WorldWideScience

Sample records for renewed environment care

  1. Kansas: Wichita Initiative to Renew the Environment (A Former EPA CARE Project)

    Science.gov (United States)

    Wichita Initiative to Renew the Environment is a recipient of a CARE Level II Cooperative agreement to reduce the risk of mobile air emissions, reduce the risk of storm water run-off, reduce the risk of solid waste pollution/greenhouse gas emissions

  2. Renewal and change for health care executives.

    Science.gov (United States)

    Burke, G C; Bice, M O

    1991-01-01

    Health care executives must consider renewal and change within their own lives if they are to breathe life into their own institutions. Yet numerous barriers to executive renewal exist, including time pressures, fatigue, cultural factors, and trustee attitudes. This essay discusses such barriers and suggests approaches that health care executives may consider for programming renewal into their careers. These include self-assessment for professional and personal goals, career or job change, process vs. outcome considerations, solitude, networking, lifelong education, surrounding oneself with change agents, business travel and sabbaticals, reading outside the field, physical exercise, mentoring, learning from failures, a sense of humor, spiritual reflection, and family and friends. Renewal is a continuous, lifelong process requiring constant learning. Individual executives would do well to develop a framework for renewal in their careers and organizations.

  3. Wind energy renewable energy and the environment

    CERN Document Server

    Nelson, Vaughn

    2013-01-01

    As the demand for energy increases, and fossil fuels continue to decrease, Wind Energy: Renewable Energy and the Environment, Second Edition considers the viability of wind as an alternative renewable energy source. This book examines the wind industry from its start in the 1970s until now, and introduces all aspects of wind energy. The phenomenal growth of wind power for utilities is covered along with applications such as wind-diesel, village power, telecommunications, and street lighting.. It covers the characteristics of wind, such as shear, power potential, turbulence, wind resource, wind

  4. Renewable energy for sustainable development and environment

    Energy Technology Data Exchange (ETDEWEB)

    Omer, Abdeen

    2010-09-15

    The increased availability of reliable and efficient energy services stimulates new development alternatives. This article discusses the potential for such integrated systems in the stationary and portable power market in response to the critical need for a cleaner energy technology. Throughout the theme several issues relating to renewable energies, environment and sustainable development are examined from both current and future perspectives. It is concluded that renewable environmentally friendly energy must be encouraged, promoted, implemented and demonstrated by full-scale plan especially for use in remote rural areas.

  5. Wind energy renewable energy and the environment

    CERN Document Server

    Nelson, Vaughn; Nelson, Vaughn

    2009-01-01

    Due to the mounting demand for energy and increasing population of the world, switching from nonrenewable fossil fuels to other energy sources is not an option-it is a necessity. Focusing on a cost-effective option for the generation of electricity, Wind Energy: Renewable Energy and the Environment covers all facets of wind energy and wind turbines. The book begins by outlining the history of wind energy, before providing reasons to shift from fossil fuels to renewable energy. After examining the characteristics of wind, such as shear, power potential, and turbulence, it discusses the measur

  6. Renewable energy to the Indian environment

    International Nuclear Information System (INIS)

    Agarwal, R.K.

    2005-12-01

    Fossil fuel reserves are diminishing rapidly across the world. Greenhouse gas emissions, climatic changes and global warming have a direct impact on the environment. A secure and accessible supply of energy is very crucial for the sustainability of modern societies. There is an urgent need for a quicker switch over of energy systems from conventional to renewable that are sustainable and can meet the present and projected world energy demand. Renewable energy has a large potential to become the fuel of the future. The present study is aimed to explore such potential and achievements in India. India is expected to have high growth rate in energy demand over the coming years due to its huge population and rapid economic development. The renewable energy prospects/spectrums of India have been highlighted. (author)

  7. Policy Enabling Environment for Corporate Renewable Energy Sourcing

    Energy Technology Data Exchange (ETDEWEB)

    2017-05-09

    Interest in renewable energy (RE) procurement in new markets is on the rise. Corporations are increasing their commitments to procuring RE, motivated by an interest in using clean energy sources and reducing their energy expenses. Many large companies have facilities and supply chains in multiple countries, and are interested in procuring renewable energy in the grids where they use energy. The policy environment around the world plays a key role in shaping where and how corporations will invest in renewables. This fact sheet details findings from a recent 21st Century Power Partnership report, Policies to Enable Corporate Renewable Energy Sourcing Internationally.

  8. Renewable energies and environment. Energias renovables y medio ambiente

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez Garrido, U

    1994-01-01

    This volume summarizes the conferences about ''Energy and environment: renewable energies'' held in Valladolid and sponsored by the Valladolid and Salamanca Universities. The book focusses on the energy consumption, energy laws, wind power, hydroelectric power, environment, biomass, solar thermal energy and their influence into the Energetic National Plan.

  9. Environment, Renewable Energy and Reduced Carbon Emissions

    Science.gov (United States)

    Sen, S.; Khazanov, G.; Kishimoto, Y.

    2011-01-01

    Increased energy security and reduced carbon emissions pose significant challenges for science and technology. However, they also create substantial opportunities for innovative research and development. In this review paper, we highlight some of the key opportunities and mention public policies that are needed to enable the efforts and to maximize the probability of their success. Climate is among the uttermost nonlinear behaviors found around us. As recent studies showed the possible effect of cosmic rays on the Earth's climate, we investigate how complex interactions between the planet and its environment can be responsible for climate anomalies.

  10. Wind energy technology: an option for a renewable clean environment energy. Low impact renewable energy: options for a clean environment and healthy Canadian economy

    International Nuclear Information System (INIS)

    Salmon, J.

    1999-01-01

    As Canada debates ways to address climate change, the country's low-impact renewable energy industries want to ensure that Canadians are provided with all of the options available to them. Accordingly, they have come together to create Options for a Clean Environment and Healthy Canadian Economy. Recognizing there is no 'silver bullet' solution to climate change, this document identifies an important suite of measures that, along with others, will allow Canada to achieve its long-term economic and environmental goals. The measures described in this document represent an investment in Canada's future. If implemented, they will reduce annual greenhouse gas (GHG) emissions by more than 12 million tonnes (Mt) by the year 2010 (roughly 8% of Canada's reduction target), create thousands of new jobs, and reduce health-care costs by millions of dollars each year. The most significant dividends from these measures, however, will occur after 2010 as a result of having set in motion fundamental changes in the attitudes of Canadians and the nature of the Canadian energy market. By 2020, the spin-off actions prompted by these measures will likely have resulted in GHG reductions twice as great as those achieved in 2010. This document highlights the opportunities associated specifically with Canada's low-impact renewable energy resources. These are non-fossil-fuel resources that are replenished through the earth's natural cycles and have a minimal impact on the environment and human health. They include wind, solar, earth energy, run-of-river hydro and sustainable biomass fuels. These resources can replace fossil fuels in a variety of areas, including electricity and space and water heating. Fuel cells, although not a renewable resource in themselves, are a promising technology that in combination with renewables have the potential to deliver versatile low-impact electricity. The document also identifies opportunities associated with the increased use of passive renewable energy

  11. Property, care, and environment

    OpenAIRE

    John O'Neill

    2001-01-01

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

  12. 48 CFR 952.223 - Clauses related to environment, energy and water efficiency, renewable energy technologies...

    Science.gov (United States)

    2010-10-01

    ... environment, energy and water efficiency, renewable energy technologies, occupational safety, and drug-free workplace. 952.223 Section 952.223 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CLAUSES AND... related to environment, energy and water efficiency, renewable energy technologies, occupational safety...

  13. Renewable energy technologies and its adaptation in an urban environment

    Energy Technology Data Exchange (ETDEWEB)

    Thampi, K. Ravindranathan, E-mail: ravindranathan.thampi@ucd.ie; Byrne, Owen, E-mail: ravindranathan.thampi@ucd.ie; Surolia, Praveen K., E-mail: ravindranathan.thampi@ucd.ie [SFI Strategic Research Cluster in Solar Energy Conversion, School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4 (Ireland)

    2014-01-28

    This general article is based on the inaugural talk delivered at the opening of OMTAT 2013 conference. It notes that the integration of renewable energy sources into living and transport sectors presents a daunting task, still. In spite of the fact that the earth and its atmosphere continually receive 1.7 × 10{sup 17} watts of radiation from the sun, in the portfolio of sustainable and environment friendly energy options, which is about 16% of the world’s energy consumption and mostly met by biomass, only a paltry 0.04% is accredited to solar. First and second generation solar cells offer mature technologies for applications. The most important difficulty with regards to integration with structures is not only the additional cost, but also the lack of sufficient knowledge in managing the available energy smartly and efficiently. The incorporation of PV as a part of building fabric greatly reduces the overall costs compared with retrofitting. BIPV (Building Integrated photovoltaic) is a critical technology for establishing aesthetically pleasing solar structures. Infusing PV and building elements is greatly simplified with some of the second generation thin film technologies now manufactured as flexible panels. The same holds true for 3{sup rd} generation technologies under development such as, and dye- and quantum dot- sensitized solar cells. Additionally, these technologies offer transparent or translucent solar cells for incorporation into windows and skylights. This review deals with the present state of solar cell technologies suitable for BIPV and the status of BIPV applications and its future prospects.

  14. Renewable energy and environment ally sustainable development in Pakistan

    International Nuclear Information System (INIS)

    Harijan, K.; Memon, M.; Uqaili, M.A.

    2005-01-01

    In Pakistan, about two-thirds of the primary energy requirements are met through conventional sources while traditional biomass accounts the remaining one-third The primary commercial energy is largely based on fossil fuels. Indigenous reserves of oil and gas are limited and the coal available in the country is of poor quality. Environmental pollution and greenhouse gas emissions from energy use are becoming significant environmental issues in the country. Achieving solutions to these environmental problems requires long-term potential actions for sustainable development. In this regard, renewable energy resources appear to be one of the most efficient and effective solutions. Pakistan's geographical location has several advantages for extensive use of most of these renewable energy sources. This paper presents review of the present energy situation and environmental sustainability, and assesses the potential of renewable energy sources in Pakistan. Also, potential solutions to current environmental problems are identified along with renewable energy technologies. Several problems relating to renewable energy sources, environmentally sustainable development are discussed from both current and future perspectives. The present study shows that there is substantial potential of renewables in Pakistan. For achieving environmentally sustainable development, renewables must be developed and utilized. (author)

  15. BUILT ENVIRONMENT: RELATING THE BENEFITS OF RENEWABLE ENERGY TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    Abdeen Mustafa Omer

    2012-06-01

    Full Text Available Recently, environmental issues have been the focus of much of the world’s attention. This has stimulated a response in many countries, which has led to a closer examination of energy conservation strategies for conventional fossil fuels. One way of reducing building energy consumption is to design buildings, which are more economical in their use of energy for: heating, lighting, cooling, ventilation and hot water supply. Passive measures, particularly natural or hybrid ventilation rather than air-conditioning, can dramatically reduce primary energy consumption. However, exploitation of renewable energy in buildings and agricultural greenhouses, can significantly contribute in reducing dependency on fossil fuels. Therefore, promoting innovative renewable applications and reinforcing the renewable energy market will contribute to preserving the ecosystem by reducing emissions at local and global levels. This will also contribute to the amelioration of environmental conditions, through a reduction in air pollution and greenhouse gases, by the replacement of conventional fuels with renewable energies.

