, minimum ventilation duration required for inclusion was ≥ 24 h for 20 of 66 studies (30%). More than half of all studies (237, 57%) did not provide a reason/rationale for definitional criteria used, with only 28 studies (7%) referring to a consensus definition. We conclude that substantial variation exists in the terminology and definitional criteria for cohorts of subjects receiving prolonged mechanical ventilation. Standardization of

  9. Consensus Based Definition of Growth Restriction in the Newborn.

    Science.gov (United States)

    Beune, Irene M; Bloomfield, Frank H; Ganzevoort, Wessel; Embleton, Nicholas D; Rozance, Paul J; van Wassenaer-Leemhuis, Aleid G; Wynia, Klaske; Gordijn, Sanne J

    2018-05-01

    To develop a consensus definition of growth restriction in the newborn that can be used clinically to identify newborn infants at risk and in research to harmonize reporting and definition in the current absence of a gold standard. An international panel of pediatric leaders in the field of neonatal growth were invited to participate in an electronic Delphi procedure using standardized methods and predefined consensus rules. Responses were fed back at group-level and the list of participants was provided. Nonresponders were excluded from subsequent rounds. In the first round, variables were scored on a 5-point Likert scale; in subsequent rounds, inclusion of variables and cut-offs were determined with a 70% level of agreement. In the final round participants selected the ultimate algorithm. In total, 57 experts participated in the first round; 79% completed the procedure. Consensus was reached on the following definition: birth weight less than the third percentile, or 3 out of the following: birth weight definition for growth restriction in the newborn. This definition recognizes that infants with birth weights 10th percentile can be growth restricted. This definition can be adopted in clinical practice and in clinical trials to better focus on newborns at risk, and is complementary to the previously determined definition of fetal growth restriction. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    Science.gov (United States)

    Singer, Sara J; Burgers, Jako; Friedberg, Mark; Rosenthal, Meredith B; Leape, Lucian; Schneider, Eric

    2011-02-01

    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b) its essential components, particularly when constructing measures.To address these issues, the authors propose a definition of integrated patient care that distinguishes it from integrated delivery organizations, acknowledging that integrated organizational structures and processes may fail to produce integrated patient care. The definition emphasizes patients' central role as active participants in managing their own health by including patient centeredness as a key element of integrated patient care. Measures based on the proposed definition will enable empirical assessment of the potential relationships between the integration of organizations, the integration of patient care, and patient outcomes, providing valuable guidance to health systems reformers.

  11. From reaching every district to reaching every community: analysis and response to the challenge of equity in immunization in Cambodia

    Science.gov (United States)

    Chan Soeung, Sann; Grundy, John; Duncan, Richard; Thor, Rasoka; Bilous, Julian B

    2013-01-01

    Background An international review of the Cambodian Expanded Programme on Immunization (EPI) in 2010 and other data show that despite immunization coverage increases and vaccine preventable diseases incidence reductions, inequities in access to immunization services exist. Utilizing immunization and health systems literature, analysis of global health databases and the EPI review findings, this paper examines the characteristics of immunization access and outcome inequities, and describes proposed longer-term strategic and operational responses to these problems. Findings The national programme has evolved from earlier central and provincial level planning to strengthening routine immunization coverage through the District level ‘Reaching Every District Strategy’. However, despite remarkable improvements, the review found over 20% of children surveyed were not fully immunized, primarily from communities where inequities of both access and impact persist. These inequities relate mainly to socio-economic exposures including wealth and education level, population mobility and ethnicity. To address these problems, a shift in strategic and operational response is proposed that will include (a) a re-focus of planning on facility level to detect disadvantaged communities, (b) establishment of monitoring systems to provide detailed information on community access and utilization, (c) development of communication strategies and health networks that enable providers to adjust service delivery according to the needs of vulnerable populations, and (d) securing financial, management and political commitment for ‘reaching every community’. Conclusions For Cambodia to achieve its immunization equity objectives and disease reduction goals, a shift of emphasis to health centre and community is needed. This approach will maximize the benefits of new vaccine introduction in the coming ‘Decade of Vaccines’, plus potentially extend the reach of other life-saving maternal

  12. Prebiotics: why definitions matter

    Science.gov (United States)

    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

    2015-01-01

    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

  13. Reaching the global target to reduce stunting: an investment framework.

    Science.gov (United States)

    Shekar, Meera; Kakietek, Jakub; D'Alimonte, Mary R; Rogers, Hilary E; Eberwein, Julia Dayton; Akuoku, Jon Kweku; Pereira, Audrey; Soe-Lin, Shan; Hecht, Robert

    2017-06-01

    Childhood stunting, being short for one's age, has life-long consequences for health, human capital and economic growth. Being stunted in early childhood is associated with slower cognitive development, reduced schooling attainment and adult incomes decreased by 5-53%. The World Health Assembly has endorsed global nutrition targets including one to reduce the number of stunted children under five by 40% by 2025. The target has been included in the Sustainable Development Goals (SDG target 2.2). This paper estimates the cost of achieving this target and develops scenarios for generating the necessary financing. We focus on a key intervention package for stunting (KIPS) with strong evidence of effectiveness. Annual scale-up costs for the period of 2016-25 were estimated for a sample of 37 high burden countries and extrapolated to all low and middle income countries. The Lives Saved Tool was used to model the impact of the scale-up on stunting prevalence. We analysed data on KIPS budget allocations and expenditure by governments, donors and households to derive a global baseline financing estimate. We modelled two financing scenarios, a 'business as usual', which extends the current trends in domestic and international financing for nutrition through 2025, and another that proposes increases in financing from all sources under a set of burden-sharing rules. The 10-year financial need to scale up KIPS is US$49.5 billion. Under 'business as usual', this financial need is not met and the global stunting target is not reached. To reach the target, current financing will have to increase from US$2.6 billion to US$7.4 billion a year on average. Reaching the stunting target is feasible but will require large coordinated investments in KIPS and a supportive enabling environment. The example of HIV scale-up over 2001-11 is instructive in identifying the factors that could drive such a global response to childhood stunting. © The Author 2017. Published by Oxford University

  14. Transparency of chemical risk assessment data under REACH.

    Science.gov (United States)

    Ingre-Khans, Ellen; Ågerstrand, Marlene; Beronius, Anna; Rudén, Christina

    2016-12-08

    The REACH regulation requires EU manufacturers and importers of substances to register information on the hazard and risk of their substances with the European Chemicals Agency (ECHA). Risk management of the substances is based on the provided information. It is known that conclusions on hazard and risk are influenced by expert judgements as well as potential conflict of interests. Thus, it is important that hazard and risk assessments are transparent and can be evaluated by a third party. The aim of this study is to scrutinize the transparency, i.e. the accessibility and comprehensibility, of information on substances registered under REACH. Data on repeated dose toxicity and hazard assessment conclusions were extracted for 60 substances from the REACH registration database available on the ECHA website. The data were compiled in a database for systematically evaluating the transparency of information related to the conclusions on hazard or risk. In addition, chemical safety reports (CSR) were requested from ECHA for five substances. The transparency of information on the hazard and risk of substances was found to be limited for several reasons. First, certain information was removed due to confidentiality and certain fields were not published because they could contain confidential information although the information had not been claimed confidential. Also, the extent to which registrants reported information varied, and the presentation of some data and certain terminology required further clarification. In addition, the data source for the majority of the key and supporting studies could not be identified due to confidentiality. Since registrants are only required to summarise studies, it cannot be verified whether all relevant information from non-public industry reports have been reported. Lastly, certain information related to the hazard and risk assessment were only reported in the CSR which is only available upon request; a time-consuming and work

  15. TARGETING THE HUMAN DOMAIN: REACHING INTERNAL, JOINT, AND ADVERSARIAL AUDIENCES

    Science.gov (United States)

    2017-04-06

    86th Medical Support Squadron, Ramstein Air Base, Germany . In this capacity, she commanded a 197-person unit providing health care support services to...religion, illustrated via such military- specific rites as the Uniformed Code of Military Justice as a moral compass. This holds for smaller groupings...within a service, as well as for larger joint and international allied warfighting. Correspondingly, service history , rhetoric and literature must focus

  16. Reaching out to the hard to reach: using a science centre model to deliver public engagement with research.

    Science.gov (United States)

    Gagen, M.; Allton, C.; Bryan, W. A.; O'Leary, M.

    2017-12-01

    Science communication is at an all-time high but public faith in expertise is low. However, within this climate of suspicion, research scientists remain a publicly trusted expert group. While there is both academic and public appetite for Public Engagement with Research (PER), there are barriers to reaching a wide range of publics. Attempts to connect the public with research often end up targeting the `already engaged'; the hard-to-reach remain just that. Engaging scientific curiosity in a wider demographic is crucial to promote scientific curiosity, itself known to profoundly counter the politically motivated reasoning that threatens informed debate around contemporary environmental issues. This requires the creation of opportunities for the public to engage with research in places in which they feel they belong. We report here on an 8 month pilot of a science centre model for PER. Oriel Science (www.orielscience.co.uk) is a research-led science exhibition in Swansea city centre delivering Swansea University's PER and run by academics and student ambassadors. Oriel Science (Oriel is Gallery in Welsh) received 16,000 visitors in 8 months, 40% of whom had no previous interaction with the university or its research and >40% of whom came from socio-economically deprived areas. We report on the public engagement leadership we enabled, working with 18 research groups over 8 months and our achievements in giving a broad range of publics the most direct access to participate in contemporary science.

  17. Rapid Automatic Motor Encoding of Competing Reach Options

    Directory of Open Access Journals (Sweden)

    Jason P. Gallivan

    2017-02-01

    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.

  18. Naturalness reach of the large hadron collider in minimal supergravity

    International Nuclear Information System (INIS)

    Allanach, B.C.; Hetherington, J.P.J.; Parker, M.A.; Webber, B.R.

    2000-01-01

    We re-analyse the prospects of discovering supersymmetry at the LHC, in order to re-express coverage in terms of a fine-tuning parameter and to extend the analysis to scalar masses (m 0 ) above 2 TeV. We use minimal supergravity (mSUGRA) unification assumptions for the SUSY breaking parameters. Such high values of m 0 have recently been found to have a focus point, leading to relatively low fine-tuning. In addition, improvements in the simulations since the last study mean that this region no longer lacks radiative electroweak symmetry breaking. The best fine tuning reach is found in a mono-leptonic channel, where for μ>0, A 0 =0 and tan β=10 (corresponding to the focus point), all points in mSUGRA with m 0 0 , mSUGRA does not evade detection provided the gaugino mass parameter M 1/2 < 460 GeV. (author)

  19. The contributions of vision and haptics to reaching and grasping

    Directory of Open Access Journals (Sweden)

    Kayla Dawn Stone

    2015-09-01

    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.

