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Sample records for referral scheme protocol

  1. Employee-referral schemes and discrimination law

    OpenAIRE

    Connolly, M.

    2015-01-01

    Employee-referral schemes (‘introduce a friend’) are in common usage in recruitment. They carry a potential to discriminate by perpetuating an already unbalanced workforce (say, by gender and ethnicity). With this, or course, comes the risk of litigation and bad publicity as well as any inherent inefficiencies associated with discrimination. This article is threefold. First, it examines the present state of the law. Second, it is based on a survey of employers who use these schemes. Third, it...

  2. The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Giné-Garriga, Maria; Coll-Planas, Laura; Guerra, Míriam; Domingo, Àlex; Roqué, Marta; Caserotti, Paolo; Denkinger, Michael; Rothenbacher, Dietrich; Tully, Mark A; Kee, Frank; McIntosh, Emma; Martín-Borràs, Carme; Oviedo, Guillermo R; Jerez-Roig, Javier; Santiago, Marta; Sansano, Oriol; Varela, Guillermo; Skjødt, Mathias; Wirth, Katharina; Dallmeier, Dhayana; Klenk, Jochen; Wilson, Jason J; Blackburn, Nicole E; Deidda, Manuela; Lefebvre, Guillaume; González, Denise; Salvà, Antoni

    2017-05-18

    Older adults are the fastest growing segment of the world's population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) guidelines. The SITLESS project aims to determine whether exercise referral schemes (ERS) can be enhanced by self-management strategies (SMSs) to reduce sedentary behaviour (SB), increase PA and improve health, quality of life and function in the long term, as well as psychosocial outcomes in community-dwelling older European citizens from four countries, within a three-armed pragmatic randomised controlled trial, compared with ERS alone and also with general recommendations about PA. A total of 1338 older adults will be included in this study, recruited from four European countries through different existing primary prevention pathways. Participants will be randomly allocated into an ERS of 16 weeks (32 sessions, 45-60 min per session), ERS enhanced by seven sessions of SMSs and four telephone prompts, or a control group. Outcomes will be assessed at baseline, month 4 (end of ERS intervention), month 16 (12 months post intervention) and month 22 (18 months post intervention). Primary outcomes will include measures of SB (time spent sedentary) and PA (counts per minute). Secondary outcomes will include muscle and physical function, health economics' related outcomes, anthropometry, quality of life, social networks, anxiety and depressive symptoms, disability, fear of falling, executive function and fatigue. A process evaluation will be conducted throughout the trial. The full analysis set will follow an intention-to-treat principle and will include all randomised participants for whom a baseline assessment is conducted. The study hypothesis will be tested with mixed linear models with repeated measures, to assess changes in the main outcomes (SB and PA) over time (baseline to month 22) and between study arms. The findings of this

  3. The influence of referral protocols on the utilization of magnetic resonance imaging: evidence from Manitoba

    Energy Technology Data Exchange (ETDEWEB)

    Mustard, C.A.; McClarty, B.M.; MacEwan, D.W. [Manitoba Univ., Winnipeg, MB (Canada)

    1994-04-01

    The influence of referral protocols on the utilization of magnetic resonance imaging (MRI) services was studied. Three neuroradiologists and one radiologist reviewed the indications for MRI for 198 referrals to a facility in Winnipeg, selected at random from patients seen in 1991 for suspected disorders of the brain or the spine. Out-of-province referrals had not been subject to referral protocols, whereas those from within Manitoba had been subject to such protocols. At least three of the four radiologists agreed on whether an examination was appropriate in 88.4 % of the cases. Out-of-province referrals were significantly more likely to be considered inappropriate for MRI (24 %) than referrals from within Manitoba (10 %). It was estimated that the combined effect of instituting protocols and reviewing each referral before the examination could result in a 16 % to 31 % reduction in the demand for MRI services without compromising diagnostic information. 18 refs., 3 tabs.

  4. Biometrics based authentication scheme for session initiation protocol

    OpenAIRE

    Xie, Qi; Tang, Zhixiong

    2016-01-01

    Many two-factor challenge-response based session initiation protocol (SIP) has been proposed, but most of them are vulnerable to smart card stolen attacks and password guessing attacks. In this paper, we propose a novel three-factor SIP authentication scheme using biometrics, password and smart card, and utilize the pi calculus-based formal verification tool ProVerif to prove that the proposed protocol achieves security and authentication. Furthermore, our protocol is highly efficient when co...

  5. Robust and Efficient Authentication Scheme for Session Initiation Protocol

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    Yanrong Lu

    2015-01-01

    Full Text Available The session initiation protocol (SIP is a powerful application-layer protocol which is used as a signaling one for establishing, modifying, and terminating sessions among participants. Authentication is becoming an increasingly crucial issue when a user asks to access SIP services. Hitherto, many authentication schemes have been proposed to enhance the security of SIP. In 2014, Arshad and Nikooghadam proposed an enhanced authentication and key agreement scheme for SIP and claimed that their scheme could withstand various attacks. However, in this paper, we show that Arshad and Nikooghadam’s authentication scheme is still susceptible to key-compromise impersonation and trace attacks and does not provide proper mutual authentication. To conquer the flaws, we propose a secure and efficient ECC-based authentication scheme for SIP. Through the informal and formal security analyses, we demonstrate that our scheme is resilient to possible known attacks including the attacks found in Arshad et al.’s scheme. In addition, the performance analysis shows that our scheme has similar or better efficiency in comparison with other existing ECC-based authentication schemes for SIP.

  6. Biometrics based authentication scheme for session initiation protocol.

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    Xie, Qi; Tang, Zhixiong

    2016-01-01

    Many two-factor challenge-response based session initiation protocol (SIP) has been proposed, but most of them are vulnerable to smart card stolen attacks and password guessing attacks. In this paper, we propose a novel three-factor SIP authentication scheme using biometrics, password and smart card, and utilize the pi calculus-based formal verification tool ProVerif to prove that the proposed protocol achieves security and authentication. Furthermore, our protocol is highly efficient when compared to other related protocols.

  7. Retrospective cohort study of the South Tyneside Exercise Referral scheme 2009-2014: Predictors of dropout and barriers to adherence

    OpenAIRE

    Kelly, Michael; Rae, Glen; Partington, Sarah; Dodd-Reynolds, Caroline; Caplan, Nick

    2016-01-01

    Background: Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence is limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout.\\ud \\ud Methods: ERS data from 2009-2014 were retrieved for analysis. Chi squared and t-tests were used to inve...

  8. Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes?

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    Nierkens Vera

    2008-10-01

    Full Text Available Abstract Background Exercise referral schemes (ERS have become a popular way of promoting physical activity. The aim of these schemes is to encourage high risk patients to exercise. In evaluating these schemes, little attention has been paid to lower socio-economic groups in a multi-ethnic urban setting. This study aimed to explore the socio-demographic and psychosocial characteristics of female participants in ERS located in deprived neighbourhoods. The second aim was to determine which elements of the intervention make it appealing to participate in the scheme. Methods A mixed method approach was utilized, combining a cross-sectional descriptive study and a qualitative component. In the quantitative part of the study, all female participants (n = 523 filled out a registration form containing questions about socio-demographic and psychosocial characteristics. Height and weight were also measured. In the qualitative part of the study, 38 of these 523 participants were interviewed. Results The majority of the participants had a migrant background, a low level of education, no paid job and a high body mass index. Although most participants were living sedentary lives, at intake they were quite motivated to start exercising. The ERS appealed to them because of its specific elements: facilitating role of the health professional, supportive environment, financial incentive, supervision and neighbourhood setting. Conclusion This study supports the idea that ERS interventions appeal to women from lower socio-economic groups, including ethnic minorities. The ERS seems to meet their contextual, economic and cultural needs. Since the elements that enabled the women to start exercising are specific to this ERS, we should become aware of whether this population continues to exercise after the end of the scheme.

  9. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report.

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    Campbell, Fiona; Holmes, Mike; Everson-Hock, Emma; Davis, Sarah; Buckley Woods, Helen; Anokye, Nana; Tappenden, Paul; Kaltenthaler, Eva

    2015-07-01

    It is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs), in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and, therefore, may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness. To assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care. Exhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled, meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD), stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon, and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits. The search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Pavey et al. [Pavey TG, Anokye N, Taylor AH, Trueman P

  10. Gaining qualitative insight into the subjective experiences of adherers to an exercise referral scheme: A thematic analysis.

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    Eynon, Michael John; O'Donnell, Christopher; Williams, Lynn

    2016-07-01

    Nine adults who had completed an exercise referral scheme participated in a semi-structured interview to uncover the key psychological factors associated with adherence to the scheme. Through thematic analysis, an exercise identity emerged to be a major factor associated with adherence to the scheme, which was formed of a number of underpinning constructs including changes in self-esteem, changes in self-efficacy and changes in self-regulatory strategies. Also, an additional theme of transitions in motivation to exercise was identified, showing participants' motivation to alter from extrinsic to intrinsic reasons to exercise during the scheme.

  11. Dual watermarking scheme for secure buyer-seller watermarking protocol

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    Mehra, Neelesh; Shandilya, Madhu

    2012-04-01

    A buyer-seller watermarking protocol utilize watermarking along with cryptography for copyright and copy protection for the seller and meanwhile it also preserve buyers rights for privacy. It enables a seller to successfully identify a malicious seller from a pirated copy, while preventing the seller from framing an innocent buyer and provide anonymity to buyer. Up to now many buyer-seller watermarking protocols have been proposed which utilize more and more cryptographic scheme to solve many common problems such as customer's rights, unbinding problem, buyer's anonymity problem and buyer's participation in the dispute resolution. But most of them are infeasible since the buyer may not have knowledge of cryptography. Another issue is the number of steps to complete the protocols are large, a buyer needs to interact with different parties many times in these protocols, which is very inconvenient for buyer. To overcome these drawbacks, in this paper we proposed dual watermarking scheme in encrypted domain. Since neither of watermark has been generated by buyer so a general layman buyer can use the protocol.

  12. Changes in referral protocols for cardiac surgery: do financial considerations come at a cost?

    Science.gov (United States)

    Amado, José; Bento, Dina; Silva, Daniela; Chin, Joana; Marques, Nuno; Gago, Paula; Mimoso, Jorge; de Jesus, Ilídio

    2015-10-01

    The aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times, hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery. In this retrospective study of patients referred for cardiac surgery between January 1, 2008 and September 30, 2014, the study population was divided into two groups: those referred before (group A, January 1, 2008 to August 31, 2011) and after (group B, September 1, 2011 to September 30, 2014) the change in referral protocols. A telephone follow-up was conducted. There were 864 patients referred for cardiac surgery, 557 in group A and 307 in group B. Patient characteristics were similar between groups. The mean waiting time for surgery was 10.6±18.5 days and 55.7±79.9 days in groups A and B, respectively (p=0.00). During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0:00); mortality was, respectively, 0% and 2.3% (p=0.00). During one-year follow-up 12.8% of group A patients and 16% of group B patients were hospitalized. Cardiovascular mortality in this period was around 5% in both groups (p>0.05). Changes to referral protocols for cardiac surgery had an impact on waiting times, on the number of hospitalizations and on mortality in this period. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Improving the Authentication Scheme and Access Control Protocol for VANETs

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    Wei-Chen Wu

    2014-11-01

    Full Text Available Privacy and security are very important in vehicular ad hoc networks (VANETs. VANETs are negatively affected by any malicious user’s behaviors, such as bogus information and replay attacks on the disseminated messages. Among various security threats, privacy preservation is one of the new challenges of protecting users’ private information. Existing authentication protocols to secure VANETs raise challenges, such as certificate distribution and reduction of the strong reliance on tamper-proof devices. In 2011, Yeh et al. proposed a PAACP: a portable privacy-preserving authentication and access control protocol in vehicular ad hoc networks. However, PAACP in the authorization phase is breakable and cannot maintain privacy in VANETs. In this paper, we present a cryptanalysis of an attachable blind signature and demonstrate that the PAACP’s authorized credential (AC is not secure and private, even if the AC is secretly stored in a tamper-proof device. An eavesdropper can construct an AC from an intercepted blind document. Any eavesdropper can determine who has which access privileges to access which service. For this reason, this paper copes with these challenges and proposes an efficient scheme. We conclude that an improving authentication scheme and access control protocol for VANETs not only resolves the problems that have appeared, but also is more secure and efficient.

  14. Assessing the impact of autonomous motivation and psychological need satisfaction in explaining adherence to an exercise referral scheme.

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    Eynon, Michael John; O'Donnell, Christopher; Williams, Lynn

    2017-10-01

    Given the mixed findings concerning self-determination theory in explaining adherence to exercise referral schemes (ERS), the present study attempted to examine whether autonomous motivation and psychological need satisfaction could predict ERS adherence. Participants referred to an 8-week ERS completed self-report measures grounded in self-determination theory and basic needs theory at baseline (N = 124), mid-scheme (N = 58), and at the end of the scheme (N = 40). Logistic regressions were used to analyse the data. Autonomous motivation measured at mid-scheme explained between 12 and 16% of the variance in ERS adherence. Autonomy, relatedness and competence measured at mid-scheme explained between 18 and 26% of the variance in ERS adherence. This model also explained between 18 and 25% when measured at the end of the scheme. The study found limited evidence for the role of autonomous motivation in explaining ERS adherence. Stronger support was found for the satisfaction of the three needs for autonomy, relatedness and competence in predicting ERS adherence. Future research should tap into the satisfaction of all three needs collectively to help foster ERS adherence.

  15. Retrospective cohort study of the South Tyneside Exercise Referral Scheme 2009-14: predictors of dropout and barriers to adherence.

    Science.gov (United States)

    Kelly, Michael C; Rae, Glen C; Walker, Diane; Partington, Sarah; Dodd-Reynolds, Caroline J; Caplan, Nick

    2017-12-01

    Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P dropouts being significantly younger (P Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% CI: 0.71-0.95), secondary care referrals (OR = 0.68, 95% CI: 0.52-0.90), having a lack of motivation (OR = 0.81, 95% CI: 0.69-0.95) or a lack of childcare (OR = 0.69, 95% CI: 0.50-0.95) decreased the likelihood of dropout. ERS dropout continues to be problematic. Smoking and having moderate-high comorbidities predicted dropout. Increasing age and patient-reported barriers of a lack of time or childcare decreased dropout risk. The reasons for dropout require further investigation. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  16. Developing a Referral Protocol for Community-Based Occupational Therapy Services in Taiwan: A Logistic Regression Analysis.

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    Mao, Hui-Fen; Chang, Ling-Hui; Tsai, Athena Yi-Jung; Huang, Wen-Ni; Wang, Jye

    2016-01-01

    Because resources for long-term care services are limited, timely and appropriate referral for rehabilitation services is critical for optimizing clients' functions and successfully integrating them into the community. We investigated which client characteristics are most relevant in predicting Taiwan's community-based occupational therapy (OT) service referral based on experts' beliefs. Data were collected in face-to-face interviews using the Multidimensional Assessment Instrument (MDAI). Community-dwelling participants (n = 221) ≥ 18 years old who reported disabilities in the previous National Survey of Long-term Care Needs in Taiwan were enrolled. The standard for referral was the judgment and agreement of two experienced occupational therapists who reviewed the results of the MDAI. Logistic regressions and Generalized Additive Models were used for analysis. Two predictive models were proposed, one using basic activities of daily living (BADLs) and one using instrumental ADLs (IADLs). Dementia, psychiatric disorders, cognitive impairment, joint range-of-motion limitations, fear of falling, behavioral or emotional problems, expressive deficits (in the BADL-based model), and limitations in IADLs or BADLs were significantly correlated with the need for referral. Both models showed high area under the curve (AUC) values on receiver operating curve testing (AUC = 0.977 and 0.972, respectively). The probability of being referred for community OT services was calculated using the referral algorithm. The referral protocol facilitated communication between healthcare professionals to make appropriate decisions for OT referrals. The methods and findings should be useful for developing referral protocols for other long-term care services.

  17. Early signaling, referral, and treatment of adolescent chronic pain: a study protocol

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    Voerman Jessica S

    2012-06-01

    Full Text Available Abstract Background Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by improving signaling, referral, and treatment of these youngsters. In this study protocol we describe the designs of two complementary studies: a signaling study and an intervention study. Methods and design The signaling study evaluates the Pain Barometer, a self-assessed signaling instrument for chronic pain in adolescents. To evaluate the feasibility of the Pain Barometer, the experiences of youth-health care nurses will be evaluated in semi-structured interviews. Also, we will explore the frequencies of referral per health-care provider. The intervention study evaluates Move It Now, a guided self-help intervention via the Internet for teenagers with chronic pain. This intervention uses cognitive behavioural techniques, including relaxation exercises and positive thinking. The objective of the intervention is to improve the ability of adolescents to cope with pain. The efficacy of Move It Now will be examined in a randomized controlled trial, in which 60 adolescents will be randomly assigned to an experimental condition or a waiting list control condition. Discussion If the Pain Barometer is proven to be feasible and Move It Now appears to be efficacious, a health care pathway can be created to provide the best tailored treatment promptly to adolescents with chronic pain. Move It Now can be easily implemented throughout the Netherlands, as the intervention is Internet based. Trial registration Dutch Trial Register NTR1926

  18. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis

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    Taylor, A H; Fox, K R; Hillsdon, M; Anokye, N; Campbell, J L; Foster, C; Green, C; Moxham, T; Mutrie, N; Searle, J; Trueman, P; Taylor, R S

    2011-01-01

    Objective To assess the impact of exercise referral schemes on physical activity and health outcomes. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references. Study selection Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. Population: sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes. Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses.Substantial heterogeneity in the quality and nature of the exercise referral

  19. Facilitating adherence to physical activity: exercise professionals' experiences of the National Exercise Referral Scheme in Wales. a qualitative study

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    Moore Graham F

    2011-12-01

    Full Text Available Abstract Background Although implementers' experiences of exercise referral schemes (ERS may provide valuable insights into how their reach and effectiveness might be improved, most qualitative research has included only views of patients. This paper explores exercise professionals' experiences of engaging diverse clinical populations in an ERS, and emergence of local practices to support uptake and adherence in the National Exercise Referral Scheme (NERS in Wales. Methods Thirty-eight exercise professionals involved in the delivery of NERS in 12 local health board (LHB areas in Wales took part in a semi-structured telephone interview. Thematic analysis was conducted. Results Professionals' accounts offered insights into how perceived needs and responses to NERS varied by patient characteristics. Adherence was described as more likely where the patient sought referral from a health professional rather than being advised to attend. Hence, professionals sometimes described a need for the referral process to identify patients for whom change was already internally motivated. In addition, mental health patients were seen as facing additional barriers, such as increased anxieties about the exercise environment. Professionals described their role as involving helping patients to overcome anxieties about the exercise environment, whilst providing education and interpersonal support to assist patients' confidence and motivation. However, some concerns were raised regarding the levels of support that the professional should offer whilst avoiding dependence. Patient-only group activities were described as supporting adherence by creating an empathic environment, social support and modelling. Furthermore, effectively fostering social support networks was identified as a key mechanism for reducing dependence and maintaining changes in the longer term. Conclusions Whether ERS should identify motivated patients, or incorporate activities to support

  20. A preliminary evaluation of optometric management and referral protocols for pa-tients with diabetic retinopathy

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    M. Mehta

    2005-12-01

    Full Text Available Aim: The purpose of this pilot study was to investigate  the  assessment,  management  and referral practices of South African optometrists in  the  care  of  patients  with  diabetic  retinop-athy  (DR  and  to  recommend  strategies  to improve  and  standardize  patient  management as required.  Methods:  The  study  design  incorporated quantitative,  qualitative  and  clinical  measures that were administered to fourteen experienced optometrists from the Durban area. The quan-titative measure, the questionnaire in appendix I, evaluated the optometrists’ management pro-tocols of patients with diabetes mellitus (DM.  These  included  the  optometrists’  referral  and co-management practices, their awareness and usage  of  appropriate  guidelines  in  the  man-agement  and  referral  of  these  patients,  their perceived levels of competence and confidence in their education, levels of service offered to the patients and finally the role of Continuous Professional  Development  (CPD.  This  self-report information was supplemented by a set of clinical measures where the study sample grad-ed levels of DR, chose appropriate management options  and  indicated  prognosis  for  disease progression based on a set of slides presented to  them.  Finally  the  fourteen  optometrists,  as well as two ophthalmologists, were interviewed using tailored, semi-structured interview sched-ules. These interviews were used to elaborate and corroborate information obtained from the other two research approaches.  Results:  Descriptive  analysis  was  used  to analyse  the  data  from  the  quantitative  and clinical  measures,  whilst  the  interviews  were analysed  thematically.  Although  86%  of  the sample routinely screened for ocular manifesta-tions of DM, there was no standardization in the criteria used by the fourteen optometrists

  1. Protocol for a feasibility randomised controlled trial of the use of Physical ACtivity monitors in an Exercise Referral Setting: the PACERS study.

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    Hawkins, Jemma; Edwards, Michelle; Charles, Joanna; Jago, Russell; Kelson, Mark; Morgan, Kelly; Murphy, Simon; Oliver, Emily; Simpson, Sharon; Edwards, Rhiannon Tudor; Moore, Graham

    2017-01-01

    Exercise referral schemes are recommended by the National Institute for Clinical Excellence (NICE) for physical activity promotion among inactive patients with health conditions or risk factors. Whilst there is evidence for the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, evidence of long-term effects is limited. Techniques such as goal setting, self-monitoring and personalised feedback may support motivation for physical activity. Technologies such as activity monitoring devices provide an opportunity to enhance delivery of motivational techniques. This paper describes the PACERS study protocol, which aims to assess the feasibility and acceptability of implementing an activity monitor within the existing Welsh National Exercise Referral Scheme (NERS) and proposed evaluation methodology for a full-scale randomised controlled trial. The PACERS study consists of a pilot randomised controlled trial, process evaluation and exploratory economic analyses. Participants will be recruited from the generic pathway of the Welsh NERS and will be randomly assigned to receive the intervention or usual practice. Usual practice is a 16-week structured exercise programme; the intervention consists of an accelerometry-based activity monitor (MyWellnessKey) and an associated web platform (MyWellnessCloud). The primary outcomes are predefined progression criteria assessing the acceptability and feasibility of the intervention and feasibility of the proposed evaluation methodology. Postal questionnaires will be completed at baseline (time 0: T0), 16 weeks after T0 (T1) and 12 months after T0 (T2). Routinely collected data will also be accessed at the same time points. A sub-sample of intervention participants and exercise referral staff will be interviewed following initiation of intervention delivery and at the end of the study. The PACERS study seeks to assess the feasibility of adding a novel motivational component to an existing

  2. Evolution of primary care referrals to urology. Impact of a protocol on prostate disease and continuing education.

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    Sopeña-Sutil, R; Tejido-Sánchez, A; Galván-Ortiz de Urbina, M; Guerrero-Ramos, F; García-Álvarez, G; Passas-Martínez, J B

    2015-06-01

    To analyze the evolution of primary care referrals to the Urology Department after the implementation of a joint protocol on prostate disease and a continuing education program in our healthcare area. In January 2011, we launched an action protocol on prostate disease, which was complemented by training sessions and an e-mail-based consultation system. We analyzed primary care referrals to the Urology Department between 2011 and 2013 and determined the reasons for the consultations and the compliance with the established criteria on prostate disease. We obtained data from the "Request for Appointment in Specialized Care" program of the Community of Madrid. We calculated the sample size with a 95% confidence level and a 50% heterogeneity. A total of 19,048 referrals were conducted. The most common reason for the referrals was lower urinary tract symptoms associated with benign prostate hyperplasia, with a 27% reduction and a compliance that went from 46% at 67%. Although prostate-specific antigen consultations increased by 40%, they improved their appropriateness (from 55% to 72%). This was the main type of consultation for suspicion of malignancy (30%). Also worth mentioning were female incontinence, which doubled in number, and a 41% reduction in erectile dysfunction, which could be due to the primary care training. The collaboration between the Department of Urology and primary care succeeded in improving the appropriateness of prostate disease referrals and modified the tendency to refer the rest of the diseases included in the project. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. REFERQUAL: a pilot study of a new service quality assessment instrument in the GP exercise referral scheme setting

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    Cock, Don; Adams, Iain C; Ibbetson, Adrian B; Baugh, Phil

    2006-01-01

    Background The development of an instrument accurately assessing service quality in the GP Exercise Referral Scheme (ERS) industry could potentially inform scheme organisers of the factors that affect adherence rates leading to the implementation of strategic interventions aimed at reducing client drop-out. Methods A modified version of the SERVQUAL instrument was designed for use in the ERS setting and subsequently piloted amongst 27 ERS clients. Results Test re-test correlations were calculated via Pearson's 'r' or Spearman's 'rho', depending on whether the variables were Normally Distributed, to show a significant (mean r = 0.957, SD = 0.02, p < 0.05; mean rho = 0.934, SD = 0.03, p < 0.05) relationship between all items within the questionnaire. In addition, satisfactory internal consistency was demonstrated via Cronbach's 'α'. Furthermore, clients responded favourably towards the usability, wording and applicability of the instrument's items. Conclusion REFERQUAL is considered to represent promise as a suitable tool for future evaluation of service quality within the ERS community. Future research should further assess the validity and reliability of this instrument through the use of a confirmatory factor analysis to scrutinise the proposed dimensional structure. PMID:16725021

  4. An enhanced password authentication scheme for session initiation protocol with perfect forward secrecy.

    Science.gov (United States)

    Qiu, Shuming; Xu, Guoai; Ahmad, Haseeb; Guo, Yanhui

    2018-01-01

    The Session Initiation Protocol (SIP) is an extensive and esteemed communication protocol employed to regulate signaling as well as for controlling multimedia communication sessions. Recently, Kumari et al. proposed an improved smart card based authentication scheme for SIP based on Farash's scheme. Farash claimed that his protocol is resistant against various known attacks. But, we observe some accountable flaws in Farash's protocol. We point out that Farash's protocol is prone to key-compromise impersonation attack and is unable to provide pre-verification in the smart card, efficient password change and perfect forward secrecy. To overcome these limitations, in this paper we present an enhanced authentication mechanism based on Kumari et al.'s scheme. We prove that the proposed protocol not only overcomes the issues in Farash's scheme, but it can also resist against all known attacks. We also provide the security analysis of the proposed scheme with the help of widespread AVISPA (Automated Validation of Internet Security Protocols and Applications) software. At last, comparing with the earlier proposals in terms of security and efficiency, we conclude that the proposed protocol is efficient and more secure.

  5. An enhanced password authentication scheme for session initiation protocol with perfect forward secrecy

    Science.gov (United States)

    2018-01-01

    The Session Initiation Protocol (SIP) is an extensive and esteemed communication protocol employed to regulate signaling as well as for controlling multimedia communication sessions. Recently, Kumari et al. proposed an improved smart card based authentication scheme for SIP based on Farash’s scheme. Farash claimed that his protocol is resistant against various known attacks. But, we observe some accountable flaws in Farash’s protocol. We point out that Farash’s protocol is prone to key-compromise impersonation attack and is unable to provide pre-verification in the smart card, efficient password change and perfect forward secrecy. To overcome these limitations, in this paper we present an enhanced authentication mechanism based on Kumari et al.’s scheme. We prove that the proposed protocol not only overcomes the issues in Farash’s scheme, but it can also resist against all known attacks. We also provide the security analysis of the proposed scheme with the help of widespread AVISPA (Automated Validation of Internet Security Protocols and Applications) software. At last, comparing with the earlier proposals in terms of security and efficiency, we conclude that the proposed protocol is efficient and more secure. PMID:29547619

  6. Persistent RCSMA: A MAC Protocol for a Distributed Cooperative ARQ Scheme in Wireless Networks

    Directory of Open Access Journals (Sweden)

    J. Alonso-Zárate

    2008-05-01

    Full Text Available The persistent relay carrier sensing multiple access (PRCSMA protocol is presented in this paper as a novel medium access control (MAC protocol that allows for the execution of a distributed cooperative automatic retransmission request (ARQ scheme in IEEE 802.11 wireless networks. The underlying idea of the PRCSMA protocol is to modify the basic rules of the IEEE 802.11 MAC protocol to execute a distributed cooperative ARQ scheme in wireless networks in order to enhance their performance and to extend coverage. A closed formulation of the distributed cooperative ARQ average packet transmission delay in a saturated network is derived in the paper. The analytical equations are then used to evaluate the performance of the protocol under different network configurations. Both the accuracy of the analysis and the performance evaluation of the protocol are supported and validated through computer simulations.

  7. Who stays, who drops out? Biosocial predictors of longer-term adherence in participants attending an exercise referral scheme in the UK

    Directory of Open Access Journals (Sweden)

    Tobi Patrick

    2012-05-01

    Full Text Available Abstract Background Exercise referral schemes are one of the most popular forms of physical activity intervention in primary care in the UK and present an opportunity to better understand the factors related to exercise adherence. But standard schemes tend to be delivered over a short period and so provide information about the factors associated with short-term adherence. This retrospective register-based study of a longer-duration scheme allowed investigation of longer-term adherence. Methods Social, physiological and anthropometric data were extracted from records of a cohort of ERS participants who had enrolled between 01 January and 31 December 2007 (n = 701. Characteristics of adherers and non-adherers were compared and potential predictors of longer-term adherence examined using binomial logistic regression. Results Significant adjusted odds ratios predicting longer-term adherence were found for age and medical condition. For every 10 year increase in age, the odds of people continuing exercise increased by 21.8% (OR = 1.02; CI = 1.00 to 1.04; p = 0.03. Participants referred with orthopaedic (OR = 0.25; CI = 0.07-0.94; p = 0.04, cardiovascular (OR = 0.18; CI = 0.05-0.70; p = 0.01 and other (OR = 0.20; CI = 0.04-0.93; p = 0.04 problems had significantly lower odds of adhering than those with metabolic conditions. Conclusion Improved understanding of the factors that influence adherence to exercise referral schemes will enable providers develop better referral guidance and tailor schemes to better meet participants’ needs. Longer-term schemes offer the opportunity to understand participants’ likelihood of maintaining adherence to exercise.

  8. A Protocol Layer Trust-Based Intrusion Detection Scheme for Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Jian Wang

    2017-05-01

    Full Text Available This article proposes a protocol layer trust-based intrusion detection scheme for wireless sensor networks. Unlike existing work, the trust value of a sensor node is evaluated according to the deviations of key parameters at each protocol layer considering the attacks initiated at different protocol layers will inevitably have impacts on the parameters of the corresponding protocol layers. For simplicity, the paper mainly considers three aspects of trustworthiness, namely physical layer trust, media access control layer trust and network layer trust. The per-layer trust metrics are then combined to determine the overall trust metric of a sensor node. The performance of the proposed intrusion detection mechanism is then analyzed using the t-distribution to derive analytical results of false positive and false negative probabilities. Numerical analytical results, validated by simulation results, are presented in different attack scenarios. It is shown that the proposed protocol layer trust-based intrusion detection scheme outperforms a state-of-the-art scheme in terms of detection probability and false probability, demonstrating its usefulness for detecting cross-layer attacks.

  9. Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit.

    Science.gov (United States)

    Armañanzas, Laura; Arroyo, Antonio; Ruiz-Tovar, Jaime; López, Alberto; Santos, Jair; Moya, Pedro; Gómez, María Amparo; Candela, Fernando; Calpena, Rafael

    2015-01-01

    Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011. We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Esther Buregyeya

    2016-11-01

    Full Text Available Abstract Background Uganda’s under-five mortality is high, currently estimated at 66/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve referral and uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics. Methods/Design A cluster randomized design will be applied to test the intervention in Mukono District, central Uganda. A sample of study clusters will implement the intervention. The intervention will consist of three components: i raising awareness in the community: village health teams will discuss the importance of referral and encourage households to save money, ii training and supervision of providers in the private sector to diagnose, treat and refer sick children, iii regular meetings between the public and private providers (convened by the district health team to discuss the referral system. Twenty clusters will be included in the study, randomized in the ratio of 1:1. A minimum of 319 sick children per cluster and the total number of sick children to be recruited from all clusters will be 8910; adjusting for a 10 % loss to follow up and possible withdrawal of private outlets. Discussion The immediate sustainable impact will be appropriate treatment of sick children. The intervention is likely to impact on private sector practices since the scope of the services they provide will have expanded. The proposed study is also likely to have an impact on families as; i they may appreciate the importance of timely referral on child illness management, ii the cost savings related to reduced morbidity will be used by household to access other social services. The linkage between the private and public sectors will create a potential avenue for delivery of other public health interventions and improved working relations in the two sectors. Further, improved quality of

  11. QoS Support Polling Scheme for Multimedia Traffic in Wireless LAN MAC Protocol

    Institute of Scientific and Technical Information of China (English)

    YANG Zhijun; ZHAO Dongfeng

    2008-01-01

    Quality of service (QoS) support is a key attribute for multimedia traffic including video, voice, and data in wireless local area networks (LANs) but is limited in 802.11-based wireless LANs. A polling-based scheme called the point coordination function (PCF) was developed for 802.11 LANs to support the trans-mission of multimedia traffic. However, the PCF is not able to meet the desired practical traffic differentiation requirements for real-time data. This paper describes a QoS support polling scheme based on the IEEE 802.11 medium access control (MAC) protocol. The scheme uses a two-level polling mechanism with the QoS classes differentiated by two different access policies. Stations with higher priority traffic such as key or real-time data form the first level and can access the common channel through an exhaustive access policy. Other stations with lower priority traffic form the second level and can access the channel through a gated access policy. A system model based on imbedded Markov chain theory and a generation function were setup to explicitly analyze the mean information packet waiting time of the two-level polling scheme. Theo-retical and simulation results show that the new scheme efficiently differentiates services to guarantee better QoS and system stability.

  12. Prediction Schemes to Enhance the Routing Process in Geographical GPSR Ad Hoc Protocol

    Directory of Open Access Journals (Sweden)

    Raed Saqour

    2007-01-01

    Full Text Available Geographical routing protocols have received a serious attention due to more advantages they have in comparison to the conventional routing protocols. They require information about the physical position of nodes needed to be available. Commonly, each node determines its own position through the use of Global Positioning System (GPS or some other type of positioning service. Greedy Perimeter Stateless Routing (GPSR protocol, which is one of geographical routing protocols, limits the forwarding decision of the packet based on the node's own position, the destination's position and the position of the forwarding node's neighbors. Location information has some inaccuracy depending on the localization system and the environment exists in. This paper aims to study the impact of mobility metrics (beacon interval, and node speed on introducing location information error in GPSR protocol using different mobility models. The effect of these metrics is identified in GPSR as Neighbor Break Link (NBL problem. Based on simulation analysis, mobility prediction schemes are proposed to migrate the observed problem.

  13. Correct mutual information, quantum bit error rate and secure transmission efficiency in Wojcik's eavesdropping scheme on ping-pong protocol

    OpenAIRE

    Zhang, Zhanjun

    2004-01-01

    Comment: The wrong mutual information, quantum bit error rate and secure transmission efficiency in Wojcik's eavesdropping scheme [PRL90(03)157901]on ping-pong protocol have been pointed out and corrected

  14. An effective implementation scheme of just-in-time protocol for optical burst switching networks

    Science.gov (United States)

    Wu, Guiling; Li, Xinwan; Chen, Jian-Ping; Wang, Hui

    2005-02-01

    Optical burst switching (OBS) has been emerging as a promising technology that can effectively support the next generation IP-oriented transportation networks. JIT signaling protocol for OBS is relatively simple and easy to be implemented by hardware. This paper presented an effective scheme to implement the JIT protocol, which not only can effectively implement reservation and release of optical channels based on JIT, but also can process the failure of channel reservation and release due to loss of burst control packets. The scheme includes: (1) a BHP (burst head packet) path table is designed and built at each OBS node. It is used to guarantee the corresponding burst control packet, i.e. BHP, BEP (burst end packet) and BEP_ACK (BEP acknowledgement), to be transmitted in the same path. (2) The timed retransmission of BEP and the reversed deletion of the item in BHP path tables triggered by the corresponding BEP_ACK are combined to solve the problems caused by the loss of the signaling messages in channel reservation and release process. (3) Burst head packets and BEP_ACK are transmitted using "best-effort" method. Related signaling messages and their formats for the proposed scheme are also given.

  15. A Novel Load Balancing Scheme for Multipath Routing Protocol in MANET

    Directory of Open Access Journals (Sweden)

    Kokilamani Mounagurusamy

    2016-09-01

    Full Text Available The recent advancements in information and communication technology create a great demand for multipath routing protocols. In MANET, nodes can be arbitrarily located and can move freely at any given time. The topology of MANET can change rapidly and unpredictably. Because wireless link capacities are usually limited, congestion is possible in MANETs. Hence, balancing the load in a MANET is important since nodes with high load will deplete their batteries quickly, thereby increasing the probability of disconnecting or partitioning the network. To overcome these, the multipath protocol should be aware of load at route discovery phase. The main objective of the proposed article is to balance the load on a node and to extend the lifetime of the node due to the congestion, energy depletion and link failures. This article describes a novel load and congestion aware scheme called Path Efficient Ad-hoc On-demand Multipath Distance Vector (PE-AOMDV protocol to increase the performance of routing process in MANET in terms of congestion, end-to-end delay and load balancing. A new threshold value and a counter variable are introduced to limit the number of communication paths passing over a node in route discovery phase. For every new request the counter variable is incremented by one and the threshold value is compared to see whether the maximum number of connections has been reached or not. The proposed method is network simulator ns-2 and it is found that there is a significant improvement in the proposed scheme. It reduces the energy consumption, average end-to-end delay and normalized routing overhead. Also the proposed scheme increases packet delivery ratio, throughput and minimizes routing overheads.

  16. A General Scheme for Information Interception in the Ping-Pong Protocol

    Directory of Open Access Journals (Sweden)

    Piotr Zawadzki

    2016-01-01

    Full Text Available The existence of undetectable eavesdropping of dense coded information has been already demonstrated by Pavičić for the quantum direct communication based on the ping-pong paradigm. However, (a the explicit scheme of the circuit is only given and no design rules are provided; (b the existence of losses is implicitly assumed; (c the attack has been formulated against qubit based protocol only and it is not clear whether it can be adapted to higher dimensional systems. These deficiencies are removed in the presented contribution. A new generic eavesdropping scheme built on a firm theoretical background is proposed. In contrast to the previous approach, it does not refer to the properties of the vacuum state, so it is fully consistent with the absence of losses assumption. Moreover, the scheme applies to the communication paradigm based on signal particles of any dimensionality. It is also shown that some well known attacks are special cases of the proposed scheme.

  17. A general scheme for information interception in the ping pong protocol

    OpenAIRE

    Zawadzki, Piotr; Miszczak, Jarosław Adam

    2016-01-01

    The existence of an undetectable eavesdropping of dense coded information has been already demonstrated by Pavi\\v{c}i\\'c for the quantum direct communication based on the ping-pong paradigm. However, a) the explicit scheme of the circuit is only given and no design rules are provided, b) the existence of losses is implicitly assumed, c) the attack has been formulated against qubit based protocol only and it is not clear whether it can be adapted to higher dimensional systems. These deficienci...

  18. The QUIT-PRIMO provider-patient Internet-delivered smoking cessation referral intervention: a cluster-randomized comparative effectiveness trial: study protocol

    Directory of Open Access Journals (Sweden)

    Ford Daniel E

    2010-11-01

    Full Text Available Abstract Background Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group. Methods The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates and patient participation (proportion referred who go to the website. We will then compare the effectiveness of the standard and augmented patient websites. Discussion Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login and patient outcomes (six-month smoking cessation. Trial Registration Web-delivered Provider Intervention for

  19. Adherence to exercise referral schemes by participants – what do providers and commissioners need to know? A systematic review of barriers and facilitators

    Directory of Open Access Journals (Sweden)

    Fiona Morgan

    2016-03-01

    Full Text Available Abstract Background Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Methods Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were ‘inactive’ (i.e. they are not currently meeting UK physical activity guidelines. Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and ‘making exercise a habit’ post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a

  20. Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators.

    Science.gov (United States)

    Morgan, Fiona; Battersby, Alysia; Weightman, Alison L; Searchfield, Lydia; Turley, Ruth; Morgan, Helen; Jagroo, James; Ellis, Simon

    2016-03-05

    Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS) continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE) on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were 'inactive' (i.e. they are not currently meeting UK physical activity guidelines). Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and 'making exercise a habit' post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a dislike of the music and TV and a lack of confidence in operating

  1. FPGA implementation cost and performance evaluation of IEEE 802.11 protocol encryption security schemes

    Science.gov (United States)

    Sklavos, N.; Selimis, G.; Koufopavlou, O.

    2005-01-01

    The explosive growth of internet and consumer demand for mobility has fuelled the exponential growth of wireless communications and networks. Mobile users want access to services and information, from both internet and personal devices, from a range of locations without the use of a cable medium. IEEE 802.11 is one of the most widely used wireless standards of our days. The amount of access and mobility into wireless networks requires a security infrastructure that protects communication within that network. The security of this protocol is based on the wired equivalent privacy (WEP) scheme. Currently, all the IEEE 802.11 market products support WEP. But recently, the 802.11i working group introduced the advanced encryption standard (AES), as the security scheme for the future IEEE 802.11 applications. In this paper, the hardware integrations of WEP and AES are studied. A field programmable gate array (FPGA) device has been used as the hardware implementation platform, for a fair comparison between the two security schemes. Measurements for the FPGA implementation cost, operating frequency, power consumption and performance are given.

  2. FPGA implementation cost and performance evaluation of IEEE 802.11 protocol encryption security schemes

    International Nuclear Information System (INIS)

    Sklavos, N; Selimis, G; Koufopavlou, O

    2005-01-01

    The explosive growth of internet and consumer demand for mobility has fuelled the exponential growth of wireless communications and networks. Mobile users want access to services and information, from both internet and personal devices, from a range of locations without the use of a cable medium. IEEE 802.11 is one of the most widely used wireless standards of our days. The amount of access and mobility into wireless networks requires a security infrastructure that protects communication within that network. The security of this protocol is based on the wired equivalent privacy (WEP) scheme. Currently, all the IEEE 802.11 market products support WEP. But recently, the 802.11i working group introduced the advanced encryption standard (AES), as the security scheme for the future IEEE 802.11 applications. In this paper, the hardware integrations of WEP and AES are studied. A field programmable gate array (FPGA) device has been used as the hardware implementation platform, for a fair comparison between the two security schemes. Measurements for the FPGA implementation cost, operating frequency, power consumption and performance are given

  3. Three-pass protocol scheme for bitmap image security by using vernam cipher algorithm

    Science.gov (United States)

    Rachmawati, D.; Budiman, M. A.; Aulya, L.

    2018-02-01

    Confidentiality, integrity, and efficiency are the crucial aspects of data security. Among the other digital data, image data is too prone to abuse of operation like duplication, modification, etc. There are some data security techniques, one of them is cryptography. The security of Vernam Cipher cryptography algorithm is very dependent on the key exchange process. If the key is leaked, security of this algorithm will collapse. Therefore, a method that minimizes key leakage during the exchange of messages is required. The method which is used, is known as Three-Pass Protocol. This protocol enables message delivery process without the key exchange. Therefore, the sending messages process can reach the receiver safely without fear of key leakage. The system is built by using Java programming language. The materials which are used for system testing are image in size 200×200 pixel, 300×300 pixel, 500×500 pixel, 800×800 pixel and 1000×1000 pixel. The result of experiments showed that Vernam Cipher algorithm in Three-Pass Protocol scheme could restore the original image.

  4. In the beginning: role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme.

    Science.gov (United States)

    Rouse, Peter C; Ntoumanis, Nikos; Duda, Joan L; Jolly, Kate; Williams, Geoffrey C

    2011-06-01

    Self-determination theory (Deci & Ryan, 2000, Intrinsic motivation and self-determination in human behaviour. New York: Plenum Publishing) highlights the impact autonomy supportive environments can have on exercise motivation and positive health outcomes. Yet little is known about whether differential effects occur as a function of which significant other is providing this support. Further, no research has examined the relationship between motivation and the social environment with participants' mental health and intentions to be physically active before entering an exercise intervention. Study participants were 347 British adults who were about to start an exercise referral scheme. Regression analyses revealed that the effects of autonomy support on mental health and physical activity intentions differed as a function of who provided the support (offspring, partner or physician), with the offspring having the weakest effects. A structural model was supported, indicating that autonomy support and more autonomous regulations led to more positive mental health outcomes and stronger intentions to be physically active. Knowledge of the social environmental and personal motivation of those about to commence an exercise programme can provide important insights for professionals supporting such efforts. © 2011 Taylor & Francis

  5. Can adding web-based support to UK primary care exercise referral schemes improve patients’ physical activity levels? Findings from an internal pilot study.