  16. Environment: renewable energy, environmental protection and energy efficiency

    International Nuclear Information System (INIS)

    1998-01-01

    The second in the series of IPPSO policy papers for discussion deals with the place of renewable energy sources and environmental protection in relation to the soon-to-be deregulated electricity industry in Ontario. The paper provides a broad statement of principles, defines the issues, identifies the problems, and discusses the various options under consideration. Some of the more important design questions regarding a renewable portfolio standard were discussed, among them the technologies to be included, the treatment of existing generators and expansions, establishment of minimum amounts and targets, responsibility for and means of compliance, compensation for the intermittent nature of some of the renewable resources, mandatory disclosure and labelling, development by the IMO of environmental dispatch protocols, research and development funding for renewable energy technologies, emission caps with tradeable targets, and concerns about the operation of a system benefits fund for energy efficiency. 5 refs

  17. Renewable energies, development, and environment: discourses, realities, and perspectives

    International Nuclear Information System (INIS)

    2007-01-01

    After two contributions describing the context of renewable energies and their different objectives and roles in the North and in the South, a set of contributions discusses some controversies and generally accepted ideas about renewable energies: fossil energy appraisal and the greenhouse effect of presently used fuels, the issue of irregularity and climate hazards, photovoltaic energy as a development key for South countries, vulnerability of energy systems, renewable energies and energy market privatisation. The next set of contributions deals with different examples: renewable energies in Africa, electricity and high dams, small hydro developments in China, wind energy in Morocco, solar water-heaters in Tunisia, bio-energies and food security, second generation bio-fuels, biomass energy in Cambodia. Sheets are then proposed with a brief historical overview, a description of the state of the art, an indication of the installed power, of market shares, and a brief discussion of perspectives for the different renewable energy sources: large and small hydro, photovoltaic, thermodynamic solar, wind, geothermal, thermal solar, bio-fuels, biomass, and biogas

  18. Issues - II. Renewable energies and environment law: the exploitation of renewable energies or when the implementation of a measure aimed at the protection of the environment impacts the environment; water as a renewable energy source: to which price?

    International Nuclear Information System (INIS)

    Cans, Chantal; Boucheix, Philippe

    2012-01-01

    A first article discusses the different impacts that renewable energies may have on the environment, i.e. on the human environment (risks associated with dams, aesthetic impacts, impacts on landscapes, neighbouring nuisances) or on the natural environment (natural media, wildlife and flora). A second article outlines that the legal framework of hydroelectricity is rather old and therefore ignored (willingly or not?) environmental concerns whereas environmental impacts actually exist. Therefore, a new legal context must be defined, notably by taking into account objectives defined in the international and European Union law, in particularly the requirements related to ecological continuity

  19. Strategic Renewal in Regulatory Environments: How inter- and intra-organisational institutional forces influence European incumbent energy firms

    OpenAIRE

    Stienstra, Marten

    2008-01-01

    textabstractHow do incumbent firms strategically renew in regulatory environments? Assuming that regulation can both constrain and enable a firm’s strategic renewal opportunities, we investigate how and to what extent incumbent firms undertake exploitative and explorative strategic renewal actions in order to remain competitive. Exploitative strategic renewal involves those actions that strengthen or optimise a firm’s current resource deployments, whereas explorative strategic renewal relates...

  20. Renewable energy: technology and the environment. V. 1

    International Nuclear Information System (INIS)

    Sayigh, A.A.M.

    1992-01-01

    The World Renewable Energy Congress took place a few months after the Earth Summit in Rio. Under the auspices of UNESCO, the World Renewable Energy Network has been established with the aim of acting as a catalyst for large-scale regional projects. The proceedings of this Congress consist of five volumes. Volume one consists of 12 papers presented in special sessions on the first day of the conference and 76 papers on photovoltaic technology which were presented during the rest of the Congress. These dealt with global warming issues, replacement of CFC gases, solar and low-energy architecture, hydrogen as an alternative fuel and photovoltaic conversion systems. The photovoltaic technology was divided into: solar materials; advanced concepts; crystalline silicon; thin films; systems and components; and applications. Two of these on radiation effects in silicon solar cells, are indexed separately. Volume two deals with solar thermal conversion systems and consists of 101 papers on: solar water heaters; solar drying; solar engines and heat pumps; solar cooling and refrigeration; solar thermal fundamentals; and process heat. Volume three is divided into two parts, biomass conversion technology which consists of 47 papers, and wind energy technology which contains 32 papers. Volume four deals with solar and low energy architecture: there are 83 papers. Volume five (106 papers) deals with the various issues which are not discussed in the previous volumes. (author)

  1. The Investment Environment for Renewable Energy Development in Lithuania: The Electricity Sector

    Directory of Open Access Journals (Sweden)

    Milčiuvienė Saulė

    2014-06-01

    Full Text Available The article analyzes the investment environment in renewable electricity generation capacities, evaluating the credibility of long term renewable energy targets, the stability of promotion schemes and the impartiality of national administrative procedure. The article explores two main questions: (i are the EU and Lithuanian energy policy targets and promotion schemes credible enough to convince private investors to put their money in renewable energy development; (ii does national administrative procedure put a disproportional burden on renewable energy investors or on certain group of investors? The assessment of the investment environment includes a large number of criteria, but we analyze three of them: the stability of long term strategy; the attractiveness of promotionmeasures; and the simplicity and transparency of administrative procedure. Two further criteria are investigated: the stability of targets in renewable energy and the stability of promotional measures. The greatest uncertainty for investors occurs because of constantly changing support schemes of renewable energy sources-schemes that are not harmonized among the member States. At the national level the main driver in the development of small generators is the feed-in tariff. However, the high feed-in tariff does not always guarantee the smooth development of small scale generators of renewable energy.

  2. The impact on climate and environment change – renewable energy sector

    Directory of Open Access Journals (Sweden)

    Elena GURGU

    2010-12-01

    Full Text Available Most of the people have an idea of what renewable energy sources are and what they can offer us. The majority of people are also very aware of the impact that non-renewable energy is having on the environment. The adage reduce, reuse, recycle is commonly recited today by adults and children alike. We have started to see an increase in the reduction of waste and consumption of energy and the recycling and reuse of products we use. It is time to see an increase, however, in the use of renewable energy.

  3. Open access in the critical care environment.

    Science.gov (United States)

    South, Tabitha; Adair, Brigette

    2014-12-01

    Open access has become an important topic in critical care over the last 3 years. In the past, critical care had restricted access and set visitation guidelines to protect patients. This article provides a review of the literature related to open access in the critical care environment, including the impact on patients, families, and health care providers. The ultimate goal is to provide care centered on patients and families and to create a healing environment to ensure safe passage of patients through their hospital stays. This outcome could lead to increased patient/family satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Clean air renewable energy (CARE) coalition : a case study

    Energy Technology Data Exchange (ETDEWEB)

    Lambert, G. [Suncor Energy, Fort McMurray, AB (Canada); Pollock, D. [Pembina Institute for Appropriate Development, Drayton Valley, AB (Canada)

    2002-07-01

    This paper highlights the opportunity for new partnerships between business and non-governmental organizations in the field of sustainable development through the growing convergence of interests. The authors also briefly describe both Suncor Energy and the Pembina Institute for Appropriate Development stances on sustainable development. Since 1990, both organizations have collaborated on the future of the emerging renewable energy industry. Renewable energy represents an energy source diversification through the regional creation of jobs and improved air quality and associated benefits resulting from the reductions in greenhouse gas emissions. The Clean Air Renewable Energy Coalition (Coalition) was established in December 2000 in order to assess the barriers to capital investment in the renewable energy industry. It was revealed that the international community as a whole was further ahead than Canada in terms of renewable support, production and export of technology and services. Some of the challenges facing the industry are: low demand for renewables and low supply. The coalition allowed for the joint identification of desired policy changes, such as new tax incentives for renewable energy supply and demand. Efforts were made in inviting the support of industry, municipalities and environmental non governmental organizations. The list of members that have joined the coalition to date was shown. The coalition is asking for consumer green energy credit, designed for the creation of demand and the education of the general public, and producer incentives to increase supply. The proposals were explained, as well as the strategic principles underlying them. A new tax incentive was announced in the December 2001 Canadian federal budget. The authors concluded by mentioning some future opportunities and the lessons learned on the importance of the right partners, of broad-based advocacy, of targeted and focuses messages, and of evolutionary change.

  5. Clean air renewable energy (CARE) coalition : a case study

    International Nuclear Information System (INIS)

    Lambert, G.; Pollock, D.

    2002-01-01

    This paper highlights the opportunity for new partnerships between business and non-governmental organizations in the field of sustainable development through the growing convergence of interests. The authors also briefly describe both Suncor Energy and the Pembina Institute for Appropriate Development stances on sustainable development. Since 1990, both organizations have collaborated on the future of the emerging renewable energy industry. Renewable energy represents an energy source diversification through the regional creation of jobs and improved air quality and associated benefits resulting from the reductions in greenhouse gas emissions. The Clean Air Renewable Energy Coalition (Coalition) was established in December 2000 in order to assess the barriers to capital investment in the renewable energy industry. It was revealed that the international community as a whole was further ahead than Canada in terms of renewable support, production and export of technology and services. Some of the challenges facing the industry are: low demand for renewables and low supply. The coalition allowed for the joint identification of desired policy changes, such as new tax incentives for renewable energy supply and demand. Efforts were made in inviting the support of industry, municipalities and environmental non governmental organizations. The list of members that have joined the coalition to date was shown. The coalition is asking for consumer green energy credit, designed for the creation of demand and the education of the general public, and producer incentives to increase supply. The proposals were explained, as well as the strategic principles underlying them. A new tax incentive was announced in the December 2001 Canadian federal budget. The authors concluded by mentioning some future opportunities and the lessons learned on the importance of the right partners, of broad-based advocacy, of targeted and focuses messages, and of evolutionary change

  6. Proceedings of the International Symposium on Renewable Energy: Environment Protection and Energy Solution

    International Nuclear Information System (INIS)

    2006-12-01

    The International Symposium and Exhibition on Renewable Energy 2003 organized by the Malaysian Institute of Energy (INTEM), the Malaysia Energy centre (PTM), Islamic Scientific, Education, and Cultural Organization (ISESCO), World Renewable Energy Network (WREN), Ministry of Energy, Communication and Multimedia, and the Ministry of Education, Malaysia has the following objectives (a) highlighting the role of renewable in meeting the energy demand particularly of developing countries (b) encouraging the effective transfer and efficient application of economic renewable energy technologies (c) assisting in the promotion of the environmental benefits of renewable energy (d) promoting business opportunities for renewable energy projects and their successful implementation (e) enhancing improved information, knowledge and education on renewable energy (f) providing a technical exhibition where manufacturers, suppliers and others can display their products and services and finally (h) providing a focal points for international networking. The topics covered are Solar Materials, Solar Thermal Applications, Photovoltaic technology, Biomass Conversion, Hydrogen and Fuel Cells, Wind Energy, Hydro Energy, Climate and the Environment, Low Energy Architecture, related Topics (Energy Management; Economics, Policy and Financing; Sustainable Energy Business Practices, Carbon tax and trading, Gender and Poverty Reduction). A total of 97 papers have been received from countries such as Malaysia, United States of America, United Kingdom, Azerbaijan, Bangladesh, Armenia, Romania, Denmark, Bahrain, Iraq, Italy, Saudi Arabia, Egypt, Libya, Australia, Brunei, Belgium, New Zealand, Indonesia, Singapore, Thailand, India, Iran, Russia, and Turkey

  7. Strategic Renewal in Regulatory Environments: How inter- and intra-organisational institutional forces influence European incumbent energy firms

    NARCIS (Netherlands)

    M. Stienstra (Marten)

    2008-01-01

    textabstractHow do incumbent firms strategically renew in regulatory environments? Assuming that regulation can both constrain and enable a firm’s strategic renewal opportunities, we investigate how and to what extent incumbent firms undertake exploitative and explorative strategic renewal actions

  8. Adjustment problems and residential care environment

    OpenAIRE

    Jan Sebastian Novotný

    2015-01-01

    Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently g...

  9. Transforming and Sustaining the Care Environment

    OpenAIRE

    Goldfisher, Anne M.; Hounslow, Barbara; Blank, Judi

    2014-01-01

    Background: Caring Science Theory and Practices have been part of the Kaiser Permanente's Strategic Priority for Kaiser Permanente Northern Region since 2010. Their goal is to ensure the continued spread across the medical center of practices guided by the Caring Sciences framework that fosters caring-healing environments and that reinforce helping-trusting relationships between caregivers and between caregivers and patients. Methods: Gaining senior-level leader sponsorship is an essential el...