  20. Undoing Racism Through Genesee County's REACH Infant Mortality Reduction Initiative.

    Science.gov (United States)

    Kruger, Daniel J; Carty, Denise C; Turbeville, Ashley R; French-Turner, Tonya M; Brownlee, Shannon

    2015-01-01

    Genesee County Racial and Ethnic Approaches to Community Health Program (REACH) is a Community-Based Public Health partnership for reducing African American infant mortality rates that hosts the Undoing Racism Workshop (URW). Assess the URW's effectiveness in promoting an understanding of racism, institutional racism, and how issues related to race/ethnicity can affect maternal and infant health. Recent URW participants (n=84) completed brief preassessment and postassessment forms; participants (n=101) also completed an on-line, long-term assessment (LTA). URWs promoted understanding of racism and institutional racism, although they were less effective in addressing racism as related to maternal and infant health. The URWs were most effective in the domains related to their standard content. Additional effort is necessary to customize URWs when utilized for activities beyond their original purpose of community mobilization.

  1. Visuo-proprioceptive interactions during adaptation of the human reach.

    Science.gov (United States)

    Judkins, Timothy; Scheidt, Robert A

    2014-02-01

    We examined whether visual and proprioceptive estimates of transient (midreach) target capture errors contribute to motor adaptation according to the probabilistic rules of information integration used for perception. Healthy adult humans grasped and moved a robotic handle between targets in the horizontal plane while the robot generated springlike loads that varied unpredictably from trial to trial. For some trials, a visual cursor faithfully tracked hand motion. In others, the handle's position was locked and subjects viewed motion of a point-mass cursor driven by hand forces. In yet other trials, cursor feedback was dissociated from hand motion or altogether eliminated. We used time- and frequency-domain analyses to characterize how sensorimotor memories influence performance on subsequent reaches. When the senses were used separately, subjects were better at rejecting physical disturbances applied to the hand than virtual disturbances applied to the cursor. In part, this observation reflected differences in how participants used sensorimotor memories to adapt to perturbations when performance feedback was limited to only proprioceptive or visual information channels. When both vision and proprioception were available to guide movement, subjects processed memories in a manner indistinguishable from the vision-only condition, regardless of whether the cursor tracked the hand faithfully or whether we experimentally dissociated motions of the hand and cursor. This was true even though, on average, perceptual uncertainty in the proprioceptive estimation of movement extent exceeded that of visual estimation by just 47%. In contrast to perceptual tasks wherein vision and proprioception both contribute to an optimal estimate of limb state, our findings support a switched-input, multisensory model of predictive load compensation wherein visual feedback of transient performance errors overwhelmingly dominates proprioception in determining adaptive reach performance.

  2. Property, care, and environment

    OpenAIRE

    John O'Neill

    2001-01-01

    One influential approach to environmental problems holds that their solution requires the definition of full liberal property rights over goods that will enable their value to be registered in actual or hypothetical markets. How adequate is that solution? In this paper I offer reasons to be sceptical, by placing recent liberal arguments in the context of older debates about property, in particular those concerned with the distribution of care. Although proposals for the extension of liberal p...

  3. Partial Remission Definition

    DEFF Research Database (Denmark)

    Andersen, Marie Louise Max; Hougaard, Philip; Pörksen, Sven

    2014-01-01

    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...

  4. COPD: Definition and Phenotypes

    DEFF Research Database (Denmark)

    Vestbo, J.

    2014-01-01

    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...

  5. Center of buoyancy definition

    International Nuclear Information System (INIS)

    Sandberg, V.

    1988-12-01

    The center of buoyancy of an arbitrary shaped body is defined in analogy to the center of gravity. The definitions of the buoyant force and center of buoyancy in terms of integrals over the area of the body are converted to volume integrals and shown to have simple intuitive interpretations

  6. VSCE technology definition study

    Science.gov (United States)

    Howlett, R. A.; Hunt, R. B.

    1979-01-01

    Refined design definition of the variable stream control engine (VSCE) concept for advanced supersonic transports is presented. Operating and performance features of the VSCE are discussed, including the engine components, thrust specific fuel consumption, weight, noise, and emission system. A preliminary engine design is presented.

  7. The definition of sarcopenia

    NARCIS (Netherlands)

    Bijlsma, Astrid Y.

    2013-01-01

    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

  8. Subjective poverty line definitions

    NARCIS (Netherlands)

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

    1991-01-01

    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

  9. Definition of Professional Development

    Science.gov (United States)

    Learning Forward, 2015

    2015-01-01

    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…

  10. Definition of Entity Authentication

    DEFF Research Database (Denmark)

    Ahmed, Naveed; Jensen, Christian D.

    2010-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Jaime Galindo-Quintero

    2014-01-01

    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.

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

    Science.gov (United States)

    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

    2014-01-01

    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

  13. The Rhode Island Life Saving Score (RILSS)--a proposed life-saving definition for EMS and emergency medicine.

    Science.gov (United States)

    Williams, Kenneth A; Sullivan, Francis M

    2013-12-03

    Emergency Medical Services (EMS) and Emergency Medicine staff are often described as life-saving providers, but there is no generally accepted objective definition of a life saved by these providers. Therefore, a proposed definition is described. Development of this definition began with conceptual rules, followed by a survey of physician EMS medical directors, and then by the development of a tool to implement the definition, and measure its validity and reliability through a review of 100 critical care transport EMS patient charts.

  14. Extending beyond Policy: Reaching UNAIDS’ Three “90”s in Malawi

    Directory of Open Access Journals (Sweden)

    Zengani Chirwa

    2018-03-01

    Full Text Available Malawi, like other countries with a generalized HIV epidemic, is striving to reach the ambitious targets set by UNAIDS known as the three 90’s for testing, provision of antiretroviral therapy and viral suppression. Assisted by Malawi’s progressive policies on HIV/AIDS, it appears possible that Malawi will attain these targets, but only by employing innovative program approaches to service delivery which help fill policy gaps. This article describes how a dedicated cadre of layperson testers and HIV-positive peers appears to have helped attain increases in HIV and viral load testing and retention in care in four districts in Malawi, and situates these innovations in a policy framework analysis.

  15. Pharmaceutical care education in Kuwait: pharmacy students’ perspectives

    OpenAIRE

    Katoue, Maram G.; Awad, Abdelmoneim I.; Schwinghammer, Terry L.; Kombian, Samuel B.

    2014-01-01

    Background: Pharmaceutical care is defined as the responsible provision of medication therapy to achieve definite outcomes that improve patients’ quality of life. Pharmacy education should equip students with the knowledge, skills, and attitudes they need to practise pharmaceutical care competently. Objective: To investigate pharmacy students’ attitudes towards pharmaceutical care, perceptions of their preparedness to perform pharmaceutical care competencies, opinions about the importance...

  16. 32 CFR 732.16 - Emergency care requirements.

    Science.gov (United States)

    2010-07-01

    ... sepsis. (9) Any other obstetrical condition that, by definition, constitutes an emergency circumstance. ... 32 National Defense 5 2010-07-01 2010-07-01 false Emergency care requirements. 732.16 Section 732... MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.16 Emergency care requirements...

  17. Defining Occupational and Consumer Exposure Limits for Nanomaterials – First Experiences from REACH Registrations

    International Nuclear Information System (INIS)

    Aschberger, K; Christensen, F M; Klöslova, Z; Falck, G

    2013-01-01

    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.

  18. Legitimacy: a new goal to reach in risk management

    International Nuclear Information System (INIS)

    Sicard, M.N.

    1992-01-01

    In a crisis situation, the prestige of companies whose industries are potentially hazardous (chemical and nuclear) is insufficient, even useless, for efficient communication if the companies involved are not legitimized in the way they act within society and if their power is not justified. One assumes their legitimacy, that is to say, their responsibility toward external and internal publics, consists of knowing how to deliver significant information about what they are doing, to whom, why, and how. These companies not only have an economic function, but also a societal one. They have to assume responsibility as citizens because their business is closely involved in the economic, social, and cultural care of their environment

  19. Definitions of Health Terms: Minerals

    Science.gov (United States)

    ... gov/definitions/mineralsdefinitions.html Definitions of Health Terms : Minerals To use the sharing features on this page, ... National Institutes of Health, Office of Dietary Supplements Minerals Minerals are those elements on the earth and ...

  20. A survey of benthic sediment contaminants in reaches of the Columbia River Estuary based on channel sedimentation characteristics.

    Science.gov (United States)

    Counihan, Timothy D; Waite, Ian R; Nilsen, Elena B; Hardiman, Jill M; Elias, Edwin; Gelfenbaum, Guy; Zaugg, Steven D

    2014-06-15

    While previous studies have documented contaminants in fish, sediments, water, and wildlife, few specifics are known about the spatial distribution of contaminants in the Columbia River Estuary (CRE). Our study goal was to characterize sediment contaminant detections and concentrations in reaches of the CRE that were concurrently being sampled to assess contaminants in water, invertebrates, fish, and osprey (Pandion haliaetus) eggs. Our objectives were to develop a survey design based on sedimentation characteristics and then assess whether sediment grain size, total organic carbon (TOC), and contaminant concentrations and detections varied between areas with different sedimentation characteristics. We used a sediment transport model to predict sedimentation characteristics of three 16km river reaches in the CRE. We then compartmentalized the modeled change in bed mass after a two week simulation to define sampling strata with depositional, stable, or erosional conditions. We collected and analyzed bottom sediments to assess whether substrate composition, organic matter composition, and contaminant concentrations and detections varied among strata within and between the reaches. We observed differences in grain size fractions between strata within and between reaches. We found that the fine sediment fraction was positively correlated with TOC. Contaminant concentrations were statistically different between depositional vs. erosional strata for the industrial compounds, personal care products and polycyclic aromatic hydrocarbons class (Indus-PCP-PAH). We also observed significant differences between strata in the number of detections of Indus-PCP-PAH (depositional vs. erosional; stable vs. erosional) and for the flame retardants, polychlorinated biphenyls, and pesticides class (depositional vs. erosional, depositional vs. stable). When we estimated mean contaminant concentrations by reach, we observed higher contaminant concentrations in the furthest downstream

  1. A survey of benthic sediment contaminants in reaches of the Columbia River Estuary based on channel sedimentation characteristics

    Science.gov (United States)

    Counihan, Timothy D.; Waite, Ian R.; Nilsen, Elena B.; Hardiman, Jill M.; Elias, Edwin; Gelfenbaum, Guy; Zaugg, Steven D.