    Directory of Open Access Journals (Sweden)

    Adrian Taylor

    2015-10-01

    Full Text Available Background: Promoting physical activity (PA via primary care exercise referral schemes (ERS is common but there is no rigorous evidence for long term changes in PA (Pavey et al, 2011 among those with chronic conditions. From July 2015, for 15 months, the e-coachER trial began to recruit 1400 patients (in SW England, Birmingham and Glasgow with one or more chronic conditions including diabetes, obesity, hypertension, osteoarthritis, or depression, who are eligible and about to attend an ERS. The two-arm parallel RCT is powered to determine if the addition of a web-based, interactive, theory-driven and evidence-based support system called e-coachER (hosted on the ‘LifeGuide’ platform will result in at least 10% more patients who do 150 mins or more per week of accelerometer assessed moderate or vigorous physical activity (MVPA at 12 months. Recruitment into the trial is within primary care, using both mail-merged patient invitations and opportunistic GP invitations (and exercise referrals. Within the trial, after participants are screened, provide consent and complete baseline assessments, they are randomised to receive usual ERS at each site or usual ERS plus a mailed Welcome Pack with registration details to access e-coachER on-line. Inclusion criteria for entering the trial are: (1 Aged 16-74 years; (2 with one or more of the following: obesity (BMI 30-35, hypertension (SBP 140-179 or DBP 90-109, type 2 diabetes, lower limb osteoarthritis, recent history of treatment for depression; (3 Participants who are in the two lowest (of four groups using the GP Physical Activity Questionnaire; (4 have an e-mail address and access to the internet; (5 Eligible for an ERS. The intervention rationale, design and content are reported in another presentation. Aims: This presentation will provide initial findings from a 3 month internal pilot phase with a focus on trial recruitment and initial intervention engagement. We will present data on the

  6. A Novel Basis Splitting Eavesdropping Scheme in Quantum Cryptography Based on the BB84 Protocol

    International Nuclear Information System (INIS)

    Zhao Nan; Zhu Chang-Hua; Quan Dong-Xiao

    2015-01-01

    We propose a novel strategy named basis-splitting scheme to split the intercepted quanta into several portions based on different bases, for eavesdropping in the process of quantum cryptography. Compared with intercept-resend strategy, our simulation results of the basis-splitting scheme under the non-ideal condition show a greater performance, especially with the increase of the length of shifted bits. Consequently our scheme can aid eavesdropper to gather much more useful information. (paper)

  7. Dynamic Channel Slot Allocation Scheme and Performance Analysis of Cyclic Quorum Multichannel MAC Protocol

    Directory of Open Access Journals (Sweden)

    Xing Hu

    2017-01-01

    Full Text Available In high diversity node situation, multichannel MAC protocol can improve the frequency efficiency, owing to fewer collisions compared with single-channel MAC protocol. And the performance of cyclic quorum-based multichannel (CQM MAC protocol is outstanding. Based on cyclic quorum system and channel slot allocation, it can avoid the bottleneck that others suffered from and can be easily realized with only one transceiver. To obtain the accurate performance of CQM MAC protocol, a Markov chain model, which combines the channel-hopping strategy of CQM protocol and IEEE 802.11 distributed coordination function (DCF, is proposed. The results of numerical analysis show that the optimal performance of CQM protocol can be obtained in saturation bound situation. And then we obtain the saturation bound of CQM system by bird swarm algorithm. In addition, to improve the performance of CQM protocol in unsaturation situation, a dynamic channel slot allocation of CQM (DCQM protocol is proposed, based on wavelet neural network. Finally, the performance of CQM protocol and DCQM protocol is simulated by Qualnet platform. And the simulation results show that the analytic and simulation results match very well; the DCQM performs better in unsaturation situation.

  8. A Scenario-Based Protocol Checker for Public-Key Authentication Scheme

    Science.gov (United States)

    Saito, Takamichi

    Security protocol provides communication security for the internet. One of the important features of it is authentication with key exchange. Its correctness is a requirement of the whole of the communication security. In this paper, we introduce three attack models realized as their attack scenarios, and provide an authentication-protocol checker for applying three attack-scenarios based on the models. We also utilize it to check two popular security protocols: Secure SHell (SSH) and Secure Socket Layer/Transport Layer Security (SSL/TLS).

  9. OPM Scheme Editor 2: A graphical editor for specifying object-protocol structures

    Energy Technology Data Exchange (ETDEWEB)

    Chen, I-Min A.; Markowitz, V.M.; Pang, F.; Ben-Shachar, O.

    1993-07-01

    This document describes an X-window based Schema Editor for the Object-Protocol Model (OPM). OPM is a data model that supports the specification of complex object and protocol classes. objects and protocols are qualified in OPM by attributes that are defined over (associated with) value classes. Connections of object and protocol classes are expressed in OPM via attributes. OPM supports the specification (expansion) of protocols in terms of alternative and sequences of component (sub) protocols. The OPM Schema Editor allows specifying, displaying, modifying, and browsing through OPM schemas. The OPM Schema Editor generates an output file that can be used as input to an OPM schema translation tool that maps OPM schemas into definitions for relational database management systems. The OPM Schema Editor was implemented using C++ and the X11 based Motif toolkit, on Sun SPARCstation under Sun Unix OS 4.1. This document consists of the following parts: (1) A tutorial consisting of seven introductory lessons for the OPM Schema Editor. (2) A reference manual describing all the windows and functions of the OPM Schema Editor. (3) An appendix with an overview of OPM.

  10. Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol.

    Science.gov (United States)

    Blane, David N; Macdonald, Sara; Morrison, David; O'Donnell, Catherine A

    2015-05-01

    Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying 'programme theory' of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. This is the

  11. A Generic, Modular and User Transparent Protocol Scheme for Inter-FPGA Communication using Serial Links

    CERN Document Server

    AUTHOR|(CDS)2209162; Emery, Jonathan

    CERN, the European Organization for Nuclear Research, is a European research organization that operates the largest particle physics laboratory in the world. A large amount of particle accelerators and detectors are developed and used for scientific research purposes. With those, a large amount of information is created and needs to be stored before it can be analysed. As a consequence, the communication reliability, integrity, latency and transfer rates between these detectors and the control room are some of the key elements for the success of those experiments. While it is true that existing communication standards, or protocols, are focused on those key elements, it is usually a balanced compromise to stay polyvalent, where the emphasis on a specific aspect reduces the efficiency of the others. To improve the performance and capabilities of one of the operational accelerator instrument called the beam wire scanner (BWS), the CERN instrumentation Group (BE-BI) has created a complete new electro-mech...

  12. A Downlink and Uplink Alignment Scheme for Power Saving in IEEE 802.16 Protocol

    Directory of Open Access Journals (Sweden)

    Jenhui Chen

    2014-01-01

    Full Text Available This study shows the problem of power saving mechanism (PSM that sleep intervals of uplink (UL connections do not synchronize with sleep intervals of downlink (DL connections. That is, the energy of a mobile station (MS is not really saved if the DL connections are in the sleep mode while the UL connections are in normal mode, and vice versa. To avoid the asynchronism of power saving (PS between UL and DL connections, we invent a mechanism of DL connections regulating UL connections, called DL and UL Alignment (DUAL scheme, to improve the energy efficiency for PS. Considering that the buffer size of MS is limited, DUAL uses the mean packet arrival rate of UL λu and a relatively safe threshold of buffer size QT as the parameters to estimate the maximum allowable waiting time to align the UL with the DL connections. To analyze the performance of DUAL, a system model of PS is proposed to evaluate the performance of DUAL under different conditions. The correctness of performance analysis of DUAL is validated by using simulation with realistic parameters. Numerical experiments show that DUAL improves the energy conservation significantly when UL traffic is greater than DL traffic.

  13. A comparative signaling cost analysis of Macro Mobility scheme in NEMO (MM-NEMO) with mobility management protocol

    Science.gov (United States)

    Islam, Shayla; Abdalla, Aisha H.; Habaebi, Mohamed H.; Latif, Suhaimi A.; Hassan, Wan H.; Hasan, Mohammad K.; Ramli, H. A. M.; Khalifa, Othman O.

    2013-12-01

    NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it's Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, "Signaling Storm" occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6.

  14. A comparative signaling cost analysis of Macro Mobility scheme in NEMO (MM-NEMO) with mobility management protocol

    International Nuclear Information System (INIS)

    Islam, Shayla; Abdalla, Aisha H; Habaebi, Mohamed H; Latif, Suhaimi A; Hassan, Wan H; Hasan, Mohammad K; Ramli, H A M; Khalifa, Othman O

    2013-01-01

    NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it's Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, ''Signaling Storm'' occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6

  15. The effect of the 2-week wait referral system on the detection of and mortality from colorectal cancer: protocol of a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Ella Mozdiak

    2016-10-01

    Full Text Available Abstract Background Colorectal cancer represents the fourth most common cancer in England and Wales; survival is high for early stage disease but declines sharply with advanced stage. UK figures suggest that cancer survival rates are lower than those of other Western European countries. Current 5-year survival is around 50 %. A rapid access strategy was introduced through the Department of Health in 2000. This 2-week wait (TWW referral pathway was devised to streamline referral for suspected cancer, allow diagnosis at an earlier stage, reduce cancer survival inequality and reduce cancer-related mortality. However, only around half of patients with colorectal cancer have symptoms that fit the TWW criteria plus there is a fourfold difference in referral rates across England and Wales. High-quality evidence of TWW outcome measures for colorectal cancer is lacking. This systematic review will collate and evaluate the latest evidence on colorectal cancer detection rate, stage at diagnosis and mortality. Methods English-language publications from 2000 reporting outcomes on the TWW referral system for suspected colorectal cancer will be eligible for inclusion. Cochrane, EMBASE, MEDLINE via PubMed, NHS Evidence, Trip and the British Library Catalogue databases will be searched. Two paired reviewers will independently screen all titles/abstracts and full text for eligibility, then extract data and assess for bias using standardised formats. They will hand review reference lists of eligible articles. Disagreement will be resolved via third party adjudication. Summary effect measures for post-referral diagnosis and mortality rates will be calculated and expressed as relative risk, hazard rate ratio or risk difference with corresponding 95 % confidence intervals. Where possible summary effect measures will be pooled, heterogeneity and its extent for pooled estimates will be assessed via visual inspection of forest plots and explored via sub-group analysis

  16. ParaMED Home: A protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home

    Directory of Open Access Journals (Sweden)

    Johnston Steven

    2011-06-01

    Full Text Available Abstract Background In Australia approximately 25% of Emergency Department (ED attendances are via ambulance. ED overcrowding in Australia, as in many countries, is common. Measures to reduce overcrowding include the provision of enhanced timely primary care in the community for appropriate low risk injury and illness. Therefore paramedic assessment and referral to a community home hospital service, in preference to transfer to ED, may confer clinical and cost benefit. Methods/Design A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to ED via ambulance transfer or referral to a rapid response service that will assess and treat the patient in their own residence. The primary outcome measure is requirement for unplanned medical attention (in or out of hospital in the first 48 hours. Secondary outcomes will include a number of other clinical endpoints. A cost effectiveness analysis will be conducted. Discussion If this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding. Trial Registration Australian and New Zealand Clinical Trials Registry Number 12610001064099

  17. Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) in primary care using total diet replacement products: a protocol for a randomised controlled trial.

    Science.gov (United States)

    Jebb, Susan A; Astbury, Nerys M; Tearne, Sarah; Nickless, Alecia; Aveyard, Paul

    2017-08-04

    The global prevalence of obesity has risen significantly in recent decades. There is a pressing need to identify effective interventions to treat established obesity that can be delivered at scale. The aim of the Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) study is to determine the clinical effectiveness, feasibility and acceptability of referral to a low-energy total diet replacement programme compared with usual weight management interventions in primary care. The DROPLET trial is a randomised controlled trial comparing a low-energy total diet replacement programme with usual weight management interventions delivered in primary care. Eligible patients will be recruited through primary care registers and randomised to receive a behavioural support programme delivered by their practice nurse or a referral to a commercial provider offering an initial 810 kcal/d low-energy total diet replacement programme for 8 weeks, followed by gradual food reintroduction, along with weekly behavioural support for 24 weeks. The primary outcome is weight change at 12 months. The secondary outcomes are weight change at 3 and 6 months, the proportion of participants achieving 5% and 10% weight loss at 12 months, and change in fat mass, haemoglobin A1c, low-density lipoprotein cholesterol and systolic and diastolic blood pressure at 12 months. Data will be analysed on the basis of intention to treat. Qualitative interviews on a subsample of patients and healthcare providers will assess their experiences of the weight loss programmes and identify factors affecting acceptability and adherence. This study has been reviewed and approved by the National Health ServiceHealth Research Authority (HRA)Research Ethics Committee (Ref: SC/15/0337). The trial findings will be disseminated to academic and health professionals through presentations at meetings and peer-reviewed journals and to the public through the media. If the intervention is effective, the results

  18. A no-key-exchange secure image sharing scheme based on Shamir's three-pass cryptography protocol and the multiple-parameter fractional Fourier transform.

    Science.gov (United States)

    Lang, Jun

    2012-01-30

    In this paper, we propose a novel secure image sharing scheme based on Shamir's three-pass protocol and the multiple-parameter fractional Fourier transform (MPFRFT), which can safely exchange information with no advance distribution of either secret keys or public keys between users. The image is encrypted directly by the MPFRFT spectrum without the use of phase keys, and information can be shared by transmitting the encrypted image (or message) three times between users. Numerical simulation results are given to verify the performance of the proposed algorithm.

  19. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    Directory of Open Access Journals (Sweden)

    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  20. Evaluation of specialist referrals at a rural health care clinic.

    Science.gov (United States)

    Biggerstaff, Mary Ellen; Short, Nancy

    2017-07-01

    Transition to a value-based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. A 6-month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6-month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements. ©2017 American Association of Nurse Practitioners.

  1. Enhanced maternal and child health nurse care for women experiencing intimate partner/family violence: protocol for MOVE, a cluster randomised trial of screening and referral in primary health care.

    Science.gov (United States)

    Taft, Angela J; Small, Rhonda; Humphreys, Cathy; Hegarty, Kelsey; Walter, Ruby; Adams, Catina; Agius, Paul

    2012-09-20

    Intimate partner violence (IPV) can result in significant harm to women and families and is especially prevalent when women are pregnant or recent mothers. Maternal and child health nurses (MCHN) in Victoria, Australia are community-based nurse/midwives who see over 95% of all mothers with newborns. MCHN are in an ideal position to identify and support women experiencing IPV, or refer them to specialist family violence services. Evidence for IPV screening in primary health care is inconclusive to date. The Victorian government recently required nurses to screen all mothers when babies are four weeks old, offering an opportunity to examine the effectiveness of MCHN IPV screening practices. This protocol describes the development and design of MOVE, a study to examine IPV screening effectiveness and the sustainability of screening practice. MOVE is a cluster randomised trial of a good practice model of MCHN IPV screening involving eight maternal and child health nurse teams in Melbourne, Victoria. Normalisation Process Theory (NPT) was incorporated into the design, implementation and evaluation of the MOVE trial to enhance and evaluate sustainability. Using NPT, the development stage combined participatory action research with intervention nurse teams and a systematic review of nurse IPV studies to develop an intervention model incorporating consensus guidelines, clinical pathway and strategies for individual nurses, their teams and family violence services. Following twelve months' implementation, primary outcomes assessed include IPV inquiry, IPV disclosure by women and referral using data from MCHN routine data collection and a survey to all women giving birth in the previous eight months. IPV will be measured using the Composite Abuse Scale. Process and impact evaluation data (online surveys and key stakeholders interviews) will highlight NPT concepts to enhance sustainability of IPV identification and referral. Data will be collected again in two years. MOVE

  2. Automatic referral to cardiac rehabilitation.

    Science.gov (United States)

    Fischer, Jane P

    2008-01-01

    The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.

  3. Design and Analysis of a Data Fusion Scheme in Mobile Wireless Sensor Networks Based on Multi-Protocol Mobile Agents

    Directory of Open Access Journals (Sweden)

    Chunxue Wu

    2017-11-01

    Full Text Available Sensors are increasingly used in mobile environments with wireless network connections. Multiple sensor types measure distinct aspects of the same event. Their measurements are then combined to produce integrated, reliable results. As the number of sensors in networks increases, low energy requirements and changing network connections complicate event detection and measurement. We present a data fusion scheme for use in mobile wireless sensor networks with high energy efficiency and low network delays, that still produces reliable results. In the first phase, we used a network simulation where mobile agents dynamically select the next hop migration node based on the stability parameter of the link, and perform the data fusion at the migration node. Agents use the fusion results to decide if it should return the fusion results to the processing center or continue to collect more data. In the second phase. The feasibility of data fusion at the node level is confirmed by an experimental design where fused data from color sensors show near-identical results to actual physical temperatures. These results are potentially important for new large-scale sensor network applications.

  4. Design and Analysis of a Data Fusion Scheme in Mobile Wireless Sensor Networks Based on Multi-Protocol Mobile Agents.

    Science.gov (United States)

    Wu, Chunxue; Wu, Wenliang; Wan, Caihua; Bekkering, Ernst; Xiong, Naixue

    2017-11-03

    Sensors are increasingly used in mobile environments with wireless network connections. Multiple sensor types measure distinct aspects of the same event. Their measurements are then combined to produce integrated, reliable results. As the number of sensors in networks increases, low energy requirements and changing network connections complicate event detection and measurement. We present a data fusion scheme for use in mobile wireless sensor networks with high energy efficiency and low network delays, that still produces reliable results. In the first phase, we used a network simulation where mobile agents dynamically select the next hop migration node based on the stability parameter of the link, and perform the data fusion at the migration node. Agents use the fusion results to decide if it should return the fusion results to the processing center or continue to collect more data. In the second phase. The feasibility of data fusion at the node level is confirmed by an experimental design where fused data from color sensors show near-identical results to actual physical temperatures. These results are potentially important for new large-scale sensor network applications.

  5. Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

    Science.gov (United States)

    Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

    2017-12-01

    Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia. A cross-sectional, health referral survey of a representative sample of health facilities in Montserrado County, Liberia was performed. A systematic random sample of all primary health care (PHC) clinics, fraction proportional to district population size, and all secondary and tertiary health facilities were included in the study sample. Collected data included baseline information about the health facility, patient flow, and qualitative and quantitative data regarding referral practices. A total of 62 health facilities-41 PHC clinics, 11 health centers (HCs), and 10 referral hospitals (RHs)-were surveyed during the 6-week study period. In sum, three percent of patients were referred to a higher-level of care. Communication between health facilities was largely unsystematic, with lack of specific protocols (n=3; 5.0%) and standardized documentation (n=26; 44.0%) for referral. While most health facilities reported walking as the primary means by which patients presented to initial health facilities (n=50; 81.0%), private vehicles, including commercial taxis (n=37; 60.0%), were the primary transport mechanism for referral of patients between health facilities. This study identified several weaknesses in acute care referral systems in Liberia, including lack of systematic care protocols for transfer, documentation, communication, and transport. However, several informal, well-functioning mechanisms for

  6. Global Imaging referral guidelines

    International Nuclear Information System (INIS)

    Kawooya, M.; Perez, M.; Lau, L.; Reeed, M.

    2010-01-01

    The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement

  7. Physician Referral Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  8. Wireless Broadband Access and Accounting Schemes

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    In this paper, we propose two wireless broadband access and accounting schemes. In both schemes, the accounting system adopts RADIUS protocol, but the access system adopts SSH and SSL protocols respectively.

  9. Packet reversed packet combining scheme

    International Nuclear Information System (INIS)

    Bhunia, C.T.

    2006-07-01

    The packet combining scheme is a well defined simple error correction scheme with erroneous copies at the receiver. It offers higher throughput combined with ARQ protocols in networks than that of basic ARQ protocols. But packet combining scheme fails to correct errors when the errors occur in the same bit locations of two erroneous copies. In the present work, we propose a scheme that will correct error if the errors occur at the same bit location of the erroneous copies. The proposed scheme when combined with ARQ protocol will offer higher throughput. (author)

  10. Cambridge community Optometry Glaucoma Scheme.

    Science.gov (United States)

    Keenan, Jonathan; Shahid, Humma; Bourne, Rupert R; White, Andrew J; Martin, Keith R

    2015-04-01

    With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. 1733 patients were evaluated by this scheme between 2010 and 2013. Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. The number of false positive referrals from initial referral into the scheme. Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

  11. Optimization of burn referrals

    DEFF Research Database (Denmark)

    Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne

    2014-01-01

    INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmar...

  12. Study protocol for a cluster randomized controlled trial to evaluate a referral strategy for axial spondyloarthritis in young primary care patients with chronic low back pain; an impact study.

    Science.gov (United States)

    van Hoeven, Lonneke; Vergouwe, Yvonne; Koes, Bart W; Hazes, Johanna M W; Weel, Angelique E A M

    2016-07-12

    Axial spondyloarthritis (axSpA) is a disabling inflammatory joint disease with chronic low back pain (CLBP) as leading symptom. Recognizing axSpA in the large amount of CLBP patients is difficult for general practioners (GP). This evaluation aims to assess the effect of a referral strategy for axSpA in young primary care patients with CLBP by comparing the use of the strategy with usual care. The effect is measured at three different levels; by patient reported outcomes (the clinical effect), process and costs evaluation. This study design is a cluster randomized controlled trial with GP as clusters. GPs throughout the Netherlands are invited to participate and randomized to either the intervention or the control group. Patients from participating GPs are invited to participate if they have ever been registered with low back pain, without radiation (ICPC L03) and aged 18-45 years. To be included in the study, patients need to have current low back pain and chronic low back pain (>12 weeks). In the intervention arm a referral strategy for axSpA will be applied in CLBP patients, in the control arm care as usual will be provided for CLBP patients. The referral strategy consists of four easy to use variables. All are questions about the back pain complaints of the patients. Data is prospectively collected in an online database at baseline (T0), 4 months (T1), 12 months (T2) and 24 months (T3). After time point T1 (4 months) patients from the control group will also receive the intervention i.e. the application of a referral strategy for axSpA. The effect of the referral strategy is measured at three different levels, by patient outcomes (e.g. pain scores, quality of life), process measures (e.g. number of axSpA diagnoses by rheumatologists) and by costs (work productivity and health care resources use). Our primary outcome is the Roland Morris Disability Questionnaire after 4 months, secondary outcomes are pain and quality of life. Costs will be assessed before

  13. Referral expectations of radiology

    International Nuclear Information System (INIS)

    Smith, W.L.; Altmaier, E.; Berberoglu, L.; Morris, K.

    1989-01-01

    The expectation of the referring physician are key to developing a successful practice in radiology. Structured interviews with 17 clinicians in both community care and academic practice documented that accuracy of the radiologic report was the single most important factor in clinician satisfaction. Data intercorrelation showed that accuracy of report correlated with frequency of referral (r = .49). Overall satisfaction of the referring physician with radiology correlated with accuracy (r = .69), patient satisfaction (r = .36), and efficiency in archiving (r = .42). These data may be weighted by departmental managers to allocate resources for improving referring physician satisfaction

  14. Towards successful coordination of electronic health record based-referrals: a qualitative analysis.

    Science.gov (United States)

    Hysong, Sylvia J; Esquivel, Adol; Sittig, Dean F; Paul, Lindsey A; Espadas, Donna; Singh, Simran; Singh, Hardeep

    2011-07-27

    breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.

  15. Towards successful coordination of electronic health record based-referrals: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Paul Lindsey A

    2011-07-01

    subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.

  16. Employee Referrals and Efficiency Wages

    OpenAIRE

    Kugler, Adriana D.

    2002-01-01

    Many workers believe that personal contacts are crucial for obtaining jobs in high-wage sectors. On the other hand, firms in high-wage sectors report using employee referrals because they help provide screening and monitoring of new employees. This Paper develops a matching model that can explain the link between inter-industry wage differentials and the use of employee referrals. Referrals lower monitoring costs because high-effort referees can exert peer pressure on co-workers, allowing fir...

  17. Radiologists' responses to inadequate referrals

    International Nuclear Information System (INIS)

    Lysdahl, Kristin Bakke; Hofmann, Bjoern Morten; Espeland, Ansgar

    2010-01-01

    To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)

  18. Verification in Referral-Based Crowdsourcing

    Science.gov (United States)

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R.

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

  19. Verifiable Secret Redistribution for Threshold Sharing Schemes

    National Research Council Canada - National Science Library

    Wong, Theodore M; Wang, Chenxi; Wing, Jeannette M

    2002-01-01

    .... Our protocol guards against dynamic adversaries. We observe that existing protocols either cannot be readily extended to allow redistribution between different threshold schemes, or have vulnerabilities that allow faulty old shareholders...

  20. An integrated web-based mental health intervention of assessment-referral-care to reduce stress, anxiety, and depression in hospitalized pregnant women with medically high-risk pregnancies: a feasibility study protocol of hospital-based implementation.

    Science.gov (United States)

    Kingston, Dawn; Janes-Kelley, Selikke; Tyrrell, Janie; Clark, Lorna; Hamza, Deena; Holmes, Penny; Parkes, Cheryl; Moyo, Nomagugu; McDonald, Sheila; Austin, Marie-Paule

    2015-01-16

    At prevalence rates of up to 40%, rates of depression and anxiety among women with medically complex pregnancies are 3 times greater than those in community-based samples of pregnant women. However, mental health care is not a component of routine hospital-based antenatal care for medically high-risk pregnant women. The purpose of this study is to evaluate the effectiveness and feasibility of the hospital-based implementation of a Web-based integrated mental health intervention comprising psychosocial assessment, referral, and cognitive behavioral therapy (CBT) for antenatal inpatients. This study is a quasi-experimental design. Pregnant women are eligible to participate if they are (1) 72 hours, (3) able to speak and read English or be willing to use a translation service to assist with completion of the questionnaires and intervention, (4) able to complete follow-up email questionnaires, (5) >16 years of age, and (6) not actively suicidal. Women admitted to the unit for induction (eg, care hospital. All women will complete a Web-based psychosocial assessment and 6 Web-based CBT modules. Results of the psychosocial assessment will be used by a Web-based clinical decision support system to generate a clinical risk score and clinician prompts to provide recommendations for the best treatment and referral options. The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6-8 weeks postrecruitment. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence at 3-months postpartum; and intervention cost-effectiveness, efficiency, feasibility, and acceptability. All women will complete email questionnaires at 6-8 weeks postrecruitment and 3-months postpartum. Qualitative interviews with 10-15 health care

  1. A full quantum network scheme

    International Nuclear Information System (INIS)

    Ma Hai-Qiang; Wei Ke-Jin; Yang Jian-Hui; Li Rui-Xue; Zhu Wu

    2014-01-01

    We present a full quantum network scheme using a modified BB84 protocol. Unlike other quantum network schemes, it allows quantum keys to be distributed between two arbitrary users with the help of an intermediary detecting user. Moreover, it has good expansibility and prevents all potential attacks using loopholes in a detector, so it is more practical to apply. Because the fiber birefringence effects are automatically compensated, the scheme is distinctly stable in principle and in experiment. The simple components for every user make our scheme easier for many applications. The experimental results demonstrate the stability and feasibility of this scheme. (general)

  2. Towards Symbolic Encryption Schemes

    DEFF Research Database (Denmark)

    Ahmed, Naveed; Jensen, Christian D.; Zenner, Erik

    2012-01-01

    , namely an authenticated encryption scheme that is secure under chosen ciphertext attack. Therefore, many reasonable encryption schemes, such as AES in the CBC or CFB mode, are not among the implementation options. In this paper, we report new attacks on CBC and CFB based implementations of the well......Symbolic encryption, in the style of Dolev-Yao models, is ubiquitous in formal security models. In its common use, encryption on a whole message is specified as a single monolithic block. From a cryptographic perspective, however, this may require a resource-intensive cryptographic algorithm......-known Needham-Schroeder and Denning-Sacco protocols. To avoid such problems, we advocate the use of refined notions of symbolic encryption that have natural correspondence to standard cryptographic encryption schemes....

  3. Caregivers' compliance with referral advice

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

    2018-01-01

    BACKGROUND: Several malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance...... in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers' referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression. RESULTS: CHW saw 18......,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings

  4. Modified Aggressive Packet Combining Scheme

    International Nuclear Information System (INIS)

    Bhunia, C.T.

    2010-06-01

    In this letter, a few schemes are presented to improve the performance of aggressive packet combining scheme (APC). To combat error in computer/data communication networks, ARQ (Automatic Repeat Request) techniques are used. Several modifications to improve the performance of ARQ are suggested by recent research and are found in literature. The important modifications are majority packet combining scheme (MjPC proposed by Wicker), packet combining scheme (PC proposed by Chakraborty), modified packet combining scheme (MPC proposed by Bhunia), and packet reversed packet combining (PRPC proposed by Bhunia) scheme. These modifications are appropriate for improving throughput of conventional ARQ protocols. Leung proposed an idea of APC for error control in wireless networks with the basic objective of error control in uplink wireless data network. We suggest a few modifications of APC to improve its performance in terms of higher throughput, lower delay and higher error correction capability. (author)

  5. Colour schemes

    DEFF Research Database (Denmark)

    van Leeuwen, Theo

    2013-01-01

    This chapter presents a framework for analysing colour schemes based on a parametric approach that includes not only hue, value and saturation, but also purity, transparency, luminosity, luminescence, lustre, modulation and differentiation.......This chapter presents a framework for analysing colour schemes based on a parametric approach that includes not only hue, value and saturation, but also purity, transparency, luminosity, luminescence, lustre, modulation and differentiation....

  6. Short Stature Diagnosis and Referral

    Directory of Open Access Journals (Sweden)

    Mohamad Maghnie

    2018-01-01

    Full Text Available The “360° GH in Europe” meeting, which examined various aspects of GH diseases, was held in Lisbon, Portugal, in June 2016. The Merck KGaA (Germany funded meeting comprised three sessions entitled “Short Stature Diagnosis and Referral,” “Optimizing Patient Management,” and “Managing Transition.” Each session had three speaker presentations, followed by a discussion period, and is reported as a manuscript, authored by the speakers. The first session examined current processes of diagnosis and referral by endocrine specialists for pediatric patients with short stature. Requirements for referral vary widely, by country and by patient characteristics such as age. A balance must be made to ensure eligible patients get referred while healthcare systems are not over-burdened by excessive referrals. Late referral and diagnosis of non-GH deficiency conditions can result in increased morbidity and mortality. The consequent delays in making a diagnosis may compromise the effectiveness of GH treatment. Algorithms for growth monitoring and evaluation of skeletal disproportions can improve identification of non-GH deficiency conditions. Performance and validation of guidelines for diagnosis of GH deficiency have not been sufficiently tested. Provocative tests for investigation of GH deficiency remain equivocal, with insufficient information on variations due to patient characteristics, and cutoff values for definition differ not only by country but also by the assay used. When referring and diagnosing causes of short stature in pediatric patients, clinicians need to rely on many factors, but the most essential is clinical experience.

  7. Managing Consumer Referrals in a Chain Network

    OpenAIRE

    Maria Arbatskaya; Hideo Konishi

    2014-01-01

    We consider the optimal pricing and referral strategy of a monopoly that uses a simple consumer communication network (a chain) to spread product information. The first-best policy with fully discriminatory position-based referral fees involves standard monopoly pricing and referral fees that provide consumers with strictly positive referral incentives. Effective price discrimination among consumers based on their positions in the chain occurs in both the first-best solution and the second-be...

  8. Tradable schemes

    NARCIS (Netherlands)

    J.K. Hoogland (Jiri); C.D.D. Neumann

    2000-01-01

    textabstractIn this article we present a new approach to the numerical valuation of derivative securities. The method is based on our previous work where we formulated the theory of pricing in terms of tradables. The basic idea is to fit a finite difference scheme to exact solutions of the pricing

  9. Development of a quarterly referral productivity report.

    Science.gov (United States)

    Wu, Cai; Sandoval, Alex; Hicks, Katrina N; Edwards, Tim J; Green, Lyle D

    2007-10-11

    The Office of Physician Relations at The University of Texas M. D. Anderson Cancer Center (MDACC) has developed a dynamic referral productivity reporting tool for its Multidisciplinary Care Centers (MCC). The tool leverages information within the institution's Enterprise Information Warehouse (EIW) using business intelligent software Hyperion Intelligent Explorer Suite 8.3. the referral productivity reports are intended to provide each MCC with detailed referral and registration data outlining how, and from where, patients arrive here for treatment. The reports supports operational and strategic initiatives aimed at improving referral processes and market related program development.

  10. Radiologists' responses to inadequate referrals

    Energy Technology Data Exchange (ETDEWEB)

    Lysdahl, Kristin Bakke [Oslo University College, Faculty of Health Sciences, Oslo (Norway); University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Hofmann, Bjoern Morten [University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Gjoevik University College, Faculty of Health Care and Nursing, Gjoevik (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway)

    2010-05-15

    To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)

  11. A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

    Science.gov (United States)

    Kotecha, A; Brookes, J; Foster, P J

    2017-06-01

    PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.

  12. Characteristics Of Referrals To An Oral And Maxillofacial Surgery ...

    African Journals Online (AJOL)

    ... Practitioners (GMPS) sent the most referrals (507 or 74.0%), specialist medical practitioners (SMPs) sent 86(12.6%) and general dental practitioners (GDPs) sent 59(8.6%) referrals. The medical specialty with most referrals was paediatrics (29.0 % of the SMPs referrals). 44.5% of the referrals had no provisional diagnosis, ...

  13. Referral for assisted reproductive technology: Indications and ...

    African Journals Online (AJOL)

    Ramakantb

    Over an 8-year period, 23 consenting infertile patients/ couples were given referral for assisted conception. The median age was 36 years and mean duration of infertility was 43 months. Indications for referral as shown in Table 1 were male factor in five (21.7%) patients, female factor in seven (30.4%) patients, and both ...

  14. Reading Intervention and Special Education Referrals

    Science.gov (United States)

    Polcyn, Dawn M.; Levine-Donnerstein, Deborah; Perfect, Michelle M.; Obrzut, John E.

    2014-01-01

    This study examined whether consistently implementing reading fluency interventions prior to referring students for a special education evaluation led to fewer overall special education referrals, as well as more accurate special education referrals. Results indicated that the implementation of a peer-mediated reading fluency intervention…

  15. Additive operator-difference schemes splitting schemes

    CERN Document Server

    Vabishchevich, Petr N

    2013-01-01

    Applied mathematical modeling isconcerned with solving unsteady problems. This bookshows how toconstruct additive difference schemes to solve approximately unsteady multi-dimensional problems for PDEs. Two classes of schemes are highlighted: methods of splitting with respect to spatial variables (alternating direction methods) and schemes of splitting into physical processes. Also regionally additive schemes (domain decomposition methods)and unconditionally stable additive schemes of multi-component splitting are considered for evolutionary equations of first and second order as well as for sy

  16. Quantum signature scheme based on a quantum search algorithm

    International Nuclear Information System (INIS)

    Yoon, Chun Seok; Kang, Min Sung; Lim, Jong In; Yang, Hyung Jin

    2015-01-01

    We present a quantum signature scheme based on a two-qubit quantum search algorithm. For secure transmission of signatures, we use a quantum search algorithm that has not been used in previous quantum signature schemes. A two-step protocol secures the quantum channel, and a trusted center guarantees non-repudiation that is similar to other quantum signature schemes. We discuss the security of our protocol. (paper)

  17. The impact of glaucoma referral refinement criteria on referral to, and first-visit discharge rates from, the hospital eye service: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project.

    Science.gov (United States)

    Ratnarajan, Gokulan; Newsom, Wendy; French, Karen; Kean, Jane; Chang, Lydia; Parker, Mike; Garway-Heath, David F; Bourne, Rupert R A

    2013-03-01

    To assess the impact of referral refinement criteria on the number of patients referred to, and first-visit discharges from, the Hospital Eye Service (HES) in relation to the National Institute for Health & Clinical Excellence (NICE) Glaucoma Guidelines, Joint College Group Guidance (JCG) and the NICE commissioning guidance. All low-risk (one risk factor: suspicious optic disc, abnormal visual field (VF), raised intra-ocular pressure (IOP) (22-28 mmHg) or IOP asymmetry (>5 mmHg) and high-risk (more than one risk factor, shallow anterior chamber or IOP >28 mmHg) referrals to the HES from 2006 to 2011 were analysed. Low-risk referrals were seen by Optometrists with a specialist interest in glaucoma and high-risk referrals were referred directly to the HES. Two thousand nine hundred and twelve patient records were analysed. The highest Consultant first-visit discharge rates were for referrals based on IOP alone (45% for IOP 22-28 mmHg) and IOP asymmetry (53%), VF defect alone (46%) and for abnormal IOP and VF (54%). The lowest first-visit discharge rates were for referrals for suspicious optic disc (19%) and IOP >28 mmHg (22%). 73% of patients aged 65-80 and 60% of patients aged >80 who were referred by the OSI due to an IOP between 22-28 mmHg would have satisfied the JCG criteria for non-referral. For patients referred with an IOP >28 mmHg and an otherwise normal examination, adherence to the NICE commissioning guidance would have resulted in 6% fewer referrals. In 2010 this scheme reduced the number of patients attending the HES by 15%, which resulted in a saving of £16 258 (13%). The results support that referrals for a raised IOP alone or in combination with an abnormal VF be classified as low-risk and undergo referral refinement. Adherence to the JCG and the NICE commissioning guidance as onward referral criteria for specialist optometrists in this referral refinement scheme would result in fewer referrals. Ophthalmic & Physiological Optics © 2013 The College

  18. Referral bias in ALS epidemiological studies.

    Science.gov (United States)

    Logroscino, Giancarlo; Marin, Benoit; Piccininni, Marco; Arcuti, Simona; Chiò, Adriano; Hardiman, Orla; Rooney, James; Zoccolella, Stefano; Couratier, Philippe; Preux, Pierre-Marie; Beghi, Ettore

    2018-01-01

    Despite concerns about the representativeness of patients from ALS tertiary centers as compared to the ALS general population, the extent of referral bias in clinical studies remains largely unknown. Using data from EURALS consortium we aimed to assess nature, extent and impact of referral bias. Four European ALS population-based registries located in Ireland, Piedmont, Puglia, Italy, and Limousin, France, covering 50 million person-years, participated. Demographic and clinic characteristics of ALS patients diagnosed in tertiary referral centers were contrasted with the whole ALS populations enrolled in registries in the same geographical areas. Patients referred to ALS centers were younger (with difference ranging from 1.1 years to 2.4 years), less likely to present a bulbar onset, with a higher proportion of familial antecedents and a longer survival (ranging from 11% to 15%) when compared to the entire ALS population in the same geographic area. A trend for referral bias is present in cohorts drawn from ALS referral centers. The magnitude of the possible referral bias in a particular tertiary center can be estimated through a comparison with ALS patients drawn from registry in the same geographic area. Studies based on clinical cohorts should be cautiously interpreted. The presence of a registry in the same area may improve the complete ascertainment in the referral center.

  19. Electronic referrals: what matters to the users.

    Science.gov (United States)

    Warren, Jim; Gu, Yulong; Day, Karen; White, Sue; Pollock, Malcolm

    2012-01-01

    Between September 2010 and May 2011 we evaluated three implementations of electronic referral (eReferral) systems at Hutt Valley, Northland and Canterbury District Health Boards in New Zealand. Qualitative and quantitative data were gathered through project documentation, database records and stakeholder interviews. This paper reports on the user perspectives based on interviews with 78 clinical, management and operational stakeholders in the three regions. Themes that emerge across the regions are compared and synthesised. Interviews focused on pre-planned domains including quality of referral, ease of use and patient safety, but agendas were adapted progressively to elaborate and triangulate on themes emerging from earlier interviews and to clarify indications from analysis of database records. The eReferral users, including general practitioners, specialists and administrative staff, report benefits in the areas of: (1) availability and transparency of referral-related data; (2) work transformation; (3) improved data quality and (4) the convenience of auto-population from the practice management system into the referral forms. eReferral provides enhanced visibility of referral data and status within the limits of the implementation (which only goes to the hospital door in some cases). Users in all projects indicated the desire to further exploit IT to enhance two-way communication between community and hospital. Reduced administrative handling is a clear work transformation benefit with mixed feedback regarding clinical workload impact. Innovations such as GP eReferral triaging teams illustrate the further potential for workflow transformation. Consistent structure in eReferrals, as well as simple legibility, enhances data quality. Efficiency and completeness is provided by auto-population of forms from system data, but opens issues around data accuracy. All three projects highlight the importance of user involvement in design, implementation and refinement. In

  20. Why doctors do not answer referral letters

    African Journals Online (AJOL)

    Referral letters act as permission slips to allow patients easy access to ... Methods: A qualitative study method was used, as the purpose of this study was to .... The total list of topics ..... Research design: qualitative and quantitative approaches.

  1. Appropriateness of Referrals for Upper Gastrointestinal Endoscopy ...

    African Journals Online (AJOL)

    Appropriateness of Referrals for Upper Gastrointestinal Endoscopy. ... Accra between January and December, 2008 were interviewed and evaluated for this study. ... Presentations with bleeding and suspicion of malignancy showed statistical ...

  2. [Evaluation of a thyroid disease referral protocal in a health area of Madrid].

    Science.gov (United States)

    López, A; Rollán, M T; Bedoya, M J; García, C

    The collaboration between healthcare levels is essential for our patients. The aim of this study is to determine the suitability of a referral protocol between the different healthcare levels. A collaboration study was carried out between general practitioners, endocrinologists, and the Department of Biochemistry. After creating the protocol together and implementing it, the suitability was evaluated. A total of 284 referral sheets were evaluated, 65% were adequately sent, and 51% were referred due to laboratory abnormalities, 42% for morphological alterations, and 7% for both reasons. Just under three-quarters (72%) were referred in the normal way (adequacy 90.6%). The clinical information in the referral sheet was considered adequate in 59%, and the request for ultrasound was adequate in 78%. A significant number (16%) of patients should have been returned to Primary Care. It is considered that creating protocols is part of our task. The compliance with the protocol can be improved in Primary Care and specialised care. Publicado por Elsevier España, S.L.U.

  3. Attitudes regarding specialist referrals in periodontics.

    Science.gov (United States)

    Sharpe, G; Durham, J A; Preshaw, P M

    2007-02-24

    To examine the attitudes of dental practitioners towards specialist periodontal referral in the North East of England. Semi-structured interviews were conducted with a purposive sample of 10 practitioners. Interviews continued until data saturation occurred. The data were organised using a framework and analysed by two researchers working independently. Perceptions of periodontal disease and treatment appear to be heavily influenced by the NHS remuneration system. Treatment in general practice was limited to simple scaling and there was an apparent reluctance to treat advanced periodontitis. Such cases were commonly referred to specialists, confirming the demand for a referral service in periodontics. The perceived potential for medico-legal consequences was a strong driver of referrals. Distance to the referral centre and the perceived costs of treatment were significant barriers to referral. Dentists valued the specialist's personal reputation and clinical skills more highly than academic status. Deficiencies in communication between primary and secondary care were highlighted. Increased resources are required to manage periodontal diseases within the NHS. There is a need for a periodontal referral service in the North East of England to improve accessibility to specialist care. This would appear to be most appropriately delivered by increased numbers of specialist practitioners.

  4. Matroids and quantum-secret-sharing schemes

    International Nuclear Information System (INIS)

    Sarvepalli, Pradeep; Raussendorf, Robert

    2010-01-01

    A secret-sharing scheme is a cryptographic protocol to distribute a secret state in an encoded form among a group of players such that only authorized subsets of the players can reconstruct the secret. Classically, efficient secret-sharing schemes have been shown to be induced by matroids. Furthermore, access structures of such schemes can be characterized by an excluded minor relation. No such relations are known for quantum secret-sharing schemes. In this paper we take the first steps toward a matroidal characterization of quantum-secret-sharing schemes. In addition to providing a new perspective on quantum-secret-sharing schemes, this characterization has important benefits. While previous work has shown how to construct quantum-secret-sharing schemes for general access structures, these schemes are not claimed to be efficient. In this context the present results prove to be useful; they enable us to construct efficient quantum-secret-sharing schemes for many general access structures. More precisely, we show that an identically self-dual matroid that is representable over a finite field induces a pure-state quantum-secret-sharing scheme with information rate 1.

  5. Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

    Directory of Open Access Journals (Sweden)

    Kyle Richard G

    2013-01-01

    Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

  6. Exact analysis of Packet Reversed Packet Combining Scheme and Modified Packet Combining Scheme; and a combined scheme

    International Nuclear Information System (INIS)

    Bhunia, C.T.

    2007-07-01

    Packet combining scheme is a well defined simple error correction scheme for the detection and correction of errors at the receiver. Although it permits a higher throughput when compared to other basic ARQ protocols, packet combining (PC) scheme fails to correct errors when errors occur in the same bit locations of copies. In a previous work, a scheme known as Packet Reversed Packet Combining (PRPC) Scheme that will correct errors which occur at the same bit location of erroneous copies, was studied however PRPC does not handle a situation where a packet has more than 1 error bit. The Modified Packet Combining (MPC) Scheme that can correct double or higher bit errors was studied elsewhere. Both PRPC and MPC schemes are believed to offer higher throughput in previous studies, however neither adequate investigation nor exact analysis was done to substantiate this claim of higher throughput. In this work, an exact analysis of both PRPC and MPC is carried out and the results reported. A combined protocol (PRPC and MPC) is proposed and the analysis shows that it is capable of offering even higher throughput and better error correction capability at high bit error rate (BER) and larger packet size. (author)

  7. The referral backfire effect: The identity threatening nature of referral failure

    NARCIS (Netherlands)

    Claus, B.; Geyskens, K.; Millet, K.; Dewitte, S.

    2012-01-01

    The present paper shows that when a person has the experience of giving advice but that advice is not acted upon, there is a reduced openness to external information. We call this the "referral backfire effect". We argue that this referral backfire effect is due to the identity threatening nature of

  8. Neurology referrals to a liaison psychiatry service.

    LENUS (Irish Health Repository)

    Fitzgerald, P

    2012-02-03

    The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.

  9. Group covariant protocols for quantum string commitment

    International Nuclear Information System (INIS)

    Tsurumaru, Toyohiro

    2006-01-01

    We study the security of quantum string commitment (QSC) protocols with group covariant encoding scheme. First we consider a class of QSC protocol, which is general enough to incorporate all the QSC protocols given in the preceding literatures. Then among those protocols, we consider group covariant protocols and show that the exact upperbound on the binding condition can be calculated. Next using this result, we prove that for every irreducible representation of a finite group, there always exists a corresponding nontrivial QSC protocol which reaches a level of security impossible to achieve classically

  10. The added value of a mobile application of Community Case Management on referral, re-consultation and hospitalization rates of children aged under 5 years in two districts in Northern Malawi: study protocol for a pragmatic, stepped-wedge cluster-randomized controlled trial.

    Science.gov (United States)

    Hardy, Victoria; O'Connor, Yvonne; Heavin, Ciara; Mastellos, Nikolaos; Tran, Tammy; O'Donoghue, John; Fitzpatrick, Annette L; Ide, Nicole; Wu, Tsung-Shu Joseph; Chirambo, Griphin Baxter; Muula, Adamson S; Nyirenda, Moffat; Carlsson, Sven; Andersson, Bo; Thompson, Matthew

    2017-10-11

    There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi. This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017. This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle

  11. Bioremediation protocols

    National Research Council Canada - National Science Library

    Sheehan, David

    1997-01-01

    ..., .. . . . . .. ,. . . .. . . . . . . . .. . . . . .. . . .. . .. 3 2 Granular Nina Sludge Christiansen, Consortia lndra for Bioremediation, M. Mathrani, and Birgitte K. Ahring . 23 PART II PROTOCOLS...