  10. Ubiquitous computing in shared-care environments.

    Science.gov (United States)

    Koch, S

    2006-07-01

    In light of future challenges, such as growing numbers of elderly, increase in chronic diseases, insufficient health care budgets and problems with staff recruitment for the health-care sector, information and communication technology (ICT) becomes a possible means to meet these challenges. Organizational changes such as the decentralization of the health-care system lead to a shift from in-hospital to both advanced and basic home health care. Advanced medical technologies provide solutions for distant home care in form of specialist consultations and home monitoring. Furthermore, the shift towards home health care will increase mobile work and the establishment of shared care teams which require ICT-based solutions that support ubiquitous information access and cooperative work. Clinical documentation and decision support systems are the main ICT-based solutions of interest in the context of ubiquitous computing for shared care environments. This paper therefore describes the prerequisites for clinical documentation and decision support at the point of care, the impact of mobility on the documentation process, and how the introduction of ICT-based solutions will influence organizations and people. Furthermore, the role of dentistry in shared-care environments is discussed and illustrated in the form of a future scenario.

  11. Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

    Science.gov (United States)

    McPherson, Charmaine M; McGibbon, Elizabeth A

    2010-09-01

    Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

  12. 75 FR 54618 - CAlifornians for Renewable Energy, Inc. (CARE) v. Pacific Gas and Electric Company, Southern...

    Science.gov (United States)

    2010-09-08

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL10-84-000] CAlifornians for Renewable Energy, Inc. (CARE) v. Pacific Gas and Electric Company, Southern California Edison Company, San Diego Gas & Electric Company, California Public Utilities Commission; Notice of Complaint...

  13. 75 FR 66744 - Californians for Renewable Energy, Inc. (CARE) v. Pacific Gas and Electric Company, Southern...

    Science.gov (United States)

    2010-10-29

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL10-84-001] Californians for Renewable Energy, Inc. (CARE) v. Pacific Gas and Electric Company, Southern California Edison Company, San Diego Gas & Electric Company, California Public Utilities Commission; Notice of Amended...

  14. Creating collaborative learning environments for transforming primary care practices now.

    Science.gov (United States)

    Miller, William L; Cohen-Katz, Joanne

    2010-12-01

    The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for the success of the PCMH. Our focus in this article is on training existing health care professionals toward being thriving members of this transformed clinical care team in a relationship-centered PCMH. Our description of the optimal conditions for collaborative training begins with delineating three types of teams and how they relate to levels of collaboration. We then describe how to create a supportive, safe learning environment for this type of training, using a different model of professional socialization, and tools for building culture. Critical skills related to practice development and the cross-disciplinary collaborative processes are also included. Despite significant obstacles in readying current clinicians to be members of thriving collaborative teams, a few next steps toward implementing collaborative training programs for existing professionals are possible using competency-based and adult learning approaches. Grasping the long awaited arrival of collaborative primary health care will also require delivery system and payment reform. Until that happens, there is an abundance of work to be done envisioning new collaborative training programs and initiating a nation-wide effort to motivate and reeducate our colleagues. PsycINFO Database Record (c) 2010 APA, all rights reserved.

  15. Business models for renewable energy in the built environment. Updated version

    Energy Technology Data Exchange (ETDEWEB)

    Wuertenberger, L.; Menkveld, M.; Vethman, P.; Van Tilburg, X. [ECN Policy Studies, Amsterdam (Netherlands); Bleyl, J.W. [Energetic Solutions, Graz (Austria)

    2012-04-15

    The project RE-BIZZ aims to provide insight to policy makers and market actors in the way new and innovative business models (and/or policy measures) can stimulate the deployment of renewable energy technologies (RET) and energy efficiency (EE) measures in the built environment. The project is initiated and funded by the IEA Implementing Agreement for Renewable Energy Technology Deployment (IEA-RETD). It analysed ten business models in three categories (amongst others different types of Energy Service Companies (ESCOs), Developing properties certified with a 'green' building label, Building owners profiting from rent increases after EE measures, Property Assessed Clean Energy (PACE) financing, On-bill financing, and Leasing of RET equipment) including their organisational and financial structure, the existing market and policy context, and an analysis of Strengths, Weaknesses, Opportunities and Threats (SWOT). The study concludes with recommendations for policy makers and other market actors.

  16. Business models for renewable energy in the built environment (RE-BIZZ)

    Energy Technology Data Exchange (ETDEWEB)

    Wuertenberger, L.; Menkveld, M.; Vethman, P.; Van Tilburg, X. [ECN Policy Studies, Amsterdam (Netherlands); Bleyl, J.W. [Energetic Solutions, Graz (Austria)

    2011-11-15

    The project RE-BIZZ aims to provide insight to policy makers and market actors in the way new and innovative business models (and/or policy measures) can stimulate the deployment of renewable energy technologies (RET) and energy efficiency (EE) measures in the built environment. The project is initiated and funded by the IEA Implementing Agreement for Renewable Energy Technology Deployment (IEA-RETD). It analysed ten business models in three categories (amongst others different types of Energy Service Companies (ESCOs), Developing properties certified with a 'green' building label, Building owners profiting from rent increases after EE measures, Property Assessed Clean Energy (PACE) financing, On-bill financing, and Leasing of RET equipment) including their organisational and financial structure, the existing market and policy context, and an analysis of Strengths, Weaknesses, Opportunities and Threats (SWOT). The study concludes with recommendations for policy makers and other market actors.

  17. Wellness health care and the architectural environment.

    Science.gov (United States)

    Verderber, S; Grice, S; Gutentag, P

    1987-01-01

    The stress management-wellness health care environment is emerging as a distinct facility type in the 1980s. Yet the idea is not a new one, with roots based in the Greek Asklepieon dating from 480 B.C. This and later Western transformations for health promotion embraced the therapeutic amenity inherent in meditation, solace and communality with nature based on the premise that the need for refuge from the stress inherent in one's daily life is deep-rooted in humans. A two-phase study is reported on wellness health care provider priorities, relative to the architectural features of stress-wellness centers. Representatives of 11 health care organizations responded to a telephone survey questionnaire, and 128 respondents completed a user needs questionnaire. Four major issues were addressed: image and appearance, location and setting, services provided and costs, and patterns of use. Convenience to one's place of work, a balanced mixture of clinical and nonclinical programs, a noninstitutional retreat-like environment, and membership cost structures were found to be major user considerations with respect to planning and design concepts for wellness health care environments. Directions for further research are discussed.

  18. Strategic Renewal in Regulatory Environments. How inter- and intra-organisational institutional forces influence European incumbent energy firms

    International Nuclear Information System (INIS)

    Stienstra, M.

    2008-01-01

    How do incumbent firms strategically renew in regulatory environments? Assuming that regulation can both constrain and enable a firm's strategic renewal opportunities, we investigate how and to what extent incumbent firms undertake exploitative and explorative strategic renewal actions in order to remain competitive. Exploitative strategic renewal involves those actions that strengthen or optimise a firm's current resource deployments, whereas explorative strategic renewal relates to actions that generate new sources of value creation for the firm. Based on old institutional theory, new institutional theory, neo-institutional theory and institutional entrepreneurship literature, a multi-level framework that combines selection and adaptation arguments has been developed and applied to investigate strategic renewal behaviour of a sample of European energy incumbents. At industry level of analysis, results show how inter-organisational institutional forces significantly impact firms' choices of exploitative and explorative strategic renewal actions through regulative, normative and cognitive forces. At organisational unit level of analysis, we find that the extent of intra-organisational regulative forces is positively related to exploitative strategic renewal actions. In addition, entrepreneurial proclivity appears to be a catalyst of both exploitative and explorative strategic renewal actions. Finally, our results provide insights how environmental selection and firm level adaptation are interrelated in the context of regulation. The extent of inter-organisational regulative forces positively moderates the relationship between intra-organisational regulative forces and exploitative strategic renewal actions.

  19. FACTORS AFFECTING TEACHING THE CONCEPT of RENEWABLE ENERGY in TECHNOLOGY ASSISTED ENVIRONMENTS AND DESIGNING PROCESSES in THE DISTANCE EDUCATION MODEL

    Directory of Open Access Journals (Sweden)

    A. Seda YUCEL

    2007-01-01

    Full Text Available The energy policies of today focus mainly on sustainable energy systems and renewable energy resources. Chemistry is closely related to energy recycling, energy types, renewable energy, and nature-energy interaction; therefore, it is now an obligation to enrich chemistry classes with renewable energy concepts and related awareness. Before creating renewable energy awareness, the factors thought to affect such awareness should be determined. Knowing these factors would facilitate finding out what to take into account in creating renewable energy awareness. In this study, certain factors thought to affect the development of renewable energy awareness were investigated. The awareness was created through a technology-assisted renewable energy module and assessed using a renewable energy assessment tool. The effects of the students’ self-directed learning readiness with Guglielmino (1977, inner-individual orientation, and anxiety orientation on the awareness were examined. These three factors were found to have significant effects on renewable energy, which was developed through technology utilization. In addition, based on the finding that delivering the subject of renewable energy in technology assisted environments is more effective, the criteria that should be taken into consideration in transforming this subject into a design model that is more suitable for distance education were identified.

  20. Strategic Renewal in Regulatory Environments. How inter- and intra-organisational institutional forces influence European incumbent energy firms

    Energy Technology Data Exchange (ETDEWEB)

    Stienstra, M.

    2008-11-20

    How do incumbent firms strategically renew in regulatory environments? Assuming that regulation can both constrain and enable a firm's strategic renewal opportunities, we investigate how and to what extent incumbent firms undertake exploitative and explorative strategic renewal actions in order to remain competitive. Exploitative strategic renewal involves those actions that strengthen or optimise a firm's current resource deployments, whereas explorative strategic renewal relates to actions that generate new sources of value creation for the firm. Based on old institutional theory, new institutional theory, neo-institutional theory and institutional entrepreneurship literature, a multi-level framework that combines selection and adaptation arguments has been developed and applied to investigate strategic renewal behaviour of a sample of European energy incumbents. At industry level of analysis, results show how inter-organisational institutional forces significantly impact firms' choices of exploitative and explorative strategic renewal actions through regulative, normative and cognitive forces. At organisational unit level of analysis, we find that the extent of intra-organisational regulative forces is positively related to exploitative strategic renewal actions. In addition, entrepreneurial proclivity appears to be a catalyst of both exploitative and explorative strategic renewal actions. Finally, our results provide insights how environmental selection and firm level adaptation are interrelated in the context of regulation. The extent of inter-organisational regulative forces positively moderates the relationship between intra-organisational regulative forces and exploitative strategic renewal actions.

  1. Adjustment problems and residential care environment

    Directory of Open Access Journals (Sweden)

    Jan Sebastian Novotný

    2015-01-01

    Full Text Available Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently growing up in an residential care environment, aged 13 to 21 (M = 16.23, SD = 1.643. The second group consisted of 214 adolescents growing up in a family, aged 15 to 20 (M = 17.07, SD = 1.070. We used a questionnaire Youth Self Report. Data were analyzed using descriptive statistics and MANOVA. Results: Results showed that adolescents in residential care exhibit higher average values in all adjustment problems. Also, in the context of diagnostic categories are the residential care adolescents more frequently in non-normal range (borderline and clinical, primarily in the border range. The greatest differences were reflected in the Thought problems and Rule-breaking behavior. MANOVA showed a significant multivariate effect between groups of adolescents, Hotelling's T = .803, F(8, 490 = 49.202, p <.001, d = .445 (large effect. Univariate analysis further showed a significant effect for Withdrawn/depressed (p = .044, d = .089, small effect, Somatic complaints (p = .002, d = .139, medium effect, Social problems (p = 004, d = .127, a small effect, Thought problems (p <.001, d = .633, strong effect, Attention problems (p <.001, d = .320,strong effect, Rule-breaking behavior (p <.001 , d = .383, strong effect, and Aggressive behavior (p = 015, d = .110, small effect. Results for the dimension of Anxious/depressed were not significant (p = .159. Discussion: The results didn’t confirmed the assumption that more than 30% of residential care adolescents have adjustment

  2. Uncertainty-averse TRANSCO planning for accommodating renewable energy in CO2 reduction environment

    DEFF Research Database (Denmark)

    Zhang, Chunyu; Ding, Yi; Wang, Qi

    2015-01-01

    , demand-side variations, market price volatility, and transmission configuration. Three objectives, i.e. social CO2 reduction benefit, energy purchase and network expansion cost and power delivery profit, are optimized simultaneously by a developed two-phase multi-objective particle swarm optimization......The concern of the environment and energy sustainability requests a crucial target of CO2 abatement and results in a relatively high penetration of renewable energy generation in the transmission system. For maintaining system reliability and security, the transmission company (TRANSCO) has to make...