    2014-01-01

    While previous studies have documented contaminants in fish, sediments, water, and wildlife, few specifics are known about the spatial distribution of contaminants in the Columbia River Estuary (CRE). Our study goal was to characterize sediment contaminant detections and concentrations in reaches of the CRE that were concurrently being sampled to assess contaminants in water, invertebrates, fish, and osprey (Pandion haliaetus) eggs. Our objectives were to develop a survey design based on sedimentation characteristics and then assess whether sediment grain size, total organic carbon (TOC), and contaminant concentrations and detections varied between areas with different sedimentation characteristics. We used a sediment transport model to predict sedimentation characteristics of three 16 km river reaches in the CRE. We then compartmentalized the modeled change in bed mass after a two week simulation to define sampling strata with depositional, stable, or erosional conditions. We collected and analyzed bottom sediments to assess whether substrate composition, organic matter composition, and contaminant concentrations and detections varied among strata within and between the reaches. We observed differences in grain size fractions between strata within and between reaches. We found that the fine sediment fraction was positively correlated with TOC. Contaminant concentrations were statistically different between depositional vs. erosional strata for the industrial compounds, personal care products and polycyclic aromatic hydrocarbons class (Indus–PCP–PAH). We also observed significant differences between strata in the number of detections of Indus–PCP–PAH (depositional vs. erosional; stable vs. erosional) and for the flame retardants, polychlorinated biphenyls, and pesticides class (depositional vs. erosional, depositional vs. stable). When we estimated mean contaminant concentrations by reach, we observed higher contaminant concentrations in the furthest

  2. Nueva política europea en productos químicos. REACH New European policy on chemical products. REACH

    Directory of Open Access Journals (Sweden)

    Francisco Vargas Marcos

    2005-12-01

    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

  3. Climate Resilience: Outreach and Engagement with Hard to Reach Communities

    Science.gov (United States)

    Baja, K.

    2017-12-01

    Baltimore faces a unique combination of shocks and stresses that cut across social, economic, and environmental sectors. Like many postindustrial cities, Baltimore has experienced a decline in its population - resulting in a lower tax base. These trends have had deleterious effects on the city's ability to attend to much needed infrastructure improvements and human services. Furthermore, Baltimore has an unfortunate history of deliberate racial segregation that is directly responsible for many of the economic and social challenges the City faces today. In addition to considerable social and economic issues, the city is already experiencing negative impacts from climate change. Baltimore is vulnerable to many natural hazards including heavy precipitation, sea level rise, storm surge, and extreme heat. Impacts from hazards and the capacity to adapt to them is not equal across all populations. Low-income residents and communities of color are most vulnerable and lack access to the resources to effectively plan, react and recover. They are also less likely to engage in government processes or input sessions, either due to distrust or ineffective outreach efforts by government employees and partners. This session is focused on sharing best practices and lessons learned from Baltimore's approach to community outreach and engagement as well as its focus on power shifting and relationship building with hard-to-reach communities. Reducing neighborhood vulnerability and strengthening the fabric that holds systems together requires a large number of diverse stakeholders coordinated around resiliency efforts. With the history of deliberate segregation and current disparities it remains critical to build trust, shift power from government to residents, and focus on relationship building. Baltimore City utilized this approach in planning, implementation and evaluation of resiliency work. This session will highlight two plan development processes, several projects, and innovative

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

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    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.

  5. Nuclear technology terms and definitions

    International Nuclear Information System (INIS)

    1979-02-01

    The terms and definitions in this standard are part of the catalogue of definitions 'Nuclear technology, terms and definitions', in eight parts; they are the latest version of the standards and draft standards of DIN 25 401, part 10 to 19, published at irregular intervals until now. (orig.) [de

  6. How to find the sedimentary archive of fluvial pollution in a bedrock-confined river reach

    Science.gov (United States)

    Elznicova, Jitka; Matys Grygar, Tomas; Kiss, Timea; Lelkova, Tereza; Balogh, Marton; Sikora, Martin

    2016-04-01

    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

  7. The electromagnetic rocket gun - a means to reach ultrahigh velocities

    International Nuclear Information System (INIS)

    Winterberg, F.

    1983-01-01

    A novel kind of electromagnetic launcher for the acceleration of multigram-size macroparticles, up to velocities required for impact fusion, is proposed. The novel launcher concept combines the efficiency of a gun with the much higher velocities attainable by a rocket. In the proposed concept a rocket-like projectile is launched inside a gun barrel, drawing its energy from a travelling magnetic wave. The travelling magnetic wave heats and ionizes the exhaust jet of the rocket. As a result, the projectile i propelled both by the recoil from the jet and the magnetic pressure of the travelling magnetic wave. In comparison to magnetic linear accelerators, accelerating either superconducting or ferromagnetic projectiles, the proposed concept has several important advantages. First, the exhaust jet is much longer than the rocket-like projectile and which permits a much longer switching time to turn on the travelling magnetic wave. Second, the proposed concept does not require superconducting projectiles, or projectiles made from expensive ferromagnetic material. Third, unlike in railgun accelerators, the projectile can be kept away from the wall, and thereby can reach much larger velocities. (orig.)

  8. Breakthrough Capability for UVOIR Space Astronomy: Reaching the Darkest Sky

    Science.gov (United States)

    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.

    2015-01-01

    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.

  9. Milestone reached for the Big Wheels of the Muon Spectrometer

    CERN Multimedia

    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...

  10. East-West European economic integration: Difficult to reach target

    International Nuclear Information System (INIS)

    D'Ermo, V.; Manca, S.

    1993-01-01

    The energy sector of Western Europe is now undergoing a slow growth period due largely to the socio-economic upheavals of East and West German unification and the political-economic restructuring of the countries making up Eastern Europe and the former Soviet Union. This paper evidences this fact by tabling and commenting on 1991-1992 coal, petroleum, natural gas and electric power production/consumption/export statistical data representing energy sector activities in the former COMECON member countries. The poor performance of these countries can be attributed to the effects of energy market liberalization, the restructuring of utility assets, limited production capacities and inflation. It is estimated that the adjustment time to reach economic parity with Western nations will be long but that the waiting period could be shortened through the implementation of technology transfer and financial cooperation programs with the more prosperous countries capable of providing the investment capital and know-how needed for the restructuring of production systems and resource development

  11. How Physics World reaches out in a digital age

    Science.gov (United States)

    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. Parametric design studies of long-reach manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.; March-Leuba, S.; Babcock, S.M.; Burks, B.L.; Hamel, W.R.

    1993-01-01

    A number of different approaches have been studied for remediation of waste storage tanks at various sites. One of the most promising approaches is the use of a high-capacity, long-reach manipulation (LRM) system with a variety of end effectors for dislodging the waste. LRMs may have characteristics significantly different from those of industrial robots due to the long links needed to cover the large workspace. Because link lengths are much greater than their diameters, link flexibility, as well as joint or drive train flexibility, is likely to be significant. LRMs 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, a design approach for determining the kinematic applicability and performance characteristics considering link flexibility is presented with a focus on waste storage tank remediation. This paper addresses key design issues for LRM-based waste retrieval systems. It discusses the effects of parameters such as payload capacity, storage tanks size, and access port diameter on manipulator structural design. The estimated weight, fundamental natural frequency, and static deflection of the manipulator have been calculated for various parameter conditions

  13. Sure start: voices of the 'hard-to-reach'.

    Science.gov (United States)

    Coe, C; Gibson, A; Spencer, N; Stuttaford, M

    2008-07-01

    This research aimed to look in depth at the factors affecting the ability of four Sure Start local programmes, based in a multicultural Midlands city, to engage with 'hard-to-reach' populations. A variety of research strategies and methods were employed. Geographical information systems, participatory research methods and interviews were used in order to understand the extent of the challenge, and hear first hand, why parents may not get involved with Sure Start. The mapping exercise involved collation and mapping of postcode data with respect to boundaries and potential and actual users of Sure Start services. This made possible the identification of any geographical patterning in the distribution of service users and non-users. Participatory research methods were used with parents, enabling them to conduct short interviews within their own communities and make sense of the data collected. Interviews were also conducted with 70 parents across the city, recruited through local schools. The results indicate that parental decisions regarding Sure Start are the product of a complex interaction between numerous factors which may act as either barriers or facilitators to service utilization. The results suggest that a multi-method approach to data collection is useful and appropriate in gaining access to those parents who are non-users of the Sure Start services and enabling their voices to be heard. These findings offer some explanations and insight into the apparent ambivalent attitudes of some families toward Sure Start services. Implications for future practice are discussed.

  14. Real-time well condition monitoring in extended reach wells

    Energy Technology Data Exchange (ETDEWEB)

    Kucs, R.; Spoerker, H.F. [OMV Austria Exploration and Production GmbH, Gaenserndorf (Austria); Thonhauser, G. [Montanuniversitaet Leoben (Austria)

    2008-10-23

    Ever rising daily operating cost for offshore operations make the risk of running into drilling problems due to torque and drag developments in extended reach applications a growing concern. One option to reduce cost related to torque and drag problems can be to monitor torque and drag trends in real time without additional workload on the platform drilling team. To evaluate observed torque or drag trends it is necessary to automatically recognize operations and to have a 'standard value' to compare the measurements to. The presented systematic approach features both options - fully automated operations recognition and real time analysis. Trends can be discussed between rig- and shore-based teams, and decisions can be based on up to date information. Since the system is focused on visualization of real-time torque and drag trends, instead of highly complex and repeated simulations, calculation time is reduced by comparing the real-time rig data against predictions imported from a commercial drilling engineering application. The system allows reacting to emerging stuck pipe situations or developing cuttings beds long before the situations become severe enough to result in substantial lost time. The ability to compare real-time data with historical data from the same or other wells makes the system a valuable tool in supporting a learning organization. The system has been developed in a joint research initiative for field application on the development of an offshore heavy oil field in New Zealand. (orig.)