  12. Primary care physician referral patterns in Ontario, Canada: a descriptive analysis of self-reported referral data.

    Science.gov (United States)

    Liddy, Clare; Arbab-Tafti, Sadaf; Moroz, Isabella; Keely, Erin

    2017-08-22

    In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of research. The purpose of this study is to describe referral patterns from primary care to specialist and allied health services from the primary care perspective. We conducted a prospective study of patient referral data submitted by primary care providers (PCP) from 20 clinics across Ontario between June 2014 and January 2016. Monthly referral volumes expressed as a total number of referrals to all medical and allied health professionals per month. For each referral, we also collected data on the specialty type, reason for referral, and whether the referral was for a procedure. PCPs submitted a median of 26 referrals per month (interquartile range 11.5 to 31.8). Of 9509 referrals eligible for analysis, 97.8% were directed to medical professionals and 2.2% to allied health professionals. 55% of medical referrals were directed to non-surgical specialties and 44.8% to surgical specialties. Medical referrals were for procedures in 30.8% of cases and non-procedural in 40.9%. Gastroenterology received the largest share (11.2%) of medical referrals, of which 62.3% were for colonoscopies. Psychology received the largest share (28.3%) of referrals to allied health professionals. We described patterns of patient referral from primary care to specialist and allied health services for 30 PCPs in 20 clinics across Ontario. Gastroenterology received the largest share of referrals, nearly two-thirds of which were for colonoscopies. Future studies should explore the use of virtual care to help manage non-procedural referrals and examine the impact that procedural referrals have on wait times for gastroenterology.

  13. Quality of oral surgery referrals and how to improve them

    Directory of Open Access Journals (Sweden)

    Bjorkeborn M

    2017-11-01

    Full Text Available Mikael Björkeborn,1 Henrik Nilsson,2 Jonas Anderud1 1Department of Oral and Maxillofacial Surgery, Halmstad Hospital, Halmstad, Sweden; 2Department of Oral and Maxillofacial Surgery, Växjö Hospital, Växjö, Sweden Aim: To assess the quality of routine oral surgery referrals received at Halmstad Hospital and Växjö Hospital and to emphasize areas for improvement. Method: A retrospective study was performed on all routine oral surgery referrals received between 2014 and 2015 at both Halmstad Hospital and Växjö Hospital. A total of 1,891 referral letters were assessed for their quality against a predetermined checklist of basic requirements of a satisfactory referral. The referrals were also categorized according to if it was sent by a male, female, private dental service, or the Swedish Public Dental Health service. Results: A diagnosis was missing in 30% of all referrals. Radiographs and information about previous radiographic examinations were not included in 10% of the referrals. Of those referrals that included radiographs, only around half were deemed adequate for diagnostic purposes. The presenting complaint was missing in 40% of all referrals. Current medical history was absent in 40% and current medication was omitted in 60% of the referrals. Information about tobacco use was only included in 10% of all referrals. Overall, female referrers performed better than male colleagues. Private referrals more regularly included information about diagnosis, previous treatment, and current medication. On the other hand, referrals from the public dental health service more frequently included radiographs, tobacco use, and current medical history. Conclusion: There is plenty of room for improving the standards of oral surgery referrals. We suggest that future electronic referral systems should only allow for submission once all of the essential information has been considered. Keywords: clinical audit, referral quality, oral surgery referrals

  14. Improvement of One Quantum Encryption Scheme

    Science.gov (United States)

    Cao, Zhengjun; Liu, Lihua

    2012-01-01

    Zhou et al. proposed a quantum encryption scheme based on quantum computation in 2006 [N. Zhou et al., Physica A362 (2006) 305]. Each qubit of the ciphertext is constrained to two pairs of conjugate states. So, its implementation is feasible with the existing technology. But it is inefficient since it entails six key bits to encrypt one message bit, and the resulting ciphertext for one message bit consists of three qubits. In addition, its security cannot be directly reduced to the well-known BB84 protocol. In this paper, we improve it using the technique developed in BB84 protocol. The new scheme entails only two key bits to encrypt one message bit. The resulting ciphertext is just composed of two qubits. It saves about a half cost without the loss of security. Moreover, the new scheme is probabilistic instead of deterministic.

  15. Four-state discrimination scheme beyond the heterodyne limit

    DEFF Research Database (Denmark)

    Muller, C. R.; Castaneda, Mario A. Usuga; Wittmann, C.

    2012-01-01

    We propose and experimentally demonstrate a hybrid discrimination scheme for the quadrature phase shift keying protocol, which outperforms heterodyne detection for any signal power. The discrimination is composed of a quadrature measurement, feed forward and photon detection.......We propose and experimentally demonstrate a hybrid discrimination scheme for the quadrature phase shift keying protocol, which outperforms heterodyne detection for any signal power. The discrimination is composed of a quadrature measurement, feed forward and photon detection....

  16. Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system.

    Science.gov (United States)

    Byrnes, Joshua M; Comans, Tracy A

    2015-02-01

    Abstract To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government ofup to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving.

  17. Chiropractors' Characteristics Associated with Physician Referrals

    DEFF Research Database (Denmark)

    Blanchette, M. A.; Rivard, M.; Dionne, C. E.

    2015-01-01

    , and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking his/her own radiographs, being the client...

  18. Behavior Analytic Consultation for Academic Referral Concerns

    Science.gov (United States)

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

    2016-01-01

    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  19. 32 CFR 701.9 - Referrals.

    Science.gov (United States)

    2010-07-01

    ... referral, a point of contact by name, a telephone number (commercial and DSN), and an e-mail address (if... record any FOIA request for investigative, intelligence, or any other type of records that are on loan to.... However, if for investigative or intelligence purposes, the outside agency desires anonymity, a DON...

  20. Referral pattern of hemodialysis patients to nephrologists

    International Nuclear Information System (INIS)

    Anees, M.; Mumtaz, A.; Nazir, M.; Ibrahim, M.; Kausar, T.

    2007-01-01

    To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients. All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and

  1. Assistance protocol for venous ulcers patients: validation of contents

    Directory of Open Access Journals (Sweden)

    Daniele Vieira Dantas

    2013-07-01

    Full Text Available Venous ulcers require complex treatment and are responsible for significant morbidity and mortality rates. This study aims at identifying aspects validated by the jury for the preparation of an assistance protocol for venous ulcer sufferers. It is a descriptive and quantitative research, with 39 professionals (30 nurses, 7 doctors and two physiotherapists, held at the Onofre Lopes University Hospital, between April and July/2010. Data collection began through a questionnaire checklist. Analysis was performed through Statistical Package for Social Science 15.0, assessing compliance with guidelines. Results were the compositional aspects of the protocol: assessment of patient and lesion history/documentation, wound care/perilesional skin, dressing suggestion, use of antibiotics and pain treatment, surgical treatment/medication, improving venous return and relapse prevention, patient referral, professional training and referral/counter-referral. It was concluded that to compose the protocol, aspects related to diagnosis, treatment and injury prevention must be considered.

  2. The Political Economy of International Emissions Trading Scheme Choice

    DEFF Research Database (Denmark)

    Boom, Jan-Tjeerd; Svendsen, Jan Tinggard

    2000-01-01

    The Kyoto Protocol allows emission trade between the Annex B countries. We consider three schemes of emissions trading: government trading, permit trading and credit trading. The schemes are compared in a public choice setting focusing on group size and rent-seeking from interest groups. We find ...

  3. determinants of referral practices of clients by traditional birth

    African Journals Online (AJOL)

    GBENGY

    referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010 ... proportion of pregnant women are attended at childbirth ... tility; management of threatened abortion; ... refuse referral and whatever is the outcome.

  4. evaluative study of medical doctors' mode of referral for physiother

    African Journals Online (AJOL)

    Olwafemi Odebiyi

    physicians' mode of referral of patients for physiotherapy in Nigeria. A total of 1192 physicians .... The Influence of Medical School of Graduation. Table 1 shows the .... This must have also been responsible for the high rate of referral observed.

  5. Finite Boltzmann schemes

    NARCIS (Netherlands)

    Sman, van der R.G.M.

    2006-01-01

    In the special case of relaxation parameter = 1 lattice Boltzmann schemes for (convection) diffusion and fluid flow are equivalent to finite difference/volume (FD) schemes, and are thus coined finite Boltzmann (FB) schemes. We show that the equivalence is inherent to the homology of the

  6. A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Aloudat Sarah

    2008-02-01

    Full Text Available Abstract Background To identify patient and health system characteristics associated with late referral of patients with chronic kidney disease to nephrologists. Methods MEDLINE, CENTRAL, and CINAHL were searched using the appropriate MESH terms in March 2007. Two reviewers individually and in duplicate reviewed the abstracts of 256 articles and selected 18 observational studies for inclusion. The reasons for late referral were categorized into patient or health system characteristics. Data extraction and content appraisal were done using a prespecified protocol. Results Older age, the existence of multiple comorbidities, race other than Caucasian, lack of insurance, lower socioeconomic status and educational levels were patient characteristics associated with late referral of patients with chronic kidney disease. Lack of referring physician knowledge about the appropriate timing of referral, absence of communication between referring physicians and nephrologists, and dialysis care delivered at tertiary medical centers were health system characteristics associated with late referral of patients with chronic kidney disease. Most studies identified multiple factors associated with late referral, although the relative importance and the combined effect of these factors were not systematically evaluated. Conclusion A combination of patient and health system characteristics is associated with late referral of patients with chronic kidney disease. Overall, being older, belonging to a minority group, being less educated, being uninsured, suffering from multiple comorbidities, and the lack of communication between primary care physicians and nephrologists contribute to late referral of patients with chronic kidney disease. Both primary care physicians and nephrologists need to engage in multisectoral collaborative efforts that ensure patient education and enhance physician awareness to improve the care of patients with chronic kidney disease.

  7. 24 CFR 17.9 - Referral to Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by the...

  8. 10 CFR 1014.7 - Referral to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by the...

  9. 8 CFR 235.6 - Referral to immigration judge.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form I...

  10. The role of referrals in financing technology-based ventures

    NARCIS (Netherlands)

    Heuven, J.M.J.

    2009-01-01

    Many referral mechanisms can be found in the context of entrepreneurship. Networks and third party referrals play a prominent role in spotting entrepreneurial opportunities and in acquiring the resources necessary for growth. In this dissertation, the focus is on the role of referrals in acquiring

  11. Referral for Outpatients Urological Services: Poor Conformity and ...

    African Journals Online (AJOL)

    Background: This study was aimed at establishing the degree of conformity with the referral system, level of pre-referral investigative evaluations and degree of diagnosis concordance between the referring centres and the referral hospital in Western region of Kenya. Methods: This was a hospital based descriptive, ...

  12. Qualitative study on maternal referrals in rural Tanzania: Decision ...

    African Journals Online (AJOL)

    Administrator

    The process in deciding to seek referral care is envisaged within community .... The three phases of delays model in accessing .... as dangerous at home and immediate care is required, the ... referral or is unable to pay the costs of referral, the ...

  13. Referral Criteria from Community Clinics to Pediatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Jacob Urkin

    2008-01-01

    Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

  14. Obstetrical referrals by traditional birth attendants.

    Science.gov (United States)

    Mustafa, Rozina; Hashmi, Haleema; Mustafa, Rubina

    2012-01-01

    In Pakistan 90% of births are conducted by TBA's. In most cases, TBA's are unable to diagnose the complications and are often unable to take decisions on timely referral. The objective of this study was to determine the prevalence, nature and outcome of life threatening obstetrical conditions in referrals by Traditional Birth Attendants (TBAs). This Observational, Descriptive study was conducted from January to December 2007, in the obstetrical unit of Fatima Hospital, Baqai Medical University, a tertiary care community based hospital. The study included patients referred by TBA's who developed life threatening obstetric conditions (LTOCs). Total 64 patients were referred by TBA's. The prevalence was 7.8%. Out of them, 53 (82.8%) patients admitted with life threatening obstetric conditions. The near-miss morbidities and mortalities were 45 (84.9%) and 8 (15%) respectively. Maternal mortality to Near-miss morbidity ratio was 1:6. Obstructed labour caused near-miss morbidity in 32 (60.3%) patients with no mortality. Postpartum haemorrhage as life threatening condition developed in 16 (30.1%) patients with 10 (18.8%) near-miss morbidities and 6 (11.3%) mortalities. Puerperal sepsis accounted for 1 (1.88%) near-miss morbidity and 2 (3.76%) mortalities. The mortality index for puerperal sepsis is (66.6%) almost double of postpartum haemorrhage (37.5%). Mortality to near miss morbidity ratio is high. Misidentification and late referrals of complicated cases by TBA's were responsible for near-miss morbidities and mortalities.

  15. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees

    Science.gov (United States)

    Shannon, Patricia J.; Vinson, Gregory A.; Cook, Tonya; Lennon, Evelyn

    2018-01-01

    In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal Components Analysis yielded categories of successful referrals that included: active care coordination, proactive resolution of barriers, establishment of trust, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, language barriers, system barriers, providers being unwilling to see refugees. Recommendations for training and policy are discussed. PMID:25735618

  16. Evaluation and Referral of Diabetic Eye Disease in the Endocrinology and Primary Care Office Settings.

    Science.gov (United States)

    Silva, Fabiana Q; Adhi, Mehreen; Wai, Karen M; Olansky, Leann; Lansang, M Cecilia; Singh, Rishi P

    2016-10-01

    The purpose of this study was to identify whether endocrinologists and primary care physicians (PCP) adequately screen for ophthalmic symptoms/signs within office visits and provide timely ophthalmology referrals in patients with diabetes. Patients between the ages of 18 years and 80 years with diabetes who underwent an office visit with an endocrinologist or a PCP between January 1, 2014, and December 31, 2014, were identified. Demographics, ophthalmic assessments, and referral information were collected. A total of 1,250 patient records were reviewed. Providers asked about ophthalmic symptoms/signs in 95.5% and 71% of endocrinology and primary care office encounters, respectively (P endocrinology and PCP visits, respectively (P < .0001). Ophthalmic complications from diabetes are not adequately screened, especially within the primary care setting, and further quality improvement measures may improve adherence to recommended screening protocols. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:930-934.]. Copyright 2016, SLACK Incorporated.

  17. Modeling and Simulation of Handover Scheme in Integrated EPON-WiMAX Networks

    DEFF Research Database (Denmark)

    Yan, Ying; Dittmann, Lars

    2011-01-01

    In this paper, we tackle the seamless handover problem in integrated optical wireless networks. Our model applies for the convergence network of EPON and WiMAX and a mobilityaware signaling protocol is proposed. The proposed handover scheme, Integrated Mobility Management Scheme (IMMS), is assisted...... by enhancing the traditional MPCP signaling protocol, which cooperatively collects mobility information from the front-end wireless network and makes centralized bandwidth allocation decisions in the backhaul optical network. The integrated network architecture and the joint handover scheme are simulated using...... OPNET modeler. Results show validation of the protocol, i.e., integrated handover scheme gains better network performances....

  18. Scheme Program Documentation Tools

    DEFF Research Database (Denmark)

    Nørmark, Kurt

    2004-01-01

    are separate and intended for different documentation purposes they are related to each other in several ways. Both tools are based on XML languages for tool setup and for documentation authoring. In addition, both tools rely on the LAML framework which---in a systematic way---makes an XML language available...... as named functions in Scheme. Finally, the Scheme Elucidator is able to integrate SchemeDoc resources as part of an internal documentation resource....

  19. Referrals and relationships: in-practice referrals meetings in a general practice.

    Science.gov (United States)

    Rowlands, G; Willis, S; Singleton, A

    2001-08-01

    GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted

  20. MULTIMEDIA DATA TRANSMISSION THROUGH TCP/IP USING HASH BASED FEC WITH AUTO-XOR SCHEME

    OpenAIRE

    R. Shalin; D. Kesavaraja

    2012-01-01

    The most preferred mode for communication of multimedia data is through the TCP/IP protocol. But on the other hand the TCP/IP protocol produces huge packet loss unavoidable due to network traffic and congestion. In order to provide a efficient communication it is necessary to recover the loss of packets. The proposed scheme implements Hash based FEC with auto XOR scheme for this purpose. The scheme is implemented through Forward error correction, MD5 and XOR for providing efficient transmissi...

  1. Referral recommendations for osteoarthritis of the knee incorporating patients' preferences

    Science.gov (United States)

    Musila, Nyokabi; Underwood, Martin; McCaskie, Andrew W; Black, Nick; Clarke, Aileen; van der Meulen, Jan H

    2011-01-01

    Background. GPs have to respond to conflicting policy developments. As gatekeeper they are supposed to manage the growing demand for specialist services and as patient advocate they should be responsive to patients' preferences. We used an innovative approach to develop a referral guideline for patients with chronic knee pain that explicitly incorporates patients' preferences. Methods. A guideline development group of 12 members including patients, GPs, orthopaedic surgeons and other health care professionals used formal consensus development informed by systematic evidence reviews. They rated the appropriateness of referral for 108 case scenarios describing patients according to symptom severity, age, body mass, co-morbidity and referral preference. Appropriateness was expressed on scale from 1 (‘strongly disagree’) to 9 (‘strongly agree’). Results. Ratings of referral appropriateness were strongly influenced by symptom severity and patients' referral preferences. The influence of other patient characteristics was small. There was consensus that patients with severe knee symptoms who want to be referred should be referred and that patient with moderate or mild symptoms and strong preference against referral should not be referred. Referral preference had a greater impact on the ratings of referral appropriateness when symptoms were moderate or severe than when symptoms were mild. Conclusions. Referral decisions for patients with osteoarthritis of the knee should only be guided by symptom severity and patients' referral preferences. The guideline development group seemed to have given priority to avoiding inefficient resource use in patients with mild symptoms and to respecting patient autonomy in patients with severe symptoms. PMID:20817791

  2. Novel Quantum Secret Sharing and Controlled Communication Schemes Based on Einstein–Podolsky–Rosen Correlations

    International Nuclear Information System (INIS)

    Yuan, Li; Gui-Hua, Zeng

    2009-01-01

    Employing quantum registers, we first proposed a novel (2, 3) quantum threshold scheme based on Einstein–Podolsky–Rosen (EPR) correlations in this letter. Motivated by the present threshold scheme, we also propose a controlled communication scheme to transmit the secret message with a controller. In the communication protocol, the encoded quantum message carried by particles sequence, is transmitted by legitimate communicators

  3. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

    2016-01-01

    artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs......Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs...

  4. Analyzing the effect of routing protocols on media access control protocols in radio networks

    Energy Technology Data Exchange (ETDEWEB)

    Barrett, C. L. (Christopher L.); Drozda, M. (Martin); Marathe, A. (Achla); Marathe, M. V. (Madhav V.)

    2002-01-01

    We study the effect of routing protocols on the performance of media access control (MAC) protocols in wireless radio networks. Three well known MAC protocols: 802.11, CSMA, and MACA are considered. Similarly three recently proposed routing protocols: AODV, DSR and LAR scheme 1 are considered. The experimental analysis was carried out using GloMoSim: a tool for simulating wireless networks. The main focus of our experiments was to study how the routing protocols affect the performance of the MAC protocols when the underlying network and traffic parameters are varied. The performance of the protocols was measured w.r.t. five important parameters: (i) number of received packets, (ii) average latency of each packet, (iii) throughput (iv) long term fairness and (v) number of control packets at the MAC layer level. Our results show that combinations of routing and MAC protocols yield varying performance under varying network topology and traffic situations. The result has an important implication; no combination of routing protocol and MAC protocol is the best over all situations. Also, the performance analysis of protocols at a given level in the protocol stack needs to be studied not locally in isolation but as a part of the complete protocol stack. A novel aspect of our work is the use of statistical technique, ANOVA (Analysis of Variance) to characterize the effect of routing protocols on MAC protocols. This technique is of independent interest and can be utilized in several other simulation and empirical studies.

  5. Generalized routing protocols for multihop relay networks

    KAUST Repository

    Khan, Fahd Ahmed

    2011-07-01

    Performance of multihop cooperative networks depends on the routing protocols employed. In this paper we propose the last-n-hop selection protocol, the dual path protocol, the forward-backward last-n-hop selection protocol and the forward-backward dual path protocol for the routing of data through multihop relay networks. The average symbol error probability performance of the schemes is analysed by simulations. It is shown that close to optimal performance can be achieved by using the last-n-hop selection protocol and its forward-backward variant. Furthermore we also compute the complexity of the protocols in terms of number of channel state information required and the number of comparisons required for routing the signal through the network. © 2011 IEEE.

  6. Asymptotic adaptive bipartite entanglement-distillation protocol

    International Nuclear Information System (INIS)

    Hostens, Erik; Dehaene, Jeroen; De Moor, Bart

    2006-01-01

    We present an asymptotic bipartite entanglement-distillation protocol that outperforms all existing asymptotic schemes. This protocol is based on the breeding protocol with the incorporation of two-way classical communication. Like breeding, the protocol starts with an infinite number of copies of a Bell-diagonal mixed state. Breeding can be carried out as successive stages of partial information extraction, yielding the same result: one bit of information is gained at the cost (measurement) of one pure Bell state pair (ebit). The basic principle of our protocol is at every stage to replace measurements on ebits by measurements on a finite number of copies, whenever there are two equiprobable outcomes. In that case, the entropy of the global state is reduced by more than one bit. Therefore, every such replacement results in an improvement of the protocol. We explain how our protocol is organized as to have as many replacements as possible. The yield is then calculated for Werner states

  7. Multiresolution signal decomposition schemes

    NARCIS (Netherlands)

    J. Goutsias (John); H.J.A.M. Heijmans (Henk)

    1998-01-01

    textabstract[PNA-R9810] Interest in multiresolution techniques for signal processing and analysis is increasing steadily. An important instance of such a technique is the so-called pyramid decomposition scheme. This report proposes a general axiomatic pyramid decomposition scheme for signal analysis

  8. Adaptive protection scheme

    Directory of Open Access Journals (Sweden)

    R. Sitharthan

    2016-09-01

    Full Text Available This paper aims at modelling an electronically coupled distributed energy resource with an adaptive protection scheme. The electronically coupled distributed energy resource is a microgrid framework formed by coupling the renewable energy source electronically. Further, the proposed adaptive protection scheme provides a suitable protection to the microgrid for various fault conditions irrespective of the operating mode of the microgrid: namely, grid connected mode and islanded mode. The outstanding aspect of the developed adaptive protection scheme is that it monitors the microgrid and instantly updates relay fault current according to the variations that occur in the system. The proposed adaptive protection scheme also employs auto reclosures, through which the proposed adaptive protection scheme recovers faster from the fault and thereby increases the consistency of the microgrid. The effectiveness of the proposed adaptive protection is studied through the time domain simulations carried out in the PSCAD⧹EMTDC software environment.

  9. Profile of respiratory problems in patients presenting to a referral pulmonary clinic

    Directory of Open Access Journals (Sweden)

    Dasgupta Angira

    2008-01-01

    Full Text Available Analysis of OPD data of 2012 patients in a referral pulmonary clinic at Kolkata was done following a protocol-based approach. Obstructive airway diseases (COPD and asthma were the most common (43% problem followed by infective lung diseases (15% including tuberculosis, bronchogenic carcinoma (8%, ILD (4%, haemopty-sis of undiagnosed etiology (4.5%, chronic cough of undiagnosed etiology (6.5% and pleural diseases (4.6%. Other diseases like obstructive sleep apnoea, sarcoid-osis, systemic diseases with lung involvements etc., and non respiratory problems formed the rest (14.4%.

  10. Physicians' opinions about partner notification methods: case reporting, patient referral, and provider referral.

    Science.gov (United States)

    Hogben, M; St Lawrence, J S; Montaño, D E; Kasprzyk, D; Leichliter, J S; Phillips, W R

    2004-02-01

    The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies. We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting. Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably. Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.

  11. Referral system in rural Iran: improvement proposals

    Directory of Open Access Journals (Sweden)

    Mansour Naseriasl

    2018-03-01

    Full Text Available Because of insufficient communication between primary health care providers and specialists, which leads to inefficiencies and ineffectiveness in rural population health outcomes, to implement a well-functioning referral system is one of the most important tasks for some countries. Using purposive and snowballing sampling methods, we included health experts, policy-makers, family physicians, clinical specialists, and experts from health insurance organizations in this study according to pre-determined criteria. We recorded all interviews, transcribed and analyzed their content using qualitative methods. We extracted 1,522 individual codes initially. We also collected supplementary data through document review. From reviews and summarizations, four main themes, ten subthemes, and 24 issues emerged from the data. The solutions developed were: care system reform, education system reform, payment system reform, and improves in culture-building and public education. Given the executive experience, the full familiarity, the occupational and geographical diversity of participants, the solutions proposed in this study could positively affect the implementation and improvement of the referral system in Iran. The suggested solutions are complementary to each other and have less interchangeability.

  12. Psychiatric referrals in two general hospitals.

    Directory of Open Access Journals (Sweden)

    Doongaji D

    1989-07-01

    Full Text Available A prospective study was undertaken to compare the patterns of psychiatric referrals in two general hospitals in Bombay viz. the King Edward Memorial Hospital (64 cases and the Jaslok Hospital and Research Centre (62 cases. It was observed that depressive symptoms were the most common presenting symptoms in these patients attending either of the hospitals. Similarly, the commonest diagnoses were depression and organic mental disorder. Attempted suicide with organophosphorous compounds was the commonest reason for hospitalization at K.E.M. Hospital (p less than 0.001. A significant number of these patients were females (p less than 0.05. The psychiatric referrals at Jaslok had been hospitalized mainly for suspected medical or neurological illness (p less than 0.001. These patients belonged to higher economic strata and hence had a better paying capacity compared to patients at KEM hospital, a significant number of whom were unemployed (p less than 0.001. The duration of pre-referred illness of patients and their stay at Jaslok hospital were longer as compared to those at KEM Hospital (p less than 0.01. The number of non-relevant special investigations carried out on patients in Jaslok was more (p less than 0.01. Further analysis of diagnoses revealed that a significant number of patients at KEM Hospital were admitted as primary psychiatric illness (p less than 0.05.

  13. Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

    Science.gov (United States)

    Ball, Sarah L; Greenhalgh, Joanne; Roland, Martin

    2016-03-24

    The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives brought in to curtail this rise, but there is currently limited evidence for their effectiveness, and little is known about their mechanisms of action. This study aimed to gain a better understanding of how RMCs operate and the factors contributing to the achievement of their goals. Drawing on the principles of realist evaluation, we sought to elicit programme theories (the ideas and assumptions about how a programme works) and to identify the key issues to be considered when establishing or evaluating such schemes. Qualitative study with a purposive sample of health professionals and managers involved in the commissioning, set-up and running of four referral management centres in England and with GPs referring through these centres. Semi-structured interviews were conducted with 18 participants. Interviews were audio-recorded and transcribed. Data were analysed thematically. Interview data highlighted the diverse aims and functions of RMCs, reflecting a range of underlying programme theories. These included the overarching theory that RMCs work by ensuring the best use of limited resources and three sub-theories, relating to how this could be achieved, namely, improving the quality of referrals and patient care, reducing referrals, and increasing efficiency in the referral process. The aims of the schemes, however, varied between sites and between stakeholders, and evolved significantly over time. Three themes were identified relating to the context in which RMCs were implemented and managed: the impact of practical and administrative difficulties; the importance and challenge of stakeholder buy-in; and the dependence of perceived effectiveness on the aims and priorities of the scheme. Many RMCs were described as successful by those involved, despite limited

  14. Cryptographic Protocols:

    DEFF Research Database (Denmark)

    Geisler, Martin Joakim Bittel

    cryptography was thus concerned with message confidentiality and integrity. Modern cryptography cover a much wider range of subjects including the area of secure multiparty computation, which will be the main topic of this dissertation. Our first contribution is a new protocol for secure comparison, presented...... implemented the comparison protocol in Java and benchmarks show that is it highly competitive and practical. The biggest contribution of this dissertation is a general framework for secure multiparty computation. Instead of making new ad hoc implementations for each protocol, we want a single and extensible...... in Chapter 2. Comparisons play a key role in many systems such as online auctions and benchmarks — it is not unreasonable to say that when parties come together for a multiparty computation, it is because they want to make decisions that depend on private information. Decisions depend on comparisons. We have...

  15. Threshold Signature Schemes Application

    Directory of Open Access Journals (Sweden)

    Anastasiya Victorovna Beresneva

    2015-10-01

    Full Text Available This work is devoted to an investigation of threshold signature schemes. The systematization of the threshold signature schemes was done, cryptographic constructions based on interpolation Lagrange polynomial, elliptic curves and bilinear pairings were examined. Different methods of generation and verification of threshold signatures were explored, the availability of practical usage of threshold schemes in mobile agents, Internet banking and e-currency was shown. The topics of further investigation were given and it could reduce a level of counterfeit electronic documents signed by a group of users.

  16. Re-examining the security of blind quantum signature protocols

    International Nuclear Information System (INIS)

    Wang Mingming; Chen Xiubo; Niu Xinxin; Yang Yixian

    2012-01-01

    Recently, blind quantum signature (BQS) protocols have been proposed with the help of a third-party verifier. However, our research shows that some of the BQS protocols are unable to complete the blind signature task fairly if the verifier is dishonest. Indeed, these protocols can be viewed as variants of the classical digital signature scheme of symmetric-key cryptography. If nobody is trusted in such protocols, digital signature cannot be implemented since disagreements cannot be solved fairly.

  17. CSR schemes in agribusiness

    DEFF Research Database (Denmark)

    Pötz, Katharina Anna; Haas, Rainer; Balzarova, Michaela

    2013-01-01

    of schemes that can be categorized on focus areas, scales, mechanisms, origins, types and commitment levels. Research limitations/implications – The findings contribute to conceptual and empirical research on existing models to compare and analyse CSR standards. Sampling technique and depth of analysis limit......Purpose – The rise of CSR followed a demand for CSR standards and guidelines. In a sector already characterized by a large number of standards, the authors seek to ask what CSR schemes apply to agribusiness, and how they can be systematically compared and analysed. Design....../methodology/approach – Following a deductive-inductive approach the authors develop a model to compare and analyse CSR schemes based on existing studies and on coding qualitative data on 216 CSR schemes. Findings – The authors confirm that CSR standards and guidelines have entered agribusiness and identify a complex landscape...

  18. Tabled Execution in Scheme

    Energy Technology Data Exchange (ETDEWEB)

    Willcock, J J; Lumsdaine, A; Quinlan, D J

    2008-08-19

    Tabled execution is a generalization of memorization developed by the logic programming community. It not only saves results from tabled predicates, but also stores the set of currently active calls to them; tabled execution can thus provide meaningful semantics for programs that seemingly contain infinite recursions with the same arguments. In logic programming, tabled execution is used for many purposes, both for improving the efficiency of programs, and making tasks simpler and more direct to express than with normal logic programs. However, tabled execution is only infrequently applied in mainstream functional languages such as Scheme. We demonstrate an elegant implementation of tabled execution in Scheme, using a mix of continuation-passing style and mutable data. We also show the use of tabled execution in Scheme for a problem in formal language and automata theory, demonstrating that tabled execution can be a valuable tool for Scheme users.

  19. User satisfaction with referrals at a collaborative virtual reference service Virtual reference services, Reference services, Referrals, User satisfaction

    Directory of Open Access Journals (Sweden)

    Nahyun Kwon

    2006-01-01

    Full Text Available Introduction. This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference service. Method. The data analysed for this study were 420 chat reference transaction transcripts along with corresponding online survey questionnaires submitted by the service users. Both sets of data were collected from an electronic archive of a southeastern state public library system that has participated in 24/7 Reference of the Metropolitan Cooperative Library System (MCLS. Results. Referrals in the collaborative chat reference service comprised approximately 30% of the total transactions. Circulation-related questions were the most often referred among all question types, possibly because of the inability of 'outside' librarians to access patron accounts. Most importantly, user satisfaction with referrals was found to be significantly lower than that of completed answers. Conclusion. The findings of this study addressed the importance of distinguishing two types of referrals: the expert research referrals conducive to collaborative virtual reference services; and the re-directional local referrals that increase unnecessary question traffic, thereby being detrimental to effective use of collaborative reference. Continuing efforts to conceptualize referrals in multiple dimensions are anticipated to fully grasp complex phenomena underlying referrals.

  20. Immunochemical protocols

    National Research Council Canada - National Science Library

    Pound, John D

    1998-01-01

    ... easy and important refinements often are not published. This much anticipated 2nd edition of Immunochemzcal Protocols therefore aims to provide a user-friendly up-to-date handbook of reliable techniques selected to suit the needs of molecular biologists. It covers the full breadth of the relevant established immunochemical methods, from protein blotting and immunoa...

  1. Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

    Directory of Open Access Journals (Sweden)

    Jolly Kate

    2009-06-01

    Full Text Available Abstract Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT-based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT exercise on prescription intervention. Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7 or to the SDT-based intervention (n = 6. Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. Discussion This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes via structural equation modelling. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833.

  2. Evaluating statistical cloud schemes

    OpenAIRE

    Grützun, Verena; Quaas, Johannes; Morcrette , Cyril J.; Ament, Felix

    2015-01-01

    Statistical cloud schemes with prognostic probability distribution functions have become more important in atmospheric modeling, especially since they are in principle scale adaptive and capture cloud physics in more detail. While in theory the schemes have a great potential, their accuracy is still questionable. High-resolution three-dimensional observational data of water vapor and cloud water, which could be used for testing them, are missing. We explore the potential of ground-based re...

  3. Gamma spectrometry; level schemes

    International Nuclear Information System (INIS)

    Blachot, J.; Bocquet, J.P.; Monnand, E.; Schussler, F.

    1977-01-01

    The research presented dealt with: a new beta emitter, isomer of 131 Sn; the 136 I levels fed through the radioactive decay of 136 Te (20.9s); the A=145 chain (β decay of Ba, La and Ce, and level schemes for 145 La, 145 Ce, 145 Pr); the A=47 chain (La and Ce, β decay, and the level schemes of 147 Ce and 147 Pr) [fr

  4. Scheme of energy utilities

    International Nuclear Information System (INIS)

    2002-04-01

    This scheme defines the objectives relative to the renewable energies and the rational use of the energy in the framework of the national energy policy. It evaluates the needs and the potentialities of the regions and preconizes the actions between the government and the territorial organizations. The document is presented in four parts: the situation, the stakes and forecasts; the possible actions for new measures; the scheme management and the regional contributions analysis. (A.L.B.)

  5. Distributed public key schemes secure against continual leakage

    DEFF Research Database (Denmark)

    Akavia, Adi; Goldwasser, Shafi; Hazay, Carmit

    2012-01-01

    -secure against continual memory leakage. Our DPKE scheme also implies a secure storage system on leaky devices, where a value s can be secretely stored on devices that continually leak information about their internal state to an external attacker. The devices go through a periodic refresh protocol......In this work we study distributed public key schemes secure against continual memory leakage. The secret key will be shared among two computing devices communicating over a public channel, and the decryption operation will be computed by a simple 2-party protocol between the devices. Similarly...... against continual memory leakage, under the Bilinear Decisional Diffie-Hellman and $2$-linear assumptions. Our schemes have the following properties: 1. Our DPKE and DIBE schemes tolerate leakage at all times, including during refresh. During refresh the tolerated leakage is a (1/2-o (1),1)-fraction...

  6. Managing outpatient consultations: from referral to discharge.

    Science.gov (United States)

    Mitchell, Rachael; Jacob, Hannah; Morrissey, Benita; Macaulay, Chloe; Gomez, Kumudini; Fertleman, Caroline

    2017-08-01

    Although a great deal of paediatric consultations are not urgent, doctors in training spend so much time providing service for acute conditions that they spend little time focusing on outpatient work before they become a consultant. Engaging clinicians in the managerial aspects of providing clinical care is a key to improving outcomes, and this article addresses these aspects of the outpatient consultation from referral to discharge. We aim to provide doctors in training with a tool to use during their training and their first few years as a consultant, to think about how outpatient work is organised and how it can be improved to maximise patient experience. The non-urgent consultation varies across the world; this article is aimed to be relevant to an international audience. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Cryptanalysis and improvement of a biometrics-based authentication and key agreement scheme for multi-server environments.

    Science.gov (United States)

    Yang, Li; Zheng, Zhiming

    2018-01-01

    According to advancements in the wireless technologies, study of biometrics-based multi-server authenticated key agreement schemes has acquired a lot of momentum. Recently, Wang et al. presented a three-factor authentication protocol with key agreement and claimed that their scheme was resistant to several prominent attacks. Unfortunately, this paper indicates that their protocol is still vulnerable to the user impersonation attack, privileged insider attack and server spoofing attack. Furthermore, their protocol cannot provide the perfect forward secrecy. As a remedy of these aforementioned problems, we propose a biometrics-based authentication and key agreement scheme for multi-server environments. Compared with various related schemes, our protocol achieves the stronger security and provides more functionality properties. Besides, the proposed protocol shows the satisfactory performances in respect of storage requirement, communication overhead and computational cost. Thus, our protocol is suitable for expert systems and other multi-server architectures. Consequently, the proposed protocol is more appropriate in the distributed networks.

  8. 7 CFR 3.21 - Referrals of Debts to Justice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section 3.21... and Compromise of Claims § 3.21 Referrals of Debts to Justice. An agency shall promptly refer to Justice for litigation debts on which aggressive collection activity has been taken in accordance with...

  9. 5 CFR 177.108 - Referral to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice is...

  10. 44 CFR 11.17 - Referral to Department of Justice.

    Science.gov (United States)

    2010-10-01

    ... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief Counsel...

  11. 40 CFR 1620.8 - Referral to Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice is...

  12. Why Doctors Do Not Answer Referral Letters | Smith | South African ...

    African Journals Online (AJOL)

    Background: Healthcare workers at primary healthcare (PHC) clinics are frustrated by the fact that they do not receive replies to their referral letters to doctors. Referral letters act as permission slips to allow patients easy access to treatment by specialists at secondary and tertiary service levels and communicate reasons for ...

  13. 10 CFR 820.72 - Referral to the Attorney General.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to the Attorney General. 820.72 Section 820.72... Referral to the Attorney General. If there is reason to believe a criminal violation of the Act or the DOE Nuclear Safety Requirements has occurred, DOE may refer the matter to the Attorney General of the United...

  14. 29 CFR 1601.29 - Referral to the Attorney General.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral to the Attorney General. 1601.29 Section 1601.29... of Civil Actions § 1601.29 Referral to the Attorney General. If the Commission is unable to obtain... shall inform the Attorney General of the appropriate facts in the case with recommendations for the...

  15. 24 CFR 107.65 - Referral to the Attorney General.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to the Attorney General... Referral to the Attorney General. If the results of a complaint investigation or a compliance review... appropriate cases shall recommend that the General Counsel refer the case to the Attorney General of the...

  16. 10 CFR 430.54 - Referral to the Attorney General.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Referral to the Attorney General. 430.54 Section 430.54... Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for exemption under this subpart shall be transmitted to the Attorney General by the Secretary and shall contain (a) a...

  17. Referral letters to the psychiatrist in Nigeria: is communication ...

    African Journals Online (AJOL)

    Result: A majority (>80%) of the referral letters had no information on the current medication list, relevant psychosocial history, outline of management to date, results of investigations to date, and known allergies. Conclusion: Deficits in communication or information transfer through referral letters to the psychiatrist are ...

  18. 8 CFR 1235.6 - Referral to immigration judge.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration judge...

  19. Referral letters to the psychiatrist in Nigeria: is communication ...

    African Journals Online (AJOL)

    history, may not be elements that non-psychiatrist phy- sicians routinely collect during their examinations and, therefore, one would not expect such information to be available to be included in referral letters. Conclusion. Deficits in communication or information transfer through referral letters to the psychiatrist are common.

  20. Quality of psychiatric referrals to secondary-level care | Struwig ...

    African Journals Online (AJOL)

    Less than 20% of the referral letters included information on previous psychiatric consultations, current psychotropic medication, the outcome of physical examinations, and results of special investigations. Only 17 (6%) referral letters indicated a preliminary diagnosis according to an officially recognised classification system ...

  1. Open-access ultrasound referrals from general practice.

    LENUS (Irish Health Repository)

    Hughes, P

    2015-03-01

    Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

  2. User Satisfaction with Referrals at a Collaborative Virtual Reference Service

    Science.gov (United States)

    Kwon, Nahyun

    2006-01-01

    Introduction: This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference…

  3. Childhood intussusception at the Moi teaching and referral hospital ...

    African Journals Online (AJOL)

    Objective: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. Design: A retrospective descriptive study covering the period January 2000 to December 2003. Setting: Moi Teaching and Referral Hospital, ...

  4. 45 CFR 1619.3 - Referral to the Corporation.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Referral to the Corporation. 1619.3 Section 1619.3 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION DISCLOSURE OF INFORMATION § 1619.3 Referral to the Corporation. If a person requests information, not required...

  5. An evaluation of a collaborative bibliotherapy scheme delivered via a library service.

    Science.gov (United States)

    Macdonald, J; Vallance, D; McGrath, M

    2013-12-01

    This paper reports on the evaluation of a bibliotherapy scheme delivered via a local library service, in conjunction with General Practice (GP) practices, local social welfare agencies and through self-referral. The Read Yourself Well (RYW) scheme was based on principles established from other similar schemes and as a way of delivering support for adults experiencing mild to moderate mental health problems for whom clinical treatments are not appropriate. The intervention consisted of initial referral and evaluation by the scheme bibliotherapist, a one-hour session at the beginning and end of the intervention where a purpose-designed questionnaire and two mental health assessments were carried out (the General Health Questionnaire and the Clinical Outcomes in Routine Evaluation questionnaire). Contact and support from the bibliotherapist was provided during the intervention period. One hundred and fifty-seven participants were recruited to the evaluation of whom 114 provided full data. Statistical analyses of the mental health scores showed significant improvements post treatment, for, both male and female participants, for all three referral routes, and for participants who were previously library users, and those who joined the library service to participate in the RYW scheme. The results of this large sample evaluation support the proposal that library-based bibliotherapy can be effective in the treatment of mental health problems. © 2012 John Wiley & Sons Ltd.

  6. Consultation and referral between physicians in new medical practice environments.

    Science.gov (United States)

    Schaffer, W A; Holloman, F C

    1985-10-01

    The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.

  7. Field Triage Decision Scheme: The National Trauma Triage Protocol

    Centers for Disease Control (CDC) Podcasts

    2009-01-22

    In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.  Created: 1/22/2009 by National Center for Injury Prevention and Control (NCIPC), Division of Injury Response (DIR).   Date Released: 1/22/2009.

  8. Field Triage Decision Scheme: The National Trauma Triage Protocol

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.

  9. Eavesdropping on the "ping-pong" quantum communication protocol

    OpenAIRE

    Wojcik, Antoni

    2002-01-01

    The proposed eavesdropping scheme reveals that the quantum communication protocol recently presented by Bostrom and Felbinger [Phys. Rev. Lett. 89, 187902 (2002)] is not secure as far as quantum channel losses are taken into account.

  10. Manet key management via Mobile Ficlke Key protocol (MFK ...

    African Journals Online (AJOL)

    Manet key management via Mobile Ficlke Key protocol (MFK) ... Journal of Fundamental and Applied Sciences. Journal Home · ABOUT THIS JOURNAL ... No Abstract. Keywords: MANET; key management scheme; simulation environment ...

  11. Lightweight SIP/SDP compression scheme (LSSCS)

    Science.gov (United States)

    Wu, Jian J.; Demetrescu, Cristian

    2001-10-01

    In UMTS new IP based services with tight delay constraints will be deployed over the W-CDMA air interface such as IP multimedia and interactive services. To integrate the wireline and wireless IP services, 3GPP standard forum adopted the Session Initiation Protocol (SIP) as the call control protocol for the UMTS Release 5, which will implement next generation, all IP networks for real-time QoS services. In the current form the SIP protocol is not suitable for wireless transmission due to its large message size which will need either a big radio pipe for transmission or it will take far much longer to transmit than the current GSM Call Control (CC) message sequence. In this paper we present a novel compression algorithm called Lightweight SIP/SDP Compression Scheme (LSSCS), which acts at the SIP application layer and therefore removes the information redundancy before it is sent to the network and transport layer. A binary octet-aligned header is added to the compressed SIP/SDP message before sending it to the network layer. The receiver uses this binary header as well as the pre-cached information to regenerate the original SIP/SDP message. The key features of the LSSCS compression scheme are presented in this paper along with implementation examples. It is shown that this compression algorithm makes SIP transmission efficient over the radio interface without losing the SIP generality and flexibility.

  12. Factors influencing adherence to referral advice following pre-referral treatment with artesunate suppositories in children in rural Tanzania.

    Science.gov (United States)

    Simba, Daudi O; Warsame, Marian; Kimbute, Omari; Kakoko, Deodatus; Petzold, Max; Tomson, Goran; Premji, Zul; Gomes, Melba

    2009-07-01

    WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers' adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories. The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions taken post-referral: taking their children to a drug shop, a traditional healer, or not seeking further treatment, and added to a random selection of patients who complied with referral advice. Caretakers of the children were interviewed about their socio-economic status (SES), knowledge about malaria, referral advice given and actions they took following pre-referral treatment. Interview data for 587 caretakers were matched with symptoms of the children, the time of treatment, arrival at a health facility or other actions taken post-pre-referral treatment. The majority (93.5%) of caretakers reported being given referral advice by the community drug dispenser. The odds of adherence with this advice were three times greater for children with altered consciousness and/or convulsions than for children with other symptoms [odds ratio (OR) 3.47, 95% confidence interval (CI) 2.32-5.17, P < 0.001]. When questioned, caretakers who remembered when (OR 2.19, 95% CI 1.48-3.23, P < 0.001) and why (OR 1.77, 95% CI 1.07-2.95, P = 0.026) they were advised to proceed to health facility - were more likely to follow referral advice. Cost did not influence adherence except within a catchment area of facilities that charged for services. In these areas, costs deterred adherence by

  13. MULTIMEDIA DATA TRANSMISSION THROUGH TCP/IP USING HASH BASED FEC WITH AUTO-XOR SCHEME

    Directory of Open Access Journals (Sweden)

    R. Shalin

    2012-09-01

    Full Text Available The most preferred mode for communication of multimedia data is through the TCP/IP protocol. But on the other hand the TCP/IP protocol produces huge packet loss unavoidable due to network traffic and congestion. In order to provide a efficient communication it is necessary to recover the loss of packets. The proposed scheme implements Hash based FEC with auto XOR scheme for this purpose. The scheme is implemented through Forward error correction, MD5 and XOR for providing efficient transmission of multimedia data. The proposed scheme provides transmission high accuracy, throughput and low latency and loss.