  3. RENEWABLE ENERGY, A KEY TO INTEGRATING COMPETITIVE POLICIES WITH ADVANCED ENVIRONMENT PROTECTION STRATEGIES

    Directory of Open Access Journals (Sweden)

    Cinade Lucian Ovidiu

    2011-12-01

    Full Text Available Development of competitive policies and improvement of environment protection strategies are two basic trends of the development of the European Unique Market. Energy, also known as 'industry bread', is basic product and strategic resource, where energy industry plays an obvious role in the economic and social development of any community. Traditional energy production is marred by three major drawbacks: it generates negative externalities by polluting; it is totally in the hands of the producers; hence, prices rise at their will, of fossil fuels such as oil and gas. Present study focuses on electric energy industry, yet bearing over the whole length of the chain producer-to-end-consumer, thus revealed as particularly complex. The question is do alternative energy sources meet the prerequisite of market being competitive meanwhile environment protection being highly observed. We identify limits in point, of the energy market; effects of market liberalization; entry barriers; interchangeability level of energy sources; active forces on the energy market. Competitive rivalry has been expressed as per market micro-economic analysis, based on Michael Porter's 5-forces model. It will thus be noticed that, morphologically, competition evolution depends firstly on the market type. For the time being, the consumer on the energy market stays captive, for various reasons such as: legislation; limits of energy transfer infrastructure; scarcity of resources; resources availability imbalance; no integrative strategy available, of renewable energy resources usage. Energy availability is vital for human society to function. Comparative advantages of renewable energy resources are twofold, as manifested: in terms of economics, i.e. improving competition by substitute products entered at the same time as new producers enter market; and in terms of ecology, by reducing CO2 emissions. As to energy production technology and transfer, the complementary nature will

  4. Impacts on the biophysical economy and environment of a transition to 100% renewable electricity in Australia

    International Nuclear Information System (INIS)

    Turner, Graham M.; Elliston, Ben; Diesendorf, Mark

    2013-01-01

    We investigate the impacts on the biophysical economy, employment and environment of a transition scenario to an energy-efficient, 100% renewable electricity (RE) system by 2060, based on wind, solar and biomass technologies, and an introduction of electric vehicles. We employ a CSIRO process-based model of the physical activity of Australia’s economy and environmental resources, the Australian Stocks and Flows Framework. The RE systems are assumed to be manufactured in Australia to identify possible employment benefits. In comparison with the business-as-usual (BAU) scenario, on a national scale, the RE scenario has much lower economy-wide net emissions, remaining below contemporary levels and becoming zero in the electricity sector by 2060. Compared with BAU, the RE scenario also has significantly lower industrial water use, somewhat higher materials use, slightly lower unemployment, lower net foreign debt (relative to a GDP proxy) and, resulting from the growth in electric vehicles, reduced oil imports. The GDP per capita growth, based on the physical stocks of capital and labour, is virtually the same in both scenarios. Hence, from the viewpoint of the biophysical economy, there are no major barriers to implementing policies to facilitate the transition to a 100% renewable electricity system for Australia. - Highlights: ► Simulation of a 100% renewable electricity (RE) system in a process-based model. ► The RE scenario achieves zero GHG emissions in the electricity sector by 2060. ► Consumption of secondary materials is higher and more variable in the RE scenario. ► The RE scenario has lower water use, unemployment, foreign debt and oil imports

  5. Modeling and Simulation of Renewable Hybrid Power System using Matlab Simulink Environment

    Directory of Open Access Journals (Sweden)

    Cristian Dragoş Dumitru

    2010-12-01

    Full Text Available The paper presents the modeling of a solar-wind-hydroelectric hybrid system in Matlab/Simulink environment. The application is useful for analysis and simulation of a real hybrid solar-wind-hydroelectric system connected to a public grid. Application is built on modular architecture to facilitate easy study of each component module influence. Blocks like wind model, solar model, hydroelectric model, energy conversion and load are implemented and the results of simulation are also presented. As an example, one of the most important studies is the behavior of hybrid system which allows employing renewable and variable in time energy sources while providing a continuous supply. Application represents a useful tool in research activity and also in teaching

  6. Smart use of storage potentials of electric vehicles for renewable energy generation in the built environment : A design scenario

    NARCIS (Netherlands)

    Van Timmeren, A.; Bauer, T.C.; Silvester, S.

    2011-01-01

    In this paper, results are reported of a technology assessment of use of electrical vehicles for energy storage (of renewable sources), their integration in the built environment and attached required power and charging systems for the Netherlands. This was done as part of the DIEMIGO project on

  7. Renewable energy

    International Nuclear Information System (INIS)

    Yoon, Cheon Seok

    2009-09-01

    This book tells of renewable energy giving description of environment problem, market of renewable energy and vision and economics of renewable energy. It also deals with solar light like solar cell, materials performance, system and merit of solar cell, solar thermal power such as solar cooker and solar collector, wind energy, geothermal energy, ocean energy like tidal power and ocean thermal energy conversion, fuel cell and biomass.

  8. Environment project: 50 measures for a development of the high environmental quality renewable energies

    International Nuclear Information System (INIS)

    2008-11-01

    This document presents the 50 measures decided by the government to develop the renewable energies in France and reach the 20% of participation to the energy production in 2020. Some measures concern all the renewable energies, they deal with the regulation, the administrative procedures of the building, others are specific to each energy. (A.L.B.)

  9. Landing Marine-derived Renewable Energy: Optimising Power Cable Routing in the Nearshore Environment

    Science.gov (United States)

    Turner, Rosalind, ,, Dr.; Keane, Tom; Mullins, Brian; Phipps, Peter

    2010-05-01

    Numerous studies have demonstrated that a vast unexploited source of energy can be derived from the marine environment. Recent evolution of the energy market and looming EU renewable energy uptake targets for 2020 have driven a huge explosion of interest in exploiting this resource, triggering both governments and industry to move forward in undertaking feasibility assessments and demonstration projects for wave, tidal and offshore wind farms across coastlines. The locations which naturally lend themselves to high yield energy capture, are by definition, exposed and may be remote, located far from the end user of the electricity generated. A fundamental constraint to successfully exploiting these resources will be whether electricity generated in high energy, variable and constantly evolving environments can be brought safely and reliably to shore without the need for constant monitoring and maintenance of the subsea cables and landfall sites. In the case of riverine cable crossings superficial sediments would typically be used to trench and bury the cable. High energy coastal environments may be stripped of soft sediments. Any superficial sediments present at the site may be highly mobile and subject to re-suspension throughout the tidal cycle or under stormy conditions. EirGrid Plc. and Mott MacDonald Ireland Ltd. have been investigating the potential for routing a cable across the exposed Shannon estuary in Ireland. Information regarding the geological ground model, meteo-oceanographic and archaeological conditions of the proposed site was limited, necessitating a clear investigation strategy. The investigation included gathering site information on currents, bathymetry and geology through desk studies, hydrographic and geophysical surveys, an intrusive ground investigation and coastal erosion assessments at the landfall sites. The study identified a number of difficulties for trenching and protecting a cable through an exposed environment such as the Shannon

  10. Educational renewal of physician training in Australia and New Zealand: Multiple educational innovations in a complex environment.

    Science.gov (United States)

    Udemans, Rebecca; Stokes, Marie-Louise; Rigby, Louise; Khanna, Priya; Christiansen, Jonathan

    2018-03-21

    The Royal Australasian College of Physicians is renewing its specialty training programs and shifting towards competency-based medical education. Our aim is to improve the quality and rigor of training and graduate outcomes, and promote high standards of physician practice to serve the health of patients, families, and communities in a changing healthcare environment. We are progressing holistic change and multiple educational innovations in a complex environment. Numerous stakeholders, a disparate training landscape and a largely volunteer supervisor workforce pose challenges in supporting effective implementation. This paper describes our progress and experience with three key components of our education renewal program: curricular renewal, a new selection process and faculty development. It offers reflections on the practical challenges, lessons learned and factors critical for success. Our experience highlights opportunities for training organizations to maximize their influence over workplace training experiences and outcomes by taking a systems approach to the design, delivery and evaluation of the components of education renewal. We found that design, development and delivery of our multiple educational innovations have benefited from co-design approaches, progressive and concurrent development, continual exploration of new strategies, and implementation as soon as viable with a commitment to iterative improvements over time.

  11. Creating LGBTQ-Inclusive Care and Work Environments.

    Science.gov (United States)

    Jones-Schenk, Jan

    2018-04-01

    In considering the full depth of inclusion in care and work environments (and developing inclusive engagement skills for lesbian, gay, bisexual, transgender, queer or questioning [LGBTQ] patients and their families), professional development leaders must bring these discussions and shared learnings into the open. Understanding the LGBTQ population's unique needs is essential to providing personalized health care, and inclusive work environments help to foster more inclusive care for this population. J Contin Educ Nurs. 2018;49(4):151-153. Copyright 2018, SLACK Incorporated.

  12. Designing an adaptive salutogenic care environment

    OpenAIRE

    Dalton, Cathy; Harrison, Jim D.

    2011-01-01

    Humans are profoundly affected by the surroundings which they inhabit. Environmental psychologists have produced numerous credible theories describing optimal human environments, based on the concept of congruence or “fit” (1, 2). Lack of person/environment fit can lead to stress-related illness and lack of psychosocial well-being (3). Conversely, appropriately designed environments can promote wellness (4) or “salutogenesis” (5). Increasingly, research in the area of Evidence-Based Design, l...

  13. [Racial discrimination in the care environment].

    Science.gov (United States)

    Labache, Lucette

    2018-05-01

    Based on interviews carried out with people from overseas working in Parisian hospitals and observations made of women from Central and North Africa working in care facilities for elderly or disabled people, this article discusses the issue of racial discrimination. We focus on the way discrimination develops, its manifestations in the care sector and the way in which it is handled. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  14. 75 FR 76453 - CAlifornians for Renewable Energy, Inc., (CARE), and Barbara Durkin v. National Grid, Cape Wind...

    Science.gov (United States)

    2010-12-08

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL11-9-000] CAlifornians for Renewable Energy, Inc., (CARE), and Barbara Durkin v. National Grid, Cape Wind, and the Massachusetts... Energy Regulatory Commission's (Commission) Rules of Practice and Procedure, 18 CFR 385.206, (2010...

  15. Requirements for reflection in the critical care environment

    Directory of Open Access Journals (Sweden)

    Celia J. Filmalter

    2015-03-01

    Full Text Available Background: Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear. Objectives: To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses. Method: A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment. Results: The themes that emerged from the focus group were buy-in from stakeholders –management, facilitators and critical care nurses, and the need to create an environment where reflection can occur. Conclusion: Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatorypractice development.

  16. Validation of Geriatric Care Environment Scale in Portuguese Nurses

    Directory of Open Access Journals (Sweden)

    João Paulo de Almeida Tavares

    2013-01-01

    Full Text Available The number of hospitalized older adults in Portugal necessitates a better understanding of the acute care environment for older adults. This study translated and examined the psychometric qualities of the Geriatric Care Environment Scale (GCES among 1,068 Portuguese registered nurses (RNs. Four factors emerged from the exploratory factor analyses: resource availability, aging-sensitive care delivery, institutional values regarding older adults and staff, and continuity of care. The internal consistency of the GCES was α=.919. The GCES was significantly associated with the variables of region, hospital type, unit type, and RNs perception of hospital educational, staff knowledge, difficulty, rewarding, and burdensome in caring for older adults. Nurses who worked in hospitals centers in the northern region and medical and surgery units had more positive perceptions of the geriatric care environment. More positive perception was also found among RNs that reported more educational support, had more knowledge, and felt more rewarding and less difficulty and burden in caring older adults. This process resulted in a valid and reliable measurement of the geriatric care environment Portuguese version which provides hospital leadership with an instrument to evaluate organizational support for geriatric nursing practice and target specific areas that support or hinder care delivery.