  15. Muscle synergy extraction during arm reaching movements at different speeds.

    Science.gov (United States)

    Sabzevari, Vahid Reza; Jafari, Amir Homayoun; Boostani, Reza

    2017-01-01

    Muscle synergy is the activation of a group of muscles that contribute to a particular movement. The goal of the present study is to examine the hypothesis that human reaching movements at different speeds share similar muscle synergies and to investigate the kinesiology basis and innervation of muscles. Electromyographic activity from six muscles of the upper limb and shoulder girdle were recorded during three movements at different speeds, i.e. slow, moderate and fast. The effect of window length on the RMS signal of the EMG was analyzed and then EMG envelope signals were decomposed using non-negative matrix factorization. For each of the ten subjects, three synergies were extracted which accounted for at least 99% of the VAF. For each movement, the muscle synergies and muscle activation coefficients of all participants were clustered in to three partitions. Investigation showed a high similarity and dependency of cluster members due to the cosine similarity and mutual information in muscle synergy clustering. For further verification, the EMG envelope signals for all subjects were reconstructed. The results indicated a lower reconstruction error using the center of the muscle synergy clusters in comparison with the average of the activation coefficients, which confirms the current research's hypothesis.

  16. Flow model for open-channel reach or network

    Science.gov (United States)

    Schaffranek, R.W.

    1987-01-01

    Formulation of a one-dimensional model for simulating unsteady flow in a single open-channel reach or in a network of interconnected channels is presented. The model is both general and flexible in that it can be used to simulate a wide range of flow conditions for various channel configurations. It is based on a four-point (box), implicit, finite-difference approximation of the governing nonlinear flow equations with user-definable weighting coefficients to permit varying the solution scheme from box-centered to fully forward. Unique transformation equations are formulated that permit correlation of the unknowns at the extremities of the channels, thereby reducing coefficient matrix and execution time requirements. Discharges and water-surface elevations computed at intermediate locations within a channel are determined following solution of the transformation equations. The matrix of transformation and boundary-condition equations is solved by Gauss elimination using maximum pivot strategy. Two diverse applications of the model are presented to illustrate its broad utility. (USGS)

  17. Reaching for the true overlay in advanced nodes

    Science.gov (United States)

    Koay, Chiew-seng; Hamieh, Bassem; Felix, Nelson; Gaudiello, John

    2017-03-01

    Traditionally, the total measurement uncertainty (TMU) of overlay metrology focuses on dynamic precision, toolinduced-shift, and matching, while rarely examining inaccuracy. However, some researchers have recently shown that measurement inaccuracy can still be large despite optimized small TMU. Moreover, this inaccuracy can consume a significant portion of the overlay budget in the advanced nodes. In addition to qualifying the overlay error of inline wafers, overlay metrology is also used for improving on-product overlay as it provides corrective feedback to the lithography scanner. The accuracy of the correction terms as a result depends directly upon the measurement accuracy. As such, enhanced overlay accuracy will improve the overlay performance of reworked wafers, or subsequently exposed wafers. We have previously shown that a segmented Blossom target is more prone to asymmetry-induced inaccuracy than a nonsegmented target is [1]. Since target segmentation is inevitable for SADP and SAQP patterning processes, their resulting overlay performance leaves a lot to be desired. In our quest to reach for the true overlay, this paper reports our investigations on accuracy enhancement techniques for image-based targets, such as redundancy and self-calibration, and on the use of simulation-optimized scatterometry-based targets.

  18. Over one million followers reached in CERN TweetUp

    CERN Multimedia

    Katherine Chapman

    2012-01-01

    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...

  19. Electromyographic activity of beating and reaching during simulated boardsailing.

    Science.gov (United States)

    Buchanan, M; Cunningham, P; Dyson, R J; Hurrion, P D

    1996-04-01

    This study examined the responses of six competitive boardsailors (three males, three females) during laboratory-based simulation tasks while the electromyographic activity of up to 13 muscles was recorded. A sailboard, mounted in a steel frame and resting on a waterbed, allowed simulation of roll and pitch movements. Wind force was simulated by attaching the boom to a weight stack with a hydraulically controlled buffered release phase. The progression of the simulation test was controlled by the sailor copying movements on an edited video of each subject boardsailing on the open water. Analysis of individual pumping movements for mean peak percentage of maximal enveloped voluntary contraction (%MEVC) in 'beating' and 'reaching' showed that muscular activity in the arm (flexor carpi ulnaris, extensor carpi radialis and biceps brachii) was greatest (66-94% MEVC), with considerable activity (58-75% MEVC) in the deltoid and trapezius shoulder muscles, but much less activity in the leg muscles (16-40% MEVC). For the combined upper and lower body muscles there was a significant difference (P reflecting the current dynamic nature of the sport.

  20. Taking OSCE examiner training on the road: reaching the masses.

    Science.gov (United States)

    Reid, Katharine; Smallwood, David; Collins, Margo; Sutherland, Ruth; Dodds, Agnes

    To ensure the rigour of objective structured clinical examinations (OSCEs) in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. The 'OSCE Roadshow' comprised a short training session delivered in the context of teaching hospital 'Grand Rounds' to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners' role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers ( n= 220). After training, participants' average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40), and the average scores did not differ according to the levels of clinical experience. The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

  1. Can impurities from soil-contaminated coffees reach the cup?

    International Nuclear Information System (INIS)

    Tagliaferro, F.S.; De Nadai Fernandes, E.A.; Bacchi, M.A.; Joacir De Franca, E.; Bode, P.

    2007-01-01

    Depending on the harvest conditions, coffee beans can be contaminated by soil when dropped to the ground. It is well known that agricultural soils act as sinks for agrochemicals applied to the crops. While coffee is brewed, substances present in the roasted and ground coffee beans are extracted by hot water, emphasizing the need to assess the possible transfer of impurities from the soil to the beverage. Soil-contaminated samples of roasted coffee beans were split into 2 groups according to the treatments: (a) washed and ground and (b) only ground. Brewing was performed in a household espresso machine for both coffees. The resulting beverage was freeze-dried and the elemental composition determined by instrumental neutron activation analysis (INAA). The mass fractions of the terrigenous elements Fe, La, Sc, Sm and Th in the freeze-dried non-washed coffee beverages were, at least, 2 times higher than in the washed samples. These elements are tracers of the soil, indicating that the impurities from the soil reached the beverage. (author)

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

    Science.gov (United States)

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

    2017-08-01

    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.

  3. Tracheostomy care

    Science.gov (United States)

    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 ...

  4. Integrated security system definition

    International Nuclear Information System (INIS)

    Campbell, G.K.; Hall, J.R. II

    1985-01-01

    The objectives of an integrated security system are to detect intruders and unauthorized activities with a high degree of reliability and the to deter and delay them until effective response/engagement can be accomplished. Definition of an effective integrated security system requires proper application of a system engineering methodology. This paper summarizes a methodology and describes its application to the problem of integrated security system definition. This process includes requirements identification and analysis, allocation of identified system requirements to the subsystem level and provides a basis for identification of synergistic subsystem elements and for synthesis into an integrated system. The paper discusses how this is accomplished, emphasizing at each step how system integration and subsystem synergism is considered. The paper concludes with the product of the process: implementation of an integrated security system

  5. Defining care products to finance health care in the Netherlands

    NARCIS (Netherlands)

    M. Westerdijk (MacHiel); J.J. Zuurbier (Joost); M. Ludwig (Martijn); S. Prins (Sarah)

    2012-01-01

    textabstractA case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the

  6. Controversy around the definition of waste

    CSIR Research Space (South Africa)

    Oelofse, Suzanna HH

    2009-11-20

    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...

  7. Toward a Definition of the Engineering Method.

    Science.gov (United States)

    Koen, Billy V.

    1988-01-01

    Describes a preliminary definition of engineering method as well as a definition and examples of engineering heuristics. After discussing some alternative definitions of the engineering method, a simplified definition of the engineering method is suggested. (YP)

  8. The need for performance governance to reach sustainable transport

    DEFF Research Database (Denmark)

    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...

  9. Rare-earth magnet ingestion: a childhood danger reaches adolescence.

    Science.gov (United States)

    Agha, Beesan Shalabi; Sturm, Jesse J; Costello, Brian E

    2013-10-01

    Ingestion of multiple magnets may cause serious gastrointestinal morbidity, such as pressure necrosis, perforation, fistula formation, or intestinal obstruction due to forceful attraction across bowel wall. Although the consequences of multiple magnet ingestion are well documented in young children, the current popularity of small, powerful rare-earth magnets marketed as "desk toys" has heightened this safety concern in all pediatric age groups. A recent US Consumer Product Safety Commission product-wide warning additionally reports the adolescent practice of using toy high-powered, ball-bearing magnets to simulate tongue and lip piercings, a behavior that may increase risk of inadvertent ingestion. We describe 2 cases of older children (male; aged 10 and 13 years, respectively) with unintentional ingestion of multiple rare-earth magnets. Health care providers should be alerted to the potential for misuse of these high-powered, ball-bearing magnets among older children and adolescents.

  10. NUKEM adjusts price definitions

    International Nuclear Information System (INIS)

    Anon.

    1994-01-01

    This article is the October-November 1994 market report, providing trading volume and prices in the Uranium market. During this period, there were five deals in the spot concentrates market, five deals in the medium and long-term market, one deal in the conversion market, and two deals in the enrichment market. Restricted prices strengthened while unrestricted prices held steady. Price re-definitions were also announced

  11. XMPP The Definitive Guide

    CERN Document Server

    Saint-Andre, Peter; Smith, Kevin

    2009-01-01

    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.

  12. The Logic of Definition

    Science.gov (United States)

    2009-05-01

    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

  13. Definition of containment issues

    International Nuclear Information System (INIS)

    Walker, D.H.

    1982-01-01

    Public Law 96-567 Nuclear Safety Research, Development and Demonstration Act of 1980, directed the US Department of Energy (DOE) to provide an accelerated and coordinated program for developing practical generic improvements that would enhance the capability for safe, reliable and economical operation of Light Water Nuclear Reactor Power Stations. The DOE approach to defining such a program will consist of two phases, (1) definition of program requirements and (2) implementation of the program plan. This paper summarizes the results of the program definition phase for the containment integrity function. The definition phase effort was carried out by two groups of knowledgeable technical experts from the nuclear industry, one of which addressed containment integrity. Tabulated in the paper are the issues identified by the working groups and their associated priorities. Also tabulated are those high priority issues for which ongoing programs do not appear to provide sufficient information to resolve the issue. The results of this review show that existing programs to a great extent address existing issues in a manner such that the issues should be resolved by the programs

  14. Patient autonomy in chronic care: solving a paradox

    Directory of Open Access Journals (Sweden)

    Reach G

    2013-12-01

    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

  15. Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes.