  14. Compact Spreader Schemes

    Energy Technology Data Exchange (ETDEWEB)

    Placidi, M.; Jung, J. -Y.; Ratti, A.; Sun, C.

    2014-07-25

    This paper describes beam distribution schemes adopting a novel implementation based on low amplitude vertical deflections combined with horizontal ones generated by Lambertson-type septum magnets. This scheme offers substantial compactness in the longitudinal layouts of the beam lines and increased flexibility for beam delivery of multiple beam lines on a shot-to-shot basis. Fast kickers (FK) or transverse electric field RF Deflectors (RFD) provide the low amplitude deflections. Initially proposed at the Stanford Linear Accelerator Center (SLAC) as tools for beam diagnostics and more recently adopted for multiline beam pattern schemes, RFDs offer repetition capabilities and a likely better amplitude reproducibility when compared to FKs, which, in turn, offer more modest financial involvements both in construction and operation. Both solutions represent an ideal approach for the design of compact beam distribution systems resulting in space and cost savings while preserving flexibility and beam quality.

  15. Determining factors for implant referral rates.

    Science.gov (United States)

    Levin, Roger P

    2002-01-01

    The research findings indicate that the field of implant dentistry will only grow at a moderately low level unless certain changes are made. Findings indicated that the effort by the implant companies has been nothing short of dramatic, and yet almost 60% of restorative doctors do not participate annually in any implant case. There was no clear indication that younger restorative doctors will significantly increase the number of implant referrals, as their overall implant education has not dramatically differed from those dentists who graduated in earlier years. Once the research was completed, it became obvious to Levin Group that the driving force behind implant referral growth will be implant surgeons, because of their one-to-one relationship with restorative doctors. The Levin Group Implant Management and Marketing Consulting Program is based on approaching restorative doctors in several different levels, starting with awareness all the way through to case facilitation and long-term tracking and communication. Finally, a continuing marketing/education effort needs to be consistently in place with effective materials, not only to create a high level of awareness, but also to motivate restorative doctors to refer cases and then work through the case with the implant surgeon to a satisfactory completion for the restorative doctor, implant surgeon, and patient. While the surgical insertion of implants may seem to carry a high-profit margin relative to the restoration of implants, the truth is that the restoration of implants usually provides a 40% higher profit margin for the restorative doctor than traditional dental services. One of the key issues is that referring doctors have not necessarily learned how to set fees and present cases with regard to implant dentistry. The key factor here is to ensure that the patient understands that implant services involve higher fees than traditional services, because of the necessarily higher levels of experience, education

  16. New analytic unitarization schemes

    International Nuclear Information System (INIS)

    Cudell, J.-R.; Predazzi, E.; Selyugin, O. V.

    2009-01-01

    We consider two well-known classes of unitarization of Born amplitudes of hadron elastic scattering. The standard class, which saturates at the black-disk limit includes the standard eikonal representation, while the other class, which goes beyond the black-disk limit to reach the full unitarity circle, includes the U matrix. It is shown that the basic properties of these schemes are independent of the functional form used for the unitarization, and that U matrix and eikonal schemes can be extended to have similar properties. A common form of unitarization is proposed interpolating between both classes. The correspondence with different nonlinear equations are also briefly examined.

  17. Families of quantum fingerprinting protocols

    Science.gov (United States)

    Lovitz, Benjamin; Lütkenhaus, Norbert

    2018-03-01

    We introduce several families of quantum fingerprinting protocols to evaluate the equality function on two n -bit strings in the simultaneous message passing model. The original quantum fingerprinting protocol uses a tensor product of a small number of O (logn ) -qubit high-dimensional signals [H. Buhrman et al., Phys. Rev. Lett. 87, 167902 (2001), 10.1103/PhysRevLett.87.167902], whereas a recently proposed optical protocol uses a tensor product of O (n ) single-qubit signals, while maintaining the O (logn ) information leakage of the original protocol [J. M. Arazola and N. Lütkenhaus, Phys. Rev. A 89, 062305 (2014), 10.1103/PhysRevA.89.062305]. We find a family of protocols which interpolate between the original and optical protocols while maintaining the O (logn ) information leakage, thus demonstrating a tradeoff between the number of signals sent and the dimension of each signal. There has been interest in experimental realization of the recently proposed optical protocol using coherent states [F. Xu et al., Nat. Commun. 6, 8735 (2015), 10.1038/ncomms9735; J.-Y. Guan et al., Phys. Rev. Lett. 116, 240502 (2016), 10.1103/PhysRevLett.116.240502], but as the required number of laser pulses grows linearly with the input size n , eventual challenges for the long-time stability of experimental setups arise. We find a coherent state protocol which reduces the number of signals by a factor 1/2 while also reducing the information leakage. Our reduction makes use of a simple modulation scheme in optical phase space, and we find that more complex modulation schemes are not advantageous. Using a similar technique, we improve a recently proposed coherent state protocol for evaluating the Euclidean distance between two real unit vectors [N. Kumar et al., Phys. Rev. A 95, 032337 (2017), 10.1103/PhysRevA.95.032337] by reducing the number of signals by a factor 1/2 and also reducing the information leakage.

  18. [Urine incontinence referral criteria for primary care].

    Science.gov (United States)

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-05-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. Study protocol

    DEFF Research Database (Denmark)

    Smith, Benjamin E; Hendrick, Paul; Bateman, Marcus

    2017-01-01

    avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach....... DISCUSSION: This study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from...... this study will inform the design of a multicentre trial. TRIAL REGISTRATION: ISRCTN35272486....

  20. 4. Payment Schemes

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 6; Issue 2. Electronic Commerce - Payment Schemes. V Rajaraman. Series Article Volume 6 Issue 2 February 2001 pp 6-13. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/006/02/0006-0013 ...

  1. Contract saving schemes

    NARCIS (Netherlands)

    Ronald, R.; Smith, S.J.; Elsinga, M.; Eng, O.S.; Fox O'Mahony, L.; Wachter, S.

    2012-01-01

    Contractual saving schemes for housing are institutionalised savings programmes normally linked to rights to loans for home purchase. They are diverse types as they have been developed differently in each national context, but normally fall into categories of open, closed, compulsory, and ‘free

  2. Alternative reprocessing schemes evaluation

    International Nuclear Information System (INIS)

    1979-02-01

    This paper reviews the parameters which determine the inaccessibility of the plutonium in reprocessing plants. Among the various parameters, the physical and chemical characteristics of the materials, the various processing schemes and the confinement are considered. The emphasis is placed on that latter parameter, and the advantages of an increased confinement in the socalled PIPEX reprocessing plant type are presented

  3. Introduction to association schemes

    NARCIS (Netherlands)

    Seidel, J.J.

    1991-01-01

    The present paper gives an introduction to the theory of association schemes, following Bose-Mesner (1959), Biggs (1974), Delsarte (1973), Bannai-Ito (1984) and Brouwer-Cohen-Neumaier (1989). Apart from definitions and many examples, also several proofs and some problems are included. The paragraphs

  4. Reaction schemes of immunoanalysis

    International Nuclear Information System (INIS)

    Delaage, M.; Barbet, J.

    1991-01-01

    The authors apply a general theory for multiple equilibria to the reaction schemes of immunoanalysis, competition and sandwich. This approach allows the manufacturer to optimize the system and provide the user with interpolation functions for the standard curve and its first derivative as well, thus giving access to variance [fr

  5. Alternative health insurance schemes

    DEFF Research Database (Denmark)

    Keiding, Hans; Hansen, Bodil O.

    2002-01-01

    In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level...... competitive insurance; this situation turns out to be at least as good as either of the alternatives...

  6. The Singapore protocol [for quantum cryptography

    International Nuclear Information System (INIS)

    Englert, B.

    2005-01-01

    The qubit protocol for quantum key distribution presented in this talk is fully tomographic and more efficient than other tomographic protocols. Under ideal circumstances the efficiency is log 2 (4/3) = 0.415 key bits per qubit sent, which is 25% more than the efficiency of 1/3 = 0.333 for the standard 6-state protocol. One can extract 0.4 key bits per qubit by a simple two-way communication scheme, and can so get close to the information-theoretical limit. The noise thresholds for secure key bit generation in the presence of unbiased noise will be reported and discussed. (author)

  7. Introduction of electronic referral from community associated with more timely review by secondary services.

    Science.gov (United States)

    Warren, J; White, S; Day, K J; Gu, Y; Pollock, M

    2011-01-01

    Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007. To measure the extent of uptake of eReferral and its association with changes in referral processing. Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders. eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (psystem usability issues. With eReferrals, a referral's status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems. We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and more transparent referral processing.

  8. The QKD network: model and routing scheme

    Science.gov (United States)

    Yang, Chao; Zhang, Hongqi; Su, Jinhai

    2017-11-01

    Quantum key distribution (QKD) technology can establish unconditional secure keys between two communicating parties. Although this technology has some inherent constraints, such as the distance and point-to-point mode limits, building a QKD network with multiple point-to-point QKD devices can overcome these constraints. Considering the development level of current technology, the trust relaying QKD network is the first choice to build a practical QKD network. However, the previous research didn't address a routing method on the trust relaying QKD network in detail. This paper focuses on the routing issues, builds a model of the trust relaying QKD network for easily analysing and understanding this network, and proposes a dynamical routing scheme for this network. From the viewpoint of designing a dynamical routing scheme in classical network, the proposed scheme consists of three components: a Hello protocol helping share the network topology information, a routing algorithm to select a set of suitable paths and establish the routing table and a link state update mechanism helping keep the routing table newly. Experiments and evaluation demonstrates the validity and effectiveness of the proposed routing scheme.

  9. PREMEDICATION PROTOCOLS IN DENTAL PRACTICE IN ALLERGIC PATIENTS.

    OpenAIRE

    Angelina Kisselova; Adriana Krasteva; Assya Krasteva

    2011-01-01

    The problem with choosing a suitable pre-medication protocols before local anesthesia in dentistry in allergic patients is always discussed, as in the dental practice different schemes are already proven (3,5). The propose of this communication is to share the experience on those pre-medication schemes in allergic patients during and outside pollen season.

  10. Deflection routing scheme for GMPLS-based OBS networks

    DEFF Research Database (Denmark)

    Eid, Arafat; Mahmood, Waqar; Alomar, Anwar

    2010-01-01

    Integrating the Generalized Multi-Protocol Label Switching (GMPLS) framework into an Optical Burst Switching (OBS) Control Plane is a promising solution to alleviating most of OBS performance and design issues. However, implementing the already proposed OBS deflection routing schemes is not appli...

  11. Audit of Childbirth Emergency Referrals by Trained Traditional Birth ...

    African Journals Online (AJOL)

    Medicine, Enugu State University of Science and Technology, 5Department of Obstetrics and ... Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a ..... training of TBAs has been documented by previous African.

  12. Referral patterns of community health workers diagnosing and treating malaria

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Magnussen, Pascal

    2016-01-01

    Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria...... rapid diagnostic tests (mRDTs) on CHW referral in two cluster-randomized trials, one conducted in a moderate-to-high malaria transmission setting and one in a low-transmission setting in Uganda, between January 2010 and July 2012. All CHWs were trained to prescribe artemisinin-based combination therapy...... (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral inpatient registers...

  13. medication history documentation in referral letters of children

    African Journals Online (AJOL)

    CHILDREN PRESENTING AT THE EMERGENCY UNIT OF A TEACHING. HOSPITAL IN LAGOS ... infrequently reported in referral letters to a tertiary care hospital in Lagos,. Nigeria. .... researcher, a pharmacist and clinical pharmacologist.

  14. Password Authenticated Key Exchange and Protected Password Change Protocols

    Directory of Open Access Journals (Sweden)

    Ting-Yi Chang

    2017-07-01

    Full Text Available In this paper, we propose new password authenticated key exchange (PAKE and protected password change (PPC protocols without any symmetric or public-key cryptosystems. The security of the proposed protocols is based on the computational Diffie-Hellman assumption in the random oracle model. The proposed scheme can resist both forgery server and denial of service attacks.

  15. Analysing Password Protocol Security Against Off-line Dictionary Attacks

    NARCIS (Netherlands)

    Corin, R.J.; Doumen, J.M.; Etalle, Sandro; Busi, Nadia; Gorrieri, Roberto; Martinelli, Fabio

    We study the security of password protocols against off-line dictionary attacks. In addition to the standard adversary abilities, we also consider further cryptographic advantages given to the adversary when considering the password protocol being instantiated with particular encryption schemes. We

  16. Secure Protocol for “Host — NFC Reader” Communication

    Directory of Open Access Journals (Sweden)

    A. O. Menshenin

    2012-06-01

    Full Text Available The paper presents a secure protocol for communication between host and NFC reader. The protocol protection scheme uses symmetric cipher with cyclic session key generation and provides confidentiality, integrity, end parties authentication and resistance to replay attacks. Deployment scenario in a typical electronic payment system is also presented.

  17. On Converting Secret Sharing Scheme to Visual Secret Sharing Scheme

    Directory of Open Access Journals (Sweden)

    Wang Daoshun

    2010-01-01

    Full Text Available Abstract Traditional Secret Sharing (SS schemes reconstruct secret exactly the same as the original one but involve complex computation. Visual Secret Sharing (VSS schemes decode the secret without computation, but each share is m times as big as the original and the quality of the reconstructed secret image is reduced. Probabilistic visual secret sharing (Prob.VSS schemes for a binary image use only one subpixel to share the secret image; however the probability of white pixels in a white area is higher than that in a black area in the reconstructed secret image. SS schemes, VSS schemes, and Prob. VSS schemes have various construction methods and advantages. This paper first presents an approach to convert (transform a -SS scheme to a -VSS scheme for greyscale images. The generation of the shadow images (shares is based on Boolean XOR operation. The secret image can be reconstructed directly by performing Boolean OR operation, as in most conventional VSS schemes. Its pixel expansion is significantly smaller than that of VSS schemes. The quality of the reconstructed images, measured by average contrast, is the same as VSS schemes. Then a novel matrix-concatenation approach is used to extend the greyscale -SS scheme to a more general case of greyscale -VSS scheme.

  18. Controlled Delegation Protocol in Mobile RFID Networks

    Directory of Open Access Journals (Sweden)

    Yang MingHour

    2010-01-01

    Full Text Available To achieve off-line delegation for mobile readers, we propose a delegation protocol for mobile RFID allowing its readers access to specific tags through back-end server. That is to say, reader-tag mutual authentication can be performed without readers being connected to back-end server. Readers are also allowed off-line access to tags' data. Compared with other delegation protocols, our scheme uniquely enables back-end server to limit each reader's reading times during delegation. Even in a multireader situation, our protocol can limit reading times and reading time periods for each of them and therefore makes back-end server's delegation more flexible. Besides, our protocol can prevent authorized readers from transferring their authority to the unauthorized, declining invalid access to tags. Our scheme is proved viable and secure with GNY logic; it is against certain security threats, such as replay attacks, denial of service (DoS attacks, Man-in-the-Middle attacks, counterfeit tags, and breaches of location and data privacy. Also, the performance analysis of our protocol proves that current tags can afford the computation load required in this scheme.

  19. Beyond protocols

    DEFF Research Database (Denmark)

    Vanderhoeven, Sonia; Branquart, Etienne; Casaer, Jim

    2017-01-01

    Risk assessment tools for listing invasive alien species need to incorporate all available evidence and expertise. Beyond the wealth of protocols developed to date, we argue that the current way of performing risk analysis has several shortcomings. In particular, lack of data on ecological impact...... information on risk and the exploration of improved methods for decision making on biodiversity management. This is crucial for efficient conservation resource allocation and uptake by stakeholders and the public......., transparency and repeatability of assessments as well as the incorporation of uncertainty should all be explicitly considered. We recommend improved quality control of risk assessments through formalized peer review with clear feedback between assessors and reviewers. Alternatively, a consensus building...

  20. HIV Viral Load Trends in Six Eastern Caribbean Countries Utilizing a Regional Laboratory Referral Service: Implications for Treatment as Prevention.

    Science.gov (United States)

    Landis, R Clive; Carmichael-Simmons, Kelly; Hambleton, Ian R; Best, Anton

    2015-01-01

    Since 2009, seven countries in the Organization of Eastern Caribbean States (OECS), Antigua & Barbuda, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines, have been utilizing a laboratory referral service for HIV-1 viral load (VL) offered by The Ladymeade Reference Unit (LRU) Laboratory, Barbados. The objective of this study was to evaluate 5 year VL trends in the six larger OECS countries participating in this regional referral service. Blood samples were collected in source countries and transported to Barbados as frozen plasma according to a standardized protocol. Plasma specimens were amplified by RT PCR on a Roche TaqMan 48 analyser (Roche Diagnostics, Panama City, Panama). VL was considered optimally suppressed below a threshold level of < 200 HIV-1 copies/mL of blood. The same threshold was used as a binary indicator in an analysis of the secular change in VL suppression. Montserrat was excluded due to insufficient number of samples. A steady rise in VL referrals from OECS countries was recorded, rising from 312 samples in 2009 to 1,060 samples in 2013. A total of 3,543 samples were tested, with a sample rejection rate (9.2%) mostly due to breaks in the cold chain. Aggregate VL data showed the odds of VL suppression in the Eastern Caribbean improved by 66% for each additional year after 2009 (Odds Ratio 1.66 [95% CI 1.46 to 1.88]; p<0.001). We demonstrate the feasibility of establishing a regional laboratory referral service for HIV VL monitoring in the Eastern Caribbean. Aggregate VL trends showed a significant year-on-year improvement in VL suppression, implying public health benefits through treatment as prevention in the OECS. VL provides a powerful monitoring & evaluation tool for strengthening HIV programs at country level among the small island states participating in this regional referral network.

  1. HIV Viral Load Trends in Six Eastern Caribbean Countries Utilizing a Regional Laboratory Referral Service: Implications for Treatment as Prevention.

    Directory of Open Access Journals (Sweden)

    R Clive Landis

    Full Text Available Since 2009, seven countries in the Organization of Eastern Caribbean States (OECS, Antigua & Barbuda, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines, have been utilizing a laboratory referral service for HIV-1 viral load (VL offered by The Ladymeade Reference Unit (LRU Laboratory, Barbados. The objective of this study was to evaluate 5 year VL trends in the six larger OECS countries participating in this regional referral service.Blood samples were collected in source countries and transported to Barbados as frozen plasma according to a standardized protocol. Plasma specimens were amplified by RT PCR on a Roche TaqMan 48 analyser (Roche Diagnostics, Panama City, Panama. VL was considered optimally suppressed below a threshold level of < 200 HIV-1 copies/mL of blood. The same threshold was used as a binary indicator in an analysis of the secular change in VL suppression. Montserrat was excluded due to insufficient number of samples.A steady rise in VL referrals from OECS countries was recorded, rising from 312 samples in 2009 to 1,060 samples in 2013. A total of 3,543 samples were tested, with a sample rejection rate (9.2% mostly due to breaks in the cold chain. Aggregate VL data showed the odds of VL suppression in the Eastern Caribbean improved by 66% for each additional year after 2009 (Odds Ratio 1.66 [95% CI 1.46 to 1.88]; p<0.001.We demonstrate the feasibility of establishing a regional laboratory referral service for HIV VL monitoring in the Eastern Caribbean. Aggregate VL trends showed a significant year-on-year improvement in VL suppression, implying public health benefits through treatment as prevention in the OECS. VL provides a powerful monitoring & evaluation tool for strengthening HIV programs at country level among the small island states participating in this regional referral network.

  2. Selectively strippable paint schemes

    Science.gov (United States)

    Stein, R.; Thumm, D.; Blackford, Roger W.

    1993-03-01

    In order to meet the requirements of more environmentally acceptable paint stripping processes many different removal methods are under evaluation. These new processes can be divided into mechanical and chemical methods. ICI has developed a paint scheme with intermediate coat and fluid resistant polyurethane topcoat which can be stripped chemically in a short period of time with methylene chloride free and phenol free paint strippers.

  3. Scalable Nonlinear Compact Schemes

    Energy Technology Data Exchange (ETDEWEB)

    Ghosh, Debojyoti [Argonne National Lab. (ANL), Argonne, IL (United States); Constantinescu, Emil M. [Univ. of Chicago, IL (United States); Brown, Jed [Univ. of Colorado, Boulder, CO (United States)

    2014-04-01

    In this work, we focus on compact schemes resulting in tridiagonal systems of equations, specifically the fifth-order CRWENO scheme. We propose a scalable implementation of the nonlinear compact schemes by implementing a parallel tridiagonal solver based on the partitioning/substructuring approach. We use an iterative solver for the reduced system of equations; however, we solve this system to machine zero accuracy to ensure that no parallelization errors are introduced. It is possible to achieve machine-zero convergence with few iterations because of the diagonal dominance of the system. The number of iterations is specified a priori instead of a norm-based exit criterion, and collective communications are avoided. The overall algorithm thus involves only point-to-point communication between neighboring processors. Our implementation of the tridiagonal solver differs from and avoids the drawbacks of past efforts in the following ways: it introduces no parallelization-related approximations (multiprocessor solutions are exactly identical to uniprocessor ones), it involves minimal communication, the mathematical complexity is similar to that of the Thomas algorithm on a single processor, and it does not require any communication and computation scheduling.

  4. Physician self-referral and physician-owned specialty facilities.

    Science.gov (United States)

    Casalino, Lawrence P

    2008-06-01

    Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

  5. Do poison center triage guidelines affect healthcare facility referrals?

    Science.gov (United States)

    Benson, B E; Smith, C A; McKinney, P E; Litovitz, T L; Tandberg, W D

    2001-01-01

    The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.

  6. Factors affecting cardiac rehabilitation referral by physician specialty.

    Science.gov (United States)

    Grace, Sherry L; Grewal, Keerat; Stewart, Donna E

    2008-01-01

    Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

  7. Improving the psychological evaluation of exercise referral: Psychometric properties of the Exercise Referral Quality of Life Scale

    Directory of Open Access Journals (Sweden)

    Charlotte Hilton

    2015-07-01

    Full Text Available There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.

  8. Improving Wojcik's eavesdropping attack on the ping-pong protocol

    International Nuclear Information System (INIS)

    Zhang Zhanjun; Man Zhongxiao; Li Yong

    2004-01-01

    The eavesdropping scheme proposed by Wojcik [Phys. Rev. Lett. 90 (2003) 157901] on the ping-pong protocol [Phys. Rev. Lett. 89 (2002) 187902] is improved by constituting a new set of attack operations. The improved scheme only induces half of the eavesdropping-induced channel loss in Wojcik's scheme, therefore, in a larger domain of the quantum channel transmission efficiency η, i.e., [0,75%], the eavesdropper Eve can attack all the transmitted bits. The improvement of the ping-pong protocol security produced by Wojcik's is also suitable for our eavesdropping attack

  9. Quantum multi-signature protocol based on teleportation

    International Nuclear Information System (INIS)

    Wen Xiao-jun; Liu Yun; Sun Yu

    2007-01-01

    In this paper, a protocol which can be used in multi-user quantum signature is proposed. The scheme of signature and verification is based on the correlation of Greenberger-Horne-Zeilinger (GHZ) states and the controlled quantum teleportation. Different from the digital signatures, which are based on computational complexity, the proposed protocol has perfect security in the noiseless quantum channels. Compared to previous quantum signature schemes, this protocol can verify the signature independent of an arbitrator as well as realize multi-user signature together. (orig.)

  10. Novel Scheme for Packet Forwarding without Header Modifications in Optical Networks

    DEFF Research Database (Denmark)

    Wessing, Henrik; Christiansen, Henrik Lehrmann; Fjelde, Tina

    2002-01-01

    We present a novel scheme for packet forwarding in optical packet-switched networks and we further demonstrate its good scalability through simulations. The scheme requires neither header modification nor any label distribution protocol, thus reducing component cost while simplifying network...

  11. 40 CFR 13.33 - Referrals to the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Referrals to the Department of Justice... COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral. The... Justice, Washington, DC 20530. (2) Unless otherwise provided by DOJ regulations or procedures, EPA refers...

  12. Establishing rational networking using the DL04 quantum secure direct communication protocol

    Science.gov (United States)

    Qin, Huawang; Tang, Wallace K. S.; Tso, Raylin

    2018-06-01

    The first rational quantum secure direct communication scheme is proposed, in which we use the game theory with incomplete information to model the rational behavior of the participant, and give the strategy space and utility function. The rational participant can get his maximal utility when he performs the protocol faithfully, and then the Nash equilibrium of the protocol can be achieved. Compared to the traditional schemes, our scheme will be more practical in the presence of rational participant.

  13. Superposition Attacks on Cryptographic Protocols

    DEFF Research Database (Denmark)

    Damgård, Ivan Bjerre; Funder, Jakob Løvstad; Nielsen, Jesper Buus

    2011-01-01

    of information. In this paper, we introduce a fundamentally new model of quantum attacks on classical cryptographic protocols, where the adversary is allowed to ask several classical queries in quantum superposition. This is a strictly stronger attack than the standard one, and we consider the security......Attacks on classical cryptographic protocols are usually modeled by allowing an adversary to ask queries from an oracle. Security is then defined by requiring that as long as the queries satisfy some constraint, there is some problem the adversary cannot solve, such as compute a certain piece...... of several primitives in this model. We show that a secret-sharing scheme that is secure with threshold $t$ in the standard model is secure against superposition attacks if and only if the threshold is lowered to $t/2$. We use this result to give zero-knowledge proofs for all of NP in the common reference...

  14. Arbitrated quantum signature scheme based on χ-type entangled states

    International Nuclear Information System (INIS)

    Zuo, Huijuan; Huang, Wei; Qin, Sujuan

    2013-01-01

    An arbitrated quantum signature scheme, which is mainly applied in electronic-payment systems, is proposed and investigated. The χ-type entangled states are used for quantum key distribution and quantum signature in this protocol. Compared with previous quantum signature schemes which also utilize χ-type entangled states, the proposed scheme provides higher efficiency. Finally, we also analyze its security under various kinds of attacks. (paper)

  15. An Authentication Protocol for Future Sensor Networks.

    Science.gov (United States)

    Bilal, Muhammad; Kang, Shin-Gak

    2017-04-28

    Authentication is one of the essential security services in Wireless Sensor Networks (WSNs) for ensuring secure data sessions. Sensor node authentication ensures the confidentiality and validity of data collected by the sensor node, whereas user authentication guarantees that only legitimate users can access the sensor data. In a mobile WSN, sensor and user nodes move across the network and exchange data with multiple nodes, thus experiencing the authentication process multiple times. The integration of WSNs with Internet of Things (IoT) brings forth a new kind of WSN architecture along with stricter security requirements; for instance, a sensor node or a user node may need to establish multiple concurrent secure data sessions. With concurrent data sessions, the frequency of the re-authentication process increases in proportion to the number of concurrent connections. Moreover, to establish multiple data sessions, it is essential that a protocol participant have the capability of running multiple instances of the protocol run, which makes the security issue even more challenging. The currently available authentication protocols were designed for the autonomous WSN and do not account for the above requirements. Hence, ensuring a lightweight and efficient authentication protocol has become more crucial. In this paper, we present a novel, lightweight and efficient key exchange and authentication protocol suite called the Secure Mobile Sensor Network (SMSN) Authentication Protocol. In the SMSN a mobile node goes through an initial authentication procedure and receives a re-authentication ticket from the base station. Later a mobile node can use this re-authentication ticket when establishing multiple data exchange sessions and/or when moving across the network. This scheme reduces the communication and computational complexity of the authentication process. We proved the strength of our protocol with rigorous security analysis (including formal analysis using the BAN

  16. ESCAP mobile training scheme.

    Science.gov (United States)

    Yasas, F M

    1977-01-01

    In response to a United Nations resolution, the Mobile Training Scheme (MTS) was set up to provide training to the trainers of national cadres engaged in frontline and supervisory tasks in social welfare and rural development. The training is innovative in its being based on an analysis of field realities. The MTS team consisted of a leader, an expert on teaching methods and materials, and an expert on action research and evaluation. The country's trainers from different departments were sent to villages to work for a short period and to report their problems in fulfilling their roles. From these grass roots experiences, they made an analysis of the job, determining what knowledge, attitude and skills it required. Analysis of daily incidents and problems were used to produce indigenous teaching materials drawn from actual field practice. How to consider the problems encountered through government structures for policy making and decisions was also learned. Tasks of the students were to identify the skills needed for role performance by job analysis, daily diaries and project histories; to analyze the particular community by village profiles; to produce indigenous teaching materials; and to practice the role skills by actual role performance. The MTS scheme was tried in Nepal in 1974-75; 3 training programs trained 25 trainers and 51 frontline workers; indigenous teaching materials were created; technical papers written; and consultations were provided. In Afghanistan the scheme was used in 1975-76; 45 participants completed the training; seminars were held; and an ongoing Council was created. It is hoped that the training program will be expanded to other countries.

  17. A security analysis of the 802.11s wireless mesh network routing protocol and its secure routing protocols.

    Science.gov (United States)

    Tan, Whye Kit; Lee, Sang-Gon; Lam, Jun Huy; Yoo, Seong-Moo

    2013-09-02

    Wireless mesh networks (WMNs) can act as a scalable backbone by connecting separate sensor networks and even by connecting WMNs to a wired network. The Hybrid Wireless Mesh Protocol (HWMP) is the default routing protocol for the 802.11s WMN. The routing protocol is one of the most important parts of the network, and it requires protection, especially in the wireless environment. The existing security protocols, such as the Broadcast Integrity Protocol (BIP), Counter with cipher block chaining message authentication code protocol (CCMP), Secure Hybrid Wireless Mesh Protocol (SHWMP), Identity Based Cryptography HWMP (IBC-HWMP), Elliptic Curve Digital Signature Algorithm HWMP (ECDSA-HWMP), and Watchdog-HWMP aim to protect the HWMP frames. In this paper, we have analyzed the vulnerabilities of the HWMP and developed security requirements to protect these identified vulnerabilities. We applied the security requirements to analyze the existing secure schemes for HWMP. The results of our analysis indicate that none of these protocols is able to satisfy all of the security requirements. We also present a quantitative complexity comparison among the protocols and an example of a security scheme for HWMP to demonstrate how the result of our research can be utilized. Our research results thus provide a tool for designing secure schemes for the HWMP.

  18. Bonus schemes and trading activity

    NARCIS (Netherlands)

    Pikulina, E.S.; Renneboog, L.D.R.; ter Horst, J.R.; Tobler, P.N.

    2014-01-01

    Little is known about how different bonus schemes affect traders' propensity to trade and which bonus schemes improve traders' performance. We study the effects of linear versus threshold bonus schemes on traders' behavior. Traders buy and sell shares in an experimental stock market on the basis of

  19. Succesful labelling schemes

    DEFF Research Database (Denmark)

    Juhl, Hans Jørn; Stacey, Julia

    2001-01-01

    . In the spring of 2001 MAPP carried out an extensive consumer study with special emphasis on the Nordic environmentally friendly label 'the swan'. The purpose was to find out how much consumers actually know and use various labelling schemes. 869 households were contacted and asked to fill in a questionnaire...... it into consideration when I go shopping. The respondent was asked to pick the most suitable answer, which described her use of each label. 29% - also called 'the labelling blind' - responded that they basically only knew the recycling label and the Government controlled organic label 'Ø-mærket'. Another segment of 6...

  20. Scheme of stepmotor control

    International Nuclear Information System (INIS)

    Grashilin, V.A.; Karyshev, Yu.Ya.

    1982-01-01

    A 6-cycle scheme of step motor is described. The block-diagram and the basic circuit of the step motor control are presented. The step motor control comprises a pulse shaper, electronic commutator and power amplifiers. The step motor supply from 6-cycle electronic commutator provides for higher reliability and accuracy than from 3-cycle commutator. The control of step motor work is realised by the program given by the external source of control signals. Time-dependent diagrams for step motor control are presented. The specifications of the step-motor is given

  1. [Primary lymphoma of the central nervous system: 20 years' experience in a referral hospital].

    Science.gov (United States)

    Calderón-Garcidueñas, A L; Pacheco-Calleros, J; Castelán-Maldonado, E; Nocedal-Rustrián, F C

    Primary central nervous system lymphomas (PCNSL) are rare neoplasms. AIM. To study the clinical aspects and the immuno-phenotype of all cases of PCNSL in a 20 years lapse in a referral hospital in Northeastern Mexico. From January 1986 to December 2005 all PCNSL histologically confirmed were studied. The primary lymphomas were 1% of malignant central nervous system neoplasms. 21 cases were studied (ages from 9-70 years) with male predominance (2:1). 24% patients had immuno-suppression. The more frequent clinical data were: papilledema (71%), headache (62%), paresis (48%) and seizures (33%). 33% of patients died during the first six months after diagnosis. The T lymphomas were 19% of cases and corresponded to small cell type. PCNSL are still a diagnostic challenge. Multicenter studies are required in order to determine the best treatment protocol.

  2. Neonatal hearing screening of high-risk infants using automated auditory brainstem response: a retrospective analysis of referral rates.

    LENUS (Irish Health Repository)

    McGurgan, I J

    2013-10-07

    The past decade has seen the widespread introduction of universal neonatal hearing screening (UNHS) programmes worldwide. Regrettably, such a programme is only now in the process of nationwide implementation in the Republic of Ireland and has been largely restricted to one screening modality for initial testing; namely transient evoked otoacoustic emissions (TEOAE). The aim of this study is to analyse the effects of employing a different screening protocol which utilises an alternative initial test, automated auditory brainstem response (AABR), on referral rates to specialist audiology services.

  3. Police referrals at the psychiatric emergency service in Taiwan.

    Science.gov (United States)

    Wang, Jen-Pang; Wu, Chia-Yi; Chiu, Chih-Chiang; Yang, Tsu-Hui; Liu, Tzong-Hsien; Chou, Pesus

    2015-12-01

    The police are the frontline workers in crisis situations involving patients with severe mental illness and act as a primary referral source for psychiatric emergency services (PES) in the community. The aims of this study were to investigate the distribution and characteristics of police referral among psychiatric patients in Taiwan. The study cohort consisted of patients who visited the PES of Taipei City Psychiatric Center from January 2009 to December 2010. The associations between the factors of demographics, clinical characteristics, and psychiatric service utilization and police referral were evaluated. Among the 7656 psychiatric emergency visits, 3029 (39.6%) were referred by the police. These patients referred by police were more likely to be male and aged between 30 to 49 years. Clinical factors related to police referrals including a higher triage assessment level, chief problems included violence, disturbance, substance use, less anxiety, and a diagnosis of unspecified psychosis. The triage assessment level and chief problems assessed by nurses were major predictors. These patients tended to be referred from the catchment area and during the nighttime shift, were discharged during the daytime shift, and stayed longer in the PES. Disposition arrangements such as discharge against medical advice and involuntary admission were also associated with police referrals. Patients referred by the police to the PES were those with more severe psychiatric problems and illnesses assessed by psychiatric nurses and psychiatrists. They tended to have more complex service utilization at the PES. © 2015 Wiley Publishing Asia Pty Ltd.

  4. Barriers to palliative radiotherapy referral: A Canadian perspective

    International Nuclear Information System (INIS)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.

    2007-01-01

    Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral

  5. A Dynamic Reallocation Based Window Access Scheme for Enhancing QoS of Vehicular Ad-hoc Networks (VANETs

    Directory of Open Access Journals (Sweden)

    Md. Amirul Islam

    2018-01-01

    Full Text Available This article proposes a new MAC scheme for Vehicle-to-Infrastructure (V2I communications that dynamically reallocates unused TDMA slots. By maintaining a balanced waiting time, the proposed TDMA based scheduling scheme allocates TDMA slots in a rational way to minimize merging and one-hop neighboring collision. The proposed scheme ensures dynamic reallocation of unused slots by using “time slot reassignment” mechanism. The scheme has been simulated in VEINS framework of OMNET++ network simulator and its performance has been compared with other conventional protocols. Experimental results show that our scheme performs better than existing schemes in terms of successfully transmitted data packets.

  6. A Survey of Authentication Schemes in Telecare Medicine Information Systems.

    Science.gov (United States)

    Aslam, Muhammad Umair; Derhab, Abdelouahid; Saleem, Kashif; Abbas, Haider; Orgun, Mehmet; Iqbal, Waseem; Aslam, Baber

    2017-01-01

    E-Healthcare is an emerging field that provides mobility to its users. The protected health information of the users are stored at a remote server (Telecare Medical Information System) and can be accessed by the users at anytime. Many authentication protocols have been proposed to ensure the secure authenticated access to the Telecare Medical Information System. These protocols are designed to provide certain properties such as: anonymity, untraceability, unlinkability, privacy, confidentiality, availability and integrity. They also aim to build a key exchange mechanism, which provides security against some attacks such as: identity theft, password guessing, denial of service, impersonation and insider attacks. This paper reviews these proposed authentication protocols and discusses their strengths and weaknesses in terms of ensured security and privacy properties, and computation cost. The schemes are divided in three broad categories of one-factor, two-factor and three-factor authentication schemes. Inter-category and intra-category comparison has been performed for these schemes and based on the derived results we propose future directions and recommendations that can be very helpful to the researchers who work on the design and implementation of authentication protocols.

  7. Multi-area layered multicast scheme for MPLS networks

    Science.gov (United States)

    Ma, Yajie; Yang, Zongkai; Wang, Yuming; Chen, Jingwen

    2005-02-01

    Multi-protocol label switching (MPLS) is multiprotocols both at layer 2 and layer 3. It is suggested to overcome the shortcomings of performing complex longest prefix matching in layer 3 routing by using short, fixed length labels. The MPLS community has put more effort into the label switching of unicast IP traffic, but less in the MPLS multicast mechanism. The reasons are the higher label consumption, the dynamical mapping of L3 multicast tree to L2 LSPs and the 20-bit shim header which is much fewer than the IPv4 IP header. On the other hand, heterogeneity of node capability degrades total performance of a multicast group. In order to achieve the scalability as well as the heterogeneity in MPLS networks, a novel scheme of MPLS-based Multi-area Layered Multicast Scheme (MALM) is proposed. Unlike the existing schemes which focus on aggregating the multicast stream, we construct the multicast tree based on the virtual topology aggregation. The MPLS area is divided into different sub-areas to form the hierarchical virtual topology and the multicast group is reconstructed into multiple layers according to the node capability. At the same time, the label stack is used to save the label space. For stability of the MALM protocol, a multi-layer protection scheme is also discussed. The experiment results show that the proposed scheme saves label space and decrease the Multicast Forwarding Table in much degree.

  8. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Vandervelde, C. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom)], E-mail: clivevandervelde@gmail.com; Connor, S E.J. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom); Department of Neuroradiology, King' s College Hospital NHS Foundation Trust, London (United Kingdom)

    2009-02-15

    Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome.

  9. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

    International Nuclear Information System (INIS)

    Vandervelde, C.; Connor, S.E.J.

    2009-01-01

    Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome

  10. Enhanced Security and Pairing-free Handover Authentication Scheme for Mobile Wireless Networks

    Science.gov (United States)

    Chen, Rui; Shu, Guangqiang; Chen, Peng; Zhang, Lijun

    2017-10-01

    With the widely deployment of mobile wireless networks, we aim to propose a secure and seamless handover authentication scheme that allows users to roam freely in wireless networks without worrying about security and privacy issues. Given the open characteristic of wireless networks, safety and efficiency should be considered seriously. Several previous protocols are designed based on a bilinear pairing mapping, which is time-consuming and inefficient work, as well as unsuitable for practical situations. To address these issues, we designed a new pairing-free handover authentication scheme for mobile wireless networks. This scheme is an effective improvement of the protocol by Xu et al., which is suffer from the mobile node impersonation attack. Security analysis and simulation experiment indicate that the proposed protocol has many excellent security properties when compared with other recent similar handover schemes, such as mutual authentication and resistance to known network threats, as well as requiring lower computation and communication cost.

  11. A robust anonymous biometric-based remote user authentication scheme using smart cards

    Directory of Open Access Journals (Sweden)

    Ashok Kumar Das

    2015-04-01

    Full Text Available Several biometric-based remote user authentication schemes using smart cards have been proposed in the literature in order to improve the security weaknesses in user authentication system. In 2012, An proposed an enhanced biometric-based remote user authentication scheme using smart cards. It was claimed that the proposed scheme is secure against the user impersonation attack, the server masquerading attack, the password guessing attack, and the insider attack and provides mutual authentication between the user and the server. In this paper, we first analyze the security of An’s scheme and we show that this scheme has three serious security flaws in the design of the scheme: (i flaw in user’s biometric verification during the login phase, (ii flaw in user’s password verification during the login and authentication phases, and (iii flaw in user’s password change locally at any time by the user. Due to these security flaws, An’s scheme cannot support mutual authentication between the user and the server. Further, we show that An’s scheme cannot prevent insider attack. In order to remedy the security weaknesses found in An’s scheme, we propose a new robust and secure anonymous biometric-based remote user authentication scheme using smart cards. Through the informal and formal security analysis, we show that our scheme is secure against all possible known attacks including the attacks found in An’s scheme. The simulation results of our scheme using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications tool ensure that our scheme is secure against passive and active attacks. In addition, our scheme is also comparable in terms of the communication and computational overheads with An’s scheme and other related existing schemes. As a result, our scheme is more appropriate for practical applications compared to other approaches.

  12. A secure quantum group signature scheme based on Bell states

    International Nuclear Information System (INIS)

    Zhang Kejia; Song Tingting; Zuo Huijuan; Zhang Weiwei

    2013-01-01

    In this paper, we propose a new secure quantum group signature with Bell states, which may have applications in e-payment system, e-government, e-business, etc. Compared with the recent quantum group signature protocols, our scheme is focused on the most general situation in practice, i.e. only the arbitrator is trusted and no intermediate information needs to be stored in the signing phase to ensure the security. Furthermore, our scheme has achieved all the characteristics of group signature—anonymity, verifiability, traceability, unforgetability and undeniability, by using some current developed quantum and classical technologies. Finally, a feasible security analysis model for quantum group signature is presented. (paper)

  13. A virtual network computer's optical storage virtualization scheme

    Science.gov (United States)

    Wang, Jianzong; Hu, Huaixiang; Wan, Jiguang; Wang, Peng

    2008-12-01

    In this paper, we present the architecture and implementation of a virtual network computers' (VNC) optical storage virtualization scheme called VOSV. Its task is to manage the mapping of virtual optical storage to physical optical storage, a technique known as optical storage virtualization. The design of VOSV aims at the optical storage resources of different clients and servers that have high read-sharing patterns. VOSV uses several schemes such as a two-level Cache mechanism, a VNC server embedded module and the iSCSI protocols to improve the performance. The results measured on the prototype are encouraging, and indicating that VOSV provides the high I/O performance.

  14. An improved biometrics-based authentication scheme for telecare medical information systems.

    Science.gov (United States)

    Guo, Dianli; Wen, Qiaoyan; Li, Wenmin; Zhang, Hua; Jin, Zhengping

    2015-03-01

    Telecare medical information system (TMIS) offers healthcare delivery services and patients can acquire their desired medical services conveniently through public networks. The protection of patients' privacy and data confidentiality are significant. Very recently, Mishra et al. proposed a biometrics-based authentication scheme for telecare medical information system. Their scheme can protect user privacy and is believed to resist a range of network attacks. In this paper, we analyze Mishra et al.'s scheme and identify that their scheme is insecure to against known session key attack and impersonation attack. Thereby, we present a modified biometrics-based authentication scheme for TMIS to eliminate the aforementioned faults. Besides, we demonstrate the completeness of the proposed scheme through BAN-logic. Compared to the related schemes, our protocol can provide stronger security and it is more practical.

  15. A Weak Value Based QKD Protocol Robust Against Detector Attacks

    Science.gov (United States)

    Troupe, James

    2015-03-01

    We propose a variation of the BB84 quantum key distribution protocol that utilizes the properties of weak values to insure the validity of the quantum bit error rate estimates used to detect an eavesdropper. The protocol is shown theoretically to be secure against recently demonstrated attacks utilizing detector blinding and control and should also be robust against all detector based hacking. Importantly, the new protocol promises to achieve this additional security without negatively impacting the secure key generation rate as compared to that originally promised by the standard BB84 scheme. Implementation of the weak measurements needed by the protocol should be very feasible using standard quantum optical techniques.

  16. Transmission usage cost allocation schemes

    International Nuclear Information System (INIS)

    Abou El Ela, A.A.; El-Sehiemy, R.A.

    2009-01-01

    This paper presents different suggested transmission usage cost allocation (TCA) schemes to the system individuals. Different independent system operator (ISO) visions are presented using the proportional rata and flow-based TCA methods. There are two proposed flow-based TCA schemes (FTCA). The first FTCA scheme generalizes the equivalent bilateral exchanges (EBE) concepts for lossy networks through two-stage procedure. The second FTCA scheme is based on the modified sensitivity factors (MSF). These factors are developed from the actual measurements of power flows in transmission lines and the power injections at different buses. The proposed schemes exhibit desirable apportioning properties and are easy to implement and understand. Case studies for different loading conditions are carried out to show the capability of the proposed schemes for solving the TCA problem. (author)

  17. Identification and Referral of Patients at Risk for Post-traumatic Stress Disorder: A Literature Review and Retrospective Analysis.