  17. The Association Between Psychosocial Work Environment and Satisfaction With Old Age Care Among Care Recipients.

    Science.gov (United States)

    Lundgren, Dan; Ernsth Bravell, Marie; Börjesson, Ulrika; Kåreholt, Ingemar

    2018-06-01

    This study examines the association between nursing assistants' perceptions of their psychosocial work environment and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted among people receiving care ( N = 1,535) and nursing assistants ( N = 1,132) in 45 nursing homes and 21 home care units within municipal old-age care. Better psychosocial work environment was related to higher satisfaction in old-age care among the recipients. Significant and stronger associations were more common in nursing homes than in home care. Perception of mastery and positive challenges at work were associated with higher recipient satisfaction both in home care and in nursing homes: social climate, perception of group work, perception of mastery, and positive challenges at work only in nursing homes. Findings suggest that recipient satisfaction may be increased by improving the psychosocial work environment for nursing assistants, both in nursing homes and in home care.

  18. Rethinking the intensive care environment: considering nature in nursing practice.

    Science.gov (United States)

    Minton, Claire; Batten, Lesley

    2016-01-01

    With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes. © 2015 John Wiley & Sons Ltd.

  19. The Living, Dynamic and Complex Environment Care in Intensive Care Unit.

    Science.gov (United States)

    Backes, Marli Terezinha Stein; Erdmann, Alacoque Lorenzini; Büscher, Andreas

    2015-01-01

    to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care. Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units. built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions); "Providing a suitable environment" and "having relatives with concern" (context); "Mediating facilities and difficulties" (intervenienting conditions); "Organizing the environment and managing the dynamics of the unit" (strategy) and "finding it difficult to accept and deal with death" (consequences). confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  20. The Living, Dynamic and Complex Environment Care in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2015-06-01

    Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  1. Preparing Students for Practice in a Managed Care Environment

    Science.gov (United States)

    Claiborne, Nancy; Fortune, Anne

    2005-01-01

    Managed care has profound effects on health and mental health service delivery in the United States. This article describes the knowledge that students need for effective social work practice within a managed care environment and evaluates a course to deliver the content. (Contains 3 tables.)

  2. Renewable energy

    International Nuclear Information System (INIS)

    Berghmans, J.

    1994-01-01

    Renewable energy sources have a small environmental impact and can be easily integrated within existing structures. Moreover, the use of renewable energy sources can contribute to achieve a zero emission of carbon dioxide by 2100, provided an efficient environmental policy during the next 40 years. This includes a correct pricing policy of renewable energy sources with respect to nuclear energy and fossil fuel. The latter energy sources have been favoured in the past. In addition, an open market policy, the restructuring or conversion of existing international energy institutes, and international treaties for the protection of the natural environment are needed in view of achieving the zero carbon dioxide emission objective. (A.S.)

  3. Biotechnology: Health care, agriculture, industry, environment

    Energy Technology Data Exchange (ETDEWEB)

    Sikyta, B; Pavlasova, E; Stejskalova, E

    1986-01-01

    New developments in different branches of biotechnology are discussed. The production of peptide hormones, new interferons and other lymphokines by the microbial and cell cultures, and new enzyme inhibitors of microbial origin are the most important for health care and pharmacy. The main direction in research in the agriculture represents the development of the new, very effective methods of nitrogen fixation and the production of animal growth hormones by gene manipulated microorganisms. One of the most important field of application of biotechnology is the chemical industry, c.f. microbial production of polymers and biotransformation of compounds previously produced by chemical methods (acrylamide, adipic acid, naphthalene conversion, etc.). Several novel methods of degradation of the cellulosic materials are mentioned and exploitation of biotechnology in environmental protection is also discussed.

  4. The Integrality of Situated Caring in Nursing and the Environment

    Science.gov (United States)

    Jarrin, Olga F.

    2012-01-01

    Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry. PMID:22222236

  5. The Integrality of Situated Caring in Nursing and the Environment

    OpenAIRE

    Jarrin, Olga F.

    2012-01-01

    Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry.

  6. Nurses' role transition from the clinical ward environment to the critical care environment.

    Science.gov (United States)

    Gohery, Patricia; Meaney, Teresa

    2013-12-01

    To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. US EPA CARE Grants

    Data.gov (United States)

    U.S. Environmental Protection Agency — This is a provisional dataset that contains point locations for the subset of Community Action for a Renewed Environment (CARE) grants given out by the US EPA. CARE...

  8. Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units.

    Science.gov (United States)

    Rochefort, Christian M; Clarke, Sean P

    2010-10-01

    This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.

  9. Interaction Between Physical Environment, Social Environment, and Child Characteristics in Determining Physical Activity at Child Care

    NARCIS (Netherlands)

    Gubbels, J.S.; Kremers, S.P.J.; Kann, D.H.H. van; Stafleu, A.; Candel, M.J.J.M.; Dagnelie, P.C.; Thijs, C.; Vries, N.K.de

    2011-01-01

    Objective: To investigate the association between the child-care environment and physical activity of 2- and 3-year-olds. Based on an ecological view of environmental influences on health behavior, we hypothesized that the social and physical environment, as well as child characteristics (age and

  10. Income statement management in a turbulent health care environment.

    Science.gov (United States)

    Covaleski, M A

    2001-03-01

    This article considers the role of accounting information embedded in the income statement of health care providers in their increasingly difficult economic environment. This turbulent economic environment has resulted from the dramatic shift in power from the seller to the buyer of health care services, with a consequential shift of risks that will mandate that health care providers obtain access to better cost and utilization information. This article looks at the 2 critical components of the income statement--the revenue function and the cost structure-in terms of their importance in the management of enhanced economic performance in both the fee-for-service and the prepaid provision of health care services. Copyright 2001 by W.B. Saunders Company

  11. Engineering design for a large scale renewable energy network installation in an urban environment

    Science.gov (United States)

    Mansouri Kouhestani, F.; Byrne, J. M.; Hazendonk, P.; Spencer, L.; Brown, M. B.

    2016-12-01

    Humanity's current avid consumption of resources cannot be maintained and the use of renewable energy is a significant approach towards sustainable energy future. Alberta is the largest greenhouse gas-producing province in Canada (per capita) and Climate change is expected to impact Alberta with warmer temperatures, intense floods, and earlier snow melting. However, as one of the sunniest and windiest places in Canada, Alberta is poised to become one of Canada's leader provinces in utilizing renewable energies. This research has four main objectives. First, to determine the feasibility of implementing solar and wind energy systems at the University of Lethbridge campus. Second, to quantify rooftop and parking lot solar photovoltaic potential for the city of Lethbridge. Third, to determine the available rooftop area for PV deployment in a large scale region (Province of Alberta). Forth, to investigate different strategies for correlating solar PV array production with electricity demand in the province of Alberta. The proposed work addresses the need for Alberta reductions to fossil fuel pollution that drives climate change, and degrades our air, water and land resources.

  12. Links between social environment and health care utilization and costs.

    Science.gov (United States)

    Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A

    2018-01-01

    The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

  13. Challenges to neurology residency education in today's health care environment.

    Science.gov (United States)

    Bega, Danny; Krainc, Dimitri

    2016-09-01

    Residency training has had to adapt to higher patient volumes, increased complexity of medical care, and the commercialized system of health care. These changes have led to a concerning culture shift in neurology. We review the relationship between the emerging health care delivery system and residency training, highlighting issues related to duty hours and work-life balance, the changing technological landscape, high patient volumes, and complex service obligations. We propose that the current challenges in health care delivery offer the opportunity to improve neurology residency through faculty development programs, bringing teaching back to the bedside, increasing resident autonomy, utilizing near-peer teaching, and rewarding educators who facilitate an environment of inquiry and scholarship, with the ultimate goal of better alignment between education and patient care. Ann Neurol 2016;80:315-320. © 2016 American Neurological Association.

  14. Renewable sea energies - The industrial Meccano is underway. Environment: in the jungle of stationary energy storage

    International Nuclear Information System (INIS)

    Lescuyer, Thibault

    2015-01-01

    A first article proposes an overview of the current developments in the field of renewable sea energies where floating wing turbines, wave energy, sea current energy, or sea thermal energy seem to be promising solutions but are still at a pre-industrial stage of development. The article presents different projects and comments their successes and failures. Some innovating and important actors are briefly presented: STX France, DCNS, IDEOL, Nenuphar and EOLR. A second article comments the situation of the energy stationary storage sector which still requires viable economic models and more innovations. Different technologies and projects and the involved actors are evoked: plants of energy transfer by pumping (STEP), hydrogen-based electrochemical storage, and lithium-ion batteries

  15. Intelligent manufacturing through participation : a participative simulation environment for integral manufacturing enterprise renewal

    NARCIS (Netherlands)

    Eijnatten, F.M. van

    2002-01-01

    This book deals with a 'Participative Simulation environment for Intelligent Manufacturing' (PSIM). PSIM is a software environment for use in assembly operations and it is developed and pilot-demonstrated in five companies: Volvo (Sweden), Finland Post, Fiat (Italy), Yamatake (Japan), Ford (USA).

  16. Work Environment and Japanese Fathers' Involvement in Child Care

    Science.gov (United States)

    Ishii-Kuntz, Masako

    2013-01-01

    Previous studies mainly examined individual and family factors affecting Japanese fathers' involvement in child care. Along with these factors, we examine how work-related factors such as father-friendly environment at work, workplace's accommodation of parental needs, job stress, and autonomy are associated with Japanese men's participation in…

  17. Cultivating engaged leadership through a learning collaborative: lessons from primary care renewal in Oregon safety net clinics.

    Science.gov (United States)

    McMullen, Carmit K; Schneider, Jennifer; Firemark, Alison; Davis, James; Spofford, Mark

    2013-01-01

    The aim of this study was to explore how learning collaboratives cultivate leadership skills that are essential for implementing patient-centered medical homes (PCMHs). We conducted an ethnographic evaluation of a payor-incentivized PCMH implementation in Oregon safety net clinics, known as Primary Care Renewal. Analyses primarily drew on in-depth interviews with organizational leaders who were involved in the initiative. We solicited perspectives on the history, barriers, facilitators, and other noteworthy factors related to the implementation of PCMH. We reviewed and summarized transcripts and created and applied a coding dictionary to identify emergent leadership themes. We reviewed field notes from clinic site visits and observations of learning collaborative activities for additional information on the role of engaged leadership. Interview data suggested that organizations followed a similar, sequential process of Primary Care Renewal implementation having 2 phases-inspiration and implementation-and that leaders needed and learned different leadership skills in each phase. Leaders reported that collaborative learning opportunities were critical for developing engaged leadership skills during the inspiration phase of transformation. Facilitative and modeling aspects of engaged leadership were most important for codesigning a vision and plan for change. Adaptive leadership skills became more important during the implementation phase, when specific operational and management skills were needed to foster standardization and spread of the Primary Care Renewal initiative throughout participating clinics. The PCMH has received much attention as a way to reorganize and potentially improve primary care. Documenting steps and stages for cultivating leaders with the vision and skills to transform their organizations into PCMHs may offer a useful roadmap to other organizations considering a similar transformation.

  18. Perceived nursing work environment of acute care pediatric nurses.

    Science.gov (United States)

    Kotzer, Anne Marie; Koepping, Dianne M; LeDuc, Karen

    2006-01-01

    Nurse job satisfaction is a complex phenomenon and includes elements of the work environment. The purpose of this study was to evaluate nurses' perception of their real (current) and ideal (preferred) work environment in a pediatric tertiary care setting. Using a descriptive survey design, a convenience sample of staff nurses from three inpatient units was surveyed using the Work Environment Scale (WES) by Moos (1994). The WES consists of 10 subscales characterizing three dimensions: Relationship, Personal Growth, and System Maintenance and Change. Overall, nurses affirmed a highly positive and supportive work environment on their units. Non-significant findings between the real and ideal scores for the Involvement and Managerial Control subscales suggest that staff are concerned about and committed to their work, and satisfied with their managers' use of rules and procedures. Statistically significant differences between selected real and ideal subscale scores will help target intervention strategies to enhance the nursing work environment.