    Science.gov (United States)

    Nelson, Lyndsay A; Mayberry, Lindsay S; Wallston, Kenneth; Kripalani, Sunil; Bergner, Erin M; Osborn, Chandra Y

    2016-09-08

    Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of adults with T2DM, but few have been tested with disadvantaged populations. To develop Rapid Education/Encouragement And Communications for Health (REACH), a tailored, text messaging intervention to support the self-care adherence of disadvantaged patients with T2DM, based on the Information-Motivation-Behavioral skills model. We then tested REACH's usability to make improvements before evaluating its effects. We developed REACH's content and functionality using an empirical and theory-based approach, findings from a previously pilot-tested intervention, and the expertise of our interdisciplinary research team. We recruited 36 adults with T2DM from Federally Qualified Health Centers to participate in 1 of 3 rounds of usability testing. For 2 weeks, participants received daily text messages assessing and promoting self-care, including tailored messages addressing users' unique barriers to adherence, and weekly text messages with adherence feedback. We analyzed quantitative and qualitative user feedback and system-collected data to improve REACH. Participants were, on average, 52.4 (SD 9.5) years old, 56% (20/36) female, 63% (22/35) were a racial or ethnic minority, and 67% (22/33) had an income less than US $35,000. About half were taking insulin, and average hemoglobin A1c level was 8.2% (SD 2.2%). We identified issues (eg, user concerns with message phrasing, technical restrictions with responding to assessment messages) and made improvements between testing rounds. Overall, participants favorably rated the ease of understanding (mean 9.6, SD 0.7) and helpfulness (mean 9.3, SD 1.4) of self-care promoting text messages on a scale of 1

  16. Reinventing Sex: The Construction of Realistic Definitions of Sex and Gender.

    Science.gov (United States)

    Small, Chanley M.

    1998-01-01

    Presents a set of criteria for constructing a fair and realistic understanding of sex. Recognizes the impact that science can have on social policies and values and recommends that the definitions of sex and gender be carefully crafted. (DDR)

  17. Expanding the reach of heavy neutrino searches at the LHC

    Directory of Open Access Journals (Sweden)

    Andrés Flórez

    2018-03-01

    Full Text Available The observation of neutrino oscillations establishes that neutrinos have non-zero mass and provides one of the more compelling arguments for physics beyond the standard model (SM of particle physics. We present a feasibility study to search for hypothetical Majorana neutrinos (N with TeV scale masses, predicted by extensions of the SM to explain the small but non-zero SM neutrino mass, using vector boson fusion (VBF processes at the 13 TeV LHC. In the context of the minimal Type-I seesaw mechanism (mTISM, the VBF production cross-section of a lepton (ℓ and associated heavy Majorana neutrino (Nℓ surpasses that of the Drell–Yan process at approximately mNℓ=1.4TeV. We consider second and third-generation heavy neutrino (Nμ or Nτ, where ℓ= muon (μ or tau (τ leptons production through VBF processes, with subsequent Nμ and Nτ decays to a lepton and two jets, as benchmark cases to show the effectiveness of the VBF topology for Nℓ searches at the 13 TeV LHC. The requirement of a dilepton pair combined with four jets, two of which are identified as VBF jets with large separation in pseudorapidity and a TeV scale dijet mass, is effective at reducing the SM background. These criteria may provide expected exclusion bounds, at 95% confidence level, of mNℓ<1.7 (2.4 TeV, assuming 100 (1000 fb−1 of 13 TeV data from the LHC and mixing |VℓNℓ|2=1. The use of the VBF topology to search for mNℓ increases the discovery reach at the LHC, with expected significances greater than 5σ (3σ for Nℓ masses up to 1.7 (2.05 TeV using 1000fb−1 of 13 TeV data from the LHC.

  18. Expanding the reach of heavy neutrino searches at the LHC

    Science.gov (United States)

    Flórez, Andrés; Gui, Kaiwen; Gurrola, Alfredo; Patiño, Carlos; Restrepo, Diego

    2018-03-01

    The observation of neutrino oscillations establishes that neutrinos have non-zero mass and provides one of the more compelling arguments for physics beyond the standard model (SM) of particle physics. We present a feasibility study to search for hypothetical Majorana neutrinos (N) with TeV scale masses, predicted by extensions of the SM to explain the small but non-zero SM neutrino mass, using vector boson fusion (VBF) processes at the 13 TeV LHC. In the context of the minimal Type-I seesaw mechanism (mTISM), the VBF production cross-section of a lepton (ℓ) and associated heavy Majorana neutrino (Nℓ) surpasses that of the Drell-Yan process at approximately mNℓ = 1.4TeV. We consider second and third-generation heavy neutrino (Nμ or Nτ, where ℓ= muon (μ) or tau (τ) leptons) production through VBF processes, with subsequent Nμ and Nτ decays to a lepton and two jets, as benchmark cases to show the effectiveness of the VBF topology for Nℓ searches at the 13 TeV LHC. The requirement of a dilepton pair combined with four jets, two of which are identified as VBF jets with large separation in pseudorapidity and a TeV scale dijet mass, is effective at reducing the SM background. These criteria may provide expected exclusion bounds, at 95% confidence level, of mNℓ < 1.7 (2.4) TeV, assuming 100 (1000) fb-1 of 13 TeV data from the LHC and mixing |VℓNℓ|2 = 1. The use of the VBF topology to search for mNℓ increases the discovery reach at the LHC, with expected significances greater than 5σ (3σ) for Nℓ masses up to 1.7 (2.05) TeV using 1000fb-1 of 13 TeV data from the LHC.

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

    Science.gov (United States)

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

    2016-12-01

    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 state of Minnesota, US between January 2010 and May 2015 to determine email frequency by brand. These emails were gathered as part of ongoing surveillance of tobacco industry direct marketing. A subset of these emails received between October 2014 and May 2015 (n = 1646) were content analyzed to identify the purpose of the email communication along with type of product promoted. Tobacco companies use email to communicate with consumers on a regular basis. This communication was observed to be as frequent as nine times per month. Emails are most commonly used to promote contests (54.1%), content on tobacco company websites (39.1%), and tobacco coupons (15.7%). Email promotion of menthol-flavored tobacco products was common and was associated with promotion of coupons. Emails promoting menthol had a 1.9 times higher prevalence of also promoting coupons (95% CI: 1.52-2.37). Little is known about tobacco company email marketing and this study fills an identified research gap. A deeper understanding of this type of marketing is needed in order to counter tobacco industry messaging and advance tobacco control.

  20. Agreement reached on integrated safeguards in European Union

    International Nuclear Information System (INIS)

    2010-01-01

    Full text: The International Atomic Energy Agency (IAEA), in cooperation with the European Commission, has reached agreement on arrangements to implement 'integrated safeguards' in all non-nuclear-weapon States of the European Union with significant nuclear activities. 'This important milestone is the result of the constructive common efforts of all parties concerned. It is a clear signal of the importance attributed by the EU and its Member States, as well as the IAEA, to the reinforcement of the nuclear non-proliferation regime,' said Andris Piebalgs, Member of the European Commission in charge of Energy. 'Once we have sufficient confidence that a State' s nuclear activities are purely peaceful, we can apply safeguards measures in a less prescriptive, more customised manner. This reduces the inspection burden on the State and the inspection effort of the IAEA, while enabling the IAEA to maintain the conclusion that all nuclear material has remained in peaceful activities,' said Olli Heinonen, Deputy Director General and Head of IAEA Safeguards Department. Background The Nuclear Non-Proliferation Treaty (NPT) is the main international Treaty prohibiting the spread of nuclear weapons. It entrusts the IAEA to verify that nuclear material is not diverted to nuclear weapons or other nuclear explosive devices through the application of 'safeguards'. IAEA safeguards include comprehensive safeguards agreements and additional protocols that enable the IAEA to conclude that all nuclear material has remained in peaceful activities in a State. Integrated Safeguards refers to the optimum combination of all safeguards measures available to the Agency under comprehensive safeguards agreements and additional protocols to achieve maximum effectiveness and efficiency in meeting the Agency ' s safeguards obligations. In the European Union, nuclear safeguards are implemented on the basis of the Euratom Treaty and trilateral agreements between Euratom, its Member States and the IAEA

  1. The Role of Absorption Cooling for Reaching Sustainable Energy Systems

    Energy Technology Data Exchange (ETDEWEB)

    Lindmark, Susanne

    2005-07-01

    This thesis focuses on the role and potential of absorption cooling in future energy systems. Two types of energy systems are investigated: a district energy system based on waste incineration and a distributed energy system with natural gas as fuel. In both cases, low temperature waste heat is used as driving energy for the absorption cooling. The main focus is to evaluate the absorption technology in an environmental perspective, in terms of reduced CO{sub 2} emissions. Economic evaluations are also performed. The reduced electricity when using absorption cooling instead of compression cooling is quantified and expressed as an increased net electrical yield. The results show that absorption cooling is an environmentally friendly way to produce cooling as it reduces the use of electrically driven cooling in the energy system and therefore also reduces global CO{sub 2} emissions. In the small-scale trigeneration system the electricity use is lowered with 84 % as compared to cooling production with compression chillers only. The CO{sub 2} emissions can be lowered to 45 CO{sub 2}/MWh{sub c} by using recoverable waste heat as driving heat for absorption chillers. However, the most cost effective cooling solution in a district energy system is a combination between absorption and compression cooling technologies according to the study. Absorption chillers have the potential to be suitable bottoming cycles for power production in distributed systems. Net electrical yields over 55 % may be reached in some cases with gas motors and absorption chillers. This small-scale system for cogeneration of power and cooling shows electrical efficiencies comparable to large-scale power plants and may contribute to reducing peak electricity demand associated with the cooling demand.