    Science.gov (United States)

    Bolduc, Aaron; Hwang, Brice; Hogan, Christopher; Bhalla, Varun K; Nesmith, Elizabeth; Medeiros, Regina; Alexander, Cassie; Holsten, Steven B

    2015-09-01

    Post-traumatic stress disorder (PTSD) is a well-established psychological disorder after severe traumatic injury but remains poorly recognized. Recent changes in the "Resources for Optimal Care of the Injured Trauma Patient 2014" stress the need for comprehensive screening and referral for PTSD and depression after injury. Our purpose was to review the current PTSD literature and perform a retrospective chart review to evaluate screening at our institution. We hypothesized a lack of documentation and thus referral of these patients to mental health professionals. We performed a literature review of 43 publications of risk factors for PTSD in the civilian adult population followed by a retrospective review. Records were analyzed for basic demographics, risk factors found in the literature, and referrals to mental health providers. Risk factors included amputation, dissociative symptoms, female gender, history of mental health disorder, and peri-traumatic emotionality. Traumatic amputation status and gender were recorded in all patients. History of mental health disorder was present in 11.5 per cent patients, absent in 80.75 per cent, and not recorded in 7.75 per cent with an overall documentation of 91.75 per cent. Dissociative symptoms and peri-traumatic emotionality were recorded in 0.5 per cent and 1.0 per cent of patients, respectively. Only 13 patients of 400 (3.25%) were referred to mental health professionals. Despite extensive evidence and literature supporting risk factors for the development of PTSD, identification and treatment at our level 1 trauma center is lacking. There is a need for consistent screening among trauma centers to identify PTSD risk factors and protocols for risk reduction and referrals for patients at risk.

  18. 49 CFR 219.403 - Voluntary referral policy.

    Science.gov (United States)

    2010-10-01

    ... section, the railroad treats the referral and subsequent handling, including counseling and treatment, as confidential. (3) The railroad will, to the extent necessary for treatment and rehabilitation, grant the employee a leave of absence from the railroad for the period necessary to complete primary treatment and...

  19. Gastrointestinal malignancies at five regional referral hospitals in ...

    African Journals Online (AJOL)

    The distribution of oesophageal, liver, stomach and colorectal cancers diagnosed per year across the five referral hospitals was ... Conclusion: Oesophageal, liver, stomach and colorectal cancer remain the most common gastrointestinal malignancies and their rate is .... intake, poor dietary patterns such as consumption of a.

  20. Attitude towards psychiatric treatment and referral pattern in the ...

    African Journals Online (AJOL)

    clinical practice in both primary and secondary care.4 It is therefore ... specifically related to stigma4, severity of illness and past ... patients, stigma, concerns about the effect of psychiatric referral on ... They found the use of psychotropic drugs often necessary, ... The cross-sectional study was conducted at the University of.

  1. Referrals of Ethiopian Orthopedic Patients for Treatment Abroad ...

    African Journals Online (AJOL)

    Most patients were young males from Addis Ababa-the capital. The commonest single diagnosis was osteoarthritis, followed by ACL tear. The top three procedures for which the patients were referred are total hip replacement, ACL reconstruction and total knee replacement. Inter-consultant variation in number of referrals ...

  2. Molecular detection of carbapenemase-producing genes in referral ...

    African Journals Online (AJOL)

    Molecular confirmation of carbapenemase-producing Enterobacteriaceae (CPE) was introduced in South Africa (SA) at the end of 2011. We report on the detection of these resistance genes based on referral isolates. Enterobacteriaceae with non-susceptibility to any of the carbapenems according to defined criteria for ...

  3. Primary care nurses: effects on secondary care referrals for diabetes?

    NARCIS (Netherlands)

    Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de

    2010-01-01

    BACKGROUND: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with

  4. 29 CFR 15.8 - Referral to Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Department of Justice. 15.8 Section 15.8 Labor Office of the Secretary of Labor ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND RELATED... Justice. An award, compromise or settlement of a claim under § 2672 title 28, United States Code, and this...

  5. Linguistic barriers at a Malawian referral hospital | Kamwendo ...

    African Journals Online (AJOL)

    The paper discusses a small segment of the findings of a sociolinguistic study that was conducted at a Republic of China-funded referral hospital located in the predominantly Chitumbuka-speaking Northern Malawi. The main objective of the study was to identify linguistic barriers to communication that existed at the hospital ...

  6. Delays in diagnosis, referral and management of head and neck ...

    African Journals Online (AJOL)

    Delays in diagnosis, referral and management of head and neck cancer presenting at Kenyatta National Hospital, Nairobi. ... Vol 83, No 4 (2006) >. Log in or Register to get access to full text downloads. ... Background: The most important prognostic factor in head and neck cancer is the stage of the disease at presentation.

  7. 20 CFR 628.510 - Intake, referrals and targeting.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Intake, referrals and targeting. 628.510 Section 628.510 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS... training have been provided subsequent to the objective assessment. (g) The SDA's method of meeting the...

  8. Developing evidence-based guidelines for referral for short stature

    NARCIS (Netherlands)

    Grote, F.K.; Dommelen, P. van; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Verkerk, P.H.; Wit, J.M.; Buuren, S. van

    2008-01-01

    Objective: To establish evidence based guidelines for growth monitoring on a population basis. Study design: Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as three samples from the general population.

  9. Patient satisfaction in neurological second opinions and tertiary referrals

    NARCIS (Netherlands)

    Wijers, D.; Wieske, L.; Vergouwen, M. D. I.; Richard, E.; Stam, J.; Smets, E. M. A.

    2010-01-01

    Although the number of neurological second opinions (SOs) and tertiary referrals (TRs) is increasing, only little is known about expectations and patient satisfaction in this group of patients. Therefore, the purpose of this study was to explore expectations of patients who get a neurological SO or

  10. Primary care referral management: a marketing strategy for hospitals.

    Science.gov (United States)

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J

    1990-06-01

    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  11. Qualitative study on maternal referrals in rural Tanzania: Decision ...

    African Journals Online (AJOL)

    The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the ...

  12. Predicting referral practices of traditional healers of their patients ...

    African Journals Online (AJOL)

    Predicting referral practices of traditional healers of their patients with a mental illness: An application of the Theory of Planned Behaviour. ... From the TPB application, the following cognitive variables were found to predict intentions: attitudes (ß = 0.612, p< 0.01); perceived behavioural control (ß = 0.355, p< 0.01); and past ...

  13. appointed forensic mental observations: Is the referral process ...

    African Journals Online (AJOL)

    2013-11-01

    Nov 1, 2013 ... One can find support for all three proposals in the scientific literature.[3]. Though this is a ... associations is the particular risk that the schizophrenic patient ... illness. This is comparable to the current study, in that all referrals for.

  14. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    Science.gov (United States)

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  15. 29 CFR 502.37 - Referral to Administrative Law Judge.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 502.37 Section 502.37 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS ENFORCEMENT OF CONTRACTUAL OBLIGATIONS FOR TEMPORARY ALIEN AGRICULTURAL WORKERS ADMITTED UNDER SECTION 218 OF...

  16. Referral and collaboration between South African psychiatrists and ...

    African Journals Online (AJOL)

    Background. Referral between psychiatrists and spiritual workers (e.g. Christian pastoral care workers, traditional healers, imams, rabbis and others) in the heterogeneous South African (SA) society is complicated and requires investigation to establish appropriate norms. Objective. To capture the views of some local ...

  17. An enhanced biometric authentication scheme for telecare medicine information systems with nonce using chaotic hash function.

    Science.gov (United States)

    Das, Ashok Kumar; Goswami, Adrijit

    2014-06-01

    Recently, Awasthi and Srivastava proposed a novel biometric remote user authentication scheme for the telecare medicine information system (TMIS) with nonce. Their scheme is very efficient as it is based on efficient chaotic one-way hash function and bitwise XOR operations. In this paper, we first analyze Awasthi-Srivastava's scheme and then show that their scheme has several drawbacks: (1) incorrect password change phase, (2) fails to preserve user anonymity property, (3) fails to establish a secret session key beween a legal user and the server, (4) fails to protect strong replay attack, and (5) lacks rigorous formal security analysis. We then a propose a novel and secure biometric-based remote user authentication scheme in order to withstand the security flaw found in Awasthi-Srivastava's scheme and enhance the features required for an idle user authentication scheme. Through the rigorous informal and formal security analysis, we show that our scheme is secure against possible known attacks. In addition, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool and show that our scheme is secure against passive and active attacks, including the replay and man-in-the-middle attacks. Our scheme is also efficient as compared to Awasthi-Srivastava's scheme.

  18. Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial.

    Science.gov (United States)

    Duda, Joan L; Williams, Geoffrey C; Ntoumanis, Nikos; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Rouse, Peter C; Lodhia, Rekha; Blamey, Ruth V; Jolly, Kate

    2014-01-29

    The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months. Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise

  19. Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial

    Science.gov (United States)

    2014-01-01

    Background The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. Methods An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres. Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise. Blood pressure and weight were assessed at baseline and 6 months. Results Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. Conclusions Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged

  20. Improving neurosurgical communication and reducing risk and registrar burden using a novel online database referral platform.

    Science.gov (United States)

    Matloob, Samir A; Hyam, Jonathan A; Thorne, Lewis; Bradford, Robert

    2016-01-01

    Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. During a 14-day period, number of bleeps, missed bleeps, calls discussing new referrals and previously processed referrals were recorded. Whether new referrals were appropriately documented and referrers received a written response was also recorded. A commercially provided secure cloud-based data archiving telecommunications and database platform for referrals was subsequently introduced within the Trust and the questionnaire repeated during another 14-day period 1 year after implementation. Missed bleeps per day reduced from 16% (SD ± 6.4%) to 9% (SD ± 4.8%; df = 13, paired t-tests p = 0.007) and mean calls per day clarifying previous referrals reduced from 10 (SD ± 4) to 5 (SD ± 3.5; df = 13, p = 0.003). Documentation of new referrals increased from 43% (74/174) to 85% (181/210), and responses to referrals increased from 74% to 98%. The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.

  1. Compliance with referral of sick children: a survey in five districts of Afghanistan

    Directory of Open Access Journals (Sweden)

    Newbrander William

    2012-04-01

    Full Text Available Abstract Background Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers’ compliance with referral of sick children to higher-level health facilities in Afghanistan. Methods The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI, or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance. Results The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs, especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies. Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28, most families (63% who went to the referral site walked and hence paid nothing. Most caretakers (75% complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers’ compliance with referral. Conclusions Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.

  2. Compliance with referral of sick children: a survey in five districts of Afghanistan.

    Science.gov (United States)

    Newbrander, William; Ickx, Paul; Werner, Robert; Mujadidi, Farooq

    2012-04-27

    Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers' compliance with referral of sick children to higher-level health facilities in Afghanistan. The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI), or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance. The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs), especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer) than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies). Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28), most families (63%) who went to the referral site walked and hence paid nothing. Most caretakers (75%) complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers' compliance with referral. Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.

  3. Coordinated renewable energy support schemes

    DEFF Research Database (Denmark)

    Morthorst, P.E.; Jensen, S.G.

    2006-01-01

    . The first example covers countries with regional power markets that also regionalise their support schemes, the second countries with separate national power markets that regionalise their support schemes. The main findings indicate that the almost ideal situation exists if the region prior to regionalising...

  4. CANONICAL BACKWARD DIFFERENTIATION SCHEMES FOR ...

    African Journals Online (AJOL)

    This paper describes a new nonlinear backward differentiation schemes for the numerical solution of nonlinear initial value problems of first order ordinary differential equations. The schemes are based on rational interpolation obtained from canonical polynomials. They are A-stable. The test problems show that they give ...

  5. Correlates of oncologist-issued referrals for psycho-oncology services: what we learned from the electronic voluntary screening and referral system for depression (eVSRS-D).

    Science.gov (United States)

    Lee, Joo-Young; Jung, Dooyoung; Kim, Won-Hyoung; Lee, Hyuk-Joon; Noh, Dong-Young; Hahm, Bong-Jin

    2016-02-01

    Depression in cancer patients is under-recognized and under-treated. To better identify depression, we designed a voluntary depression screening system. Based on its data, we examined trends in oncologist-issued referrals for the psycho-oncology service (POS). The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprises self-screening, automated reporting, and referral guidance. Using touch-screen kiosks at a tertiary hospital in Korea, participants with cancer completed the Patient Health Questionnaire-9 at their convenience, received the results, and reported their willingness to participate in POS. At oncology appointments, oncologists received the screening reports and issued referrals following pre-recommended guidelines. The correlates of actual referrals were examined across all participants and within the willing and non-willing groups. Among the 838 participants, 56.3% reported severe depression symptoms, 30.5% wanted a referral, and 14.8% were actually referred. The correlates of participants' desire for referral were more severe depression symptoms, being unmarried, and being metastasis and recurrence free. Among all participants, the correlates of actual referrals were unemployment, less severe depression symptoms, poorer performance, treatment status, and wanting a referral. The sole correlate of actual referrals within the non-willing group was poorer performance, and no significant correlates existed within the willing group. The non-referrals were mostly (87.1%) because of postponed decisions. The eVSRS-D cannot definitively diagnose major depression but may efficiently self-select a population with significant depression symptoms. The patients' willingness to engage the POS most strongly predicted the actual referrals. Oncologist reviews of screening reports may not result in further depression severity-specific referrals. Copyright © 2015 John Wiley & Sons, Ltd.

  6. The impact of a change in referral pathway on a paediatric short-stay ...

    African Journals Online (AJOL)

    healthcare systems in certain regions of SA. ... Care Unit owing to incorrect use of referral pathways or during ... Due to budget constraints, limited resources .... Hospital. Home. Primary care clinic. Fig. 2. Origin of referral for each SD for 2011.

  7. Appropriate diagnostic imaging - Assessment of the quality of referrals from general practice

    DEFF Research Database (Denmark)

    Andersen, Merethe Kirstine Kousgaard; Torfing, Trine; Ulrichsen, Walther

    and MRI regarding musculoskeletal issues. The reviews were conducted according to a preformed registration schema. Themes for the survey were: Relevance of referral, relevance of chosen modality, exhaustiveness of referral information, relevance of information and eventual suggestions for a more relevant......-scanning was the most relevant (87%). Overall, referral information was relevant in 80% of the cases, and most relevant in referrals to x-ray (87%). In 9.5% of referrals the chosen modality was not the optimal, which was most pronounced for ultrasound referrals (13%). Referral information was most insufficient...... regarding MRI, where 56.4% of information was described as less insufficient/insufficient. It was a frequent notation, that there was too much irrelevant information, which was ascribed to copy-paste from the general practitioners’ records. Conclusion A majority of referrals from general practice...

  8. When your words count: a discriminative model to predict approval of referrals

    Directory of Open Access Journals (Sweden)

    Adol Esquivel

    2009-12-01

    Conclusions Three iterations of the model correctly predicted at least 75% of the approved referrals in the validation set. A correct prediction of whether or not a referral will be approved can be made in three out of four cases.

  9. A Review Of Referral Patterns For Sagittal Synostosis In Ireland: 2008-2013

    LENUS (Irish Health Repository)

    Berney, M J

    2018-01-01

    Sagittal synostosis (SS) is the commonest form of craniosynostosis. Children with sagittal synostosis in Ireland are treated in the National Paediatric Craniofacial Centre (NPCC) in Temple Street Children’s University Hospital. This retrospective study analysed the correlation between referral patterns to the unit and age at operation. The notes of 81 patients referred over a 5 year period (April 2008 – April 2013) to the NPCC with non-syndromic SS were reviewed and demographics and referral information were recorded. Of 81 patients reviewed, 60 (74%) were referred before 6 months of age, while 21 (26%) had late referrals. Neonatologists referred 100% of infants before 6 months, paediatricians referred 71%, and GPs 64%. Later referral was associated with a more complex referral pathway, including multiple-steps of referral and unnecessary investigations. Improved clinician knowledge and emphasis on the importance of early referral may lead to a reduction in late referrals.

  10. Analyses of resource reservation schemes for optical burst switching networks

    Science.gov (United States)

    Solanska, Michaela; Scholtz, Lubomir; Ladanyi, Libor; Mullerova, Jarmila

    2017-12-01

    With growing demands of Internet Protocol services for transmission capacity and speed, the Optical Burst Switching presents the solution for future high-speed optical networks. Optical Burst Switching is a technology for transmitting large amounts of data bursts through a transparent optical switching network. To successfully transmit bursts over OBS network and reach the destination node, resource reservation schemes have to be implemented to allocate resources and configure optical switches for that burst at each node. The one-way resource reservation schemes and the performance evaluation of reservation schemes are presented. The OBS network model is performed using OMNeT++ simulation environment. During the reservation of network resources, the optical cross-connect based on semiconductor optical amplifier is used as the core node. Optical switches based on semiconductor optical amplifiers are a promising technology for high-speed optical communication networks.

  11. Implicit Block ACK Scheme for IEEE 802.11 WLANs

    Science.gov (United States)

    Sthapit, Pranesh; Pyun, Jae-Young

    2016-01-01

    The throughput of IEEE 802.11 standard is significantly bounded by the associated Medium Access Control (MAC) overhead. Because of the overhead, an upper limit exists for throughput, which is bounded, including situations where data rates are extremely high. Therefore, an overhead reduction is necessary to achieve higher throughput. The IEEE 802.11e amendment introduced the block ACK mechanism, to reduce the number of control messages in MAC. Although the block ACK scheme greatly reduces overhead, further improvements are possible. In this letter, we propose an implicit block ACK method that further reduces the overhead associated with IEEE 802.11e’s block ACK scheme. The mathematical analysis results are presented for both the original protocol and the proposed scheme. A performance improvement of greater than 10% was achieved with the proposed implementation.

  12. Vertical Protocol Composition

    DEFF Research Database (Denmark)

    Groß, Thomas; Mödersheim, Sebastian Alexander

    2011-01-01

    The security of key exchange and secure channel protocols, such as TLS, has been studied intensively. However, only few works have considered what happens when the established keys are actually used—to run some protocol securely over the established “channel”. We call this a vertical protocol.......e., that the combination cannot introduce attacks that the individual protocols in isolation do not have. In this work, we prove a composability result in the symbolic model that allows for arbitrary vertical composition (including self-composition). It holds for protocols from any suite of channel and application...

  13. Referrals to a regional allergy clinic - an eleven year audit

    Directory of Open Access Journals (Sweden)

    Hewson Paul

    2010-12-01

    Full Text Available Abstract Background Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i differences over time and by demographics, (ii types of allergy, (iii co-occurrence, and (iv spatial distributions. Methods Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. Results Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65% than males. Airborne allergies were the most frequent (623, and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410 patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142 had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg. There were age differences by types of allergy; people referred with food allergies were

  14. Eavesdropping on the two-way quantum communication protocols with invisible photons

    Energy Technology Data Exchange (ETDEWEB)

    Cai Qingyu [State Key Laboratory of Magnetics Resonance and Atomic and Molecular Physics, Wuhan Institution of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China)]. E-mail: qycai@wipm.ac.cn

    2006-02-20

    The crucial issue of quantum communication protocol is its security. In this Letter, we show that all the deterministic and direct two-way quantum communication protocols, sometimes called ping-pong (PP) protocols, are insecure when an eavesdropper uses the invisible photon to eavesdrop on the communication. With our invisible photon eavesdropping (IPE) scheme, the eavesdropper can obtain full information of the communication with zero risk of being detected. We show that this IPE scheme can be implemented experimentally with current technology. Finally, a possible improvement of PP communication protocols security is proposed00.

  15. Eavesdropping on the two-way quantum communication protocols with invisible photons

    International Nuclear Information System (INIS)

    Cai Qingyu

    2006-01-01

    The crucial issue of quantum communication protocol is its security. In this Letter, we show that all the deterministic and direct two-way quantum communication protocols, sometimes called ping-pong (PP) protocols, are insecure when an eavesdropper uses the invisible photon to eavesdrop on the communication. With our invisible photon eavesdropping (IPE) scheme, the eavesdropper can obtain full information of the communication with zero risk of being detected. We show that this IPE scheme can be implemented experimentally with current technology. Finally, a possible improvement of PP communication protocols security is proposed

  16. Pulmonary hypertension: Real-world data from a Portuguese expert referral centre.

    Science.gov (United States)

    Gomes, A; Cruz, C; Rocha, J; Ricardo, M; Vicente, M; Melo, A; Santos, M; Carvalho, L; Gonçalves, F; Reis, A

    2018-04-16

    Pulmonary hypertension (PH) is a heterogeneous, debilitating condition with highly relevant impact on functional capacity, quality of life, and life-expectancy. This study aims to provide long-term data on the Portuguese PH population, by characterising the clinical presentation, evolution, and outcomes of PH patients in a specialised referral centre. Retrospective analysis of a cohort of 101 patients with pre-capillary PH (pcPH) referenced to an expert tertiary care referral centre in northern Portugal from 2002 to 2013. Diagnosis was confirmed by right heart catheterisation (RHC). PH classification followed consensus criteria from the 5th World Symposium in Nice, 2013. The most frequent causes of pcPH were Group 1 PH - pulmonary arterial hypertension (PAH) (54.4%) and Group 4 PH - Chronic thromboembolic pulmonary hypertension (CTEPH) (25.7%); importantly, 17.8% of patients presented PH associated with multiple aetiologies. Targeted therapy was used in 91.1% of patients (48.5% combination therapy). 1-, 3-, and 5-year survival was estimated at 86.6%, 76.7%, and 64.1%, respectively. Survival was significantly better for those ≤40 years old (10.5 vs. 6.4 years; P=0.003) and for women with I/HPAH (9.3 vs. 4.5 years; P=0.039). This study provides long-term, real-world data for the management of PAH and CTEPH in Portugal and demonstrates the importance of dedicated electronic medical records and well defined clinical management protocols for better patient outcomes. Patients presented mostly with intermediate or high risk of mortality, which suggests delayed diagnosis and highlights the need to increase awareness among clinicians. Copyright © 2018 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  17. BSEA: A Blind Sealed-Bid E-Auction Scheme for E-Commerce Applications

    Directory of Open Access Journals (Sweden)

    Rohit Kumar Das

    2016-12-01

    Full Text Available Due to an increase in the number of internet users, electronic commerce has grown significantly during the last decade. Electronic auction (e-auction is one of the famous e-commerce applications. Even so, security and robustness of e-auction schemes still remain a challenge. Requirements like anonymity and privacy of the b i d value are under threat from the attackers. Any auction protocol must not leak the anonymity and the privacy of the b i d value of an honest Bidder. Keeping these requirements in mind, we have firstly proposed a controlled traceable blind signature scheme (CTBSS because e-auction schemes should be able to trace the Bidders. Using CTBSS, a blind sealed-bid electronic auction scheme is proposed (BSEA. We have incorporated the notion of blind signature to e-auction schemes. Moreover, both the schemes are based upon elliptic curve cryptography (ECC, which provides a similar level of security with a comparatively smaller key size than the discrete logarithm problem (DLP based e-auction protocols. The analysis shows that BSEA fulfills all the requirements of e-auction protocol, and the total computation overhead is lower than the existing schemes.

  18. Network-topology-adaptive quantum conference protocols

    International Nuclear Information System (INIS)

    Zhang Sheng; Wang Jian; Tang Chao-Jing; Zhang Quan

    2011-01-01

    As an important application of the quantum network communication, quantum multiparty conference has made multiparty secret communication possible. Previous quantum multiparty conference schemes based on quantum data encryption are insensitive to network topology. However, the topology of the quantum network significantly affects the communication efficiency, e.g., parallel transmission in a channel with limited bandwidth. We have proposed two distinctive protocols, which work in two basic network topologies with efficiency higher than the existing ones. We first present a protocol which works in the reticulate network using Greeberger—Horne—Zeilinger states and entanglement swapping. Another protocol, based on quantum multicasting with quantum data compression, which can improve the efficiency of the network, works in the star-like network. The security of our protocols is guaranteed by quantum key distribution and one-time-pad encryption. In general, the two protocols can be applied to any quantum network where the topology can be equivalently transformed to one of the two structures we propose in our protocols. (general)

  19. 75 FR 50880 - TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy

    Science.gov (United States)

    2010-08-18

    ... 0720-AB36 TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech... referrals of beneficiaries to the Military Health System for physical therapy, occupational therapy, and... practitioners will be allowed to issue referrals to patients for physical therapy, occupational therapy, and...

  20. Comparison of patient referral processes between rural and urban health facilities in Liberia

    Directory of Open Access Journals (Sweden)

    J. Kim*

    2013-12-01

    Conclusions: Patient referral systems in Liberia are relatively unsystematic. While formal and informal mechanisms for referrals exist at both rural and urban health facilities, establishing guidelines for referral care practices and transportation strategies tailored to each of these settings will help to strengthen the healthcare system as a whole.

  1. 6 CFR 11.13 - Referrals to the Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection will...

  2. 22 CFR 304.9 - Referral to the Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of Justice...

  3. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive of...

  4. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.953 Minimum amount of referrals to the Department of Justice. (a) Except as otherwise provided in paragraphs...

  5. 10 CFR 15.67 - Referral to the Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Referral to the Department of Justice. 15.67 Section 15.67 Energy NUCLEAR REGULATORY COMMISSION DEBT COLLECTION PROCEDURES Referral of a Claim § 15.67 Referral to the Department of Justice. (a) Unless excepted by DOJ, the NRC shall complete the CCLR accompanied by...

  6. Audit of Referrals to an Ophthalmic Outpatient Clinic of a Tertiary ...

    African Journals Online (AJOL)

    Objectives: To determine the referral pattern and assess the quality and accuracy of referral letters to the ophthalmic outpatient clinic of University of Nigeria Teaching Hospital, Enugu. Methods: This study is a prospective cross-sectional survey of all new ophthalmic referrals to the ophthalmic outpatient clinic at University of ...

  7. PHACK: An Efficient Scheme for Selective Forwarding Attack Detection in WSNs

    Directory of Open Access Journals (Sweden)

    Anfeng Liu

    2015-12-01

    Full Text Available In this paper, a Per-Hop Acknowledgement (PHACK-based scheme is proposed for each packet transmission to detect selective forwarding attacks. In our scheme, the sink and each node along the forwarding path generate an acknowledgement (ACK message for each received packet to confirm the normal packet transmission. The scheme, in which each ACK is returned to the source node along a different routing path, can significantly increase the resilience against attacks because it prevents an attacker from compromising nodes in the return routing path, which can otherwise interrupt the return of nodes’ ACK packets. For this case, the PHACK scheme also has better potential to detect abnormal packet loss and identify suspect nodes as well as better resilience against attacks. Another pivotal issue is the network lifetime of the PHACK scheme, as it generates more acknowledgements than previous ACK-based schemes. We demonstrate that the network lifetime of the PHACK scheme is not lower than that of other ACK-based schemes because the scheme just increases the energy consumption in non-hotspot areas and does not increase the energy consumption in hotspot areas. Moreover, the PHACK scheme greatly simplifies the protocol and is easy to implement. Both theoretical and simulation results are given to demonstrate the effectiveness of the proposed scheme in terms of high detection probability and the ability to identify suspect nodes.

  8. hybrid modulation scheme fo rid modulation scheme fo dulation

    African Journals Online (AJOL)

    eobe

    control technique is done through simulations and ex control technique .... HYBRID MODULATION SCHEME FOR CASCADED H-BRIDGE INVERTER CELLS. C. I. Odeh ..... and OR operations. Referring to ... MATLAB/SIMULINK environment.

  9. BVS: A Lightweight Forward and Backward Secure Scheme for PMU Communications in Smart Grid

    Directory of Open Access Journals (Sweden)

    Wei Ren

    2011-01-01

    Full Text Available In smart grid, phaser measurement units (PMUs can upload readings to utility centers via supervisory control and data acquisition (SCADA or energy management system (EMS to enable intelligent controlling and scheduling. It is critical to maintain the secrecy of readings so as to protect customers' privacy, together with integrity and source authentication for the reliability and stability of power scheduling. In particular, appealing security scheme needs to perform well in PMUs that usually have computational resource constraints, thus designed security protocols have to remain lightweight in terms of computation and storage. In this paper, we propose a family of schemes to solve this problem. They are public key based scheme (PKS, password based scheme (PWS and billed value-based scheme (BVS. BVS can achieve forward and backward security and only relies on hash functions. Security analysis justifies that the proposed schemes, especially BVS, can attain the security goals with low computation and storage cost.

  10. A User Authentication Scheme Based on Elliptic Curves Cryptography for Wireless Ad Hoc Networks.

    Science.gov (United States)

    Chen, Huifang; Ge, Linlin; Xie, Lei

    2015-07-14

    The feature of non-infrastructure support in a wireless ad hoc network (WANET) makes it suffer from various attacks. Moreover, user authentication is the first safety barrier in a network. A mutual trust is achieved by a protocol which enables communicating parties to authenticate each other at the same time and to exchange session keys. For the resource-constrained WANET, an efficient and lightweight user authentication scheme is necessary. In this paper, we propose a user authentication scheme based on the self-certified public key system and elliptic curves cryptography for a WANET. Using the proposed scheme, an efficient two-way user authentication and secure session key agreement can be achieved. Security analysis shows that our proposed scheme is resilient to common known attacks. In addition, the performance analysis shows that our proposed scheme performs similar or better compared with some existing user authentication schemes.

  11. Distributed protocols for digital signatures and public key encryption.

    OpenAIRE

    Kuchta, Veronika

    2016-01-01

    Distributed protocols allow a cryptographic scheme to distribute its operation among a group of participants (servers). This new concept of cryptosystems was introduced by Desmedt [56]. We consider two different flavours of distributed protocols. One of them considers a distributed model with n parties where all of these parties are honest. The other allows up to t − 1 parties to be faulty. Such cryptosystems are called threshold cryptosystems. The distribution of cryptographic process is ...

  12. Development of a Single Locus Sequence Typing (SLST) Scheme for Typing Bacterial Species Directly from Complex Communities.

    Science.gov (United States)

    Scholz, Christian F P; Jensen, Anders

    2017-01-01

    The protocol describes a computational method to develop a Single Locus Sequence Typing (SLST) scheme for typing bacterial species. The resulting scheme can be used to type bacterial isolates as well as bacterial species directly from complex communities using next-generation sequencing technologies.

  13. Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre.

    Science.gov (United States)

    Künkele, Annette; Wilm, Josephine; Holdt, Markus; Lohmann, Dietmar; Bornfeld, Norbert; Eggert, Angelika; Temming, Petra; Schulte, Johannes H

    2015-07-01

    Retinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk factors are used worldwide. Between 1997 and 2009, 420 children were diagnosed with retinoblastoma at the German Retinoblastoma Referral Centre and risk factors were assessed. Patients with post-laminar optic nerve infiltration or choroid or minor scleral invasion received six courses of adjuvant chemotherapy using vincristine, etoposide, carboplatin and cyclophosphamide (group 1). Patients with microscopic extension beyond the sclera to the resection margin of the optic nerve or potential spread due to vitrectomy received chemotherapy plus orbital radiotherapy (group 2). Neoadjuvant chemotherapy was performed in patients with local extraocular invasion detected on MRI. Following this protocol, 42 of the 420 patients and 21 referred from other centres showed high-risk histopathological factors qualifying for adjuvant therapy (57 in group 1 and 6 in group 2). Seven of the 63 patients received neoadjuvant and adjuvant treatment. During a mean follow-up of 5.8 (range 0.4-15.4) years, one of six patients in group 2 developed metastases and died. No patients died from toxicity. The 5-year overall survival was 100% for group 1 and 80% for group 2. This retrospective single-site study reveals a 10% incidence of high-risk features in children with retinoblastoma diagnosed at the German Retinoblastoma Referral Centre. Overall survival rates of 98.3% underline the safety of this adjuvant chemotherapy protocol and its efficiency in preventing metastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Patient factors in referral choice for total joint replacement surgery.

    Science.gov (United States)

    Conner-Spady, Barbara L; Marshall, Deborah A; Bohm, Eric; Dunbar, Michael J; Loucks, Lynda; Hennigar, Allan W; Frank, Cy; Noseworthy, Tom W

    2014-04-01

    Although the option of next available surgeon can be found on surgeon referral forms for total joint replacement surgery, its selection varies across surgical practices. Objectives are to assess the determinants of (a) a patient's request for a particular surgeon; and (b) the actual referral to a specific versus the next available surgeon. Questionnaires were mailed to 306 consecutive patients referred to orthopedic surgeons. We assessed quality of life (Oxford Hip and Knee scores, Short Form-12, EuroQol 5D, Pain Visual Analogue Scale), referral experience, and the importance of surgeon choice, surgeon reputation, and wait time. We used logistic regression to build models for the 2 objectives. We obtained 176 respondents (response rate, 58%), 60% female, 65% knee patients, mean age of 65 years, with no significant differences between responders versus nonresponders. Forty-three percent requested a particular surgeon. Seventy-one percent were referred to a specific surgeon. Patients who rated surgeon choice as very/extremely important [adjusted odds ratio (OR), 6.54; 95% confidence interval (CI), 2.57-16.64] and with household incomes of $90,000+ versus <$30,000 (OR, 5.74; 95% CI, 1.56-21.03) were more likely to request a particular surgeon. Hip patients (OR, 3.03; 95% CI, 1.18-7.78), better Physical Component Summary-12 (OR, 1.29; 95% CI, 1.02-1.63), and patients who rated surgeon choice as very/extremely important (OR, 3.88; 95% CI, 1.56-9.70) were more likely to be referred to a specific surgeon. Most patients want some choice in the referral decision. Providing sufficient information is important, so that patients are aware of their choices and can make an informed choice. Some patients prefer a particular surgeon despite longer wait times.

  15. Does accessibility to antiretroviral care improve after down-referral ...

    African Journals Online (AJOL)

    Down-referral was associated with reduced transportation and meal costs (p ≤ 0.001) and travel time to an ART facility (p = 0.043). The down-referred users were less likely to complain of long queues (adjusted odds ratio [AOR] 0.06; 95% confidence interval [95% CI]: 0.01–0.29), were more likely to feel respected by health ...

  16. Bridging the care continuum: patient information needs for specialist referrals

    Directory of Open Access Journals (Sweden)

    Steltenkamp Carol L

    2009-09-01

    Full Text Available Abstract Background Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians. Methods Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base. Results Most patients (85% received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management. Conclusion Preparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.

  17. Secure Multi-Player Protocols

    DEFF Research Database (Denmark)

    Fehr, Serge

    While classically cryptography is concerned with the problem of private communication among two entities, say players, in modern cryptography multi-player protocols play an important role. And among these, it is probably fair to say that secret sharing, and its stronger version verifiable secret...... sharing (VSS), as well as multi-party computation (MPC) belong to the most appealing and/or useful ones. The former two are basic tools to achieve better robustness of cryptographic schemes against malfunction or misuse by “decentralizing” the security from one single to a whole group of individuals...... (captured by the term threshold cryptography). The latter allows—at least in principle—to execute any collaboration among a group of players in a secure way that guarantees the correctness of the outcome but simultaneously respects the privacy of the participants. In this work, we study three aspects...

  18. The ‘wild and woolly’ world of exercise referral schemes: contested interpretations of an exercise as medicine programme

    DEFF Research Database (Denmark)

    Henderson, Hannah; Evans, Adam Brian; Allen-Collinson, Jacquelyn

    2017-01-01

    conflicting and inconsistent stakeholder accounts within and across groups, suggesting participants attached specific, interdependent and sometimes contradictory meanings to ERS. This created conflict and generated interesting unintended consequences. Perceived divisions between strategic and local levels...... insights into the meanings attached to ERS, and their contestation through service delivery models. Thematic analysis generated salient themes regarding divergent interpretations of ERS goals, and conflict within both service delivery pathways and perceptions of programme impact. Data highlighted...

  19. The ‘wild and woolly’ world of exercise referral schemes: contested interpretations of an exercise as medicine programme

    DEFF Research Database (Denmark)

    Henderson, Hannah; Evans, Adam Brian; Allen-Collinson, Jacquelyn

    2018-01-01

    conflicting and inconsistent stakeholder accounts within and across groups, suggesting participants attached specific, interdependent and sometimes contradictory meanings to ERS. This created conflict and generated interesting unintended consequences. Perceived divisions between strategic and local levels...... insights into the meanings attached to ERS, and their contestation through service delivery models. Thematic analysis generated salient themes regarding divergent interpretations of ERS goals, and conflict within both service delivery pathways and perceptions of programme impact. Data highlighted...

  20. Referrals for pediatric weight management: the importance of proximity

    Directory of Open Access Journals (Sweden)

    Hagedorn Douglas WJ

    2010-11-01

    Full Text Available Abstract Background Limited access to weight management care can have a negative impact on the health and well-being of obese children and youth. Our objectives were to describe the characteristics of clients referred to a pediatric weight management centre and explore potential differences according to proximity. Methods All demographic and anthropometric data were abstracted from standardized, one-page referral forms, which were received by a pediatric weight management centre in Edmonton, AB (Canada between April, 2005 and April, 2009. Results Referrals (n = 555; 52% male; age [mean +/- standard deviation]: 12.4 +/- 2.6 y; BMI: 32.3 +/- 6.8 kg/m2; BMI percentile: 98.4 +/- 1.7; BMI z-score: 2.3 +/- 0.4 were received from 311 physicians. Approximately 95% of referrals were for boys and girls classified as obese or very obese. Based on postal code data, individuals were dichotomized as either living within (local; n = 455 or beyond (distant; n = 100 the Edmonton Census Metropolitan Area. Numerous families resided several hundred kilometres away from our centre. Overall, distant clients were taller, weighed more, and were more overweight than their local counterparts. For distant clients, the degree of overweight was higher in youth versus children. Conclusion Pediatric weight management services must be designed to optimize access to health services, especially for distant clients who may be at increased obesity-related health risk.

  1. Aperture referral in dioptric systems with stigmatic elements

    Directory of Open Access Journals (Sweden)

    W. F. Harris

    2012-12-01

    Full Text Available A previous paper develops the general theory of aperture referral in linear optics and shows how several ostensibly distinct concepts, including the blur patch on the retina, the effective corneal patch, the projective field and the field of view, are now unified as particular applications of the general theory.  The theory allows for astigmatism and heterocentricity.  Symplecticity and the generality of the approach, however, make it difficult to gain insight and mean that the material is not accessible to readers unfamiliar with matrices and linear algebra. The purpose of this paper is to examine whatis, perhaps, the most important special case, that in which astigmatism is ignored.  Symplecticity and, hence, the mathematics become greatly simplified. The mathematics reduces largely to elementary vector algebra and, in some places, simple scalar algebra and yet retains the mathematical form of the general approach.  As a result the paper allows insight into and provides a stepping stone to the general theory.  Under referral an aperture under-goes simple scalar magnification and transverse translation.  The paper pays particular attention to referral to transverse planes in the neighbourhood of a focal point where the magnification may be positive, zero or negative.  Circular apertures are treated as special cases of elliptical apertures and the meaning of referred apertures of negative radius is explained briefly. (S Afr Optom 2012 71(1 3-11

  2. Second opinion oral pathology referrals in New Zealand.

    Science.gov (United States)

    Seo, B; Hussaini, H M; Rich, A M

    2017-04-01

    Referral for a second opinion is an important aspect of pathology practice, which reduces the rate of diagnostic error and ensures consistency with diagnoses. The Oral Pathology Centre (OPC) is the only specialist oral diagnostic centre in New Zealand. OPC provides diagnostic services to dentists and dental specialists throughout New Zealand and acts as a referral centre for second opinions for oral pathology specimens that have been sent to anatomical pathologists. The aim of this study was to review second opinion referral cases sent to the OPC over a 15-year period and to assess the levels of concordance between the original and final diagnoses. The findings indicated that the majority of referred cases were odontogenic lesions, followed by connective tissue, epithelial and salivary lesions. The most prevalent diagnoses were ameloblastoma and keratocystic odontogenic tumour, followed by oral squamous cell carcinoma. Discordant diagnoses were recorded in 24% of cases. Diagnostic discrepancies were higher in odontogenic and salivary gland lesions, resulting in the change of diagnoses. Second opinion of oral pathology cases should be encouraged in view of the relative rarity of these lesions in general pathology laboratories and the rates of diagnostic discrepancy, particularly for odontogenic and salivary gland lesions. Copyright © 2017 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.

  3. A slotted access control protocol for metropolitan WDM ring networks

    Science.gov (United States)

    Baziana, P. A.; Pountourakis, I. E.

    2009-03-01

    In this study we focus on the serious scalability problems that many access protocols for WDM ring networks introduce due to the use of a dedicated wavelength per access node for either transmission or reception. We propose an efficient slotted MAC protocol suitable for WDM ring metropolitan area networks. The proposed network architecture employs a separate wavelength for control information exchange prior to the data packet transmission. Each access node is equipped with a pair of tunable transceivers for data communication and a pair of fixed tuned transceivers for control information exchange. Also, each access node includes a set of fixed delay lines for synchronization reasons; to keep the data packets, while the control information is processed. An efficient access algorithm is applied to avoid both the data wavelengths and the receiver collisions. In our protocol, each access node is capable of transmitting and receiving over any of the data wavelengths, facing the scalability issues. Two different slot reuse schemes are assumed: the source and the destination stripping schemes. For both schemes, performance measures evaluation is provided via an analytic model. The analytical results are validated by a discrete event simulation model that uses Poisson traffic sources. Simulation results show that the proposed protocol manages efficient bandwidth utilization, especially under high load. Also, comparative simulation results prove that our protocol achieves significant performance improvement as compared with other WDMA protocols which restrict transmission over a dedicated data wavelength. Finally, performance measures evaluation is explored for diverse numbers of buffer size, access nodes and data wavelengths.

  4. Good governance for pension schemes

    CERN Document Server

    Thornton, Paul

    2011-01-01

    Regulatory and market developments have transformed the way in which UK private sector pension schemes operate. This has increased demands on trustees and advisors and the trusteeship governance model must evolve in order to remain fit for purpose. This volume brings together leading practitioners to provide an overview of what today constitutes good governance for pension schemes, from both a legal and a practical perspective. It provides the reader with an appreciation of the distinctive characteristics of UK occupational pension schemes, how they sit within the capital markets and their social and fiduciary responsibilities. Providing a holistic analysis of pension risk, both from the trustee and the corporate perspective, the essays cover the crucial role of the employer covenant, financing and investment risk, developments in longevity risk hedging and insurance de-risking, and best practice scheme administration.

  5. Optimum RA reactor fuelling scheme

    International Nuclear Information System (INIS)

    Strugar, P.; Nikolic, V.

    1965-10-01

    Ideal reactor refueling scheme can be achieved only by continuous fuel elements movement in the core, which is not possible, and thus approximations are applied. One of the possible approximations is discontinuous movement of fuel elements groups in radial direction. This enables higher burnup especially if axial exchange is possible. Analysis of refueling schemes in the RA reactor core and schemes with mixing the fresh and used fuel elements show that 30% higher burnup can be achieved by applying mixing, and even 40% if reactivity due to decrease in experimental space is taken into account. Up to now, mean burnup of 4400 MWd/t has been achieved, and the proposed fueling scheme with reduction of experimental space could achieve mean burnup of 6300 MWd/t which means about 25 Mwd/t per fuel channel [sr

  6. A Novel Iris Segmentation Scheme

    Directory of Open Access Journals (Sweden)

    Chen-Chung Liu

    2014-01-01

    Full Text Available One of the key steps in the iris recognition system is the accurate iris segmentation from its surrounding noises including pupil, sclera, eyelashes, and eyebrows of a captured eye-image. This paper presents a novel iris segmentation scheme which utilizes the orientation matching transform to outline the outer and inner iris boundaries initially. It then employs Delogne-Kåsa circle fitting (instead of the traditional Hough transform to further eliminate the outlier points to extract a more precise iris area from an eye-image. In the extracted iris region, the proposed scheme further utilizes the differences in the intensity and positional characteristics of the iris, eyelid, and eyelashes to detect and delete these noises. The scheme is then applied on iris image database, UBIRIS.v1. The experimental results show that the presented scheme provides a more effective and efficient iris segmentation than other conventional methods.

  7. Numerical schemes for explosion hazards

    International Nuclear Information System (INIS)

    Therme, Nicolas

    2015-01-01

    In nuclear facilities, internal or external explosions can cause confinement breaches and radioactive materials release in the environment. Hence, modeling such phenomena is crucial for safety matters. Blast waves resulting from explosions are modeled by the system of Euler equations for compressible flows, whereas Navier-Stokes equations with reactive source terms and level set techniques are used to simulate the propagation of flame front during the deflagration phase. The purpose of this thesis is to contribute to the creation of efficient numerical schemes to solve these complex models. The work presented here focuses on two major aspects: first, the development of consistent schemes for the Euler equations, then the buildup of reliable schemes for the front propagation. In both cases, explicit in time schemes are used, but we also introduce a pressure correction scheme for the Euler equations. Staggered discretization is used in space. It is based on the internal energy formulation of the Euler system, which insures its positivity and avoids tedious discretization of the total energy over staggered grids. A discrete kinetic energy balance is derived from the scheme and a source term is added in the discrete internal energy balance equation to preserve the exact total energy balance at the limit. High order methods of MUSCL type are used in the discrete convective operators, based solely on material velocity. They lead to positivity of density and internal energy under CFL conditions. This ensures that the total energy cannot grow and we can furthermore derive a discrete entropy inequality. Under stability assumptions of the discrete L8 and BV norms of the scheme's solutions one can prove that a sequence of converging discrete solutions necessarily converges towards the weak solution of the Euler system. Besides it satisfies a weak entropy inequality at the limit. Concerning the front propagation, we transform the flame front evolution equation (the so called

  8. Evaluation of cardiovascular risk-lowering health benefits accruing from laboratory-based, community-based and exercise-referral exercise programmes.