  19. High-dependency care: experiences of the psychosocial work environment.

    Science.gov (United States)

    Rahman, Hanif Abdul; Naing, Lin; Abdul-Mumin, Khadizah

    2017-11-23

    to explore high-dependency care nurses' experiences of their psychosocial work environment. four focus groups were conducted with 23 emergency and critical care hospital nurses in Brunei. All sessions were recorded, transcribed verbatim and analysed using inductive-approach thematic analysis. three major themes were identified. 'Specialisation/specific skills' explained a fundamental requirement for the high-dependency care nurses to work effectively and efficiently in their workplace. 'Task completion' narrated the pressure they experienced to complete their tasks within time constraints exacerbated by a reduced number of staff. 'Acknowledgement' signified their need for fair and adequate reward for their hard work through career progression and promotion. this study facilitates the design of future interventions and policies that promote a healthy psychosocial work environment by ensuring nurses working in these areas have the required specialisation skills, there is a balance of workload and nurse-to-patient ratios, and they are offered fairness and equity in career progression and promotion.

  20. Nursing care in a high-technological environment: Experiences of critical care nurses.

    Science.gov (United States)

    Tunlind, Adam; Granström, John; Engström, Åsa

    2015-04-01

    Management of technical equipment, such as ventilators, infusion pumps, monitors and dialysis, makes health care in an intensive care setting more complex. Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximise efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. The aim of this study is to describe critical care nurses' experience of performing nursing care in a high technology healthcare environment. Qualitative, personal interviews were conducted during 2012 with eight critical care nurses in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Three themes with six categories emerged. The technology was described as a security that could facilitate nursing care, but also one that could sometimes present obstacles. The importance of using the clinical gaze was highlighted. Nursing care in a high technological environment must be seen as multi-faceted when it comes to how it affects CCNs' experience. The advanced care conducted in an ICU could not function without high-tech equipment, nor could care operate without skilled interpersonal interaction and maintenance of basal nursing. That technology is seen as a major tool and simultaneously as a barrier to patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Optimizing cardiothoracic surgery information for a managed care environment.

    Science.gov (United States)

    Denton, T A; Matloff, J M

    1995-11-01

    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

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

    Science.gov (United States)

    Read, Marilyn A.

    2003-01-01

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

  3. Grappling with a half-hearted policy: The case of renewable energy and the environment in South Africa

    International Nuclear Information System (INIS)

    Sebitosi, A.B.; Pillay, P.

    2008-01-01

    Integrated resource planning (IRP) of power generation and delivery characterized by higher penetration of distributed energy resources (DERs) has taken the 21st century world by storm. It promises power markets that are more resilient to resource and capital cost uncertainties as well as environmental sustainability. The success of this new paradigm has been largely anchored by decisive support policy mechanisms and good implementation. But while the developed and emerging economies are registering phenomenal growth in their renewable energy industries, South Africa would appear to be caught in a time warp with a weak environment policy and a power sector that continues to plan its future in the traditional way. The consequences are continued environmental degradation and a high-energy intensive economy with intermittent power supplies. (author)

  4. Assessment of indoor environment in Paris child day care centers.

    Science.gov (United States)

    Roda, Célina; Barral, Sophie; Ravelomanantsoa, Hanitriniala; Dusséaux, Murielle; Tribout, Martin; Le Moullec, Yvon; Momas, Isabelle

    2011-11-01

    Children are sensitive to indoor environmental pollution. Up until now there has been a lack of data on air quality in child day care centers. The aim of this study is to document the indoor environment quality of Paris child day care centers by repeated measurements, and to compare pollutant levels in child day care centers with levels in Paris dwellings. We selected 28 child day care centers frequented by a random sample of babies who participated in the PARIS birth cohort environmental investigation, and visited the child day care centers for one week twice in one year. Biological contaminants assessed were fungi, endotoxin, dust mite allergens, and chemical pollutants: aldehydes, volatile organic compounds and nitrogen dioxide (NO2). Relative humidity, temperature, and carbon dioxide levels were measured simultaneously. A standardized questionnaire was used to gather information about the buildings and their inhabitants. Airborne endotoxin levels in child day care centers were higher than those found in Paris dwellings. Dust mite allergens in child day care centers were below the threshold level for sensitization in the majority of samples, and in common with dwelling samples. Penicillium and Cladosporium were the most commonly identified genera fungi. The child day care center indoor/outdoor ratio for most chemical pollutants was above unity except for NO2, the levels for NO2 being significantly higher than those measured in homes. Chemical and biological contamination in child day care centers appears to be low, apart from endotoxin and NO2. Failure to take child exposure in child day care centers into account could result in an overestimation of children's exposure to other pollutants. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Challenges in care of the child with special health care needs in a resource limited environment

    Directory of Open Access Journals (Sweden)

    Edwin Ehi Eseigbe

    2013-01-01

    Full Text Available To identify challenges encountered in the care of children with special health care needs in a resource limited environment a 10 year-old child with a diagnosis of Tuberous Sclerosis was studied. Challenges identified were in: making a definitive diagnosis, provision of adequate care, cost of care, meeting parental expectations and accessing community support for the child and family. Available specialist health care and related services, including community rehabilitation, were provided for the child and family. The study highlights the need for improved community awareness, development in the provision of specialist health care services and institution of governmental policies that identify, support and protect children with special health care needs.

  6. Renewable energy sources project appraisal under uncertainty: the case of wind energy exploitation within a changing energy market environment

    International Nuclear Information System (INIS)

    Venetsanos, K.; Angelopoulou, P.; Tsoutsos, T.

    2002-01-01

    There are four elements, which contribute to the oncoming increase of electricity demand: climate changes, the expected growth rates of EU Member State economies, changes in the consumption patterns and the introduction of new technologies. The new deregulated Electricity Market is expected to respond to this challenge and the energy supply will be adequate and cost effective within this new environment which offers promising opportunities for power producers both existing and newcomers. In this paper a framework for the appraisal of power projects under uncertainty within a competitive market environment is identified, focusing on the electricity from Renewable Energy Sources. To this end the wind energy-to-electricity, production in Greece will serve as a case study. The subject matter is centred on the following areas: the uncertainties within the new deregulated energy market; the evaluation methods including an analysis of the introduced uncertainties after deregulation and a new approach to project evaluation using the real options, as well as comparison of the valuation methodologies within the new environment drawing from the case for Greece. (author)

  7. The family child care home environment and children's diet quality.

    Science.gov (United States)

    Benjamin-Neelon, Sara E; Vaughn, Amber E; Tovar, Alison; Østbye, Truls; Mazzucca, Stephanie; Ward, Dianne S

    2018-07-01

    Developing healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care, but little research has assessed the nutritional quality of meals and snacks in family child care homes. Therefore, it is important to assess foods and beverages provided, policies related to nutrition and feeding children, and interactions between providers and children during mealtimes. We examined associations between the nutrition environments of family child care homes and children's diet quality. We assessed the nutrition environments of 166 family child care homes using the Environment and Policy Assessment and Observation (EPAO) (scores range: 0-21). We also recorded foods and beverages consumed by 496 children in care and calculated healthy eating index (HEI) (scores range: 0-100). We used a mixed effects linear regression model to examine the association between the EPAO nutrition environment (and EPAO sub-scales) and child HEI, controlling for potential confounders. Family child care homes had a mean (standard deviation, SD) of 7.2 (3.6) children in care, 74.1% of providers were black or African American, and children had a mean (SD) age of 35.7 (11.4) months. In adjusted multivariable models, higher EPAO nutrition score was associated with increased child HEI score (1.16; 95% CI: 0.34, 1.98; p = 0.006). Higher scores on EPAO sub-scales for foods provided (8.98; 95% CI: 3.94, 14.01; p = 0.0006), nutrition education (5.37; 95% CI: 0.80, 9.94; p = 0.02), and nutrition policy (2.36; 95% CI: 0.23, 4.49; p = 0.03) were all associated with greater child HEI score. Foods and beverages served, in addition to nutrition education and nutrition policies in family child care homes, may be promising intervention targets for improving child diet quality. Copyright © 2018. Published by Elsevier Ltd.

  8. The applicability of SERVQUAL in different health care environments.

    Science.gov (United States)

    Dean, A M

    1999-01-01

    This paper reports on a study that investigates the applicability of a modified SERVQUAL instrument as a means of measuring service quality in two types of health service environments; medical care and health care (incorporating medical, social, cognitive and emotional elements). The research confirms a four factor structure that is stable for both environments, and similar to the service quality dimensions recognised in the literature. However, the relative importance of the dimensions of quality is inconsistent for the two types of health services. These results confirm the suggestion that importance values should be part of the measurement tool. Finally, the extra diagnostic advantage achieved by the use of gap scores to measure service quality, when compared to perception only scores is demonstrated.

  9. Increasing Military Physician Productivity in a Managed Care Environment

    Science.gov (United States)

    1992-07-13

    allows us to obtain to a common denominator, or one single rating even though the services are dissimilar and the input units are not "weighted." Serway ...many ideas as possible to catalyze the process. In removing barriers to productivity in the work environment, a thorough analysis of the physical ...physician and the organization has increased. The whole text of the book "Doctor’s Decisions and the Cost of Medical Care" is dedicated to this concept

  10. Human-centered environment design in intensive care unit

    OpenAIRE

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland based on related standards. We also premeditate the indoor environment from planning perspective, analyze patients, their families, medical staff and space requirement to conduct research in ICU desi...

  11. Abnormal environmental light exposure in the intensive care environment.

    Science.gov (United States)

    Fan, Emily P; Abbott, Sabra M; Reid, Kathryn J; Zee, Phyllis C; Maas, Matthew B

    2017-08-01

    We sought to characterize ambient light exposure in the intensive care unit (ICU) environment to identify patterns of light exposure relevant to circadian regulation. A light monitor was affixed to subjects' bed at eye level in a modern intensive care unit and continuously recorded illuminescence for at least 24h per subject. Blood was sampled hourly and measured for plasma melatonin. Subjects underwent hourly vital sign and bedside neurologic assessments. Care protocols and the ICU environment were not modified for the study. A total of 67,324 30-second epochs of light data were collected from 17 subjects. Light intensity peaked in the late morning, median 64.1 (interquartile range 19.7-138.7) lux. The 75th percentile of light intensity exceeded 100lx only between 9AM and noon, and never exceeded 150lx. There was no correlation between melatonin amplitude and daytime, nighttime or total light exposure (Spearman's correlation coefficients all 0.5). Patients' environmental light exposure in the intensive care unit is consistently low and follows a diurnal pattern. No effect of nighttime light exposure was observed on melatonin secretion. Inadequate daytime light exposure in the ICU may contribute to abnormal circadian rhythms. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Using a strengths-based approach to build caring work environments.

    Science.gov (United States)

    Henry, Linda S; Henry, James D

    2007-12-01

    The current health care environment has a growing shortage of nurses and other health care professionals. Health care organizations face the twofold task of retaining employees and preventing "brain drain". A caring work environment can be instrumental in attracting and retaining productive and loyal employees, leading to increased employee and patient satisfaction and a positively impacted bottom line. A strengths-based approach powerfully and effectively promotes and nurtures a caring work environment in all health care specialties and organizations.

  13. [Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia].

    Science.gov (United States)

    Bullich-Marín, Ingrid; Miralles Basseda, Ramón; Torres Egea, Pilar; Planas-Campmany, Carme; Juvé-Udina, María Eulalia

    A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Environment, renewable sources and NPPs: Strategy of Slovak Republic for the back end of nuclear power

    International Nuclear Information System (INIS)

    Timulak, J.