  2. Taking OSCE examiner training on the road: reaching the masses

    Directory of Open Access Journals (Sweden)

    Katharine Reid

    2016-09-01

    Full Text Available Background: To ensure the rigour of objective structured clinical examinations (OSCEs in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. Methods: The ‘OSCE Roadshow’ comprised a short training session delivered in the context of teaching hospital ‘Grand Rounds’ to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners’ role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. Results: OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers (n=220. After training, participants’ average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40, and the average scores did not differ according to the levels of clinical experience. Conclusion: The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

  3. Solid expandable systems put deepwater targets within reach

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Roca, Eduardo [Enventure Global Technology L.L.C., Houston, TX (United States). Latin America; Fristch, Jerry [Enventure Global Technology L.L.C., Houston, TX (United States)

    2008-07-01

    Enabling technologies that take drilling operations to deeper objectives have made a significant impact on the practicality of many projects, especially deep water offshore targets. Increasing vertical depth and lateral reach requires adequate hole size to attain the desired objectives of the well bore. Solid expandable technology can maintain and retain hole size to address both the physical limitations and the economic feasibility of deep water operations. With each and every casing point, the potential for adequate hole size at total depth (TD) decreases. Solid expandable open hole liners and single-diameter systems reduce and eliminate, respectively, the well bore tapering that dictates hole size at TD and subsequent completion size. Successful mitigation of this tapering, whether through the entire well bore or through select zones, enables operators to gain access to previously unreachable reserves. Solid expandable systems have proven to be reliable and effective with over 1,000 installations in a myriad of conditions and environments worldwide. To date, over 115 of those applications have been in deep water environments. The current operating envelope for solid expandable systems include the deepest installation at {approx}28,750 ft (8,763 m) and the longest at 6,867 ft (2,083 m) in water depth over 3,150 ft (960 m). This record-length application consisted of an open hole liner installed and expanded in a single run. This paper will discuss the effectiveness of solid expandable systems in deep water operations and how the technology brings value to offshore projects especially when planned into the initial design. Case histories will be used to further illustrate the features, advantages, and benefits of expandable technology. In addition, this paper will examine the state of the solid expandable technology and its continuing evolution to provide even more drilling solutions. (author)

  4. Integration of QSAR models for bioconcentration suitable for REACH

    International Nuclear Information System (INIS)

    Gissi, Andrea; Nicolotti, Orazio; Carotti, Angelo; Gadaleta, Domenico; Lombardo, Anna; Benfenati, Emilio

    2013-01-01

    QSAR (Quantitative Structure Activity Relationship) models can be a valuable alternative method to replace or reduce animal test required by REACH. In particular, some endpoints such as bioconcentration factor (BCF) are easier to predict and many useful models have been already developed. In this paper we describe how to integrate two popular BCF models to obtain more reliable predictions. In particular, the herein presented integrated model relies on the predictions of two among the most used BCF models (CAESAR and Meylan), together with the Applicability Domain Index (ADI) provided by the software VEGA. Using a set of simple rules, the integrated model selects the most reliable and conservative predictions and discards possible outliers. In this way, for the prediction of the 851 compounds included in the ANTARES BCF dataset, the integrated model discloses a R 2 (coefficient of determination) of 0.80, a RMSE (Root Mean Square Error) of 0.61 log units and a sensitivity of 76%, with a considerable improvement in respect to the CAESAR (R 2 = 0.63; RMSE = 0.84 log units; sensitivity 55%) and Meylan (R 2 = 0.66; RMSE = 0.77 log units; sensitivity 65%) without discarding too many predictions (118 out of 851). Importantly, considering solely the compounds within the new integrated ADI, the R 2 increased to 0.92, and the sensitivity to 85%, with a RMSE of 0.44 log units. Finally, the use of properly set safety thresholds applied for monitoring the so called “suspicious” compounds, which are those chemicals predicted in proximity of the border normally accepted to discern non-bioaccumulative from bioaccumulative substances, permitted to obtain an integrated model with sensitivity equal to 100%. - Highlights: • Applying two independent QSAR models for bioconcentration factor increases the prediction. • The concordance of the models is an important component of the integration. • The measurement of the applicability domain improves the prediction. • The use of a

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

    Directory of Open Access Journals (Sweden)

    Betsy Brock

    2016-12-01

    Full Text Available 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 state of Minnesota, US between January 2010 and May 2015 to determine email frequency by brand. These emails were gathered as part of ongoing surveillance of tobacco industry direct marketing. A subset of these emails received between October 2014 and May 2015 (n = 1646 were content analyzed to identify the purpose of the email communication along with type of product promoted. Tobacco companies use email to communicate with consumers on a regular basis. This communication was observed to be as frequent as nine times per month. Emails are most commonly used to promote contests (54.1%, content on tobacco company websites (39.1%, and tobacco coupons (15.7%. Email promotion of menthol-flavored tobacco products was common and was associated with promotion of coupons. Emails promoting menthol had a 1.9 times higher prevalence of also promoting coupons (95% CI: 1.52–2.37. Little is known about tobacco company email marketing and this study fills an identified research gap. A deeper understanding of this type of marketing is needed in order to counter tobacco industry messaging and advance tobacco control.

  6. Impulsivity modulates performance under response uncertainty in a reaching task.

    Science.gov (United States)

    Tzagarakis, C; Pellizzer, G; Rogers, R D

    2013-03-01

    We sought to explore the interaction of the impulsivity trait with response uncertainty. To this end, we used a reaching task (Pellizzer and Hedges in Exp Brain Res 150:276-289, 2003) where a motor response direction was cued at different levels of uncertainty (1 cue, i.e., no uncertainty, 2 cues or 3 cues). Data from 95 healthy adults (54 F, 41 M) were analysed. Impulsivity was measured using the Barratt Impulsiveness Scale version 11 (BIS-11). Behavioral variables recorded were reaction time (RT), errors of commission (referred to as 'early errors') and errors of precision. Data analysis employed generalised linear mixed models and generalised additive mixed models. For the early errors, there was an interaction of impulsivity with uncertainty and gender, with increased errors for high impulsivity in the one-cue condition for women and the three-cue condition for men. There was no effect of impulsivity on precision errors or RT. However, the analysis of the effect of RT and impulsivity on precision errors showed a different pattern for high versus low impulsives in the high uncertainty (3 cue) condition. In addition, there was a significant early error speed-accuracy trade-off for women, primarily in low uncertainty and a 'reverse' speed-accuracy trade-off for men in high uncertainty. These results extend those of past studies of impulsivity which help define it as a behavioural trait that modulates speed versus accuracy response styles depending on environmental constraints and highlight once more the importance of gender in the interplay of personality and behaviour.

  7. Forming Agroindustries Clusters for Reaching Competitiveness of Ukrainian Agroindustrial Sector

    Directory of Open Access Journals (Sweden)

    Larisa Zadorozhna

    2014-03-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 The article deals with the theoretical principles of forming the Agro Industries clusters in the context of the innovative aspect. Being one of Ukraine’s major sources of economic revenue, the country’s agroindustrial sector proved, at the same time, to be perhaps the most vulnerable branch of economy in the times of political and social turbulence. While the state is searching for the ways of strengthening its positions at the global market, its agricultural potential to a considerable extent remains both under- and misused. The cluster approach has become in recent years as a key instrument of municipal economic policies of the leading industrialized countries. Utilizing the experience of other European countries’ with regards to making agriculture more sustainable and competitive in the modern world, the author describes the ways of applying these practices against the background of Ukrainian agribusiness system. Innovation of our research presented as adaptation policy measures for clustering Ukrainian agribusiness and the structure of corn production cluster in Ukraine is proposed. The basic elements of government policy in supporting the development of agricultural clusters are proposed. The ways of creating the Agro Industries clusters are described. Advantages of forming clusters and possibility of the cluster approach in the organization and management of Agro Industries operations are considered. st1\\:*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0pt 5.4pt 0pt 5.4pt; mso-para-margin:0pt; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso

  8. A Note on the Definition of a Smooth Curve

    Science.gov (United States)

    Euler, Russell; Sadek, Jawad

    2005-01-01

    In many elementary calculus textbooks in use today, the definition of a "smooth curve" is slightly ambiguous from the students' perspective. Even when smoothness is defined carefully, there is a shortage of relevant exercises that would serve to elaborate on related subtle points which many students may find confusing. In this article, the authors…

  9. What is the health care product?

    Science.gov (United States)

    France, K R; Grover, R

    1992-06-01

    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.

  10. Video assistance in mitral surgery: reaching the "Thru" port access.

    Science.gov (United States)

    Irace, Francesco G; Rose, David; D'Ascoli, Riccardo; Caldaroni, Federica; Andriani, Ines; Piscioneri, Fernando; Vitulli, Piergiusto; Piattoli, Matteo; Tritapepe, Luigi; Greco, Ernesto

    2015-01-01

    Minimally invasive and video assisted mitral valve surgery has been used widely since beginning of 20 th . Different reduced surgical approaches allowed replacing or repairing a mitral valve sparing sternal incision. Nevertheless the most used strategy has been in the last years the right mini thoracotomy and the extra thoracic cardiopulmonary bypass (CPB). The main goal is avoiding sternal approach for mitral valve procedures and improve postoperative course of the patients. Some postoperative complication likes blood loss, need for transfusion, prolonged intubation and infection has been reduced using this alternative technique. A special advantages has been reported in elderly or high risk patients and in redo cases. Several cardiac centres using videoscopy and a revolutionary set up for CPB management and aortic occlusion have adopted the approach. The team approach, including surgeon, anaesthesiologist, nurse, cardiologist and perfusionist, is crucial for a safe and effective realization of this surgical strategy. The proper use of catheters and Seldinger skilfulness, and the guidance of trans-esophageal echocardiography (TEE) during the procedure are two milestones of this technique. A careful and progressive learning curve is required for all the components of the team. In fact some peculiarity likes modified surgical instruments, 3D and Full HD video assisted view, percutaneous canulation for CPB and myocardial protection, etc., make this procedure challenging for all members of the operative room (OR) team. Our favourite set-up include right mini thoracotomy in the IV intercostal space, femoral vein and arterial canulation and an additional venous cannula in the superior vena cava for the drainage of the upper part of the body. Aortic occlusion is achieved usually using an endo-aortic clamp positioned by means of continuous and careful TEE guidance. A mitral valve procedure is realized by direct or video guided view; using adapted and shaft instruments or

  11. Progress towards a new definition of the kelvin

    Science.gov (United States)

    Fischer, Joachim

    2015-10-01

    At its 24th meeting (2011) the General Conference on Weights and Measures noted the CIPM’s intention to express new definitions of the kilogram, ampere, kelvin, and mole in terms of fixed numerical values of the Planck constant, elementary charge, Boltzmann constant, and Avogadro constant, respectively. The changes proposed for the International System of Units will not actually be adopted until the experimental results on the new definitional constants that are proposed have reached a further stage of refinement. This paper provides an overview of the activities and progress of the research groups who are carrying out experiments to determine the Boltzmann constant. The most promising methods, acoustic gas thermometry, dielectric-constant gas thermometry, Johnson noise thermometry and Doppler-broadening thermometry, are reviewed. The prospects for meeting the requirements of the Consultative Committee for Thermometry for a new definition of the kelvin are discussed.