    Science.gov (United States)

    Webb, R; Thompson, J E S; Ruffino, J-S; Davies, N A; Watkeys, L; Hooper, S; Jones, P M; Walters, G; Clayton, D; Thomas, A W; Morris, K; Llewellyn, D H; Ward, M; Wyatt-Williams, J; McDonnell, B J

    2016-01-01

    To evaluate the ability of community-based exercise programmes to facilitate public participation in exercise and hence improved cardiovascular health, we assessed the respective impacts of: a continuously monitored exercise programme based within our university (study 1); a Valleys Regional Park-facilitated community-based outdoor exercise programme (study 2); a Wales National Exercise Referral Scheme-delivered exercise-referral programme (study 3). Biomolecular (monocytic PPARγ target gene expression), vascular haemodynamic (central/peripheral blood pressure, arterial stiffness), clinical (insulin sensitivity, blood lipids) and anthropometric (body mass index, waist circumference, heart rate) parameters were investigated using RT-PCR, applanation tonometry, chemical analysis and standard anthropometric techniques. In studies 1-3, 22/28, 32/65 and 11/14 participants adhered to their respective exercise programmes, and underwent significant increases in physical activity levels. Importantly, beneficial effects similar to those seen in our previous studies (eg, modulations in expression of monocytic PPARγ target genes, decreases in blood pressure/arterial stiffness, improvements in blood lipids/insulin sensitivity) were observed (albeit to slightly differing extents) only in participants who adhered to their respective exercise programmes. While study 1 achieved more intense exercise and more pronounced beneficial effects, significant cardiovascular risk-lowering health benefits related to biomolecular markers, blood pressure, arterial stiffness and blood lipids were achieved via community/referral-based delivery modes in studies 2 and 3. Because cardiovascular health benefits were observed in all 3 studies, we conclude that the majority of benefits previously reported in laboratory-based studies can also be achieved in community-based/exercise-referral settings. These findings may be of use in guiding policymakers with regard to introduction and/or continued

  9. Breeding schemes in reindeer husbandry

    Directory of Open Access Journals (Sweden)

    Lars Rönnegård

    2003-04-01

    Full Text Available The objective of the paper was to investigate annual genetic gain from selection (G, and the influence of selection on the inbreeding effective population size (Ne, for different possible breeding schemes within a reindeer herding district. The breeding schemes were analysed for different proportions of the population within a herding district included in the selection programme. Two different breeding schemes were analysed: an open nucleus scheme where males mix and mate between owner flocks, and a closed nucleus scheme where the males in non-selected owner flocks are culled to maximise G in the whole population. The theory of expected long-term genetic contributions was used and maternal effects were included in the analyses. Realistic parameter values were used for the population, modelled with 5000 reindeer in the population and a sex ratio of 14 adult females per male. The standard deviation of calf weights was 4.1 kg. Four different situations were explored and the results showed: 1. When the population was randomly culled, Ne equalled 2400. 2. When the whole population was selected on calf weights, Ne equalled 1700 and the total annual genetic gain (direct + maternal in calf weight was 0.42 kg. 3. For the open nucleus scheme, G increased monotonically from 0 to 0.42 kg as the proportion of the population included in the selection programme increased from 0 to 1.0, and Ne decreased correspondingly from 2400 to 1700. 4. In the closed nucleus scheme the lowest value of Ne was 1300. For a given proportion of the population included in the selection programme, the difference in G between a closed nucleus scheme and an open one was up to 0.13 kg. We conclude that for mass selection based on calf weights in herding districts with 2000 animals or more, there are no risks of inbreeding effects caused by selection.

  10. The French dosimetry protocol

    International Nuclear Information System (INIS)

    Dutreix, A.

    1985-01-01

    After a general introduction the protocol is divided in five sections dealing with: determination of the quality of X-ray, γ-ray and electron beams; the measuring instrument; calibration of the reference instrument; determination of the reference absorbed dose in the user's beams; determination of the absorbed dose in water at other points, in other conditions. The French protocol is not essentially different from the Nordic protocol and it is based on the experience gained in using both the American and the Nordic protocols. Therefore, only the main difference with the published protocols are discussed. (Auth.)

  11. A robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care.

    Science.gov (United States)

    Wen, Fengtong

    2013-12-01

    User authentication plays an important role to protect resources or services from being accessed by unauthorized users. In a recent paper, Das et al. proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. This scheme uses three factors, e.g. biometrics, password, and smart card, to protect the security. It protects user privacy and is believed to have many abilities to resist a range of network attacks, even if the secret information stored in the smart card is compromised. In this paper, we analyze the security of Das et al.'s scheme, and show that the scheme is in fact insecure against the replay attack, user impersonation attacks and off-line guessing attacks. Then, we also propose a robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. Compared with the existing schemes, our protocol uses a different user authentication mechanism to resist replay attack. We show that our proposed scheme can provide stronger security than previous protocols. Furthermore, we demonstrate the validity of the proposed scheme through the BAN (Burrows, Abadi, and Needham) logic.

  12. Escalator: An Autonomous Scheduling Scheme for Convergecast in TSCH

    Directory of Open Access Journals (Sweden)

    Sukho Oh

    2018-04-01

    Full Text Available Time Slotted Channel Hopping (TSCH is widely used in the industrial wireless sensor networks due to its high reliability and energy efficiency. Various timeslot and channel scheduling schemes have been proposed for achieving high reliability and energy efficiency for TSCH networks. Recently proposed autonomous scheduling schemes provide flexible timeslot scheduling based on the routing topology, but do not take into account the network traffic and packet forwarding delays. In this paper, we propose an autonomous scheduling scheme for convergecast in TSCH networks with RPL as a routing protocol, named Escalator. Escalator generates a consecutive timeslot schedule along the packet forwarding path to minimize the packet transmission delay. The schedule is generated autonomously by utilizing only the local routing topology information without any additional signaling with other nodes. The generated schedule is guaranteed to be conflict-free, in that all nodes in the network could transmit packets to the sink in every slotframe cycle. We implement Escalator and evaluate its performance with existing autonomous scheduling schemes through a testbed and simulation. Experimental results show that the proposed Escalator has lower end-to-end delay and higher packet delivery ratio compared to the existing schemes regardless of the network topology.

  13. Escalator: An Autonomous Scheduling Scheme for Convergecast in TSCH.

    Science.gov (United States)

    Oh, Sukho; Hwang, DongYeop; Kim, Ki-Hyung; Kim, Kangseok

    2018-04-16

    Time Slotted Channel Hopping (TSCH) is widely used in the industrial wireless sensor networks due to its high reliability and energy efficiency. Various timeslot and channel scheduling schemes have been proposed for achieving high reliability and energy efficiency for TSCH networks. Recently proposed autonomous scheduling schemes provide flexible timeslot scheduling based on the routing topology, but do not take into account the network traffic and packet forwarding delays. In this paper, we propose an autonomous scheduling scheme for convergecast in TSCH networks with RPL as a routing protocol, named Escalator. Escalator generates a consecutive timeslot schedule along the packet forwarding path to minimize the packet transmission delay. The schedule is generated autonomously by utilizing only the local routing topology information without any additional signaling with other nodes. The generated schedule is guaranteed to be conflict-free, in that all nodes in the network could transmit packets to the sink in every slotframe cycle. We implement Escalator and evaluate its performance with existing autonomous scheduling schemes through a testbed and simulation. Experimental results show that the proposed Escalator has lower end-to-end delay and higher packet delivery ratio compared to the existing schemes regardless of the network topology.

  14. GAME ANALYSIS OF KYOTO AND POST-KYOTO SCHEMES

    Energy Technology Data Exchange (ETDEWEB)

    Haruo Imai [Kyoto Institute of Economic Research, Kyoto University, Sakyo, Kyoto (Japan)

    2008-09-30

    Kyoto protocol, put in force in Feb. 2005, is criticized from both sides, those demanding a stricter target for GHG (green house gas) emission reduction on the one side, and those claiming for more flexible and comprehensive controls of the emission on the other side, for its modest target and narrow coverage. Even though its value could be that of a mere precedent and experimentation, Kyoto protocol includes very special experimentation to assist the world wide cooperation for a mitigation of climate change, i.e. the introduction of three mechanisms, emissions trading, joint implementation, and clean development mechanism (CDM). Together, they are called Kyoto mechanisms. Evaluation of mechanisms is one important role of microeconomics and the game theory is a major tool for it. We shall scrutinize these mechanisms from such viewpoint. A special attention is placed on CDM, as it is the novel mechanism introduced by Kyoto protocol, and gives a unique link between Annex I nations (mostly developed countries) and non-Annex I nations (mostly developing countries). Next, we examine some of the currently proposed schemes after 2013, the post Kyoto schemes. One of the chief issues is the possibility of making a comprehensive agreement including both the USA and large developing countries with rapidly increasing emission levels of GHG like China and India. Adding to these, not only the proposed schemes themselves, but the process of negotiation itself inspired several researches in cooperative game theory and in particular, coalition formation theory. We shall touch upon this issue separately, and examine how successfully they predicted the outcome leading to Kyoto, retrospectively. Finally, we end our discussion with a brief consideration over the underlining normative argument concerning these schemes.

  15. How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

    Science.gov (United States)

    Cubbin, S; Llewellyn-Jones, S; Donnelly, P

    2000-01-01

    It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

  16. Protocol Implementation Generator

    DEFF Research Database (Denmark)

    Carvalho Quaresma, Jose Nuno; Probst, Christian W.

    2010-01-01

    Users expect communication systems to guarantee, amongst others, privacy and integrity of their data. These can be ensured by using well-established protocols; the best protocol, however, is useless if not all parties involved in a communication have a correct implementation of the protocol and a...... Generator framework based on the LySatool and a translator from the LySa language into C or Java....... necessary tools. In this paper, we present the Protocol Implementation Generator (PiG), a framework that can be used to add protocol generation to protocol negotiation, or to easily share and implement new protocols throughout a network. PiG enables the sharing, verification, and translation...

  17. The Political Economy of International Emission Trading Scheme Choice: Empirical Evidence

    DEFF Research Database (Denmark)

    Boom, J.T.; Svendsen, Gert Tinggaard

    2000-01-01

    The Kyoto Protocol allows emissions trading. It does however not specify how this is to take place and the discussion on the design of an emissions trading scheme is ongoing. In this paper, we give some empirical evidence on the preference of industry and environmental organizations for internati...... for international emissions trading scheme. Since they may have an influence on decision makers, their opinion is important. Our conclusion is that both industry and environmental organizations prefer credit trading, although for widely different reasons....

  18. An Effective Collaborative Mobile Weighted Clustering Schemes for Energy Balancing in Wireless Sensor Networks.

    Science.gov (United States)

    Tang, Chengpei; Shokla, Sanesy Kumcr; Modhawar, George; Wang, Qiang

    2016-02-19

    Collaborative strategies for mobile sensor nodes ensure the efficiency and the robustness of data processing, while limiting the required communication bandwidth. In order to solve the problem of pipeline inspection and oil leakage monitoring, a collaborative weighted mobile sensing scheme is proposed. By adopting a weighted mobile sensing scheme, the adaptive collaborative clustering protocol can realize an even distribution of energy load among the mobile sensor nodes in each round, and make the best use of battery energy. A detailed theoretical analysis and experimental results revealed that the proposed protocol is an energy efficient collaborative strategy such that the sensor nodes can communicate with a fusion center and produce high power gain.

  19. Mac protocols for wireless sensor network (wsn): a comparative study

    International Nuclear Information System (INIS)

    Arshad, J.; Akram, Q.; Saleem, Y.

    2014-01-01

    Data communication between nodes is carried out under Medium Access Control (MAC) protocol which is defined at data link layer. The MAC protocols are responsible to communicate and coordinate between nodes according to the defined standards in WSN (Wireless Sensor Networks). The design of a MAC protocol should also address the issues of energy efficiency and transmission efficiency. There are number of MAC protocols that exist in the literature proposed for WSN. In this paper, nine MAC protocols which includes S-MAC, T-MAC, Wise-MAC, Mu-MAC, Z-MAC, A-MAC, D-MAC, B-MAC and B-MAC+ for WSN have been explored, studied and analyzed. These nine protocols are classified in contention based and hybrid (combination of contention and schedule based) MAC protocols. The goal of this comparative study is to provide a basis for MAC protocols and to highlight different mechanisms used with respect to parameters for the evaluation of energy and transmission efficiency in WSN. This study also aims to give reader a better understanding of the concepts, processes and flow of information used in these MAC protocols for WSN. A comparison with respect to energy reservation scheme, idle listening avoidance, latency, fairness, data synchronization, and throughput maximization has been presented. It was analyzed that contention based MAC protocols are less energy efficient as compared to hybrid MAC protocols. From the analysis of contention based MAC protocols in term of energy consumption, it was being observed that protocols based on preamble sampling consume lesser energy than protocols based on static or dynamic sleep schedule. (author)

  20. Latest approaches of Kyoto protocol

    International Nuclear Information System (INIS)

    Matei, M.; Matei, L.

    2005-01-01

    Recently EURELECTRIC welcome the proposal of new EC Directive concerning the inclusion in the EU Emissions Trading Scheme (ETS) of credits from the project mechanisms - Joint Implementation (JI) and Clean Development Mechanism (CDM). The proposed Directive is an amendment to the EU Emissions Trading Directive adopted in June 2003. EURELECTRIC calls for unlimited use of credits in ETS. The draft Directive provides for the application of these mechanisms to begin as of 2008, on condition that the Kyoto Protocol does actually enter into force, an event which is still dependent on Russia's ratification. Such ratification has been subject to contradictory statements from the Russian Government, and the question of whether their signature to the Protocol is forthcoming is still fraught with uncertainty. Although it is not anticipated that significant quantities of JI or CDM certified credits will be available in the period 2005-2007, those that do become available would provide some additional liquidity in the emissions trading market. There is a direct relation between the coming ETS and electricity pricing: environmental policy is the driver, based on the need to switch to a low-carbon future and manage the necessary investments in a rational manner - and emissions trading is the best solution available. Romania has good opportunities to be involved in the greenhouse gases market, both in ETS and JI mechanisms. Some JI projects between Romanian and The Netherlands are already done or underway. (author)

  1. On the security of two remote user authentication schemes for telecare medical information systems.

    Science.gov (United States)

    Kim, Kee-Won; Lee, Jae-Dong

    2014-05-01

    The telecare medical information systems (TMISs) support convenient and rapid health-care services. A secure and efficient authentication scheme for TMIS provides safeguarding patients' electronic patient records (EPRs) and helps health care workers and medical personnel to rapidly making correct clinical decisions. Recently, Kumari et al. proposed a password based user authentication scheme using smart cards for TMIS, and claimed that the proposed scheme could resist various malicious attacks. However, we point out that their scheme is still vulnerable to lost smart card and cannot provide forward secrecy. Subsequently, Das and Goswami proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. They simulated their scheme for the formal security verification using the widely-accepted automated validation of Internet security protocols and applications (AVISPA) tool to ensure that their scheme is secure against passive and active attacks. However, we show that their scheme is still vulnerable to smart card loss attacks and cannot provide forward secrecy property. The proposed cryptanalysis discourages any use of the two schemes under investigation in practice and reveals some subtleties and challenges in designing this type of schemes.

  2. Detecting child abuse based on parental characteristics: Does The Hague Protocol cause parents to avoid the Emergency Department?

    NARCIS (Netherlands)

    Diderich, H.M.; Fekkes, M.; Dechesne, M.; Buitendijk, S.E.; Oudesluys-Murphy, A.M.

    2015-01-01

    Objectives: The Hague Protocol is used by professionals at the adult Emergency Departments (ED) in The Netherlands to detect child abuse based on three parental characteristics: (1) domestic violence, (2) substance abuse or (3) suicide attempt or self-harm. After detection, a referral is made to the

  3. Efficient authentication scheme based on near-ring root extraction problem

    Science.gov (United States)

    Muthukumaran, V.; Ezhilmaran, D.

    2017-11-01

    An authentication protocolis the type of computer communication protocol or cryptography protocol specifically designed for transfer of authentication data between two entities. We have planned a two new entity authentication scheme on the basis of root extraction problem near-ring in this article. We suggest that this problem is suitably difficult to serve as a cryptographic assumption over the platform of near-ring N. The security issues also discussed.

  4. An Energy-aware Routing Scheme in Delay Tolerant Mobile Sensor Networking

    Directory of Open Access Journals (Sweden)

    Zhe Chen

    2014-08-01

    Full Text Available In Delay Tolerant Mobile Sensor Networking (DTMSN, mobile sensor nodes are usually limited to their energy capacity, one important concern in routing design of DTMSN is energy consumption. This paper presents a number of variations of the Epidemic Routing Protocol (ERP to extend the DTMSN lifetime. It introduces the analytical model for ERP, after introducing the concepts behind the Target Delivery Probability and Minimum Delivery Probability, it defines the network lifetime. In this paper, it firstly studies many variations of the Epidemic Routing Protocol to extend the lifetime of the DTMSN. Secondly, based on the Epidemic Routing Protocol, three schemes are introduced. Those schemes rely on the limiting the times of message allowed for propagation (LT scheme, directly controlling the number of the copies (LC scheme, split the copies to the residual energies of the nodes (LE scheme. Finally, with the experiment and the validation of the simulation, the LE scheme can significantly maximize the lifetime of DTMSN, because it minimizes the number of copies and that shifts the generation of the copies to the nodes with larger residual energy.

  5. Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention.

    Science.gov (United States)

    Dahhan, Ali; Maddox, William R; Krothapalli, Siva; Farmer, Matthew; Shah, Amit; Ford, Benjamin; Rhodes, Marc; Matthews, Laurie; Barnes, Vernon A; Sharma, Gyanendra K

    2015-08-01

    Cardiac rehabilitation (CR) is an effective preventive measure that remains underutilised in the United States. The study aimed to determine the CR referral rate (RR) after percutaneous coronary intervention (PCI) at an academic tertiary care centre, identify barriers to referral, and evaluate awareness of CR benefits and indications (CRBI) among cardiologists. Subsequently, it aimed to evaluate if an intervention consisting of physicians' education about CRBI and implementation of a formal CR referral system could improve RR and consequently participation rate (PR). Data were retrospectively collected for all consecutive patients who underwent PCI over 12 months. Referral rate was determined and variables were compared for differences between referred and non-referred patients. A questionnaire was distributed among the physicians in the Division of Cardiology to assess awareness of CRBI and referral practice patterns. After implementation of the intervention, data were collected retrospectively for consecutive patients who underwent PCI in the following six months. Referral rate and changes in PRs were determined. Prior to the intervention, RR was 17.6%. Different barriers were identified, but the questionnaire revealed lack of physicians' awareness of CRBI and inconsistent referral patterns. After the intervention, RR increased to 88.96% (Odds Ratio 37.73, 95% CI 21.34-66.70, pEducation of providers and implementation of a formal referral system can improve RR and PR. Published by Elsevier B.V.

  6. Audit of the Health Service Executive orthodontic referral pathway between 2009 and 2011 in the Dublin Mid-Leinster region.

    LENUS (Irish Health Repository)

    Wolstencroft, Simon

    2014-03-21

    An audit was undertaken in 2009 to determine the success of the new national orthodontic referral protocol introduced to the Health Service Executive (HSE) in 2007 and operated in the Dublin Mid-Leinster HSE region. It was repeated in 2011 to determine if the HSE austerity measures have had a bearing on the orthodontic service performance in the Dublin Mid-Leinster HSE region. The audit also measured the success of referring practitioners in identifying the correct Index of Orthodontic Treatment Need (IOTN) classification of the patient. In the 2011 audit, the figures were broken down to identify the occlusal variables that caused dental practitioners most difficulties in identification. The audit demonstrates a good referral to assessment timeframe in 2009 (85-80% compliance for IOTN 5 and 4 within three to six months, respectively), which deteriorates significantly in 2011 (26-4% for IOTN 5 and 4 within three to six months, respectively). The ability of dentists to identify the correct IOTN classification was better in 2009 (60% correct) compared to 2011 (51% correct), but both figures fell below the audit standard of 75% of referrals with correct IOTN classifications. The IOTN occlusal dental health components most readily identified by referring practitioners and meeting audit standards were 5a (overjet >9mm), 5i (impacted teeth) and 5h (extensive hypodontia). The remaining occlusal dental health components in the HSE IOTN fell below the audit standard. The audit clearly identifies a requirement for a continued educational effort to maintain the HSE IOTN skill base in primary care, and a need for additional resources to manage the demand for orthodontic assessments.

  7. WDM Network and Multicasting Protocol Strategies

    Directory of Open Access Journals (Sweden)

    Pinar Kirci

    2014-01-01

    Full Text Available Optical technology gains extensive attention and ever increasing improvement because of the huge amount of network traffic caused by the growing number of internet users and their rising demands. However, with wavelength division multiplexing (WDM, it is easier to take the advantage of optical networks and optical burst switching (OBS and to construct WDM networks with low delay rates and better data transparency these technologies are the best choices. Furthermore, multicasting in WDM is an urgent solution for bandwidth-intensive applications. In the paper, a new multicasting protocol with OBS is proposed. The protocol depends on a leaf initiated structure. The network is composed of source, ingress switches, intermediate switches, edge switches, and client nodes. The performance of the protocol is examined with Just Enough Time (JET and Just In Time (JIT reservation protocols. Also, the paper involves most of the recent advances about WDM multicasting in optical networks. WDM multicasting in optical networks is given as three common subtitles: Broadcast and-select networks, wavelength-routed networks, and OBS networks. Also, in the paper, multicast routing protocols are briefly summarized and optical burst switched WDM networks are investigated with the proposed multicast schemes.

  8. Multiuser switched diversity scheduling schemes

    KAUST Repository

    Shaqfeh, Mohammad; Alnuweiri, Hussein M.; Alouini, Mohamed-Slim

    2012-01-01

    Multiuser switched-diversity scheduling schemes were recently proposed in order to overcome the heavy feedback requirements of conventional opportunistic scheduling schemes by applying a threshold-based, distributed, and ordered scheduling mechanism. The main idea behind these schemes is that slight reduction in the prospected multiuser diversity gains is an acceptable trade-off for great savings in terms of required channel-state-information feedback messages. In this work, we characterize the achievable rate region of multiuser switched diversity systems and compare it with the rate region of full feedback multiuser diversity systems. We propose also a novel proportional fair multiuser switched-based scheduling scheme and we demonstrate that it can be optimized using a practical and distributed method to obtain the feedback thresholds. We finally demonstrate by numerical examples that switched-diversity scheduling schemes operate within 0.3 bits/sec/Hz from the ultimate network capacity of full feedback systems in Rayleigh fading conditions. © 2012 IEEE.

  9. Nonlinear secret image sharing scheme.

    Science.gov (United States)

    Shin, Sang-Ho; Lee, Gil-Je; Yoo, Kee-Young

    2014-01-01

    Over the past decade, most of secret image sharing schemes have been proposed by using Shamir's technique. It is based on a linear combination polynomial arithmetic. Although Shamir's technique based secret image sharing schemes are efficient and scalable for various environments, there exists a security threat such as Tompa-Woll attack. Renvall and Ding proposed a new secret sharing technique based on nonlinear combination polynomial arithmetic in order to solve this threat. It is hard to apply to the secret image sharing. In this paper, we propose a (t, n)-threshold nonlinear secret image sharing scheme with steganography concept. In order to achieve a suitable and secure secret image sharing scheme, we adapt a modified LSB embedding technique with XOR Boolean algebra operation, define a new variable m, and change a range of prime p in sharing procedure. In order to evaluate efficiency and security of proposed scheme, we use the embedding capacity and PSNR. As a result of it, average value of PSNR and embedding capacity are 44.78 (dB) and 1.74t⌈log2 m⌉ bit-per-pixel (bpp), respectively.

  10. Multiuser switched diversity scheduling schemes

    KAUST Repository

    Shaqfeh, Mohammad

    2012-09-01

    Multiuser switched-diversity scheduling schemes were recently proposed in order to overcome the heavy feedback requirements of conventional opportunistic scheduling schemes by applying a threshold-based, distributed, and ordered scheduling mechanism. The main idea behind these schemes is that slight reduction in the prospected multiuser diversity gains is an acceptable trade-off for great savings in terms of required channel-state-information feedback messages. In this work, we characterize the achievable rate region of multiuser switched diversity systems and compare it with the rate region of full feedback multiuser diversity systems. We propose also a novel proportional fair multiuser switched-based scheduling scheme and we demonstrate that it can be optimized using a practical and distributed method to obtain the feedback thresholds. We finally demonstrate by numerical examples that switched-diversity scheduling schemes operate within 0.3 bits/sec/Hz from the ultimate network capacity of full feedback systems in Rayleigh fading conditions. © 2012 IEEE.

  11. Practices and attitudes of doctors and patients to downward referral in Shanghai, China.

    Science.gov (United States)

    Yu, Wenya; Li, Meina; Nong, Xin; Ding, Tao; Ye, Feng; Liu, Jiazhen; Dai, Zhixing; Zhang, Lulu

    2017-04-03

    In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ 2 test and stepwise logistic regression analysis were employed for statistical analysis. Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. To increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for

  12. An XML-Based Protocol for Distributed Event Services

    Science.gov (United States)

    Smith, Warren; Gunter, Dan; Quesnel, Darcy; Biegel, Bryan (Technical Monitor)

    2001-01-01

    This viewgraph presentation provides information on the application of an XML (extensible mark-up language)-based protocol to the developing field of distributed processing by way of a computational grid which resembles an electric power grid. XML tags would be used to transmit events between the participants of a transaction, namely, the consumer and the producer of the grid scheme.

  13. E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review.

    Science.gov (United States)

    Naseriasl, Mansour; Adham, Davoud; Janati, Ali

    2015-06-01

    around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment's and services. In order to respond these challenges and reduction of health system's transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby's index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.

  14. A project investigating music therapy referral trends within palliative care: an Australian perspective.

    Science.gov (United States)

    Horne-Thompson, Anne; Daveson, Barbara; Hogan, Bridgit

    2007-01-01

    The purpose of this project is to analyze music therapy (MT) referral trends from palliative care team members across nine Australian inpatient and community-based palliative care settings. For each referral 6 items were collected: referral source, reason and type; time from Palliative Care Program (PCP) admission to MT referral; time from MT referral to death/discharge; and profile of referred patient. Participants (196 female, 158 male) were referred ranging in age from 4-98 years and most were diagnosed with cancer (91%, n = 323). Nurses (47%, n = 167) referred most frequently to music therapy. The mean average time in days for all referrals from PCP admission to MT referral was 11.47 and then 5.19 days to time of death. Differences in length of time to referral ranged from 8.19 days (allied health staff) to 43.75 days (families). Forty-eight percent of referrals (48.5%, n = 172) were completed when the patient was rated at an Eastern Cooperative Oncology Group Performance (ECOG) of three. Sixty-nine percent (n = 244) were living with others at the time of referral and most were Australian born. Thirty-six percent (36.7%, n = 130) were referred for symptom-based reasons, and 24.5% (n = 87) for support and coping. Implications for service delivery of music therapy practice, interdisciplinary care and benchmarking of music therapy services shall be discussed.

  15. Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?

    Science.gov (United States)

    Bottino, Clement J; Rhodes, Erinn T; Kreatsoulas, Catherine; Cox, Joanne E; Fleegler, Eric W

    2017-07-01

    To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  16. Pattern of Uveitis in a Referral Eye Clinic in North India

    Directory of Open Access Journals (Sweden)

    Singh Ramandeep

    2004-01-01

    Full Text Available Purpose: To report the pattern of uveitis in a north Indian tertiary eye center. Methods: A retrospective study was done to identify the pattern of uveitis in a uveitis clinic population of a major referral center in north India from January 1996 to June 2001. A standard clinical protocol, the "naming and meshing" approach with tailored laboratory investigations, was used for the final diagnosis. Results: 1233 patients were included in the study; 641 (51.98% were males and 592 (48.01% females ranging in age from 1.5 to 75 years. The anterior uveitis was seen in 607 patients (49.23% followed by posterior uveitis (247 patients, 20.23%, intermediate uveitis (198 patients, 16.06% and panuveitis (181 patients, 14.68%. A specific diagnosis could be established in 602 patients (48.82%. The infective aetiology was seen in 179 patients, of which tuberculosis was the commonest cause in 125 patients followed by toxoplasmosis (21 patients, 11.7%. Non-infectious aetiology was seen in 423 patients, of which ankylosing spondylitis was the commonest cause in 80 patients followed by sepigionous choroidopathy (62 patients, 14.65% . Conclusion: Tuberculosis and toxoplasmosis were the commonest form of infective uveitis, while ankylosing spondylitis and serpiginous choroidopathy were commonly seen as the non-infective causes of uveitis in North India.

  17. Classification of rhinoplasties performed in an otorhinolaryngology referral center in Brazil

    Directory of Open Access Journals (Sweden)

    Flávio Barbosa Nunes

    2014-12-01

    Full Text Available Introduction: Facial plastic and reconstructive surgery involves the use of surgical procedures to achieve esthetic and functional improvement. It can be used for traumatic, congenital, or developmental injuries. Medicine, with an emphasis on facial plastic surgery, has made progress in several areas, including rhinoplasty, providing good long-term results and higher patient satisfaction. Objective: To evaluate cases of rhinoplasty and its subtypes in a referral center, and to understand the relevance of teaching rhinoplasty techniques in a service of otolaryngology residency. Methods: A retrospective study that assessed 325 rhinoplasties performed by third-year medical residents under the supervision of chief residents in charge of the Service of Facial Plastic Surgery in this hospital was conducted from January of 2003 to August of 2012. The Service Protocol included the following subtypes: functional, esthetic, post-traumatic, revision, and reconstructive rhinoseptoplasty. Results: Of the rhinoplasties performed 184 (56.21% were functional, 59 (18.15% were post-traumatic, 27 were (8.30% esthetic, 15 were (4.61% reconstructive, and 40 (12.30% were revision procedures. Conclusion: Functional rhinoseptoplasties were the most prevalent type, which highlights the relevance of teaching surgical techniques, not only for septoplasty, but also the inclusion of rhinoplasty techniques in teaching centers.

  18. Provider attributes correlation analysis to their referral frequency and awards.

    Science.gov (United States)

    Wiley, Matthew T; Rivas, Ryan L; Hristidis, Vagelis

    2016-03-14

    There has been a recent growth in health provider search portals, where patients specify filters-such as specialty or insurance-and providers are ranked by patient ratings or other attributes. Previous work has identified attributes associated with a provider's quality through user surveys. Other work supports that intuitive quality-indicating attributes are associated with a provider's quality. We adopt a data-driven approach to study how quality indicators of providers are associated with a rich set of attributes including medical school, graduation year, procedures, fellowships, patient reviews, location, and technology usage. In this work, we only consider providers as individuals (e.g., general practitioners) and not organizations (e.g., hospitals). As quality indicators, we consider the referral frequency of a provider and a peer-nominated quality designation. We combined data from the Centers for Medicare and Medicaid Services (CMS) and several provider rating web sites to perform our analysis. Our data-driven analysis identified several attributes that correlate with and discriminate against referral volume and peer-nominated awards. In particular, our results consistently demonstrate that these attributes vary by locality and that the frequency of an attribute is more important than its value (e.g., the number of patient reviews or hospital affiliations are more important than the average review rating or the ranking of the hospital affiliations, respectively). We demonstrate that it is possible to build accurate classifiers for referral frequency and quality designation, with accuracies over 85 %. Our findings show that a one-size-fits-all approach to ranking providers is inadequate and that provider search portals should calibrate their ranking function based on location and specialty. Further, traditional filters of provider search portals should be reconsidered, and patients should be aware of existing pitfalls with these filters and educated on local

  19. A fully distributed geo-routing scheme for wireless sensor networks

    KAUST Repository

    Bader, Ahmed

    2013-12-01

    When marrying randomized distributed space-time coding (RDSTC) to beaconless geo-routing, new performance horizons can be created. In order to reach those horizons, however, beaconless geo-routing protocols must evolve to operate in a fully distributed fashion. In this letter, we expose a technique to construct a fully distributed geo-routing scheme in conjunction with RDSTC. We then demonstrate the performance gains of this novel scheme by comparing it to one of the prominent classical schemes. © 2013 IEEE.

  20. A fully distributed geo-routing scheme for wireless sensor networks

    KAUST Repository

    Bader, Ahmed; Abed-Meraim, Karim; Alouini, Mohamed-Slim

    2013-01-01

    When marrying randomized distributed space-time coding (RDSTC) to beaconless geo-routing, new performance horizons can be created. In order to reach those horizons, however, beaconless geo-routing protocols must evolve to operate in a fully distributed fashion. In this letter, we expose a technique to construct a fully distributed geo-routing scheme in conjunction with RDSTC. We then demonstrate the performance gains of this novel scheme by comparing it to one of the prominent classical schemes. © 2013 IEEE.

  1. An efficient deterministic secure quantum communication scheme based on cluster states and identity authentication

    International Nuclear Information System (INIS)

    Wen-Jie, Liu; Han-Wu, Chen; Zhi-Qiang, Li; Zhi-Hao, Liu; Wen-Bo, Hu; Ting-Huai, Ma

    2009-01-01

    A novel efficient deterministic secure quantum communication scheme based on four-qubit cluster states and single-photon identity authentication is proposed. In this scheme, the two authenticated users can transmit two bits of classical information per cluster state, and its efficiency of the quantum communication is 1/3, which is approximately 1.67 times that of the previous protocol presented by Wang et al [Chin. Phys. Lett. 23 (2006) 2658]. Security analysis shows the present scheme is secure against intercept-resend attack and the impersonator's attack. Furthermore, it is more economic with present-day techniques and easily processed by a one-way quantum computer. (general)

  2. Cryptanalysis and improvement of a biometrics-based authentication and key agreement scheme for multi-server environments

    Science.gov (United States)

    Zheng, Zhiming

    2018-01-01

    According to advancements in the wireless technologies, study of biometrics-based multi-server authenticated key agreement schemes has acquired a lot of momentum. Recently, Wang et al. presented a three-factor authentication protocol with key agreement and claimed that their scheme was resistant to several prominent attacks. Unfortunately, this paper indicates that their protocol is still vulnerable to the user impersonation attack, privileged insider attack and server spoofing attack. Furthermore, their protocol cannot provide the perfect forward secrecy. As a remedy of these aforementioned problems, we propose a biometrics-based authentication and key agreement scheme for multi-server environments. Compared with various related schemes, our protocol achieves the stronger security and provides more functionality properties. Besides, the proposed protocol shows the satisfactory performances in respect of storage requirement, communication overhead and computational cost. Thus, our protocol is suitable for expert systems and other multi-server architectures. Consequently, the proposed protocol is more appropriate in the distributed networks. PMID:29534085

  3. An Overview and Analysis of Mobile Internet Protocols in Cellular Environments.

    Science.gov (United States)

    Chao, Han-Chieh

    2001-01-01

    Notes that cellular is the inevitable future architecture for the personal communication service system. Discusses the current cellular support based on Mobile Internet Protocol version 6 (Ipv6) and points out the shortfalls of using Mobile IP. Highlights protocols especially for mobile management schemes which can optimize a high-speed mobile…

  4. La interconsulta y la referencia Interconsultation and referral

    Directory of Open Access Journals (Sweden)

    José Díaz Novás

    2005-08-01

    Full Text Available Se aborda el tema de la ínterconsulta y la referencia como habilidades esenciales del Médico de Familia, se explica su naturaleza y cómo llevar a cabo estos procedimientos, enfatizándose en la importancia de su desarrollo correcto, las causas que los motivan y la responsabilidad del médico con el paciente.Interconsultation and referral as essential skills of the family physician are approached. Their nature is also explained, as well as how to implement these procedures, making emphasis on the importance of their correct development, the causes motivating them and the responsibility of the doctor with the patient.

  5. Referring physician satisfaction: toward a better understanding of hospital referrals.

    Science.gov (United States)

    Ponzurick, T G; France, K R; Logar, C M

    1998-01-01

    Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians.

  6. THINKING ABOUT REFERRALS TO ALCOHOLICS ANONYMOUS IN RELATIONAL WAYS

    Directory of Open Access Journals (Sweden)

    Christopher K. Bitten

    2010-02-01

    Full Text Available This article examines Alcoholics Anonymous (AA as a relational therapy, seen through the lens of the relational needs described by Richard Erskine. AA as a resource may be underemployed by therapists who do not realize its potential to heal the relational damage suffered and inflicted by their alcoholic clients. Common misconceptions about AA are addressed, and ways for therapists to facilitate successful referrals of clients to AA are described. The author posits that there is a synergistic benefit in combining integrative psychotherapy with the client’s involvement in AA.

  7. Electrical Injection Schemes for Nanolasers

    DEFF Research Database (Denmark)

    Lupi, Alexandra; Chung, Il-Sug; Yvind, Kresten

    2014-01-01

    Three electrical injection schemes based on recently demonstrated electrically pumped photonic crystal nanolasers have been numerically investigated: 1) a vertical p-i-n junction through a post structure; 2) a lateral p-i-n junction with a homostructure; and 3) a lateral p-i-n junction....... For this analysis, the properties of different schemes, i.e., electrical resistance, threshold voltage, threshold current, and internal efficiency as energy requirements for optical interconnects are compared and the physics behind the differences is discussed....

  8. Signal multiplexing scheme for LINAC

    International Nuclear Information System (INIS)

    Sujo, C.I.; Mohan, Shyam; Joshi, Gopal; Singh, S.K.; Karande, Jitendra

    2004-01-01

    For the proper operation of the LINAC some signals, RF (radio frequency) as well as LF (low frequency) have to be available at the Master Control Station (MCS). These signals are needed to control, calibrate and characterize the RF fields in the resonators. This can be achieved by proper multiplexing of various signals locally and then routing the selected signals to the MCS. A multiplexing scheme has been designed and implemented, which will allow the signals from the selected cavity to the MCS. High isolation between channels and low insertion loss for a given signal are important issues while selecting the multiplexing scheme. (author)

  9. Capacity-achieving CPM schemes

    OpenAIRE

    Perotti, Alberto; Tarable, Alberto; Benedetto, Sergio; Montorsi, Guido

    2008-01-01

    The pragmatic approach to coded continuous-phase modulation (CPM) is proposed as a capacity-achieving low-complexity alternative to the serially-concatenated CPM (SC-CPM) coding scheme. In this paper, we first perform a selection of the best spectrally-efficient CPM modulations to be embedded into SC-CPM schemes. Then, we consider the pragmatic capacity (a.k.a. BICM capacity) of CPM modulations and optimize it through a careful design of the mapping between input bits and CPM waveforms. The s...

  10. An Enhanced Secure Identity-Based Certificateless Public Key Authentication Scheme for Vehicular Sensor Networks

    Science.gov (United States)

    Li, Congcong; Zhang, Xi; Wang, Haiping; Li, Dongfeng

    2018-01-01

    Vehicular sensor networks have been widely applied in intelligent traffic systems in recent years. Because of the specificity of vehicular sensor networks, they require an enhanced, secure and efficient authentication scheme. Existing authentication protocols are vulnerable to some problems, such as a high computational overhead with certificate distribution and revocation, strong reliance on tamper-proof devices, limited scalability when building many secure channels, and an inability to detect hardware tampering attacks. In this paper, an improved authentication scheme using certificateless public key cryptography is proposed to address these problems. A security analysis of our scheme shows that our protocol provides an enhanced secure anonymous authentication, which is resilient against major security threats. Furthermore, the proposed scheme reduces the incidence of node compromise and replication attacks. The scheme also provides a malicious-node detection and warning mechanism, which can quickly identify compromised static nodes and immediately alert the administrative department. With performance evaluations, the scheme can obtain better trade-offs between security and efficiency than the well-known available schemes. PMID:29324719

  11. An Enhanced Secure Identity-Based Certificateless Public Key Authentication Scheme for Vehicular Sensor Networks.

    Science.gov (United States)

    Li, Congcong; Zhang, Xi; Wang, Haiping; Li, Dongfeng

    2018-01-11

    Vehicular sensor networks have been widely applied in intelligent traffic systems in recent years. Because of the specificity of vehicular sensor networks, they require an enhanced, secure and efficient authentication scheme. Existing authentication protocols are vulnerable to some problems, such as a high computational overhead with certificate distribution and revocation, strong reliance on tamper-proof devices, limited scalability when building many secure channels, and an inability to detect hardware tampering attacks. In this paper, an improved authentication scheme using certificateless public key cryptography is proposed to address these problems. A security analysis of our scheme shows that our protocol provides an enhanced secure anonymous authentication, which is resilient against major security threats. Furthermore, the proposed scheme reduces the incidence of node compromise and replication attacks. The scheme also provides a malicious-node detection and warning mechanism, which can quickly identify compromised static nodes and immediately alert the administrative department. With performance evaluations, the scheme can obtain better trade-offs between security and efficiency than the well-known available schemes.

  12. Efficient quantum secret sharing scheme with two-particle entangled states

    International Nuclear Information System (INIS)

    Zhu Zhen-Chao; Fu An-Min; Zhang Yu-Qing

    2011-01-01

    This paper proposes a protocol for multi-party quantum secret sharing utilizing four non-orthogonal two-particle entangled states following some ideas in the schemes proposed by Liu et al. (2006 Chin. Phys. Lett. 23 3148) and Zhang et al. (2009 Chin. Phys. B 18 2149) respectively. The theoretical efficiency for qubits of the new protocol is improved from 50% to approaching 100%. All the entangled states can be used for generating the private key except those used for the eavesdropping check. The validity of a probable attack called opaque cheat attack to this kind of protocols is considered in the paper for the first time. (general)

  13. A lightweight privacy preserving authenticated key agreement protocol for SIP-based VoIP

    OpenAIRE

    Zhang, Liping; Tang, Shanyu; Zhu, Shaohui

    2016-01-01

    Session Initiation Protocol (SIP) is an essential part of most Voice over Internet Protocol (VoIP) architecture. Although SIP provides attractive features, it is exposed to various security threats, and so an efficient and secure authentication scheme is sought to enhance the security of SIP. Several attempts have been made to address the tradeoff problem between security and efficiency, but designing a successful authenticated key agreement protocol for SIP is still a challenging task from t...

  14. On 165Ho level scheme

    International Nuclear Information System (INIS)

    Ardisson, Claire; Ardisson, Gerard.

    1976-01-01

    A 165 Ho level scheme was constructed which led to the interpretation of sixty γ rays belonging to the decay of 165 Dy. A new 702.9keV level was identified to be the 5/2 - member of the 1/2 ) 7541{ Nilsson orbit. )] [fr

  15. Homogenization scheme for acoustic metamaterials

    KAUST Repository

    Yang, Min; Ma, Guancong; Wu, Ying; Yang, Zhiyu; Sheng, Ping

    2014-01-01

    the scattering amplitudes. We verify our scheme by applying it to three different examples: a layered lattice, a two-dimensional hexagonal lattice, and a decorated-membrane system. It is shown that the predicted characteristics and wave fields agree almost

  16. Homogenization scheme for acoustic metamaterials

    KAUST Repository

    Yang, Min

    2014-02-26

    We present a homogenization scheme for acoustic metamaterials that is based on reproducing the lowest orders of scattering amplitudes from a finite volume of metamaterials. This approach is noted to differ significantly from that of coherent potential approximation, which is based on adjusting the effective-medium parameters to minimize scatterings in the long-wavelength limit. With the aid of metamaterials’ eigenstates, the effective parameters, such as mass density and elastic modulus can be obtained by matching the surface responses of a metamaterial\\'s structural unit cell with a piece of homogenized material. From the Green\\'s theorem applied to the exterior domain problem, matching the surface responses is noted to be the same as reproducing the scattering amplitudes. We verify our scheme by applying it to three different examples: a layered lattice, a two-dimensional hexagonal lattice, and a decorated-membrane system. It is shown that the predicted characteristics and wave fields agree almost exactly with numerical simulations and experiments and the scheme\\'s validity is constrained by the number of dominant surface multipoles instead of the usual long-wavelength assumption. In particular, the validity extends to the full band in one dimension and to regimes near the boundaries of the Brillouin zone in two dimensions.

  17. New practicable Siberian Snake schemes

    International Nuclear Information System (INIS)

    Steffen, K.

    1983-07-01

    Siberian Snake schemes can be inserted in ring accelerators for making the spin tune almost independent of energy. Two such schemes are here suggested which lend particularly well to practical application over a wide energy range. Being composed of horizontal and vertical bending magnets, the proposed snakes are designed to have a small maximum beam excursion in one plane. By applying in this plane a bending correction that varies with energy, they can be operated at fixed geometry in the other plane where most of the bending occurs, thus avoiding complicated magnet motion or excessively large magnet apertures that would otherwise be needed for large energy variations. The first of the proposed schemes employs a pair of standard-type Siberian Snakes, i.e. of the usual 1st and 2nd kind which rotate the spin about the longitudinal and the transverse horizontal axis, respectively. The second scheme employs a pair of novel-type snakes which rotate the spin about either one of the horizontal axes that are at 45 0 to the beam direction. In obvious reference to these axes, they are called left-pointed and right-pointed snakes. (orig.)

  18. Nonlinear Secret Image Sharing Scheme

    Directory of Open Access Journals (Sweden)

    Sang-Ho Shin

    2014-01-01

    efficiency and security of proposed scheme, we use the embedding capacity and PSNR. As a result of it, average value of PSNR and embedding capacity are 44.78 (dB and 1.74tlog2⁡m bit-per-pixel (bpp, respectively.

  19. Improving Wojcik's eavesdropping attack on the ping-pong protocol

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Zhanjun [Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China) and School of Physics and Material Science, Anhui University, Hefei 230039 (China)]. E-mail: zhangzj@wipm.ac.cn; Man Zhongxiao [Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China); Li Yong [Department of Physics, Central China Normal University, Wuhan 430079 (China)

    2004-11-29

    The eavesdropping scheme proposed by Wojcik [Phys. Rev. Lett. 90 (2003) 157901] on the ping-pong protocol [Phys. Rev. Lett. 89 (2002) 187902] is improved by constituting a new set of attack operations. The improved scheme only induces half of the eavesdropping-induced channel loss in Wojcik's scheme, therefore, in a larger domain of the quantum channel transmission efficiency {eta}, i.e., [0,75%], the eavesdropper Eve can attack all the transmitted bits. The improvement of the ping-pong protocol security produced by Wojcik's is also suitable for our eavesdropping attack.

  20. Congenital heart disease screening: which referral factors are most important

    International Nuclear Information System (INIS)

    Fayyaz, A.; Ahmed, W.