    2009-01-01

    The term 'back end of nuclear power' means set of activities corresponding to the final stage of utilizing the nuclear energy for peaceful purposes, or at the border of nuclear facilities with the environment. Strategy of back end of nuclear power is a basic document that specifies strategy of the Slovak Republic and all relevant subjects for the next five years in detail and for the period up to 2025 in general terms, with the prospect till the end of 21 st century. It provides proposals for implementation of the back end strategy in accordance with requirements for the health and environmental protection so that its consequences are not unacceptably transferred to next generations. The goal of the back end strategy is: - to set acceptable bases back end of nuclear power in Slovakia; - to create framework for decision-making in financial covering of the strategy activities; - to provide information on conceptual solutions of back end of nuclear power to all relevant subjects and to the public. (author)

  15. Motivating teacher and student engagement with the environment through renewable energy education

    Science.gov (United States)

    Patel, Nirav Sanat

    Environmental and energy education is focused on fostering environmental behavior. This study investigates empirically if education leads to changes in environmental attitudes and subsequent environmentally significant behavior (ESB). The study contextualizes teachers' and students' motivation to engage in ESB within an environmental educational training framework. The results of structured questionnaires administered in Northeast, Mid-Atlantic, and Midwestern K-12 schools (n=214 for teachers and n=1498 for students) reveal that environmental attitudes are not a good predictor of teaching behavior but they do predict students' intent towards ESB. Teachers' energy attitudes are a better predictor in motivating them to teach while students are most responsive to their affective attitudes. The study finds that education does not play a significant role in changing environmental or energy attitudes of teachers and students. The study also advances a methodological tool for data collection that can expand the reach of evaluation instruments and measure learning across formal and informal audiences. It highlights how interactional technology can be readily utilized for future research and outreach in classrooms, nature learning centers, professional training programs, and museums. Overall, the work advances social-psychological understanding of how adults and youth respond to educational programming. It highlights the need to go beyond the cognitive shifts in affecting behavior. Curriculum based on environment might be necessary but is often not sufficient for changing environmental values. Finally, information and knowledge acquired must motivate the teachers' and students' desire and ability to conscientiously act, wherever necessary.

  16. Leadership and the psychosocial work environment in old age care.

    Science.gov (United States)

    Lundgren, Dan; Ernsth-Bravell, Marie; Kåreholt, Ingemar

    2016-03-01

    To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services. Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services. Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed. The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in

  17. 6. national energy symposium. Theme: solar, new and renewable energies: interface with the environment for sustainable socio-economic development in Ghana. Abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    The publication contains abstracts of the 6th National Energy Symposium. The theme of the symposium was, solar, new and renewable energies: interface with the environment for a sustainable socio-economic development in Ghana. The abstracts have been grouped under the following sections: (A) energy and environmental policy issues; (B) application of renewable energy technologies; (C) energy conservation; (D) institutional framework and capacity building and (E) those abstracts that were received late. The sequence of the abstracts does not follow any particular order.

  18. 6. national energy symposium. Theme: solar, new and renewable energies: interface with the environment for sustainable socio-economic development in Ghana. Abstracts

    International Nuclear Information System (INIS)

    1994-01-01

    The publication contains abstracts of the 6th National Energy Symposium. The theme of the symposium was, solar, new and renewable energies: interface with the environment for a sustainable socio-economic development in Ghana. The abstracts have been grouped under the following sections: (A) energy and environmental policy issues; (B) application of renewable energy technologies; (C) energy conservation; (D) institutional framework and capacity building and (E) those abstracts that were received late. The sequence of the abstracts does not follow any particular order

  19. The Methodology for Integral Assessment of the Impact of Renewable Energy on the Environment under Non-Stationary Economy

    Directory of Open Access Journals (Sweden)

    Petrakov Iaroslav V.

    2017-12-01

    Full Text Available The need to reduce anthropogenic load, eliminate threats to environmental safety and provide ecologically oriented development are one of the main global challenges of our time. At the same time, the replacement of traditional energy sources with alternatives ones requires a quantitative assessment of direct and indirect environmental impacts. The article analyzes the dynamics and structure of pollution in Ukraine in terms of its sources and forms as well as their impact on the carbon productivity of the GDP. It is proposed to assess the impact of alternative energy on the environment under non-stationary economy using an integral indicator that takes into account a number of factors, in particular the change in the share of RES in the total primary energy supply, share of renewable energy production, the index of greenhouse gases by the energy sector, change in the quality of atmospheric air in the urban populated area, amount of investment in reducing CO2 emissions, carbon intensity of energy production, share of thermal generation capacity that meets the ecological requirements of the EU.

  20. Analyzing the health care environment: "You can't hit what you can't see".

    Science.gov (United States)

    Ginter, P M; Duncan, W J; Richardson, W D; Swayne, L E

    1991-01-01

    The health care environment of the 1990s promises to be every bit as dynamic and complex as the environment of the 1980s. Health care managers must identify emerging issues and incorporate these issues into the strategic management process. This article discusses a five-step process for analyzing the changing environment facing health care organizations.

  1. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

    Science.gov (United States)

    Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

  2. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

    Science.gov (United States)

    Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

  3. Multiple benefits of alloparental care in a fluctuating environment

    Science.gov (United States)

    2018-01-01

    Although cooperatively breeding vertebrates occur disproportionately in unpredictable environments, the underlying mechanism shaping this biogeographic pattern remains unclear. Cooperative breeding may buffer against harsh conditions (hard life hypothesis), or additionally allow for sustained breeding under benign conditions (temporal variability hypothesis). To distinguish between the hard life and temporal variability hypotheses, we investigated whether the number of alloparents at a nest increased reproductive success or load-lightening in superb starlings (Lamprotornis superbus), and whether these two types of benefits varied in harsh and benign years. We found that mothers experienced both types of benefits consistent with the temporal variability hypothesis, as larger contingents of alloparents increased the number of young fledged while simultaneously allowing mothers to reduce their provisioning rates under both harsh and benign rainfall conditions. By contrast, fathers experienced load-lightening only under benign rainfall conditions, suggesting that cooperative breeding may serve to take advantage of unpredictable benign breeding seasons when they do occur. Cooperative breeding in unpredictable environments may thus promote flexibility in offspring care behaviour, which could mitigate variability in the cost of raising young. Our results highlight the importance of considering how offspring care decisions vary among breeding roles and across fluctuating environmental conditions. PMID:29515910

  4. Multiple benefits of alloparental care in a fluctuating environment.

    Science.gov (United States)

    Guindre-Parker, Sarah; Rubenstein, Dustin R

    2018-02-01

    Although cooperatively breeding vertebrates occur disproportionately in unpredictable environments, the underlying mechanism shaping this biogeographic pattern remains unclear. Cooperative breeding may buffer against harsh conditions (hard life hypothesis), or additionally allow for sustained breeding under benign conditions (temporal variability hypothesis). To distinguish between the hard life and temporal variability hypotheses, we investigated whether the number of alloparents at a nest increased reproductive success or load-lightening in superb starlings ( Lamprotornis superbus ), and whether these two types of benefits varied in harsh and benign years. We found that mothers experienced both types of benefits consistent with the temporal variability hypothesis, as larger contingents of alloparents increased the number of young fledged while simultaneously allowing mothers to reduce their provisioning rates under both harsh and benign rainfall conditions. By contrast, fathers experienced load-lightening only under benign rainfall conditions, suggesting that cooperative breeding may serve to take advantage of unpredictable benign breeding seasons when they do occur. Cooperative breeding in unpredictable environments may thus promote flexibility in offspring care behaviour, which could mitigate variability in the cost of raising young. Our results highlight the importance of considering how offspring care decisions vary among breeding roles and across fluctuating environmental conditions.

  5. Dental Education Required for the Changing Health Care Environment.

    Science.gov (United States)

    Fontana, Margherita; González-Cabezas, Carlos; de Peralta, Tracy; Johnsen, David C

    2017-08-01

    To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  6. The social responsibility commitment to the community and care environment

    Directory of Open Access Journals (Sweden)

    Martha Elena López Regalado

    2015-12-01

    Full Text Available The concept of csr has evolved in recent years, currently the main objective of the Company cannot lie only meet the monetary needs of the shareholders, but to seek the participation of all stakeholders in the company, with the different stakeholders that interact with the environment either customers, suppliers, employees and society at large, impacting the community with socially responsible actions. Because the concept has acquired new shades as social, economic and environmental responsibility among others, being on the great responsibility of the actions of companies to make social or common good acts to achieve their objectives without harming their economies community, the next job is presented focusing especially on two major indicators of social responsibility such as environmental care, and welfare of the community.

  7. Effects of hospital care environment on patient mortality and nurse outcomes.

    Science.gov (United States)

    Aiken, Linda H; Clarke, Sean P; Sloane, Douglas M; Lake, Eileen T; Cheney, Timothy

    2008-05-01

    The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

  8. Association of the Nurse Work Environment, Collective Efficacy, and Missed Care.

    Science.gov (United States)

    Smith, Jessica G; Morin, Karen H; Wallace, Leigh E; Lake, Eileen T

    2018-06-01

    Missed nursing care is a significant threat to quality patient care. Promoting collective efficacy within nurse work environments could decrease missed care. The purpose was to understand how missed care is associated with nurse work environments and collective efficacy of hospital staff nurses. A cross-sectional, convenience sample was obtained through online surveys from registered nurses working at five southwestern U.S. hospitals. Descriptive, correlational, regression, and path analyses were conducted ( N = 233). The percentage of nurses who reported that at least one care activity was missed frequently or always was 94%. Mouth care (36.0% of nurses) and ambulation (35.3%) were missed frequently or always. Nurse work environments and collective efficacy were moderately, positively correlated. Nurse work environments and collective efficacy were associated with less missed care (χ 2 = 10.714, p = .0054). Fostering collective efficacy in the nurse work environment could reduce missed care and improve patient outcomes.

  9. Implementation by Albania of the Acquis Communautaire on Renewable Energy, and Environment with Focus to the Energy Community

    Energy Technology Data Exchange (ETDEWEB)

    Dervishi, Dael

    2010-09-15

    The Energy Community aims at establishing a common regulatory framework for energy markets in contracting parties by extending the acquis communautaire of the European Union to the territories of participating countries. The Albanian Government is drafting the Law on Renewable Energy Sources. The purpose of the law is to promote a greater contribution of renewable sources of energy to the production of electricity in the domestic energy market. In this paper, I describe the policy mechanisms and the market conditions mandated by the EU directive aimed at liberalizing the electric energy market.

  10. Nurse-perceived quality of care in intensive care units and associations with work environment characteristics : a multicentre survey study

    NARCIS (Netherlands)

    Stalpers, Dewi; Van Der Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.

    2017-01-01

    Aims: To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics. Background: Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes

  11. [Elderly human being with ostomy and environments of care: reflection on the perspective of complexity].

    Science.gov (United States)

    Barros, Edaiane Joana Lima; Santos, Silvana Sidney Costa; Lunardi, Valéria Lerch; Lunardi Filho, Wilson Danilo

    2012-01-01

    This is discussion about the relationship between elderly human beings with ostomy and their environments care, under the perspective of Complexity Edgar Morin. An axis holds the reflection: environments of care for elderly humans with ostomy. In this sense, we present three types of environment that surround the context of elderly humans with ostomy: home environment, group environment and hospital environment. This brings, as a social contribution, a new look about resizing caring of elderly humans with ostomy in their environment. It is considered that the environment hosting this human being contains a diversity of feelings, emotions, experiences; it binds multiple meanings, from the Complexity perspective, about the relationship between the environment and the caring process.

  12. Renewable energy resources

    CERN Document Server

    Twidell, John

    2015-01-01

    Renewable Energy Resources is a numerate and quantitative text covering the full range of renewable energy technologies and their implementation worldwide. Energy supplies from renewables (such as from biofuels, solar heat, photovoltaics, wind, hydro, wave, tidal, geothermal, and ocean-thermal) are essential components of every nation's energy strategy, not least because of concerns for the local and global environment, for energy security and for sustainability. Thus in the years between the first and this third edition, most renewable energy technologies have grown from fledgling impact to s

  13. Renewables. The clean advantage

    International Nuclear Information System (INIS)

    Klein, A.