  12. Using Facebook to Reach People Who Experience Auditory Hallucinations.

    Science.gov (United States)

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

    2016-06-14

    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. The objective of this proof-of-concept study was to examine the viability of leveraging Web-based social media as a method of engaging people who experience auditory hallucinations and to evaluate their attitudes toward using social media platforms as a resource for Web-based support and technology-based treatment. We used Facebook advertisements to recruit individuals who experience auditory hallucinations to complete an 18-item Web-based survey focused on issues related to auditory hallucinations and technology use in American adults. We systematically tested multiple elements of the advertisement and survey layout including image selection, survey pagination, question ordering, and advertising targeting strategy. Each element was evaluated sequentially and the most cost-effective strategy was implemented in the subsequent steps, eventually deriving an optimized approach. Three open-ended question responses were analyzed using conventional inductive content analysis. Coded responses were quantified into binary codes, and frequencies were then calculated. Recruitment netted N=264 total sample over a 6-week period. Ninety-seven participants fully completed all measures at a total cost of $8.14 per participant across testing phases. Systematic adjustments to advertisement design, survey layout, and targeting strategies improved data quality and cost efficiency. People were willing to provide information on what triggered their auditory hallucinations along with strategies they use to cope, as well as provide suggestions to others who experience auditory hallucinations. Women, people

  13. Economic interpretation of environmental flow regime downstream diverted river reaches.

    Science.gov (United States)

    Gorla, Lorenzo; Perona, Paolo

    2013-04-01

    feasible and doesn't imply high costs or advanced management tools. Our approach is a simple but effective step towards eco-sustainability in the growing market of mini hydropower plants, where operation rules like MFR are still widespread. As such, this method is a powerful instrument for political managers to explicit contradictions thus enlightening best compromise measures/decisions. References Perona, P., Characklis, G., Duerrenmatt, D.J., in revision. Inverse parameters estimation of simple riparian benefit economical models. Journal of Environmental Management . Gorla, L. and Perona, P., in revision. On quantifying ecologically sustainable flow releases in a diverted river reach. Journal of Hydrology.

  14. Integration of QSAR models for bioconcentration suitable for REACH

    Energy Technology Data Exchange (ETDEWEB)

    Gissi, Andrea [Laboratory of Chemistry and Environmental Toxicology, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156 Milan (Italy); Dipartimento di Farmacia — Scienze del Farmaco, Università degli Studi di Bari “Aldo Moro”, via Orabona 4, I-70125 Bari (Italy); Nicolotti, Orazio; Carotti, Angelo; Gadaleta, Domenico [Dipartimento di Farmacia — Scienze del Farmaco, Università degli Studi di Bari “Aldo Moro”, via Orabona 4, I-70125 Bari (Italy); Lombardo, Anna [Laboratory of Chemistry and Environmental Toxicology, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156 Milan (Italy); Benfenati, Emilio, E-mail: benfenati@marionegri.it [Laboratory of Chemistry and Environmental Toxicology, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156 Milan (Italy)

    2013-07-01

    QSAR (Quantitative Structure Activity Relationship) models can be a valuable alternative method to replace or reduce animal test required by REACH. In particular, some endpoints such as bioconcentration factor (BCF) are easier to predict and many useful models have been already developed. In this paper we describe how to integrate two popular BCF models to obtain more reliable predictions. In particular, the herein presented integrated model relies on the predictions of two among the most used BCF models (CAESAR and Meylan), together with the Applicability Domain Index (ADI) provided by the software VEGA. Using a set of simple rules, the integrated model selects the most reliable and conservative predictions and discards possible outliers. In this way, for the prediction of the 851 compounds included in the ANTARES BCF dataset, the integrated model discloses a R{sup 2} (coefficient of determination) of 0.80, a RMSE (Root Mean Square Error) of 0.61 log units and a sensitivity of 76%, with a considerable improvement in respect to the CAESAR (R{sup 2} = 0.63; RMSE = 0.84 log units; sensitivity 55%) and Meylan (R{sup 2} = 0.66; RMSE = 0.77 log units; sensitivity 65%) without discarding too many predictions (118 out of 851). Importantly, considering solely the compounds within the new integrated ADI, the R{sup 2} increased to 0.92, and the sensitivity to 85%, with a RMSE of 0.44 log units. Finally, the use of properly set safety thresholds applied for monitoring the so called “suspicious” compounds, which are those chemicals predicted in proximity of the border normally accepted to discern non-bioaccumulative from bioaccumulative substances, permitted to obtain an integrated model with sensitivity equal to 100%. - Highlights: • Applying two independent QSAR models for bioconcentration factor increases the prediction. • The concordance of the models is an important component of the integration. • The measurement of the applicability domain improves the

  15. Using Facebook to Reach People Who Experience Auditory Hallucinations

    Science.gov (United States)

    Brian, Rachel Marie; Ben-Zeev, Dror

    2016-01-01

    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 Web-based social media as a method of engaging people who experience auditory hallucinations and to evaluate their attitudes toward using social media platforms as a resource for Web-based support and technology-based treatment. Methods We used Facebook advertisements to recruit individuals who experience auditory hallucinations to complete an 18-item Web-based survey focused on issues related to auditory hallucinations and technology use in American adults. We systematically tested multiple elements of the advertisement and survey layout including image selection, survey pagination, question ordering, and advertising targeting strategy. Each element was evaluated sequentially and the most cost-effective strategy was implemented in the subsequent steps, eventually deriving an optimized approach. Three open-ended question responses were analyzed using conventional inductive content analysis. Coded responses were quantified into binary codes, and frequencies were then calculated. Results Recruitment netted N=264 total sample over a 6-week period. Ninety-seven participants fully completed all measures at a total cost of $8.14 per participant across testing phases. Systematic adjustments to advertisement design, survey layout, and targeting strategies improved data quality and cost efficiency. People were willing to provide information on what triggered their auditory hallucinations along with strategies they use to cope, as well as provide suggestions to others who experience

  16. Chemical placement in heterogeneous and long reach horizontal wells

    Energy Technology Data Exchange (ETDEWEB)

    Stalker, Robert; Wahid, Fazrie; Graham, Gordon M.

    2006-03-15

    The effective placement of chemical squeeze treatments in heterogeneous wells and long reach horizontal wells has proved a significant challenge, with various factors including heterogeneity, crossflow and pressure gradients between otherwise non-communicating zones within the well, all contributing to an uneven placement of the scale squeeze treatment into the reservoir. Current methods to circumvent these problems often rely on extremely expensive coiled tubing operations, staged diversion (temporary shut off) treatments or by designing treatments to deliberately overdose some zones in order to gain placement in other (e.g. low permeability) zones. Moreover for deepwater sub sea horizontal wells the costs associated with ''spot'' treating along the length of horizontal wells by coil tubing tractor operations can often be prohibitively expensive. For other very near well bore treatments such as acid stimulation a number of self diverting strategies including gelled acid treatments, staged viscoelastic surfactant treatments and foams have been applied in field treatments with some success. However the properties which make such treatments applicable for acid stimulation may also make them inappropriate for bullhead scale squeeze treatments. Recent work by the current authors has however indicated the possible benefits of using modified injection fluids to aid uniform scale inhibitor placement in such wells in order to effect more even placement. In summary this paper will describe the various options available for achieving self diversion and describes the potential drawbacks associated with the viscous placement fluids commonly used for acid simulation techniques. In addition, various simulation packages commonly used for scale related calculations are reviewed and their limitations, primarily due to the inherent assumptions made and input parameters used, for modelling squeeze treatments using such modified fluids are described. The paper

  17. Bibliotherapy in a Library Setting: Reaching out to Vulnerable Youth

    Directory of Open Access Journals (Sweden)

    Natalia Tukhareli

    2011-07-01

    Full Text Available Bibliotherapy, as a part of expressive therapy, involves the systematic use of books to help people cope with mental, physical, emotional, or social problems. It has been widely recognized as an approach that holds great promise in helping librarians to better address emotional, behavioural and socials concerns of various groups of people. The benefits of bibliotherapeutic services such as reading groups, expanded readers’ advisory, books-on-prescription and information-on-prescription services as well as various outreach programs are well documented in the library literature. On the other hand, health professionals who work in cooperation with educators and librarians share medical records on the healing and consoling power of books. The paper will explore the role of bibliotherapy in a library setting and identify particular bibliotherapeutic schemes to be used when serving people affected by HIV/AIDS. The paper will provide an overview of the library project developed to address educational and recreational needs of the African people living with HIV/AIDS. The project was successfully implemented at the Nkosi’s Haven Library in Johannesburg, South Africa in 2010. Although the project targeted all the residents of Nkosi’s Haven, the paper will focus mostly on the part of the program developed for children and young adults. The paper will identify psychological and social factors that affect the targeted group of children within the African environment. Particularly, it will highlight a negative effect that stigmatization around the disease has on the lives of the HIV-infected individuals and their families. Within this context, bibliotherapy is seen as an effective way of reaching out and breaking the isolation of people, especially children living with HIV/AIDS. The paper will describe specific activities strategically chosen for the bibliotherapy sessions to provide a channel through which the participants of the program could analyze

  18. Reaching teachers: The first step in teaching students

    Energy Technology Data Exchange (ETDEWEB)

    Berry, G.

    1991-12-31

    A 1984 American Association of the Academy of Sciences study of more than 150 successful science in-service programs developed a list of their characteristics, which included: Strong academic component in mathematics, science, and communications, focused on enrichment rather than remediation; academic subjects taught by teachers who are highly competent in the subject matter and believe that students can learn the materials; heavy emphasis on the applications of science and mathematics and careers in these fields; integrative approach to teaching that incorporates all subject areas, hands-on opportunities, and computers; multiyear involvement with students; recruitment of participants from all relevant target populations; opportunities for in-school and out-of-school learning experiences; parental involvement and development of base of community support; specific attention to removing educational inequalities related to race and gender; involvement of professionals and staff who look like the target population; development of peer support systems (involvement of a critical mass of any kind of student); evaluation, long-term follow-up, and careful data collection; and, ``mainstreaming`` -- integration of program elements supportive of women and minorities into the institutional support programs. I shall illustrate these points with ongoing teacher-support programs in progress in the Chicago area.