    2013-01-01

    To identify the referral factors for fetal echocardiography which are associated with congenital cardiac defects in the fetus. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Radiology Department, CMH, Rawalpindi, from January 2007 to November 2010. Methodology: All patients referred for fetal echocardiography with one or more risk factors for the development of congenital heart disease, and those patients with incidental discovery of congenital heart disease on antenatal ultrasound were evaluated. Patients with no risk factors who were found to have normal fetal echocardiography were excluded from the study. Univariate logistic regression analysis was carried out for each variable. The variables with statistical significance of less than 0.05 were subjected to multivariate logistic regression. Fetal echocardiographic diagnosis was taken as the dependent variable and all other variables were the independent variables. Results: Two hundred and sixty four patients were evaluated by fetal echocardiography for congenital heart disease. The statistically significant factor was detection of congenital heart disease on routine ultrasound examination. Conclusion: A routine obstetric scan should include evaluation of the heart with four-chamber and base-of-heart views to exclude cardiac anomalies. A cardiac anomaly picked up on routine ultrasound scan is the most important indication for referral for fetal echocardiography. Fetal arrhythmias and echogenic focus in the left ventricle do not have a significant association with structural cardiac malformation. (author)

  1. A Transactional Asynchronous Replication Scheme for Mobile Database Systems

    Institute of Scientific and Technical Information of China (English)

    丁治明; 孟小峰; 王珊

    2002-01-01

    In mobile database systems, mobility of users has a significant impact on data replication. As a result, the various replica control protocols that exist today in traditional distributed and multidatabase environments are no longer suitable. To solve this problem, a new mobile database replication scheme, the Transaction-Level Result-Set Propagation (TLRSP)model, is put forward in this paper. The conflict detection and resolution strategy based on TLRSP is discussed in detail, and the implementation algorithm is proposed. In order to compare the performance of the TLRSP model with that of other mobile replication schemes, we have developed a detailed simulation model. Experimental results show that the TLRSP model provides an efficient support for replicated mobile database systems by reducing reprocessing overhead and maintaining database consistency.

  2. Efficient Asymmetric Index Encapsulation Scheme for Anonymous Content Centric Networking

    Directory of Open Access Journals (Sweden)

    Rong Ma

    2017-01-01

    Full Text Available Content Centric Networking (CCN is an effective communication paradigm that well matches the features of wireless environments. To be considered a viable candidate in the emerging wireless networks, despite the clear benefits of location-independent security, CCN must at least have parity with existing solutions for confidential and anonymous communication. This paper designs a new cryptographic scheme, called Asymmetric Index Encapsulation (AIE, that enables the router to test whether an encapsulated header matches the token without learning anything else about both of them. We suggest using the AIE as the core protocol of anonymous Content Centric Networking. A construction of AIE which strikes a balance between efficiency and security is given. The scheme is proved to be secure based on the DBDH assumption in the random oracle with tight reduction, while the encapsulated header and the token in our system consist of only three elements.

  3. Butterfly Encryption Scheme for Resource-Constrained Wireless Networks

    Directory of Open Access Journals (Sweden)

    Raghav V. Sampangi

    2015-09-01

    Full Text Available Resource-constrained wireless networks are emerging networks such as Radio Frequency Identification (RFID and Wireless Body Area Networks (WBAN that might have restrictions on the available resources and the computations that can be performed. These emerging technologies are increasing in popularity, particularly in defence, anti-counterfeiting, logistics and medical applications, and in consumer applications with growing popularity of the Internet of Things. With communication over wireless channels, it is essential to focus attention on securing data. In this paper, we present an encryption scheme called Butterfly encryption scheme. We first discuss a seed update mechanism for pseudorandom number generators (PRNG, and employ this technique to generate keys and authentication parameters for resource-constrained wireless networks. Our scheme is lightweight, as in it requires less resource when implemented and offers high security through increased unpredictability, owing to continuously changing parameters. Our work focuses on accomplishing high security through simplicity and reuse. We evaluate our encryption scheme using simulation, key similarity assessment, key sequence randomness assessment, protocol analysis and security analysis.

  4. Butterfly Encryption Scheme for Resource-Constrained Wireless Networks.

    Science.gov (United States)

    Sampangi, Raghav V; Sampalli, Srinivas

    2015-09-15

    Resource-constrained wireless networks are emerging networks such as Radio Frequency Identification (RFID) and Wireless Body Area Networks (WBAN) that might have restrictions on the available resources and the computations that can be performed. These emerging technologies are increasing in popularity, particularly in defence, anti-counterfeiting, logistics and medical applications, and in consumer applications with growing popularity of the Internet of Things. With communication over wireless channels, it is essential to focus attention on securing data. In this paper, we present an encryption scheme called Butterfly encryption scheme. We first discuss a seed update mechanism for pseudorandom number generators (PRNG), and employ this technique to generate keys and authentication parameters for resource-constrained wireless networks. Our scheme is lightweight, as in it requires less resource when implemented and offers high security through increased unpredictability, owing to continuously changing parameters. Our work focuses on accomplishing high security through simplicity and reuse. We evaluate our encryption scheme using simulation, key similarity assessment, key sequence randomness assessment, protocol analysis and security analysis.

  5. Network protocols and sockets

    OpenAIRE

    BALEJ, Marek

    2010-01-01

    My work will deal with network protocols and sockets and their use in programming language C#. It will therefore deal programming network applications on the platform .NET from Microsoft and instruments, which C# provides to us. There will describe the tools and methods for programming network applications, and shows a description and sample applications that work with sockets and application protocols.

  6. Improving an Anonymous and Provably Secure Authentication Protocol for a Mobile User

    Directory of Open Access Journals (Sweden)

    Jongho Moon

    2017-01-01

    Full Text Available Recently many authentication protocols using an extended chaotic map were suggested for a mobile user. Many researchers demonstrated that authentication protocol needs to provide key agreement, mutual authentication, and user anonymity between mobile user and server and resilience to many possible attacks. In this paper, we cautiously analyzed chaotic-map-based authentication scheme and proved that it is still insecure to off-line identity guessing, user and server impersonation, and on-line identity guessing attacks. To address these vulnerabilities, we proposed an improved protocol based on an extended chaotic map and a fuzzy extractor. We proved the security of the proposed protocol using a random oracle and AVISPA (Automated Validation of Internet Security Protocols and Applications tool. Furthermore, we present an informal security analysis to make sure that the improved protocol is invulnerable to possible attacks. The proposed protocol is also computationally efficient when compared to other previous protocols.

  7. Critical care outreach referrals: a mixed-method investigative study of outcomes and experiences.

    Science.gov (United States)

    Pattison, Natalie; Eastham, Elizabeth

    2012-01-01

    To explore referrals to a critical care outreach team (CCOT), associated factors around patient management and survival to discharge, and the qualitative exploration of referral characteristics (identifying any areas for service improvement around CCOT). A single-centre mixed method study in a specialist hospital was undertaken, using an explanatory design: participant selection model. In this model, quantitative results (prospective and retrospective episode of care review, including modified early warning system (MEWS), time and delay of referral and patient outcomes for admission and survival) are further explained by qualitative (interview) data with doctors and nurses referring to outreach. Quantitative data were analysed using SPSS +17 and 19, and qualitative data were analysed using grounded theory principles. A large proportion of referrals (124/407 = 30·5%) were made by medical staff. For 97 (97/407 = 23·8%) referrals, there was a delay between the point at which patients deteriorated (as verified by retrospective record review and MEWS score triggers) and the time at when patients were referred. The average delay was 2·96 h (95% CI 1·97-3·95; SD 9·56). Timely referrals were associated with improved outcomes; however, no causal attribution can be made from the circumstances around CCOT referral. Qualitative themes included indications for referral, facilitating factors for referral, barriers to referral and consequences of referral, with an overarching core theory of reassurance. Outreach was seen as back-up and this core theory demonstrates the important, and somewhat less tangible, role outreach has in supporting ward staff to care for at-risk patients. Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care

  8. Quality of optometry referrals to neovascular age-related macular degeneration clinic: a prospective study

    OpenAIRE

    Muen, Wisam J; Hewick, Simon A

    2011-01-01

    Objectives To evaluate the quality of referrals to a neovascular age-related macular degeneration clinic from optometrists using the standard Rapid Access Referral Form (RARF) from the Royal College of Ophthalmologists. Design A prospective study. Prospective data were gathered from all optometry referrals using the RARF, between the periods of December 2006 to August 2009. These were assessed for accuracy of history, clinical signs and final diagnosis as compared to a macula expert. Setting ...

  9. Exact Throughput Analyses of Energy-Harvesting Cooperation Scheme with Best Relay Selections Under I/Q Imbalance

    Directory of Open Access Journals (Sweden)

    Tan Phuoc Huynh

    2017-01-01

    Full Text Available In this paper, we propose an energy-harvesting cooperation scheme in which relays suffer in-phase and quadrature-phase imbalances (IQI and harvest energy from a wireless transmit source. A best relay is selected based on end-to-end signal-to-interference-plus-noise ratios (SINRs in both Amplify-and-Forward (called an EHAF protocol and Decode-and-Forward (called an EHDF protocol cooperation methods. We analyze and evaluate the system performance in terms of exact closed-form throughputs over Rayleigh fading channels. Simulation and analysis results discover contributions as follows. Firstly, the throughput performance of the proposed protocols EHAF and EHDF is improved when comparing with that of a non-selection cooperation scheme. Secondly, the EHDF protocol is more efficient than the EHAF protocol. Finally, the theoretical analyses are validated by performing Monte Carlo simulations.

  10. Locally decodable codes and private information retrieval schemes

    CERN Document Server

    Yekhanin, Sergey

    2010-01-01

    Locally decodable codes (LDCs) are codes that simultaneously provide efficient random access retrieval and high noise resilience by allowing reliable reconstruction of an arbitrary bit of a message by looking at only a small number of randomly chosen codeword bits. Local decodability comes with a certain loss in terms of efficiency - specifically, locally decodable codes require longer codeword lengths than their classical counterparts. Private information retrieval (PIR) schemes are cryptographic protocols designed to safeguard the privacy of database users. They allow clients to retrieve rec

  11. ETEEM- Extended Traffic Aware Energy Efficient MAC Scheme for WSNs

    OpenAIRE

    Younas Khan; Sheeraz Ahmed; Fakhri Alam Khan; Imran Ahmad; Saqib Shahid Rahim; M. Irfan Khattak

    2016-01-01

    Idle listening issue arises when a sensor node listens to medium despite the absence of data which results in consumption of energy. ETEEM is a variant of Traffic Aware Energy Efficient MAC protocol (TEEM) which focuses on energy optimization due to reduced idle listening time and much lesser overhead on energy sources. It uses a novel scheme for using idle listening time of sensor nodes. The nodes are only active for small amount of time and most of the time, will be in sleep mode when no da...

  12. Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

    Science.gov (United States)

    Larsson, Laura S; Kuster, Emilie

    2013-01-01

    The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

  13. Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India

    Directory of Open Access Journals (Sweden)

    Shashi Kant

    2018-01-01

    Full Text Available Background: The maternal mortality ratio in India is high. An effective emergency obstetric care (EmOC strategy has been identified as a priority to reduce maternal deaths. Since the capacity of different levels of public health facilities to provide EmOC is varied, an effective referral system is crucial. However, few studies have evaluated the functioning and quality of referral systems in India. A systematic monitoring of referrals helps to identify current gaps in the provision of essential obstetric care. Objective: This study was conducted to identify the medical and logistic reasons for emergency obstetric referrals from a subdistrict hospital (SDH. Methods: An audit of emergency referrals during the period January 2015–December 2015 was carried out. Records of all obstetric patients referred from the maternity ward during the study period were reviewed. Results: The referral rate was found to be 31.7%. Preterm labor (30.6%, pregnancy-induced hypertension (17%, and fetal distress (10.6% were the main reasons for referral. Deficiencies were found in critical determinants of functionality, that is, nonavailability of emergency cesarean, neonatal care unit, and blood bank. Conclusions: The referral rate at the SDH was high. Lack of workforce and infrastructural facilities led to referrals of women who ought to have been managed at this level of the hospital.

  14. Timely Referral to Outpatient Nephrology Care Slows Progression and Reduces Treatment Costs of Chronic Kidney Diseases

    Directory of Open Access Journals (Sweden)

    Gerhard Lonnemann

    2017-03-01

    Discussion: Timely referral to outpatient nephrology care is associated with slowed disease progression, less hospital admissions, reduced total treatment costs, and improved survival in patients with CKD.

  15. HIV+ deceased donor referrals: A national survey of organ procurement organizations.

    Science.gov (United States)

    Cash, Ayla; Luo, Xun; Chow, Eric K H; Bowring, Mary Grace; Shaffer, Ashton A; Doby, Brianna; Wickliffe, Corey E; Alexander, Charles; McRann, Deborah; Tobian, Aaron A R; Segev, Dorry L; Durand, Christine M

    2018-02-01

    HIV-infected (HIV+) donor organs can be transplanted into HIV+ recipients under the HIV Organ Policy Equity (HOPE) Act. Quantifying HIV+ donor referrals received by organ procurement organizations (OPOs) is critical for HOPE Act implementation. We surveyed the 58 USA OPOs regarding HIV+ referral records and newly discovered HIV+ donors. Using data from OPOs that provided exact records and CDC HIV prevalence data, we projected a national estimate of HIV+ referrals. Fifty-five (95%) OPOs reported HIV+ referrals ranging from 0 to 276 and newly discovered HIV+ cases ranging from 0 to 10 annually. Six OPOs in areas of high HIV prevalence reported more than 100 HIV+ donor referrals. Twenty-seven (47%) OPOs provided exact HIV+ referral records and 28 (51%) OPOs provided exact records of discovered HIV+ cases, totaling 1450 HIV+ referrals and 39 discovered HIV+ donors in the prior year. These OPOs represented 67% and 59% of prevalent HIV cases in the USA; thus, we estimated 2164 HIV+ referrals and 66 discovered HIV+ cases nationally per year. OPOs reported a high volume of HIV+ referrals annually, of which a subset will be medically eligible for donation. Particularly in areas of high HIV prevalence, OPOs require ongoing support to implement the HOPE Act. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Nsungwa-Sabiiti Jesca

    2006-03-01

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

  17. Epidemiology of infective endocarditis in a large Belgian non-referral hospital.

    Science.gov (United States)

    Poesen, K; Pottel, H; Colaert, J; De Niel, C

    2014-06-01

    Guidelines for diagnosis of infective endocarditis are largely based upon epidemiological studies in referral hospitals. Referral bias, however, might impair the validity of guidelines in non-referral hospitals. Recent studies in non-referral care centres on infective endocarditis are sparse. We conducted a retrospective epidemiological study on infective endocarditis in a large non-referral hospital in a Belgian city (Kortrijk). The medical record system was searched for all cases tagged with a putative diagnosis of infective endocarditis in the period 2003-2010. The cases that fulfilled the modified Duke criteria for probable or definite infective endocarditis were included. Compared to referral centres, an older population with infective endocarditis, and fewer predisposing cardiac factors and catheter-related infective endocarditis is seen in our population. Our patients have fewer prosthetic valve endocarditis as well as fewer staphylococcal endocarditis. Our patients undergo less surgery, although mortality rate seems to be highly comparable with referral centres, with nosocomial infective endocarditis as an independent predictor of mortality. The present study suggests that characteristics of infective endocarditis as well as associative factors might differ among non-referral hospitals and referral hospitals.

  18. Survival analysis to explore the characteristics of employee assistance program (EAP) referrals that remain employed.

    Science.gov (United States)

    Macdonald, S; Albert, W; Maynard, M; French, P

    1989-02-01

    This study examined characteristics of referrals to employee assistance programs (EAP) associated with subsequent termination of employment. As well, relationships between characteristics of the referrals and program characteristics were explored. Longitudinal data were collected at several time periods for 163 referrals to EAPs from five organizations. Survival analysis was conducted to determine which variables were associated with termination of employment. Females, cohabitating couples, and employees who worked for the organization for 5 or more years were most likely to remain employed. One interesting finding was that people with alcohol problems were significantly more likely to be formal referrals.

  19. Green-Frag: Energy-Efficient Frame Fragmentation Scheme for Wireless Sensor Networks

    KAUST Repository

    Daghistani, Anas H.

    2013-01-01

    that is optimized to be energy efficient, which is originated from the chosen frame fragmentation scheme. This new energy-efficient frame fragmentation protocol is called (Green-Frag). Green-Frag uses an algorithm that gives sensor nodes the ability to transmit data

  20. May the Kyoto protocol produce results?

    International Nuclear Information System (INIS)

    Jaureguy-Naudin, M.

    2009-01-01

    A not well managed drastic reduction of greenhouse emissions might result in significant decrease of living standards, but without such reduction efforts, climate change might have five to twenty times higher costs. Thus, while indicating estimated consequences or evolutions of greenhouse emissions and temperature, the author stresses the need of emission reduction. She discusses the role of economic instruments which can be used in policies aimed at the struggle against climate change. She recalls the emission reduction commitments specified in the Kyoto protocol, discusses the present status, operation and results of the international emission trading scheme, the lessons learned after the first years of operation, comments the involvement of emerging countries in relationship with another mechanism defined in the protocol: the Clean Development Mechanism

  1. Cognitive Radio MAC Protocol for WLAN

    DEFF Research Database (Denmark)

    Zhang, Qi; Fitzek, Frank H.P.; Iversen, Villy Bæk

    2008-01-01

    hole; moreover, it designs dual inband sensing scheme to detect primary user appearance. Additionally, C-CSMA/CA has the advantage to effectively solve the cognitive radio self-coexistence issues in the overlapping CR BSSs scenario. It also realizes station-based dynamic resource selection......To solve the performance degradation issue in current WLAN caused by the crowded unlicensed spectrum, we propose a cognitive radio (CR) media access protocol, C-CSMA/CA. The basic idea is that with cognitive radio techniques the WLAN devices can not only access the legacy WLAN unlicensed spectrum...

  2. Harmonisation between National and International Tradeable Permit Schemes. CATEP Synthesis Paper

    International Nuclear Information System (INIS)

    Haites, E.

    2003-01-01

    It is technically possible to link national emissions trading schemes with widely divergent designs. Where design differences create potential problems, technical solutions are available. The greater the similarity of their designs, the easier schemes are to link. During the 2005 - 2007 period the EU Directive, if it is adopted, will lead to the establishment of at least 25 national emissions trading schemes. The Directive specifies many of the design features of these schemes, but leaves the allocation of allowances, rules for banking allowances into the commitment period, use of the opt-out provision, and a few other design features to Member States. The resulting differences among Member State schemes are unlikely to undermine the links between the schemes established by the Directive. The Community may enter into agreements with non-members for mutual recognition of allowances between their emissions trading schemes, but few, if any, links of this type are expected prior to 2008 for practical reasons. Beginning in 2008, Article 17 of the Kyoto Protocol establishes an international emissions trading scheme that can link the national trading schemes of Annex I Parties. It imposes no requirements for harmonisation on the national emissions trading schemes linked. Some design differences could create technical problems, although solutions are available and at least one of the governments involved has an incentive to solve the problem. Adverse competitiveness impacts due to differences in the distribution of allowances across national schemes may need to be addressed through institutions such as the WTO. Most of the national trading schemes will also be subject to the EU Directive and be subject to greater harmonisation after 2008. The result is likely to be a progressive expansion and integration of greenhouse gas allowance markets over the next decade

  3. The emergency department: An appropriate referral rate for radiography

    International Nuclear Information System (INIS)

    Richards, P.J.; Tins, B.; Cherian, R.; Rae, F.; Dharmarajah, R.; Phair, I.C.; McCall, I.

    2002-01-01

    AIM: To evaluate the hypothesis that where there is good clinical practice in an emergency department (ED), there is a low uptake of plain radiography. MATERIALS AND METHODS: Emergency notes and radiography records were reviewed over one week in January 1999, to determine the rate of radiography of first time attenders at the North Staffordshire NHS Trust. The clinical appropriateness of the imaging was assessed by pairs of radiology specialist registrars and casualty physicians. They judged the appropriateness of the imaging by the 1998 Royal College of Radiologists (RCR) guidelines and/or their clinical judgement, by consensus. Where there was no consensus or the data appeared incomplete, the radiology and ED consultant reviewed the notes. RESULTS: A total of 1615 notes were found out of 1643 (98%). Of these, 147 (9%) return attenders were excluded and 32 patients left without being seen. The number of first time attenders was 1436 (87%), of whom 637 (44%) were radiographed; 95% of these radiography examinations were appropriate and 5% were inappropriate. Of the first time attenders who were not radiographed the decision was appropriate in 95% of cases, and inappropriate for 5%, i.e. 5% of those who had no radiography, should have been X-rayed. There were no disagreements between RCR guidelines and the clinical judgements, but in 16% there were no suitable RCR guidelines. Junior doctors were not always able to find the relevant RCR guideline (relevant clinical guideline found in 73% of cases) in the guideline book, compared to the consultants (relevant clinical guideline found in 84% of cases). CONCLUSION: The application of the RCR guidelines is taken as representing good clinical practice in determining when to refer a patient for radiography. Based on this assumption, a referral rate for radiography of 44% of first time attenders was found to be appropriate. This referral rate can be taken as a benchmark. A benchmark is necessary in order to allow departments

  4. A secure and robust password-based remote user authentication scheme using smart cards for the integrated EPR information system.

    Science.gov (United States)

    Das, Ashok Kumar

    2015-03-01

    An integrated EPR (Electronic Patient Record) information system of all the patients provides the medical institutions and the academia with most of the patients' information in details for them to make corrective decisions and clinical decisions in order to maintain and analyze patients' health. In such system, the illegal access must be restricted and the information from theft during transmission over the insecure Internet must be prevented. Lee et al. proposed an efficient password-based remote user authentication scheme using smart card for the integrated EPR information system. Their scheme is very efficient due to usage of one-way hash function and bitwise exclusive-or (XOR) operations. However, in this paper, we show that though their scheme is very efficient, their scheme has three security weaknesses such as (1) it has design flaws in password change phase, (2) it fails to protect privileged insider attack and (3) it lacks the formal security verification. We also find that another recently proposed Wen's scheme has the same security drawbacks as in Lee at al.'s scheme. In order to remedy these security weaknesses found in Lee et al.'s scheme and Wen's scheme, we propose a secure and efficient password-based remote user authentication scheme using smart cards for the integrated EPR information system. We show that our scheme is also efficient as compared to Lee et al.'s scheme and Wen's scheme as our scheme only uses one-way hash function and bitwise exclusive-or (XOR) operations. Through the security analysis, we show that our scheme is secure against possible known attacks. Furthermore, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool and show that our scheme is secure against passive and active attacks.

  5. Computerised sepsis protocol management. Description of an early warning system.

    Science.gov (United States)

    de Dios, Begoña; Borges, Marcio; Smith, Timothy D; Del Castillo, Alberto; Socias, Antonia; Gutiérrez, Leticia; Nicolás, Jordi; Lladó, Bartolomé; Roche, Jose A; Díaz, Maria P; Lladó, Yolanda

    2018-02-01

    New strategies need to be developed for the early recognition and rapid response for the management of sepsis. To achieve this purpose, the Multidisciplinary Sepsis Team (MST) developed the Computerised Sepsis Protocol Management (PIMIS). The aim of this study was to evaluate the convenience of using PIMIS, as well as the activity of the MST. An analysis was performed on the data collected from solicited MST consultations (direct activation of PIMIS by attending physician or telephone request) and unsolicited ones (by referral from the microbiology laboratory or an automatic referral via the hospital vital signs recording software [SIDCV]), as well as the hospital department, source of infection, treatment recommendation, and acceptance of this. Of the 1,581 first consultations, 65.1% were solicited consultations (84.1% activation of PIMIS and 15.9% by telephone). The majority of unsolicited consultations were generated by the microbiology laboratory (95.2%), and 4.8% from the SIDCV. Referral from solicited consultations were generated sooner (5.63days vs 8.47days; P<.001) and came from clinical specialties rather than from the surgical ward (73.0% vs 39.1%; P<.001). A recommendation was made for antimicrobial prescription change in 32% of first consultations. The treating physician accepted 78.1% of recommendations. The high rate of solicited consultations and acceptance of recommended prescription changes suggest that a MST is seen as a helpful resource, and that PIMIS software is perceived to be useful and convenient to use, as it is the main source of referral. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  6. A data seamless interaction scheme between electric power secondary business systems

    Science.gov (United States)

    Ai, Wenkai; Qian, Feng

    2018-03-01

    At present, the data interaction of electric power secondary business systems is very high, and it is not universal to develop programs when data interaction is carried out by different manufacturers' electric power secondary business systems. There are different interaction schemes for electric power secondary business systems with different manufacturers, which lead to high development cost, low reusability and high maintenance difficulty. This paper introduces a new data seamless interaction scheme between electric power secondary business systems. The scheme adopts the international common Java message service protocol as the transmission protocol, adopts the common JavaScript object symbol format as the data interactive format, unified electric power secondary business systems data interactive way, improve reusability, reduce complexity, monitor the operation of the electric power secondary business systems construction has laid a solid foundation.

  7. Support Schemes and Ownership Structures

    DEFF Research Database (Denmark)

    Ropenus, Stephanie; Schröder, Sascha Thorsten; Costa, Ana

    , Denmark, France and Portugal. Another crucial aspect for the diffusion of the mCHP technology is possible ownership structures. These may range from full consumer ownership to ownership by utilities and energy service companies, which is discussed in Section 6. Finally, a conclusion (Section 7) wraps up......In recent years, fuel cell based micro‐combined heat and power has received increasing attention due to its potential contribution to energy savings, efficiency gains, customer proximity and flexibility in operation and capacity size. The FC4Home project assesses technical and economic aspects...... of support scheme simultaneously affects risk and technological development, which is the focus of Section 4. Subsequent to this conceptual overview, Section 5 takes a glance at the national application of support schemes for mCHP in practice, notably in the three country cases of the FC4Home project...

  8. [PICS: pharmaceutical inspection cooperation scheme].

    Science.gov (United States)

    Morénas, J

    2009-01-01

    The pharmaceutical inspection cooperation scheme (PICS) is a structure containing 34 participating authorities located worldwide (October 2008). It has been created in 1995 on the basis of the pharmaceutical inspection convention (PIC) settled by the European free trade association (EFTA) in1970. This scheme has different goals as to be an international recognised body in the field of good manufacturing practices (GMP), for training inspectors (by the way of an annual seminar and experts circles related notably to active pharmaceutical ingredients [API], quality risk management, computerized systems, useful for the writing of inspection's aide-memoires). PICS is also leading to high standards for GMP inspectorates (through regular crossed audits) and being a room for exchanges on technical matters between inspectors but also between inspectors and pharmaceutical industry.

  9. Project financing renewable energy schemes

    International Nuclear Information System (INIS)

    Brandler, A.

    1993-01-01

    The viability of many Renewable Energy projects is critically dependent upon the ability of these projects to secure the necessary financing on acceptable terms. The principal objective of the study was to provide an overview to project developers of project financing techniques and the conditions under which project finance for Renewable Energy schemes could be raised, focussing on the potential sources of finance, the typical project financing structures that could be utilised for Renewable Energy schemes and the risk/return and security requirements of lenders, investors and other potential sources of financing. A second objective is to describe the appropriate strategy and tactics for developers to adopt in approaching the financing markets for such projects. (author)

  10. Network Regulation and Support Schemes

    DEFF Research Database (Denmark)

    Ropenus, Stephanie; Schröder, Sascha Thorsten; Jacobsen, Henrik

    2009-01-01

    -in tariffs to market-based quota systems, and network regulation approaches, comprising rate-of-return and incentive regulation. National regulation and the vertical structure of the electricity sector shape the incentives of market agents, notably of distributed generators and network operators......At present, there exists no explicit European policy framework on distributed generation. Various Directives encompass distributed generation; inherently, their implementation is to the discretion of the Member States. The latter have adopted different kinds of support schemes, ranging from feed....... This article seeks to investigate the interactions between the policy dimensions of support schemes and network regulation and how they affect the deployment of distributed generation. Firstly, a conceptual analysis examines how the incentives of the different market agents are affected. In particular...

  11. Distance labeling schemes for trees

    DEFF Research Database (Denmark)

    Alstrup, Stephen; Gørtz, Inge Li; Bistrup Halvorsen, Esben

    2016-01-01

    We consider distance labeling schemes for trees: given a tree with n nodes, label the nodes with binary strings such that, given the labels of any two nodes, one can determine, by looking only at the labels, the distance in the tree between the two nodes. A lower bound by Gavoille et al. [Gavoille...... variants such as, for example, small distances in trees [Alstrup et al., SODA, 2003]. We improve the known upper and lower bounds of exact distance labeling by showing that 1/4 log2(n) bits are needed and that 1/2 log2(n) bits are sufficient. We also give (1 + ε)-stretch labeling schemes using Theta...

  12. Small-scale classification schemes

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2004-01-01

    Small-scale classification schemes are used extensively in the coordination of cooperative work. This study investigates the creation and use of a classification scheme for handling the system requirements during the redevelopment of a nation-wide information system. This requirements...... classification inherited a lot of its structure from the existing system and rendered requirements that transcended the framework laid out by the existing system almost invisible. As a result, the requirements classification became a defining element of the requirements-engineering process, though its main...... effects remained largely implicit. The requirements classification contributed to constraining the requirements-engineering process by supporting the software engineers in maintaining some level of control over the process. This way, the requirements classification provided the software engineers...

  13. Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral.

    Science.gov (United States)

    Rahman, Rachel Jane; Thogersen-Ntoumani, Cecilie; Thatcher, Joanne; Doust, Jonathan

    2011-11-01

    Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N = 293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.

  14. Protocol Fuel Mix reporting

    International Nuclear Information System (INIS)

    2002-07-01

    The protocol in this document describes a method for an Electricity Distribution Company (EDC) to account for the fuel mix of electricity that it delivers to its customers, based on the best available information. Own production, purchase and sale of electricity, and certificates trading are taken into account. In chapter 2 the actual protocol is outlined. In the appendixes additional (supporting) information is given: (A) Dutch Standard Fuel Mix, 2000; (B) Calculation of the Dutch Standard fuel mix; (C) Procedures to estimate and benchmark the fuel mix; (D) Quality management; (E) External verification; (F) Recommendation for further development of the protocol; (G) Reporting examples

  15. Coded Splitting Tree Protocols

    DEFF Research Database (Denmark)

    Sørensen, Jesper Hemming; Stefanovic, Cedomir; Popovski, Petar

    2013-01-01

    This paper presents a novel approach to multiple access control called coded splitting tree protocol. The approach builds on the known tree splitting protocols, code structure and successive interference cancellation (SIC). Several instances of the tree splitting protocol are initiated, each...... instance is terminated prematurely and subsequently iterated. The combined set of leaves from all the tree instances can then be viewed as a graph code, which is decodable using belief propagation. The main design problem is determining the order of splitting, which enables successful decoding as early...

  16. Playing With Population Protocols

    Directory of Open Access Journals (Sweden)

    Xavier Koegler

    2009-06-01

    Full Text Available Population protocols have been introduced as a model of sensor networks consisting of very limited mobile agents with no control over their own movement: A collection of anonymous agents, modeled by finite automata, interact in pairs according to some rules. Predicates on the initial configurations that can be computed by such protocols have been characterized under several hypotheses. We discuss here whether and when the rules of interactions between agents can be seen as a game from game theory. We do so by discussing several basic protocols.

  17. ATM and Internet protocol

    CERN Document Server

    Bentall, M; Turton, B

    1998-01-01

    Asynchronous Transfer Mode (ATM) is a protocol that allows data, sound and video being transferred between independent networks via ISDN links to be supplied to, and interpreted by, the various system protocols.ATM and Internet Protocol explains the working of the ATM and B-ISDN network for readers with a basic understanding of telecommunications. It provides a handy reference to everyone working with ATM who may not require the full standards in detail, but need a comprehensive guide to ATM. A substantial section is devoted to the problems of running IP over ATM and there is some discussion o

  18. Referral Practices Among U.S. Publicly Funded Health Centers That Offer Family Planning Services.

    Science.gov (United States)

    Carter, Marion W; Robbins, Cheryl L; Gavin, Loretta; Moskosky, Susan

    2018-01-29

    Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning. We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices. In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62). Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.

  19. Referrral Systems Development and Survey of Perioperative and Critical Care Referral to Anesthetists.

    Science.gov (United States)

    Narendra, P L; Hegde, Harihar V; Khan, Maroof Ahmad; Talikoti, Dayanand G; Nallamilli, Samson

    2017-01-01

    Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome. The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams. The response rate was 43.8%. Sixty percent (55.3-64.8, P - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42-72.45, P - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16-8.98, P - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92-29.42, P - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) ( P - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) ( P - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) ( P = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) ( P = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place. Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.

  20. [Self-referrals at Emergency Care Access Points and triage by General Practitioner Cooperatives].

    Science.gov (United States)

    Smits, M; Rutten, M; Schepers, L; Giesen, P

    2017-01-01

    There is a trend for General Practitioner Cooperatives (GPCs) to co-locate with emergency departments (EDs) of hospitals at Emergency Care Access Points (ECAPs), where the GPCs generally conduct triage and treat a large part of self-referrals who would have gone to the ED by themselves in the past. We have examined patient and care characteristics of self-referrals at ECAPs where triage was conducted by GPCs, also to determine the percentage of self-referrals being referred to the ED. Retrospective cross-sectional observational study. Descriptive analyses of routine registration data from self-referrals of five ECAPs (n = 20.451). Patient age, gender, arrival time, urgency, diagnosis and referral were analysed. Of the self-referrals, 57.9% was male and the mean age was 32.7 years. The number of self-referrals per hour was highest during weekends, particularly between 11 a.m. and 5 p.m. On weekdays, there was a peak between 5 and 9 p.m. Self-referrals were mostly assigned a low-urgency grade (35.7% - U4 or U5) or a mid-urgency grade (49% - U3). Almost half of the self-referrals had trauma of the locomotor system (28%) or the skin (27.3%). In total, 23% of the patients was referred to the ED. Self-referred patients at GPCs are typically young, male and have low- to mid-urgency trauma-related problems. Many self-referrals present themselves on weekend days or early weekday evenings. Over three quarters of these patients can be treated by the GPCs, without referral to the ED. This reduces the workload at the ED.

  1. New schemes for particle accelerators

    International Nuclear Information System (INIS)

    Nishida, Y.

    1985-01-01

    In the present paper, the authors propose new schemes for realizing the v/sub p/xB accelerator, by using no plasma system for producing the strong longitudinal waves. The first method is to use a grating for obtaining extended interaction of an electron beam moving along the grating surface with light beam incident also along the surface. Here, the light beam propagates obliquely to the grating grooves for producing strong electric field, and the electron beam propagates in parallel to the light beam. The static magnetic field is applied perpendicularly to the grating surface. In the present system, the beam interacts synchronously with the p-polarized wave which has the electric field be parallel to the grating surface. Another conventional scheme is to use a delay circuit. Here, the light beam propagates obliquely between a pair of array of conductor fins or slots. The phase velocity of the spatial harmonics in the y-direction (right angle to the array of slots) is slower than the speed of light. With the aid of powerful laser light or microwave source, it should be possible to miniaturise linacs by using the v/sub p/xB effect and schemes proposed here

  2. A Two-Layered Mobility Architecture Using Fast Mobile IPv6 and Session Initiation Protocol

    Directory of Open Access Journals (Sweden)

    Nursimloo DeeyaS

    2008-01-01

    Full Text Available Abstract This paper proposes an integrated mobility scheme that combines the procedures of fast handover for Mobile IPv6 (FMIPv6 and session initiation protocol (SIP mobility for realtime communications. This integrated approach is based on the context of the applications utilized. Furthermore, to reduce system redundancies and signaling loads, several functionalities of FMIPv6 and SIP have been integrated to optimize the integrated mobility scheme. The proposed scheme aims at reducing the handover latency and packet loss for an ongoing realtime traffic. Using ns-2 simulation, we analyze the performance of the proposed integrated scheme and compare it with the existing protocols for a VoIP and for a video stream traffic. This mobility architecture achieves lower handover delay and less packet loss than using either FMIPv6 or SIP and hence presents a powerful handover mobility scheme for next generation IP-based wireless systems.

  3. A Two-Layered Mobility Architecture Using Fast Mobile IPv6 and Session Initiation Protocol

    Directory of Open Access Journals (Sweden)

    Deeya S. Nursimloo

    2007-12-01

    Full Text Available This paper proposes an integrated mobility scheme that combines the procedures of fast handover for Mobile IPv6 (FMIPv6 and session initiation protocol (SIP mobility for realtime communications. This integrated approach is based on the context of the applications utilized. Furthermore, to reduce system redundancies and signaling loads, several functionalities of FMIPv6 and SIP have been integrated to optimize the integrated mobility scheme. The proposed scheme aims at reducing the handover latency and packet loss for an ongoing realtime traffic. Using ns-2 simulation, we analyze the performance of the proposed integrated scheme and compare it with the existing protocols for a VoIP and for a video stream traffic. This mobility architecture achieves lower handover delay and less packet loss than using either FMIPv6 or SIP and hence presents a powerful handover mobility scheme for next generation IP-based wireless systems.

  4. Different causes of referral to ophthalmology emergency room

    Directory of Open Access Journals (Sweden)

    Alireza Keshtkar Jafari

    2012-01-01

    Full Text Available Background: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients′ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6% were males. While 299 patients (9.5% were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%. In patients referred due to trauma (1950 patients, work-related injuries occurred in 955 patients (49% and occurred accidentally (by chance in 819 patients (42%. The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%. The most common etiologies of eye trauma (1950 patients were metal filings (814 patients; 41.8%, blunt trauma (338 patients; 17.3%, fireworks (236 patients; 12.1% and sharp objects (222 patients; 11.4%. Globe injury was diagnosed in 1865 patients (95.7% of trauma cases. In patients referred due to non-traumatic reason (1200 patients, eye infection occurred in 482 patients (40.2% and 299 patients (24.9% were referred for non-urgent reasons. There was little difference

  5. Comparison of referral and non-referral hypertensive disorders during pregnancy: an analysis of 271 consecutive cases at a tertiary hospital.

    Science.gov (United States)

    Liu, Ching-Ming; Chang, Shuenn-Dyh; Cheng, Po-Jen

    2005-05-01

    This retrospective cohort study analyzed the clinical manifestations in patients with preeclampsia and eclampsia, assessed the risk factors compared to the severity of hypertensive disorders on maternal and perinatal morbidity, and mortality between the referral and non-referral patients. 271 pregnant women with preeclampsia and eclampsia were assessed (1993 to 1997). Chi-square analysis was used for the comparison of categorical variables, and the comparison of the two independent variables of proportions in estimation of confidence intervals and calculated odds ratio of the referral and non-referral groups. Multivariate logistic regression was used for adjusting potential confounding risk factors. Of the 271 patients included in this study, 71 (26.2%) patients were referrals from other hospitals. Most of the 62 (87.3%) referral patients were transferred during the period 21 and 37 weeks of gestation. Univariate analysis revealed that referral patients with hypertensive disorder were significantly associated with SBP > or =180, DBP > or =105, severe preclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP), emergency C/S, maternal complications, and low birth weight babies, as well as poor Apgar score. Multivariate logistic regression analyses revealed that the risk factors identified to be significantly associated with increased risk of referral patients included: diastolic blood pressure above 105 mmHg (adjusted odds ratio, 2.09; 95 percent confidence interval, 1.06 to 4.13; P = 0.034), severe preeclampsia (adjusted odds ratio, 3.46; 95 percent confidence interval, 1.76 to 6.81; P < 0.001), eclampsia (adjusted odds ratio, 2.77; 95 percent confidence interval, 0.92 to 8.35; P = 0.071), HELLP syndrome (adjusted odds ratio, 18.81; 95 percent confidence interval, 2.14 to 164.99; P = 0.008). The significant factors associated with the referral patients with hypertensive disorders were severe preeclampsia, HELLP, and eclampsia. Lack of prenatal care was

  6. A Memory Efficient Network Encryption Scheme

    Science.gov (United States)

    El-Fotouh, Mohamed Abo; Diepold, Klaus

    In this paper, we studied the two widely used encryption schemes in network applications. Shortcomings have been found in both schemes, as these schemes consume either more memory to gain high throughput or low memory with low throughput. The need has aroused for a scheme that has low memory requirements and in the same time possesses high speed, as the number of the internet users increases each day. We used the SSM model [1], to construct an encryption scheme based on the AES. The proposed scheme possesses high throughput together with low memory requirements.

  7. An Arbitrated Quantum Signature Scheme without Entanglement*

    International Nuclear Information System (INIS)

    Li Hui-Ran; Luo Ming-Xing; Peng Dai-Yuan; Wang Xiao-Jun

    2017-01-01

    Several quantum signature schemes are recently proposed to realize secure signatures of quantum or classical messages. Arbitrated quantum signature as one nontrivial scheme has attracted great interests because of its usefulness and efficiency. Unfortunately, previous schemes cannot against Trojan horse attack and DoS attack and lack of the unforgeability and the non-repudiation. In this paper, we propose an improved arbitrated quantum signature to address these secure issues with the honesty arbitrator. Our scheme takes use of qubit states not entanglements. More importantly, the qubit scheme can achieve the unforgeability and the non-repudiation. Our scheme is also secure for other known quantum attacks . (paper)

  8. Load Experiment of the vDACS Scheme in case of the 300 Clients

    Directory of Open Access Journals (Sweden)

    Kazuya Odagiri

    2017-09-01

    Full Text Available In the current Internet system, there are many problems using anonymity of the network communication such as personal information leaks and crimes using the Internet system. This is why TCP/IP protocol used in Internet system does not have the user identification information on the communication data, and it is difficult to supervise the user performing the above acts immediately. As a study for solving the above problem, there is the study of Policy Based Network Management (PBNM. This is the scheme for managing a whole Local Area Network (LAN through communication control for every user. In this PBNM, two types of schemes exist. The first is the scheme for managing the whole LAN by locating the communication control mechanisms on the path between network servers and clients. The second is the scheme of managing the whole LAN by locating the communication control mechanisms on clients. As the second scheme, we have studied theoretically about the Destination Addressing Control System (DACS Scheme. By applying this DACS Scheme to Internet system management, we will realize the policy-based Internet system management. In this paper, as the progression phase for the last goal, we perform the load experiment of the cloud type virtual PBNM named the vDACS Scheme, which can be used by plural organizations, for applications to the small and medium size scale organization. The number of clients used in an experiment is 300.

  9. Mobile Internet Protocol Analysis

    National Research Council Canada - National Science Library

    Brachfeld, Lawrence

    1999-01-01

    ...) and User Datagram Protocol (UDP). Mobile IP allows mobile computers to send and receive packets addressed with their home network IP address, regardless of the IP address of their current point of attachment on the Internet...

  10. USA-USSR protocol

    CERN Multimedia

    1970-01-01

    On 30 November the USA Atomic Energy Commission and the USSR State Committee for the Utilization of Atomic Energy signed, in Washington, a protocol 'on carrying out of joint projects in the field of high energy physics at the accelerators of the National Accelerator Laboratory (Batavia) and the Institute for High Energy Physics (Serpukhov)'. The protocol will be in force for five years and can be extended by mutual agreement.

  11. The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger

    Directory of Open Access Journals (Sweden)

    Van Lerberghe Wim

    2004-04-01

    Full Text Available Abstract Background For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. Methods Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. Results Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. Conclusions Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns.

  12. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of the...

  13. An analysis of referrals received by a psychiatric unit in a general ...

    African Journals Online (AJOL)

    An analysis of referrals received by a psychiatric unit in a general hospital part 1: the need for and research design adopted to study referrals received by a psychiatric unit in a general hospital: research. M. Dor, V.J. Ehlers, M.M. Van der Merwe ...

  14. 29 CFR 6.41 - Referral to Chief Administrative Law Judge.

    Science.gov (United States)

    2010-07-01

    ... Administrative Law Judge to conduct such hearings as may be necessary to decide the disputed matters. A copy of... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Chief Administrative Law Judge. 6.41 Section 6... Substantial Interest Proceedings § 6.41 Referral to Chief Administrative Law Judge. (a) Upon timely receipt of...

  15. A Collaborative Process Model for Promoting Successful Referrals in College Counseling

    Science.gov (United States)

    Iarussi, Melanie M.; Shaw, Brian M.

    2016-01-01

    The need to refer students to off-campus mental health providers is common in college counseling. Such referrals can be challenging for college counselors who strive to meet students' counseling needs while adhering to ethical and center policy guidelines. In this article, the authors explore the nature and challenges of referral in college…

  16. Study of Herpes Zoster in a Self-Referral Out-Patient Clinic ...

    African Journals Online (AJOL)

    Aim: To study the presentation of herpes zoster (shingles) in self-referral urban primary care setting. Patients and method: During nearly 20 years, patients of Igbo ethnic group presented with herpes zoster, on a self-referral basis, to my urban, week day evening, out patient clinic. The recorded epidemiological parameters ...

  17. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action. ...

  18. 31 CFR 904.4 - Minimum amount of referrals to the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... Department of Justice. 904.4 Section 904.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FEDERAL CLAIMS COLLECTION STANDARDS (DEPARTMENT OF THE TREASURY-DEPARTMENT OF JUSTICE) REFERRALS TO THE DEPARTMENT OF JUSTICE § 904.4 Minimum amount of referrals to the Department of Justice. (a...

  19. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be compromised...

  20. 49 CFR 1018.72 - Referral to the Department of Justice.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount is... Justice, Washington, DC 20530. Claims for which the gross original amount is $500,000 or less must be...

  1. 22 CFR 213.37 - Referrals to the Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37... Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS cross... of Justice's Nationwide Central Intake Facility as required by the Claims Collection Litigation...

  2. Physician self-referral for imaging and the cost of chronic care for Medicare beneficiaries.

    Science.gov (United States)

    Hughes, Danny R; Sunshine, Jonathan H; Bhargavan, Mythreyi; Forman, Howard

    2011-09-01

    As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. Self-referral in imaging was significantly (P nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.

  3. Innovation in managing the referral process at a Canadian pediatric hospital.

    Science.gov (United States)

    MacGregor, Daune; Parker, Sandra; MacMillan, Sharon; Blais, Irene; Wong, Eugene; Robertson, Chris J; Bruce-Barrett, Cindy

    2009-01-01

    The provision of timely and optimal patient care is a priority in pediatric academic health science centres. Timely access to care is optimized when there is an efficient and consistent referral system in place. In order to improve the patient referral process and, therefore, access to care, an innovative web-based system was developed and implemented. The Ambulatory Referral Management System enables the electronic routing for submission, review, triage and management of all outpatient referrals. The implementation of this system has provided significant metrics that have informed how processes can be improved to increase access to care. Use of the system has improved efficiency in the referral process and has reduced the work associated with the previous paper-based referral system. It has also enhanced communication between the healthcare provider and the patient and family and has improved the security and confidentiality of patient information management. Referral guidelines embedded within the system have helped to ensure that referrals are more complete and that the patient being referred meets the criteria for assessment and treatment in an ambulatory setting. The system calculates and reports on wait times, as well as other measures.