  19. Reaching teachers: The first step in teaching students

    Energy Technology Data Exchange (ETDEWEB)

    Berry, G.

    1991-01-01

    A 1984 American Association of the Academy of Sciences study of more than 150 successful science in-service programs developed a list of their characteristics, which included: Strong academic component in mathematics, science, and communications, focused on enrichment rather than remediation; academic subjects taught by teachers who are highly competent in the subject matter and believe that students can learn the materials; heavy emphasis on the applications of science and mathematics and careers in these fields; integrative approach to teaching that incorporates all subject areas, hands-on opportunities, and computers; multiyear involvement with students; recruitment of participants from all relevant target populations; opportunities for in-school and out-of-school learning experiences; parental involvement and development of base of community support; specific attention to removing educational inequalities related to race and gender; involvement of professionals and staff who look like the target population; development of peer support systems (involvement of a critical mass of any kind of student); evaluation, long-term follow-up, and careful data collection; and, mainstreaming'' -- integration of program elements supportive of women and minorities into the institutional support programs. I shall illustrate these points with ongoing teacher-support programs in progress in the Chicago area.

  20. Organisational fundamentals of medical care in catastrophes

    International Nuclear Information System (INIS)

    Ahnefeld, F.W.

    1983-01-01

    The author presents definitions, considerations, and fundamentals of discussion. He starts by listing the institutions, equipment and traning required for medical care and life-saving services in cases of emergency. A central coordination service for medical care and life saving is proposed. The present situation is reviewed, future needs are stated, and the necessary components of a medical service are listed. (DG) [de

  1. Is Palliative Care Right for You?

    Science.gov (United States)

    ... to you, need help with: Coping with the stress of a serious illness Emotional support Spiritual or religious support Talking with your family about your illness and what is important to ... What Is Palliative Care Definition Pediatric Palliative Care Disease Types FAQ Handout for ...

  2. Dry blood spot testing for hepatitis C in people who injected drugs: reaching the populations other tests cannot reach.

    Science.gov (United States)

    Tait, J M; Stephens, Brian P; McIntyre, Paul G; Evans, Morgan; Dillon, John F

    2013-10-01

    The aim of the study was to evaluate the effectiveness of Dry Blood Spot testing (DBST) for hepatitis C within a geographical area. This is a prospective cohort study of all individuals living in Tayside who had received a hepatitis C virus (HCV) DBST between 2009 and 2011. During the study, 1123 DBSTs were carried out. 946 individuals had one test. 295 (31.2%) of these individuals were HCV antibody positive on their first test. Overall, 94.3% (902/956) individuals returned for the results of their test. During the course of the study 177 individuals were retested and 29 new cases of hepatitis C were detected. 249 individuals attended for further follow-up, and 164 (65.5%) were PCR positive. All 164 PCR-positive individuals were offered referral into specialist HCV services for further assessment. Data showed 62.5% were genotype 3, 65.1% had a low viral load (<600 000 iu/ml) and 77.5% had a Fibroscan score below 7 KPa. To date, 40 have commenced treatment and a further 16 are currently in the assessment period. Overall, we have retained in services or treated 63.6% (105/164) of patients who were initially referred and with effective support mechanisms in place we have achieved sustained viral response rates of 90%. The study has shown that DBST is a complementary technique to conventional venepuncture for the diagnosis of HCV. The majority of patients have low viral loads and low fibrosis scores, so that while this group of patients may be difficult to reach and may be challenging to maintain in therapy, they are easier to cure.

  3. Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh.

    Science.gov (United States)

    Moinuddin, Md; Christou, Aliki; Hoque, Dewan Md Emdadul; Tahsina, Tazeen; Salam, Shumona Sharmin; Billah, Sk Masum; Kuppens, Lianne; Matin, Md Ziaul; Arifeen, Shams El

    2017-01-01

    Birth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh. To describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices. A cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis. Less than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband's education (OR = 1.3; CI: 1.1-1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2-3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2-1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0-1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9-3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9-3.1), practice clean cord care (OR = 1.3, CI: 1.0-1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0-3.2) or their newborn (OR = 2.6, CI: 2.1-3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3-2.6). Greater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low

  4. Birth preparedness and complication readiness (BPCR among pregnant women in hard-to-reach areas in Bangladesh.

    Directory of Open Access Journals (Sweden)

    Md Moinuddin

    Full Text Available Birth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh.To describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices.A cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis.Less than a quarter (24.5% of women were considered well prepared for birth. Predictors of being well-prepared included: husband's education (OR = 1.3; CI: 1.1-1.7, district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2-3.9, receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2-1.8, and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0-1.9. Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9-3.1, use a skilled birth attendant (OR = 2.4, CI: 1.9-3.1, practice clean cord care (OR = 1.3, CI: 1.0-1.5, receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0-3.2 or their newborn (OR = 2.6, CI: 2.1-3.3, and seek care for delivery complications (OR = 1.8, CI: 1.3-2.6.Greater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality

  5. 38 CFR 17.900 - Definitions.

    Science.gov (United States)

    2010-07-01

    .... Habilitative and rehabilitative care means such professional, counseling, and guidance services and such... means home care, hospital care, nursing home care, outpatient care, preventive care, habilitative and..., health care plans, insurers, organizations, and institutions. Home care means medical care, habilitative...

  6. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

    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.

  7. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

    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.

  8. [Social inequality in home care].

    Science.gov (United States)

    Möller, A; Osterfeld, A; Büscher, A

    2013-06-01

    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.

  9. Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

    Science.gov (United States)

    Ahmed, Osman I

    2016-01-01

    With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

  10. Reaching help on time in an emergency delivery.

    Science.gov (United States)

    1991-01-01

    Many maternal deaths in developing countries occur because mothers with complicated pregnancies or deliveries cannot be transported at all or fast enough to a health facility. A pregnant woman hemorrhaging greatly had to wait for a taxi because an unauthorized person had the health center's vehicle in Tanzania. Since most physicians practice in cities, most maternal deaths involve rural women. Further the less educated, lower the socioeconomic status, and lower the family's income the more likely she is to die. 3 phases contributed to transport delays of pregnant women. The 1st phase includes the time it take for a woman and her family to decide if her condition is serious enough to require medical attention, and if so, can they afford to pay for transport. Sometimes the services scare her or she considers the services to be of poor quality. The next phase involves the availability of transport and the distance between the mother and the services. Indeed in Nigeria, 96% of mothers who do not use medical delivery services report that they do not do so because of distance. Once at the health facility, the waiting period between arrival and meeting the woman's medical needs make up the 3rd phase. Often health facilities have inadequate number of medical personnel. Moreover the family must buy needed medical supplies before treatment can even begin. Alarm and transport systems are needed. In 1 area of India, pigeons carry messages to a physician that a woman is experiencing labor difficulties. Prior to the civil war in Somalia, a distinct flag informed passing motorists that emergency transport was needed for a pregnant woman who was carried to the roadside on a stretcher or in a cart. High technology transport is not cost effective and should not be part of a primary health care system.

  11. Healthcare service quality: towards a broad definition.

    Science.gov (United States)

    Mosadeghrad, Ali Mohammad

    2013-01-01

    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.

  12. On the quantitative definition of risk

    International Nuclear Information System (INIS)

    Kaplan, S.; Garrick, B.J.

    1985-01-01

    The purpose of this paper is to provide some suggestions and contributions toward a uniform conceptual/linguistic framework for quantifying and making precise the notion of risk. The concepts and definitions the authors present in this connection have shown themselves to be sturdy and serviceable in practical application to a wide variety of risk situations. They have demonstrated in the courtroom and elsewhere the ability to improve communication and greatly diminish the confusion and controversy that often swirls around public decision making involving risk. They hope therefore with this paper to widen the understanding and adoption of this framework, and to that end adopt a leisurely and tutorial place. In particular, they carefully draw a distinction between ''probability'' and ''frequency.'' Then, using this distinction, they return to the idea of risk, and give a ''second-level'' definition (of risk which generalizes the first-level definition) and is large enough and flexible enough to include at least all the aspects and subtleties of risk that have been encountered in the authors' experience

  13. Jenkins The Definitive Guide

    CERN Document Server

    Smart, John

    2011-01-01

    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

  14. Hadoop The Definitive Guide

    CERN Document Server

    White, Tom

    2009-01-01

    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

  15. Apache The Definitive Guide

    CERN Document Server

    Laurie, Ben

    2003-01-01

    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

  16. Cassandra the definitive guide

    CERN Document Server

    Hewitt, Eben

    2011-01-01

    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. Contemporary jewelry definitions

    Directory of Open Access Journals (Sweden)

    Marlon Aparecido Mercaldi

    2016-12-01

    Full Text Available Contemporary jewelry terminology is open to many criticism and weaknesses as it is confronted with the classic definition of jewelry and also often attached to the historical widespread idea of adornment and jewelry to modernity. Therefore one of the this article issues is to approach about what it is contemporary jewelry and how it can be defined. Thus, we present the topics related to the jewel discussion in contemporary times that are organized into a set of assumptions and approaches that help us provide an overview about the contemporary jewelry.

  18. The definition of alcoholism.

    Science.gov (United States)

    Madden, J S

    1993-11-01

    Formulations of alcohol dependence are continuously refreshed, in line with changing concepts and altered needs. Two new descriptions have been prepared: the revised WHO criteria for substance use disorders and an educative definition of alcoholism. The major sets of diagnostic criteria provided by WHO and by the American Psychiatric Association are moving closer together but have not solved all the semantic problems. More refined assessments are also available to quicken fulfillment of the long-awaited hope that treatments can be matched to patients.

  19. The definition and natural history of severe exacerbation of hepatitis B

    Directory of Open Access Journals (Sweden)

    GUO Wei

    2014-10-01

    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.

  20. HOME CARE OF THE SICK CHILD *

    African Journals Online (AJOL)

    is separated from his mother was high-lighted by the work· ... disturbance, reaching sometimes far into later life. Although ... of child care, together with the trend towards smaller families, .... balance between hospital and domiciliary practice; for.