  4. Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

    Science.gov (United States)

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

    The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

  5. Impact of Ages and Stages Questionnaire Scores on Pediatrician Referral Patterns

    Science.gov (United States)

    Roane, Brandy Michelle; Valleley, Rachel J.; Allen, Keith D.

    2012-01-01

    The American Academy of Pediatrics has recommended an algorithm for identifying children with potential developmental delays. It includes a recommendation that positive screening should result in referral for additional evaluation or intervention. Yet, it is not known whether positive screens do, in fact, influence physician referrals. The primary…

  6. 6 CFR 13.11 - Referral of Complaint and answer to the ALJ.

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referral of Complaint and answer to the ALJ. 13.11 Section 13.11 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of Complaint and answer to the ALJ. Upon receipt of an answer, the...

  7. Community care workers, poor referral networks and consumption of personal resources in rural South Africa

    NARCIS (Netherlands)

    Sips, I.I.; Haeri Mazanderani, A.; Schneider, H.; Greeff, M.; Barten, F.J.; Moshabela, M.

    2014-01-01

    Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral

  8. Referral patterns of children with poor growth in primary health care

    NARCIS (Netherlands)

    Grote, F.K.; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Dekker, F.W.; Dommelen, P. van; Buuren, S. van; Lodder-van der Kooij, A.M.; Verkerk, P.H.; Wit, J.M.

    2007-01-01

    Background. To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these

  9. Referral criteria for school-based hearing screening in South Africa ...

    African Journals Online (AJOL)

    Referral criteria for school-based hearing screening in South Africa: Considerations for resource-limited contexts. ... Diagnostic audiometry confirmed that almost half (47%) of the referred children had a hearing loss. Conclusion: A screening intensity of 25 dB HL andimmediate rescreen reduces the referral rate significantly ...

  10. Why Do At-Risk Mothers Fail To Reach Referral Level? Barriers ...

    African Journals Online (AJOL)

    In southern Tanzania, few high-risk pregnancies are channeled through antenatal care to the referral level. We studied the influences that make pregnant women heed or reject referral advice. Semi-structured interviews with sixty mothers-to-be, twenty-six health workers and six key-informants to identify barriers to use of ...

  11. Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review.

    Science.gov (United States)

    Selhorst, Mitchell; Fischer, Anastasia; Graft, Kristine; Ravindran, Reno; Peters, Eric; Rodenberg, Richard; Welder, Eric; MacDonald, James

    2017-05-01

    The purposes of this study were (1) to determine whether the duration of rest before referral to physical therapy (PT) affects the time to make a full return to activity for patients with an acute spondylolysis, (2) to assess the safety of an early referral to PT in patients with an acute spondylolysis. Retrospective chart review. Hospital-based sports medicine clinic. The medical charts of 196 adolescent athletes (mean age = 14.3 ± 1.8 years) with an acute spondylolytic injury met the inclusion criteria and were reviewed. Patients were subgrouped based on physician referral to PT. An aggressive referral group (10 weeks). Duration of rest before clearance to a full return to activity and the frequency of adverse reactions during the course of treatment. Safety was assessed by calculating the risk of experiencing an adverse reaction in each group. Median days to a full return to activity for aggressive referral group (115.5 days, interquartile range 98-150 days) and conservative referral group (140.0 days, interquartile range 114.5-168 days) were significantly different (P = 0.002). Eleven patients had adverse reactions during the course of treatment. The risk of adverse reaction was not statistically significant between groups (P = 0.509). Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups.

  12. Asthma referrals: a key component of asthma management that needs to be addressed

    Directory of Open Access Journals (Sweden)

    Price D

    2017-07-01

    Full Text Available David Price,1,2 Leif Bjermer,3 David A Bergin,4 Rafael Martinez5 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Observational and Pragmatic Research Institute, Singapore; 3Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden; 4Novartis Ireland Limited, Dublin, Ireland; 5Novartis Pharma AG, Basel, Switzerland Abstract: Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient’s health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature. Keywords: asthma, disease management, specialization, primary care physicians, referral

  13. Comparison of different strategies of referral to a fall clinic: How to achieve an optimal casemix?

    NARCIS (Netherlands)

    Schoon, Y.; Hoogsteen Ossewaarde, M. E.; Scheffer, A. C.; van Rooij, F. J. M.; Olde Rikkert, M. G. M.; de Rooij, S. E.

    2011-01-01

    To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner. Cross-sectional

  14. Comparison of different strategies of referral to a fall clinic: how to achieve an optimal casemix?

    NARCIS (Netherlands)

    Schoon, Y.; Hoogsteen-Ossewaarde, M.E.; Scheffer, A.C.; Rooij, F.J.M. van; Olde Rikkert, M.G.M.; Rooij, S.E. De

    2011-01-01

    OBJECTIVE To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner. DESIGN:

  15. Impaired Job Performance and Critical Incidents: Factors Influencing Supervisory EAP Referrals.

    Science.gov (United States)

    Harley, David A.

    Relatively little empirical research has been done on the supervisory referral of employees to employee assistance programs (EAPs). Inclusion of constructive confrontation (supervisory referral) into program standards and its continued promotion as a "central strategy" of program theory and operation calls for critical investigation of…

  16. Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds.

    Science.gov (United States)

    Rawlins, Matthew D M; Raby, Edward; Sanfilippo, Frank M; Douglass, Rae; Chambers, Jonathan; McLellan, Duncan; Dyer, John R

    2018-05-04

    To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). Retrospective, single-centre observational study between March 2015 and February 2016. A new quaternary referral centre. Adults referred for antimicrobial rounds outside of the intensive care and haematology units. Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

  17. CAD for CT colonography: toward a preparation-independent scheme

    International Nuclear Information System (INIS)

    Naeppi, J.

    2007-01-01

    Computer-aided detection (CAD) systems can be used to automatically detect and display the locations of polyps and masses in computed tomographic colonography (CTC) data for assisting radiologists' image interpretation. Rapid technical advancements over the last few years have established a fundamental CAD scheme for CTC that includes the steps of colon extraction, polyp detection, and false-positive (FP) reduction. Several CAD prototype systems have demonstrated clinically acceptable high polyp detection sensitivity with relatively few FP detections in cathartic CTC, and observer studies have demonstrated the potential benefit of such systems in improving the accuracy and consistency of radiologists' detection performance. Some CAD prototype systems have also demonstrated promising performance in reduced cathartic and non-cathartic CTC. Recent advancements suggest that CAD systems can soon be expected to provide a preparation-independent scheme that can yield consistently high detection sensitivity with moderately low FP rate not only with cathartic CTC protocols but over a wide range of cathartic, reduced cathartic, and non-cathartic CTC protocols. (orig.)

  18. Decoupling schemes for the SSC Collider

    International Nuclear Information System (INIS)

    Cai, Y.; Bourianoff, G.; Cole, B.; Meinke, R.; Peterson, J.; Pilat, F.; Stampke, S.; Syphers, M.; Talman, R.

    1993-05-01

    A decoupling system is designed for the SSC Collider. This system can accommodate three decoupling schemes by using 44 skew quadrupoles in the different configurations. Several decoupling schemes are studied and compared in this paper

  19. Renormalization scheme-invariant perturbation theory

    International Nuclear Information System (INIS)

    Dhar, A.

    1983-01-01

    A complete solution to the problem of the renormalization scheme dependence of perturbative approximants to physical quantities is presented. An equation is derived which determines any physical quantity implicitly as a function of only scheme independent variables. (orig.)

  20. The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction

    DEFF Research Database (Denmark)

    Lewinter, Christian; Bland, John M; Crouch, Simon

    2014-01-01

    BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI......% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion...... (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003. CONCLUSIONS: CR referral was associated with improved survival in 2003...

  1. Current referral practices and adolescent transition to Adult clinic ...

    African Journals Online (AJOL)

    ... before transfer(90.7%). Most respondents, (97%), see refused transfer or returning clients. Possible reasons for refusal of transfer are fear (90%); difficulty with new treatment relationship (89.1%); and physician attitude (61.7%). Conclusion: Little or no guidelines exist and a robust adolescent transition protocol is required.

  2. Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members.

    Science.gov (United States)

    Pembe, Andrea B; Mbekenga, Columba K; Olsson, Pia; Darj, Elisabeth

    2017-01-01

    In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process. In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives' advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral. Declining maternal referral advice centred around the pregnant women's position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.

  3. Tightly Secure Signatures From Lossy Identification Schemes

    OpenAIRE

    Abdalla , Michel; Fouque , Pierre-Alain; Lyubashevsky , Vadim; Tibouchi , Mehdi

    2015-01-01

    International audience; In this paper, we present three digital signature schemes with tight security reductions in the random oracle model. Our first signature scheme is a particularly efficient version of the short exponent discrete log-based scheme of Girault et al. (J Cryptol 19(4):463–487, 2006). Our scheme has a tight reduction to the decisional short discrete logarithm problem, while still maintaining the non-tight reduction to the computational version of the problem upon which the or...

  4. To refer or not to refer: a qualitative study of reasons for referral from Role 1.

    Science.gov (United States)

    Driver, J M; Nelson, T G; Simpson, R; Wall, C

    2012-09-01

    There are currently over 9000 British soldiers serving in Afghanistan. The Defence Medical Services provide primary health care to soldiers at forward locations using Regimental Medical Officers (RMOs) and General Duties Medical Officers (GDMOs). If required, GDMOs can refer patients to senior colleagues. Currently, little is known about the reasons for referrals by GDMOs. This study aims to identify the main factors affecting why GDMOs refer from forward locations. Nine GDMOs, who deployed on Operation HERRICK 13, were invited to join the study. They maintained a log of their referrals for two 14 day periods, one in each half of their tour. In addition, a semi-structured interview was performed with each GDMO in order to elicit the common themes surrounding referrals. The mean referral rate was 0.9 referrals/GDMO/week. The main reasons for referral were dental problems, musculoskeletal injuries, abdominal pain of unknown cause, and ano-genital problems. Factors that influenced referrals included availability of forwardly projected services (dentist and physiotherapist), manpower availability at the locations, the availability of flights (affected by weather, enemy action, and schedule of routine flights), and the timing of the tour in relation to leave. Referrals from GDMOs were due to doctor inexperience in the treatment of a particular condition, lack of access to investigations and the potential for deterioration in a location without adequate support. The referral decision process was affected by the patient's importance with regards to the mission, the weather and access to safe transportation. The introduction of clinical guidelines for common conditions in conjunction with minor alterations to GDMO training could help reduce referrals from Role 1, preserving manpower, reducing costs, and minimising risk to evacuation aircraft.

  5. High risk pregnancy referrals adequacy in the Basic Health Services of Sobral, Ceará, Brazil

    Directory of Open Access Journals (Sweden)

    José Juvenal Linhares

    2009-03-01

    Full Text Available Objective: To describe the appropriateness of referrals of high-risk pregnancies in the basic healthcare network of Sobral, in Ceará, Brazil. Methods: A descriptive quantitative study. The medical files of 173 pregnant patients referred to the high-risk outpatient clinic of Centro de Especialidades Médicas of Sobral, during the period from July 2006 to April 2007, were analyzed. Variables analyzed were correctness of the referrals, professionals who made them, causes and origins of the referrals, and age bracket of the patients referred. The referrals were divided into “appropriate” and “inappropriate”, according to the classification of risk established by the technical manual of the Ministry of Health. Rresults: Of the 173 cases, 102 (59% were considered appropriate/correct, and 71 (41% referrals were considered inappropriate/incorrect. The referrals were divided according to the professional class of the referring individuals: physicians or nurses. Of the 173 referrals, 49 (28.3% were made by physicians, and 124 (71.7% by nurses. Of the 49 patients referred by physicians, 39 (79.6% were considered correct. Of the 124 referrals made by nurses, 63 (50.8% were considered incorrect, revealing a significant difference between the groups (p < 0.00001. The most common causes of referrals of pregnant patients were hypertensive syndromes (23.6%, physiological modifications of pregnancy (22.6%, prolonged pregnancy (15.1%, and diabetes (12.3%. Cconclusions: There was a low rate of appropriate/correct referrals. There is a need for training in the basic healthcare network for quality prenatal care, with special emphasis on referring nurses.

  6. Structured printed referral letter (form letter; saves time and improves communication

    Directory of Open Access Journals (Sweden)

    R.P.J.C. Ramanayake

    2013-01-01

    Full Text Available Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. Patients are referred to specialists when investigation or therapeutic options are exhausted in primary care or when opinion or advice is needed from them. Referral has considerable implications for patients, health care system and health care costs. Good communication between primary and secondary care is essential for the smooth running of any health care system. Referral and reply letters are the sole means of communication between doctors most of the time and breakdown in communication could lead to poor continuity of care, delayed diagnoses, polypharmacy, increased litigation risk and unnecessary testing. A referral letter also helps to avoid patient dissatisfaction and loss of confidence in family physician. Studies of referral letters have reported that specialists are dissatisfied with their quality and content. Inclusion of letter writing skills in the medical curriculum, peer assessment and feedback have shown to improve the quality of referral letters. . Form letters have shown to enhance information content and communication in referral process. In Sri Lanka referral letters are usually hand written and frequent complaints are that these letters do not contain adequate information and retrieval of information is a problem due to poor legibility and clarity. Sometimes Primary care doctors refer patients to hospitals and specialists with only verbal instructions. To address these short comings this form letter was introduced. Based on the guidelines and systematic review of published articles, items of information to be included were decided. Printed forms of the letter are kept in the practice and the doctor has to just fill up relevant information under each heading. The objectives of introducing this structured referral letter was to improve the quality and standard of referral letters and save time for both general

  7. Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States.

    Science.gov (United States)

    Aragam, Krishna G; Dai, Dadi; Neely, Megan L; Bhatt, Deepak L; Roe, Matthew T; Rumsfeld, John S; Gurm, Hitinder S

    2015-05-19

    Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. This study sought to determine the prevalence of and factors associated with referral to cardiac rehabilitation in a national PCI cohort, and to assess the association between insurance status and referral patterns. Consecutive patients who underwent PCI and survived to hospital discharge in the National Cardiovascular Data Registry between July 1, 2009 and March 31, 2012 were analyzed. Cardiac rehabilitation referral rates, and patient and institutional factors associated with referral were evaluated for the total study population and for a subset of Medicare patients presenting with acute myocardial infarction. Patients who underwent PCI (n = 1,432,399) at 1,310 participating hospitals were assessed. Cardiac rehabilitation referral rates were 59.2% and 66.0% for the overall population and the AMI/Medicare subgroup, respectively. In multivariable analyses, presentation with ST-segment elevation myocardial infarction (odds ratio 2.99; 95% confidence interval: 2.92 to 3.06) and non-ST-segment elevation myocardial infarction (odds ratio: 1.99; 95% confidence interval: 1.94 to 2.03) were associated with increased odds of referral to cardiac rehabilitation. Models adjusted for insurance status showed significant site-specific variability in referral rates, with more than one-quarter of all hospitals referring rehabilitation. Site-specific variation in referral rates is significant and is unexplained by insurance coverage. These findings highlight the potential need for hospital-level interventions to improve cardiac rehabilitation referral rates after PCI. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Rationing of hip and knee referrals in the public hospital: the true unmet need.

    Science.gov (United States)

    Inglis, Tom; Armour, Paul; Inglis, Grahame; Hooper, Gary

    2017-03-24

    The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care. During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need. This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.

  9. Comparative study of numerical schemes of TVD3, UNO3-ACM and optimized compact scheme

    Science.gov (United States)

    Lee, Duck-Joo; Hwang, Chang-Jeon; Ko, Duck-Kon; Kim, Jae-Wook

    1995-01-01

    Three different schemes are employed to solve the benchmark problem. The first one is a conventional TVD-MUSCL (Monotone Upwind Schemes for Conservation Laws) scheme. The second scheme is a UNO3-ACM (Uniformly Non-Oscillatory Artificial Compression Method) scheme. The third scheme is an optimized compact finite difference scheme modified by us: the 4th order Runge Kutta time stepping, the 4th order pentadiagonal compact spatial discretization with the maximum resolution characteristics. The problems of category 1 are solved by using the second (UNO3-ACM) and third (Optimized Compact) schemes. The problems of category 2 are solved by using the first (TVD3) and second (UNO3-ACM) schemes. The problem of category 5 is solved by using the first (TVD3) scheme. It can be concluded from the present calculations that the Optimized Compact scheme and the UN03-ACM show good resolutions for category 1 and category 2 respectively.

  10. Blood transfusion in burn patients: Triggers of transfusion in a referral burn center in Iran.

    Science.gov (United States)

    Tavousi, S H; Ahmadabadi, A; Sedaghat, A; Khadem-Rezaiyan, M; Yaghoubi Moghaddam, Z; Behrouzian, M J; Nemati, S; Saghafi, H

    2018-02-01

    Blood and its derivatives are one of the most lifesaving products in the modern medicine practice. However, it is not an absolutely safe prescription. Many adverse effects such as infection, transfusion-related acute lung injury, immunosuppression, multi-organ dysfunction, acute respiratory syndrome, transfusion errors, transmission of infectious agents such as HIV, HBV, HCV are attributable to blood transfusion. The aim of this study was to describe how and when blood products were transfused in a referral burn center. This cross-sectional study was performed on medical records of all admitted patients in the Department of Burns and Reconstructive Surgery of Imam Reza Hospital, Mashhad, Iran during September 2014 up to August 2015. Transfusion measures such as Hb, Hct and demographic data were extracted from patient records. SPSS version 11.5 was used for data analysis. During the study period, 701 acute burnt patients were admitted with the mean age of 25.5±20.5 years. Sixty-four percent were male and burnt percentage of total body surface area (TBSA) was 30.9±24.3%. About one third (240) of patients received at least one blood product. Mean of the transfused packed red blood cell was 274.1±674.6mL per patient and 8.85mL per 1% of burnt TBSA. Anemia was the most common transfusion trigger. Mortality in burnt patients who received blood products was two folds more than patients who did not receive any blood products. We prescribed less blood products compared with other reviewed burn centers. However, following a written blood transfusion protocol by all clinicians may reduce blood transfusion in unnecessary situations even more significantly. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Optimal Sales Schemes for Network Goods

    DEFF Research Database (Denmark)

    Parakhonyak, Alexei; Vikander, Nick

    consumers simultaneously, serve them all sequentially, or employ any intermediate scheme. We show that the optimal sales scheme is purely sequential, where each consumer observes all previous sales before choosing whether to buy himself. A sequential scheme maximizes the amount of information available...

  12. THROUGHPUT ANALYSIS OF EXTENDED ARQ SCHEMES

    African Journals Online (AJOL)

    PUBLICATIONS1

    ABSTRACT. Various Automatic Repeat Request (ARQ) schemes have been used to combat errors that befall in- formation transmitted in digital communication systems. Such schemes include simple ARQ, mixed mode ARQ and Hybrid ARQ (HARQ). In this study we introduce extended ARQ schemes and derive.

  13. Arbitrated quantum signature scheme with message recovery

    International Nuclear Information System (INIS)

    Lee, Hwayean; Hong, Changho; Kim, Hyunsang; Lim, Jongin; Yang, Hyung Jin

    2004-01-01

    Two quantum signature schemes with message recovery relying on the availability of an arbitrator are proposed. One scheme uses a public board and the other does not. However both schemes provide confidentiality of the message and a higher efficiency in transmission

  14. Semi-quantum communication: protocols for key agreement, controlled secure direct communication and dialogue

    Science.gov (United States)

    Shukla, Chitra; Thapliyal, Kishore; Pathak, Anirban

    2017-12-01

    Semi-quantum protocols that allow some of the users to remain classical are proposed for a large class of problems associated with secure communication and secure multiparty computation. Specifically, first-time semi-quantum protocols are proposed for key agreement, controlled deterministic secure communication and dialogue, and it is shown that the semi-quantum protocols for controlled deterministic secure communication and dialogue can be reduced to semi-quantum protocols for e-commerce and private comparison (socialist millionaire problem), respectively. Complementing with the earlier proposed semi-quantum schemes for key distribution, secret sharing and deterministic secure communication, set of schemes proposed here and subsequent discussions have established that almost every secure communication and computation tasks that can be performed using fully quantum protocols can also be performed in semi-quantum manner. Some of the proposed schemes are completely orthogonal-state-based, and thus, fundamentally different from the existing semi-quantum schemes that are conjugate coding-based. Security, efficiency and applicability of the proposed schemes have been discussed with appropriate importance.

  15. A novel authentication scheme using self-certified public keys for telecare medical information systems.

    Science.gov (United States)

    Guo, Dianli; Wen, Qiaoyan; Li, Wenmin; Zhang, Hua; Jin, Zhengping

    2015-06-01

    Telecare medical information systems (TMIS), with the explosive growth of communication technology and physiological monitoring devices, are applied increasingly to enable and support healthcare delivery services. In order to safeguard patients' privacy and tackle the illegal access, authentication schemes for TMIS have been investigated and designed by many researchers. Many of them are promising for adoption in practice, nevertheless, they still have security flaws. In this paper, we propose a novel remote authentication scheme for TMIS using self-certified public keys, which is formally secure in the ID-mBJM model. Besides, the proposed scheme has better computational efficiency. Compared to the related schemes, our protocol is more practical for telemedicine system.

  16. Evaluation of frame aggregation schemes for the p-persistent based next generation WLANS

    Science.gov (United States)

    Ahmad, Ashar; Anna, Kiran; Bassiouni, Mostafa A.

    2010-04-01

    The next Generation IEEE 802.11n is designed to improve the throughput of the existing standard 802.11. It aims to achieve this by increasing the data rate from 54 Mbps to 600 Mbps with the help of physical layer enhancements. Therefore, the Medium Access Layer (MAC) requires improvements to fully utilize the capabilities of the enhanced 802.11n physical layer. In this paper, we present the performance evaluation results of two frame aggregation schemes viz., MAC Protocol Data Unit Aggregation (A-MPDU) and MAC Service Data Unit Aggregation (A-MSDU) and study their performance impact when the two schemes are incorporated in a p-persistent based 802.11n. The simulation results have shown that the two schemes achieve consistent performance improvement over the standard non-aggregation scheme.

  17. Eavesdropping on the Bostroem-Filbinger Communication Protocol in Noisy Quantum Channel

    OpenAIRE

    Cai, Qing-yu

    2004-01-01

    We show an eavesdropping scheme on Bostr\\UNICODE{0xf6}m-Felbinger communication protocol (called ping-pong protocol) [Phys. Rev. Lett. 89, 187902 (2002)] in an ideal quantum channel. A measurement attack can be perfectly used to eavesdrop Alice's information instead of a most general quantum operation attack. In a noisy quantum channel, the direct communication is forbidden. We present a quantum key distribution protocol based on the ping-pong protocol, which can be used in a low noisy quantu...

  18. Fuzzy Extractor and Elliptic Curve Based Efficient User Authentication Protocol for Wireless Sensor Networks and Internet of Things

    Directory of Open Access Journals (Sweden)

    Anup Kumar Maurya

    2017-10-01

    Full Text Available To improve the quality of service and reduce the possibility of security attacks, a secure and efficient user authentication mechanism is required for Wireless Sensor Networks (WSNs and the Internet of Things (IoT. Session key establishment between the sensor node and the user is also required for secure communication. In this paper, we perform the security analysis of A.K.Das’s user authentication scheme (given in 2015, Choi et al.’s scheme (given in 2016, and Park et al.’s scheme (given in 2016. The security analysis shows that their schemes are vulnerable to various attacks like user impersonation attack, sensor node impersonation attack and attacks based on legitimate users. Based on the cryptanalysis of these existing protocols, we propose a secure and efficient authenticated session key establishment protocol which ensures various security features and overcomes the drawbacks of existing protocols. The formal and informal security analysis indicates that the proposed protocol withstands the various security vulnerabilities involved in WSNs. The automated validation using AVISPA and Scyther tool ensures the absence of security attacks in our scheme. The logical verification using the Burrows-Abadi-Needham (BAN logic confirms the correctness of the proposed protocol. Finally, the comparative analysis based on computational overhead and security features of other existing protocol indicate that the proposed user authentication system is secure and efficient. In future, we intend to implement the proposed protocol in real-world applications of WSNs and IoT.

  19. Acceptance of referral for partners by clients testing positive for human immunodeficiency virus

    Directory of Open Access Journals (Sweden)

    Netsanet F

    2013-01-01

    Full Text Available Fetene Netsanet,1 Ayalew Dessie21IMA World Health SuddHealth Multi Donor Trust Fund-Basic Package of Health Services Project, Juba, South Sudan; 2United States Agency for International Development, Private Health Sector Program, Abt Associates Inc, Addis Ababa, EthiopiaBackground: Human immunodeficiency virus (HIV-positive individuals who do not disclose their HIV status to their partners are more likely to present late for HIV and acquired immune deficiency syndrome (AIDS care than those who have disclosed their HIV status to their partners. A major area of challenge with regards to HIV counseling for clients is disclosure of their HIV status to their partners. The main methods of partner notification are patient referral, provider referral, contract referral, and outreach assistance. The emphasis on a plausible and comprehensive partner referral strategy for widespread positive case detection in resource-limited countries needs to be thought out and developed.Methods: A qualitative study was conducted among newly HIV-positive clients to identify partners for notification and acceptance of referral by their partners. Health service providers working in HIV testing and counseling clinics were also provided with semistructured questionnaires in order to assess their view towards partner notification strategies for clients testing positive for HIV.Results: Fifteen newly diagnosed HIV-positive clients were counseled to provide referral slips to their partners. All clients agreed and took the referral card. However, only eight were willing and actually provided the card to their partners. Five of the eight partners of clients who tested HIV-positive and who were provided with referral cards responded to the referral and were tested for HIV. Three were positive and two were negative. Nine of 11 counselors did not agree to requesting partner locator information from HIV-positive clients for contractual referral and/or outreach assistance. The findings

  20. Privacy-Preserving Data Aggregation Protocol for Fog Computing-Assisted Vehicle-to-Infrastructure Scenario

    Directory of Open Access Journals (Sweden)

    Yanan Chen

    2018-01-01

    Full Text Available Vehicle-to-infrastructure (V2I communication enables moving vehicles to upload real-time data about road surface situation to the Internet via fixed roadside units (RSU. Thanks to the resource restriction of mobile vehicles, fog computation-enhanced V2I communication scenario has received increasing attention recently. However, how to aggregate the sensed data from vehicles securely and efficiently still remains open to the V2I communication scenario. In this paper, a light-weight and anonymous aggregation protocol is proposed for the fog computing-based V2I communication scenario. With the proposed protocol, the data collected by the vehicles can be efficiently obtained by the RSU in a privacy-preserving manner. Particularly, we first suggest a certificateless aggregate signcryption (CL-A-SC scheme and prove its security in the random oracle model. The suggested CL-A-SC scheme, which is of independent interest, can achieve the merits of certificateless cryptography and signcryption scheme simultaneously. Then we put forward the anonymous aggregation protocol for V2I communication scenario as one extension of the suggested CL-A-SC scheme. Security analysis demonstrates that the proposed aggregation protocol achieves desirable security properties. The performance comparison shows that the proposed protocol significantly reduces the computation and communication overhead compared with the up-to-date protocols in this field.

  1. REMINDER: Saved Leave Scheme (SLS)

    CERN Multimedia

    2003-01-01

    Transfer of leave to saved leave accounts Under the provisions of the voluntary saved leave scheme (SLS), a maximum total of 10 days'* annual and compensatory leave (excluding saved leave accumulated in accordance with the provisions of Administrative Circular No 22B) can be transferred to the saved leave account at the end of the leave year (30 September). We remind you that unused leave of all those taking part in the saved leave scheme at the closure of the leave year accounts is transferred automatically to the saved leave account on that date. Therefore, staff members have no administrative steps to take. In addition, the transfer, which eliminates the risk of omitting to request leave transfers and rules out calculation errors in transfer requests, will be clearly shown in the list of leave transactions that can be consulted in EDH from October 2003 onwards. Furthermore, this automatic leave transfer optimizes staff members' chances of benefiting from a saved leave bonus provided that they ar...

  2. In silico toxicology protocols.

    Science.gov (United States)

    Myatt, Glenn J; Ahlberg, Ernst; Akahori, Yumi; Allen, David; Amberg, Alexander; Anger, Lennart T; Aptula, Aynur; Auerbach, Scott; Beilke, Lisa; Bellion, Phillip; Benigni, Romualdo; Bercu, Joel; Booth, Ewan D; Bower, Dave; Brigo, Alessandro; Burden, Natalie; Cammerer, Zoryana; Cronin, Mark T D; Cross, Kevin P; Custer, Laura; Dettwiler, Magdalena; Dobo, Krista; Ford, Kevin A; Fortin, Marie C; Gad-McDonald, Samantha E; Gellatly, Nichola; Gervais, Véronique; Glover, Kyle P; Glowienke, Susanne; Van Gompel, Jacky; Gutsell, Steve; Hardy, Barry; Harvey, James S; Hillegass, Jedd; Honma, Masamitsu; Hsieh, Jui-Hua; Hsu, Chia-Wen; Hughes, Kathy; Johnson, Candice; Jolly, Robert; Jones, David; Kemper, Ray; Kenyon, Michelle O; Kim, Marlene T; Kruhlak, Naomi L; Kulkarni, Sunil A; Kümmerer, Klaus; Leavitt, Penny; Majer, Bernhard; Masten, Scott; Miller, Scott; Moser, Janet; Mumtaz, Moiz; Muster, Wolfgang; Neilson, Louise; Oprea, Tudor I; Patlewicz, Grace; Paulino, Alexandre; Lo Piparo, Elena; Powley, Mark; Quigley, Donald P; Reddy, M Vijayaraj; Richarz, Andrea-Nicole; Ruiz, Patricia; Schilter, Benoit; Serafimova, Rositsa; Simpson, Wendy; Stavitskaya, Lidiya; Stidl, Reinhard; Suarez-Rodriguez, Diana; Szabo, David T; Teasdale, Andrew; Trejo-Martin, Alejandra; Valentin, Jean-Pierre; Vuorinen, Anna; Wall, Brian A; Watts, Pete; White, Angela T; Wichard, Joerg; Witt, Kristine L; Woolley, Adam; Woolley, David; Zwickl, Craig; Hasselgren, Catrin

    2018-04-17

    The present publication surveys several applications of in silico (i.e., computational) toxicology approaches across different industries and institutions. It highlights the need to develop standardized protocols when conducting toxicity-related predictions. This contribution articulates the information needed for protocols to support in silico predictions for major toxicological endpoints of concern (e.g., genetic toxicity, carcinogenicity, acute toxicity, reproductive toxicity, developmental toxicity) across several industries and regulatory bodies. Such novel in silico toxicology (IST) protocols, when fully developed and implemented, will ensure in silico toxicological assessments are performed and evaluated in a consistent, reproducible, and well-documented manner across industries and regulatory bodies to support wider uptake and acceptance of the approaches. The development of IST protocols is an initiative developed through a collaboration among an international consortium to reflect the state-of-the-art in in silico toxicology for hazard identification and characterization. A general outline for describing the development of such protocols is included and it is based on in silico predictions and/or available experimental data for a defined series of relevant toxicological effects or mechanisms. The publication presents a novel approach for determining the reliability of in silico predictions alongside experimental data. In addition, we discuss how to determine the level of confidence in the assessment based on the relevance and reliability of the information. Copyright © 2018. Published by Elsevier Inc.

  3. Quantum Secure Communication Scheme with W State

    International Nuclear Information System (INIS)

    Wang Jian; Zhang Quan; Tang Chaojng

    2007-01-01

    We present a quantum secure communication scheme using three-qubit W state. It is unnecessary for the present scheme to use alternative measurement or Bell basis measurement. Compared with the quantum secure direct communication scheme proposed by Cao et al. [H.J. Cao and H.S. Song, Chin. Phys. Lett. 23 (2006) 290], in our scheme, the detection probability for an eavesdropper's attack increases from 8.3% to 25%. We also show that our scheme is secure for a noise quantum channel.

  4. Labeling schemes for bounded degree graphs

    DEFF Research Database (Denmark)

    Adjiashvili, David; Rotbart, Noy Galil

    2014-01-01

    We investigate adjacency labeling schemes for graphs of bounded degree Δ = O(1). In particular, we present an optimal (up to an additive constant) log n + O(1) adjacency labeling scheme for bounded degree trees. The latter scheme is derived from a labeling scheme for bounded degree outerplanar...... graphs. Our results complement a similar bound recently obtained for bounded depth trees [Fraigniaud and Korman, SODA 2010], and may provide new insights for closing the long standing gap for adjacency in trees [Alstrup and Rauhe, FOCS 2002]. We also provide improved labeling schemes for bounded degree...

  5. Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members

    OpenAIRE

    Pembe, Andrea B.; Mbekenga, Columba K.; Olsson, Pia; Darj, Elisabeth

    2017-01-01

    ABSTRACT Background: In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. Objective: To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. Methods: Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe ...

  6. Using the emergency department as a screening site for high blood pressure. A method for improving hypertension detection and appropriate referral.

    Science.gov (United States)

    Mamon, J; Green, L; Levine, D M; Gibson, G; Gurley, H T

    1987-08-01

    This study describes the development and testing of a high blood pressure protocol for use in emergency departments (ED) to enhance detection of those patients appropriate for subsequent referral. The protocol involves two serial blood pressure measurements and a patient interview to determine: 1) previous history of high blood pressure (HBP), 2) treatment in past year for HBP, and 3) usual source of medical care. The accuracy of patient reporting was validated by comparison with the patients' hospital record (reflecting outpatient and inpatient visits). Results indicate that these self-reports have high levels of sensitivity (range 90-100%) and specificity (range 79-96%). Use of the additional patient information increased the sensitivity of the screening protocol in identifying when and where a patient should be referred. Use of this methodology indicates that the protocol is a simple and effective method for HBP screening. The findings also suggest that the ED is an ideal site for screening the "hard-to-reach" hypertensive population.

  7. Business protocol in integrated Europe

    OpenAIRE

    Pavelová, Nina

    2009-01-01

    The first chapter devotes to definitions of basic terms such as protocol or business protocol, to differences between protocol and etiquette, and between social etiquette and business etiquette. The second chapter focuses on the factors influencing the European business protocol. The third chapter is devoted to the etiquette of business protocol in the European countries. It touches the topics such as punctuality and planning of business appointment, greeting, business cards, dress and appear...

  8. Security Protocols in a Nutshell

    OpenAIRE

    Toorani, Mohsen

    2016-01-01

    Security protocols are building blocks in secure communications. They deploy some security mechanisms to provide certain security services. Security protocols are considered abstract when analyzed, but they can have extra vulnerabilities when implemented. This manuscript provides a holistic study on security protocols. It reviews foundations of security protocols, taxonomy of attacks on security protocols and their implementations, and different methods and models for security analysis of pro...

  9. A secure user anonymity-preserving three-factor remote user authentication scheme for the telecare medicine information systems.

    Science.gov (United States)

    Das, Ashok Kumar

    2015-03-01

    Recent advanced technology enables the telecare medicine information system (TMIS) for the patients to gain the health monitoring facility at home and also to access medical services over the Internet of mobile networks. Several remote user authentication schemes have been proposed in the literature for TMIS. However, most of them are either insecure against various known attacks or they are inefficient. Recently, Tan proposed an efficient user anonymity preserving three-factor authentication scheme for TMIS. In this paper, we show that though Tan's scheme is efficient, it has several security drawbacks such as (1) it fails to provide proper authentication during the login phase, (2) it fails to provide correct updation of password and biometric of a user during the password and biometric update phase, and (3) it fails to protect against replay attack. In addition, Tan's scheme lacks the formal security analysis and verification. Later, Arshad and Nikooghadam also pointed out some security flaws in Tan's scheme and then presented an improvement on Tan's s scheme. However, we show that Arshad and Nikooghadam's scheme is still insecure against the privileged-insider attack through the stolen smart-card attack, and it also lacks the formal security analysis and verification. In order to withstand those security loopholes found in both Tan's scheme, and Arshad and Nikooghadam's scheme, we aim to propose an effective and more secure three-factor remote user authentication scheme for TMIS. Our scheme provides the user anonymity property. Through the rigorous informal and formal security analysis using random oracle models and the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool, we show that our scheme is secure against various known attacks, including the replay and man-in-the-middle attacks. Furthermore, our scheme is also efficient as compared to other related schemes.

  10. DNA repair protocols

    DEFF Research Database (Denmark)

    Bjergbæk, Lotte

    In its 3rd edition, this Methods in Molecular Biology(TM) book covers the eukaryotic response to genomic insult including advanced protocols and standard techniques in the field of DNA repair. Offers expert guidance for DNA repair, recombination, and replication. Current knowledge of the mechanisms...... that regulate DNA repair has grown significantly over the past years with technology advances such as RNA interference, advanced proteomics and microscopy as well as high throughput screens. The third edition of DNA Repair Protocols covers various aspects of the eukaryotic response to genomic insult including...... recent advanced protocols as well as standard techniques used in the field of DNA repair. Both mammalian and non-mammalian model organisms are covered in the book, and many of the techniques can be applied with only minor modifications to other systems than the one described. Written in the highly...

  11. First quality score for referral letters in gastroenterology—a validation study

    Science.gov (United States)

    Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas

    2016-01-01

    Objective To create and validate an objective and reliable score to assess referral quality in gastroenterology. Design An observational multicentre study. Setting and participants 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Main outcome measure Correlation between the TPS and a visual analogue scale (VAS) for referral quality. Results The 327 referrals had an average TPS of 13.2 (range 1–25) and an average VAS of 4.7 (range 0.2–9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. Conclusions The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. PMID:27855107

  12. Outcome of referrals for deceased organ donation to the government organ procurement organization.

    Science.gov (United States)

    Suguitan, G A; Cabanayan-Casasola, C B; Danguilan, R A; Jaro, J M A

    2014-05-01

    The Human Organ Preservation Effort is a government organ procurement organization that pioneered the Deceased Organ Donation Program in the Philippines. Deceased organ donation comprises only 20% of kidney transplantation in the Philippines in the last 3 years. Various measures were implemented to improve deceased organ donor referrals and organ retrieval. To compare outcome of deceased organ donor referrals from 2002 to 2008 and 2009 to 2012 in the Philippines. This retrospective study reviewed the deceased organ donor referrals from 2002 to 2008 and 2009 to 2012. There were 437 referrals for potential deceased organ donors from 2009 to 2012, compared to 434 referrals from 2002 to 2008. Referrals were mainly trauma victims (76%) followed by those with cerebrovascular accidents (12%). In the recent cohort, 81% were approached and 60% consented for donation, but only 23% were retrieved and transplanted. Among those not retrieved, the majority (19%) were medically unsuitable and 6% retracted their consent. Although there was an increasing trend of organ donation referrals in the last 4 years, only 25% were procured. The reasons for nonprocurement should be addressed. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. The youngest children in each school cohort are overrepresented in referrals to mental health services.

    Science.gov (United States)

    Berg, Shipra; Berg, Erlend

    2014-05-01

    To investigate whether the youngest children in each school cohort are overrepresented as users of specialist mental health services. Dates of birth were obtained for all 9,157 children and adolescents referred to specialist mental health services in 3 London boroughs from 2008 to 2011. The actual frequency of referrals by month of birth is compared to the expected frequency of referrals as determined by birth statistics for the relevant age group. August-born children, who are the youngest in their cohorts in England, represent 9.38% of referrals but only 8.59% of the population in the relevant age segment. Hence, August-born children are overrepresented in referrals to specialist mental health services (P value = .007). September- and October-born children, who are the oldest in their cohorts, are underrepresented: September-born children represent 8.62% of the population but 7.99% of referrals to mental health services (P value = .032), and October-born children are 8.56% of the population but 7.86% of referrals (P value = .016). Being among the youngest in a school cohort is associated with a higher risk of referral to mental health services, while being among the oldest is a protective factor. © Copyright 2014 Physicians Postgraduate Press, Inc.

  14. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

    Science.gov (United States)

    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

  15. Differential referral of women and men to employee assistance programs: the role of supervisory attitudes.

    Science.gov (United States)

    Young, D W; Reichman, W R; Levy, M F

    1987-01-01

    Potential factors underlying sex differences in the referral of problem-drinking subordinates to employee assistance programs (EAPs) were explored in interviews with 120 supervisors in four organizations. Analyses of data obtained in these interviews assessed the relative ability of eight variables to predict supervisor's actual identification and referral of female and male problem drinkers. In addition to numbers of employees supervised, the supervisors' judgment of the EAP's effectiveness was the best predictor of referral and identification, regardless of the sex of the referred subordinate. Knowledge and training in the EAP was a secondary contributor to referral of men, but played no role in female referrals. When controlling for all other variables, the extent to which supervisors held an egalitarian attitude toward women's rights and roles was found to be marginally positively related to identification of female drinkers. Similarly, a less stigmatized, stereotyped view of women's use and abuse of alcohol was marginally associated with a greater likelihood of referral of a female drinker to the EAP. Neither of these attitudinal variables was related to identification or referral of male problem drinkers.

  16. Design and Analysis of an Enhanced Patient-Server Mutual Authentication Protocol for Telecare Medical Information System.

    Science.gov (United States)

    Amin, Ruhul; Islam, S K Hafizul; Biswas, G P; Khan, Muhammad Khurram; Obaidat, Mohammad S

    2015-11-01

    In order to access remote medical server, generally the patients utilize smart card to login to the server. It has been observed that most of the user (patient) authentication protocols suffer from smart card stolen attack that means the attacker can mount several common attacks after extracting smart card information. Recently, Lu et al.'s proposes a session key agreement protocol between the patient and remote medical server and claims that the same protocol is secure against relevant security attacks. However, this paper presents several security attacks on Lu et al.'s protocol such as identity trace attack, new smart card issue attack, patient impersonation attack and medical server impersonation attack. In order to fix the mentioned security pitfalls including smart card stolen attack, this paper proposes an efficient remote mutual authentication protocol using smart card. We have then simulated the proposed protocol using widely-accepted AVISPA simulation tool whose results make certain that the same protocol is secure against active and passive attacks including replay and man-in-the-middle attacks. Moreover, the rigorous security analysis proves that the proposed protocol provides strong security protection on the relevant security attacks including smart card stolen attack. We compare the proposed scheme with several related schemes in terms of computation cost and communication cost as well as security functionalities. It has been observed that the proposed scheme is comparatively better than related existing schemes.

  17. Optimal Referral Reward Considering Customer’s Budget Constraint

    Directory of Open Access Journals (Sweden)

    Dan Zhou

    2015-12-01

    Full Text Available Everyone likes Porsche but few can afford it. Budget constraints always play a critical role in a customer’s decision-making. The literature disproportionally focuses on how firms can induce customer valuations toward the product, but does not address how to assess the influence of budget constraints. We study these questions in the context of a referral reward program (RRP. RRP is a prominent marketing strategy that utilizes recommendations passed from existing customers to their friends and effectively stimulates word of mouth (WoM. We build a stylized game-theoretical model with a nested Stackelberg game involving three players: a firm, an existing customer, and a potential customer who is a friend of the existing customer. The budget is the friend’s private information. We show that RRPs might be optimal when the friend has either a low or a high valuation, but they work differently in each situation because of the budget. Furthermore, there are two budget thresholds, a fixed one and a variable one, which limit a firm’s ability to use rewards.

  18. Referral of sensation to an advanced humanoid robotic hand prosthesis.

    Science.gov (United States)

    Rosén, Birgitta; Ehrsson, H Henrik; Antfolk, Christian; Cipriani, Christian; Sebelius, Fredrik; Lundborg, Göran

    2009-01-01

    Hand prostheses that are currently available on the market are used by amputees to only a limited extent, partly because of lack of sensory feedback from the artificial hand. We report a pilot study that showed how amputees can experience a robot-like advanced hand prosthesis as part of their own body. We induced a perceptual illusion by which touch applied to the stump of the arm was experienced from the artificial hand. This illusion was elicited by applying synchronous tactile stimulation to the hidden amputation stump and the robotic hand prosthesis in full view. In five people who had had upper limb amputations this stimulation caused referral touch sensation from the stump to the artificial hand, and the prosthesis was experienced more like a real hand. We also showed that this illusion can work when the amputee controls the movements of the artificial hand by recordings of the arm muscle activity with electromyograms. These observations indicate that the previously described "rubber hand illusion" is also valid for an advanced hand prosthesis, even when it has a robotic-like appearance.

  19. The Westgate Service and Related Referral, Assessment, and Treatment Processes.

    Science.gov (United States)

    Bennett, Alice L

    2015-12-01

    The formerly named "Dangerous and Severe Personality Disorder" (DSPD) units are no longer standalone services within the criminal justice system in England and Wales. These sites now provide personality disorder treatment services in the high-security prison estate as part of the new national Offender Personality Disorder (OPD) Pathway Strategy. The OPD Pathway intends to take responsibility for the assessment, treatment, and management of offenders who are likely to have a personality disorder and who present a high risk of re-offending (men and women) and serious harm to others (men). Further PD treatment and progression services are being commissioned in lower security prisons and in the community as part of the new PD Strategy. While the suitability criteria for the two male high-security PD treatment sites are the same, the individual units have their own assessment and treatment methods. This article aims to communicate the referral, assessment, and treatment methods employed within the prison-based Westgate Personality Disorder Treatment Service, HMP Frankland. © The Author(s) 2014.

  20. When should social service referral be considered in phenylketonuria?

    Directory of Open Access Journals (Sweden)

    Margreet van Rijn

    2015-03-01

    Full Text Available Lifelong low-phenylalanine (Phe dietary management is the foundation of care in phenylketonuria (PKU. However, strict monitoring of food intake places a burden on patients and their caregivers, and adherence to the required diet frequently decreases in later childhood and adolescence. Rarely, parents of children with PKU refuse to recognise the importance of treatment and follow-up for this chronic condition. Here, two case studies are presented that document consideration of placement of children into foster care or kinship homes as a last resort to improve persistently high Phe concentrations. In the first case, social service referral led to a 3-year-old girl being placed in a kinship home with her grandparents, resulting in excellent Phe control thereafter. In the second case, discussion with the parents of possible placement of a 12-year-old child into foster care was sufficient to have a positive effect on Phe control. A staged approach for managing intractable non-adherence in PKU is proposed.