    2006-01-01

    Europe's big utilities are increasingly seeing renewable energy as a viable alternative to conventional forms of power generation which at present have disadvantages in terms of cost and/or environment. Europe's biggest 20 utilities aim to double their renewables capacity in the next five years and nearly 20 billion US dollars have been earmarked for such projects. This report by Emerging Energy Research discusses the likely trends for the next five years. The various sources of renewable energy and how they might be developed are discussed. The companies leading exploitation of renewables and their market share are named

  14. Improving work environments in health care: test of a theoretical framework.

    Science.gov (United States)

    Rathert, Cheryl; Ishqaidef, Ghadir; May, Douglas R

    2009-01-01

    In light of high levels of staff turnover and variability in the quality of health care, much attention is currently being paid to the health care work environment and how it potentially relates to staff, patient, and organizational outcomes. Although some attention has been paid to staffing variables, more attention must be paid to improving the work environment for patient care. The purpose of this study was to empirically explore a theoretical model linking the work environment in the health care setting and how it might relate to work engagement, organizational commitment, and patient safety. This study also explored how the work environment influences staff psychological safety, which has been show to influence several variables important in health care. Clinical care providers at a large metropolitan hospital were surveyed using a mail methodology. The overall response rate was 42%. This study analyzed perceptions of staff who provided direct care to patients. Using structural equation modeling, we found that different dimensions of the work environment were related to different outcome variables. For example, a climate for continuous quality improvement was positively related to organizational commitment and patient safety, and psychological safety partially mediated these relationships. Patient-centered care was positively related to commitment but negatively related to engagement. Health care managers need to examine how organizational policies and practices are translated into the work environment and how these influence practices on the front lines of care. It appears that care provider perceptions of their work environments may be useful to consider for improvement efforts.

  15. Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals.

    Science.gov (United States)

    Fox, Mary T; Sidani, Souraya; Butler, Jeffrey I; Tregunno, Deborah

    2017-06-01

    Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.

  16. International scientists’ priorities for research on pharmaceutical and personal care products in the environment

    Science.gov (United States)

    Pharmaceuticals and personal care products (PPCPs) are widely discharged into the environment via diverse pathways. The effects of PPCPs in the environment have potentially important human and ecosystem health implications, so credible, salient, and legitimate scientific evidence...

  17. Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment.

    Science.gov (United States)

    Fridh, Isabell; Forsberg, Anna; Bergbom, Ingegerd

    2009-10-01

    The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects. Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15]. The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment. This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.

  18. Promoting Students' Problem Solving Skills and Knowledge of STEM Concepts in a Data-Rich Learning Environment: Using Online Data as a Tool for Teaching about Renewable Energy Technologies

    Science.gov (United States)

    Thurmond, Brandi

    2011-01-01

    This study sought to compare a data-rich learning (DRL) environment that utilized online data as a tool for teaching about renewable energy technologies (RET) to a lecture-based learning environment to determine the impact of the learning environment on students' knowledge of Science, Technology, Engineering, and Math (STEM) concepts related…

  19. A GIS-based decision support tool for renewable energy management and planning in semi-arid rural environments of northeast of Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Tiba, C.; Fraidenraich, N.; Barbosa, E.M. de S. [Departamento de Energia Nuclear da Universidade Federal de Pernambuco, Av. Prof. Luiz Freire, 1000 - CDU, CEP 50.740-540, Recife, Pernambuco (Brazil); Candeias, A.L.B. [Departamento de Engenharia Cartografica da Universidade Federal de Pernambuco, Av. Academico Helio Ramos, s/n - CDU, Recife, Pernambuco (Brazil); de Carvalho Neto, P.B.; de Melo Filho, J.B. [Companhia Hidro Eletrica do Sao Francisco -DTG- CHESF, Recife, Pernambuco (Brazil)

    2010-12-15

    This work describes the development of a management and planning system on a GIS (Geographic Information System) platform destined to decision makers that is, administrators, planners or consultants in renewable energies. It was conceived to deal with the management and planning of solar systems, biomass and aeolics in rural regions of Brazil. The prototype of the GIS tool covers an area of 183, 500 km{sup 2} and is made up of three blocks: management of installed renewable systems, inclusion (planning) of new systems and updating of the data banks. The GISA SOL 1.0 (Geographic Information System Applied to Solar Energy) has a total of 80 layers of information that permit the realization of spatial analyses on management and planning of renewable sources of energy at macro-spatial (state) and local (municipality) levels. A description and the methodology used for its development and a description of the functionalities will be made here. The system was developed mainly for PV systems as a support tool for management and planning of the Energy Development Program for States and Municipalities (PRODEEM), a program for inclusion in large scale of solar photovoltaic energy in the rural environment, conducted by the Ministry of Mines and Energy of Brazil. (author)

  20. Essential elements of professional nursing environments in Primary Care and their influence on the quality of care.

    Science.gov (United States)

    Gea-Caballero, Vicente; Castro-Sánchez, Enrique; Júarez-Vela, Raúl; Díaz-Herrera, Miguel Ángel; de Miguel-Montoya, Isabel; Martínez-Riera, José Ramón

    Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  1. Comment: The Economics of Interdependent Renewable and Non-renewable Resources revisited.

    OpenAIRE

    Viktoria Kahui; Claire W. Armstrong

    2009-01-01

    This work expands upon Swallow's theoretical analysis of interactions between renewable and non-renewable resources. In this comment the interaction is such that the renewable resource prefers the non-renewable environment, as opposed to SwallowÕs (op cit) case of the non-renewable environment being essential to the renewable resource. We find that this difference strongly affects the results, and makes the resources change from being complements to being substitutes, i.e. in the essential ca...

  2. The relationship between individualized care and the practice environment: an international study.

    Science.gov (United States)

    Papastavrou, Evridiki; Acaroglu, Rengin; Sendir, Merdiye; Berg, Agneta; Efstathiou, Georgios; Idvall, Ewa; Kalafati, Maria; Katajisto, Jouko; Leino-Kilpi, Helena; Lemonidou, Chryssoula; da Luz, Maria Deolinda Antunes; Suhonen, Riitta

    2015-01-01

    Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. This study had an international, multisite, prospective, cross-sectional, exploratory survey design. The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were

  3. Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

    Science.gov (United States)

    Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

    2004-07-20

    Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

  4. Renewable Energy: Policy Considerations for Deploying Renewables

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    This information paper accompanies the IEA publication Deploying Renewables 2011: Best and Future Policy Practice (IEA, 2011a). It provides more detailed data and analysis on policies for Deploying Renewables, and is intended to complement the main publication. It provides an account of the strategic drivers underpinning renewable energy (RE) technology deployment (energy security, economic development and environment protection) and assesses RE technologies with respect to these drivers, including an estimate of GHG emissions reductions due to RE technologies. The paper also explores the different barriers to deploying renewables at a given stage of market maturity and discusses what tools policy makers can avail of to succeed in removing deployment barriers. An additional topical highlight explores the challenges associated with accelerating the diffusion of RE technologies in developing countries.

  5. Building a sustainable market for renewables

    Energy Technology Data Exchange (ETDEWEB)

    Rader, N.

    1996-12-31

    Opinions regarding marketing approaches for electricity generation from renewable resources are presented in the paper. The Renewables Portfolio Standard of the California Public Utilities Commission is described. This system is based on renewable energy credits. Other marketing approaches, including surcharges, auctioned renewables credit, green pricing, and green marketing are also assessed. It is concluded that the Renewables Portfolio Standard creates a stable economic environment for the renewable energy industries.

  6. Creating and Maintaining a Wellness Environment in Child Care Centers Participating in the Child and Adult Care Food Program

    Science.gov (United States)

    Lofton, Kristi L.; Carr, Deborah H.

    2010-01-01

    Purpose/Objectives: This study identifies issues associated with creating and maintaining a wellness environment in child care centers (CCCs) participating in the Child and Adult Care Food Program (CACFP). Methods: Structured interviews and focus groups were conducted with CCC professionals and state agency personnel to develop a survey to assess…

  7. Critical Care Performance in a Simulated Military Aircraft Cabin Environment

    Science.gov (United States)

    2007-01-01

    ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments, and recovery rooms. This...S89-S99. MacGeorge, J. M., & Nelson, K. M. (2003). The experience of the nurse at triage influences the timing of CPAP intervention. Accid Emerg Nurs

  8. Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study.

    Science.gov (United States)

    Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

    2015-10-01

    To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. Cross-sectional study. National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  9. Renewal processes

    CERN Document Server

    Mitov, Kosto V

    2014-01-01

    This monograph serves as an introductory text to classical renewal theory and some of its applications for graduate students and researchers in mathematics and probability theory. Renewal processes play an important part in modeling many phenomena in insurance, finance, queuing systems, inventory control and other areas. In this book, an overview of univariate renewal theory is given and renewal processes in the non-lattice and lattice case are discussed. A pre-requisite is a basic knowledge of probability theory.

  10. How do health care education and training professionals learn about the environment?

    Science.gov (United States)

    Glazer, H R; Stein, D S; Schafer, D S

    1993-01-01

    Preparing for the health care system of the future includes the ability to abstract information from relevant sectors of the environment. This study looked at the way health care educators scan the environment and the relationship of scanning behavior to management style. Results indicate that education and training professionals focus on the regulatory and customer sectors of the environment more than the technological and sociopolitical sectors.

  11. Urban renewal based wind environment at pedestrian level in high-density and high-rise urban areas in Sai Ying Pun, Hong Kong

    Science.gov (United States)

    Yao, J. W.; Zheng, J. Y.; Zhao, Y.; Shao, Y. H.; Yuan, F.

    2017-11-01

    In high-density and high-rise urban areas, pedestrian level winds contribute to improve comfort, safety and diffusion of heat in urban areas. Outdoor wind study is extremely vital and a prerequisite in high-density cities considering that the immediate pedestrian level wind environment is fundamentally impacted by the presence of a series of high-rise buildings. In this paper, the research site of Sai Ying Pun in Hong Kong will be analysed in terms of geography, climate and urban morphology, while the surrounding natural ventilation has also been simulated by the wind tunnel experiment Computational Fluid Dynamics (CFD). It has found that, the existing problems in this district are the contradiction between planning control and commercial interests, which means some areas around tall buildings are not benefit to the residents because of the unhealthy wind environment. Therefore, some recommendation of urban renewal strategy has been provided.

  12. Renewable energy

    DEFF Research Database (Denmark)

    Olsen, Birgitte Egelund

    2016-01-01

    Renewable energy projects are increasingly confronted by local opposition, which delays and sometimes even prevents their implementation. This reflects the frequent gap between support for the general idea of renewables as a strategy for reducing carbon emissions, and acceptance of renewable energy...

  13. Does job satisfaction mediate the relationship between healthy work environment and care quality?

    Science.gov (United States)

    Bai, Jinbing

    2016-01-01

    A healthy work environment can increase nurse-reported job satisfaction and patient care outcomes. Yet the associations between healthy work environment, nurse job satisfaction and QC have not been comprehensively examined in Chinese ICUs. To investigate the mediating effect of nurse job satisfaction on the relationship between healthy work environment and nurse-reported quality of care (QC) in Chinese intensive care units (ICUs). A total of 706 nurses were recruited from 28 ICUs of 14 tertiary hospitals. The nurses completed self-reported questionnaires to evaluate healthy work environment, job satisfaction and quality of patient care. Mediation analysis was conducted to explore the mediating effect between nurse-reported healthy work environment and QC. Nurse work environment showed positive correlations with nurse-reported QC in the ICUs. Nurse-reported job satisfaction showed full mediating effects between healthy work environment and QC in the medical-surgical ICUs, surgical ICUs and neonatal/paediatric ICUs and indicated a partial mediating effect in the medical ICUs. Significant mediating effects of nurse job satisfaction provide more support for thinking about how to use this mediator to increase nurse and patient care outcomes. Nurse administrators can design interventions to increase nurse work environment and patient care outcomes with this mediating factor addressed. © 2015 British Association of Critical Care Nurses.

  14. Introducing Namaste Care to the hospital environment: a pilot study.

    Science.gov (United States)

    St John, Kimberley; Koffman, Jonathan

    2017-10-01

    The rising prevalence of dementia is impacting on acute hospitals and placing increased expectations on health and social care professionals to improve the support and services they are delivering. It has been recommended that good practice in dementia care relies on adopting a palliative approach to care and meeting people's physical, psychological, social and spiritual needs. Increased dementia training for staff that includes initiatives that promote dignity; enhancing communication skills and recognizing that a person with dementia may be approaching the end of their lives are needed. Our study aim was to explore whether Namaste Care is an acceptable and effective service for people with advanced dementia being cared for on an acute hospital ward. This was an exploratory qualitative interview, pilot study. Individual, semi-structured, face-to-face interviews were conducted with hospital healthcare staff working in an area of the hospital where Namaste Care had been implemented. Data were analysed using the framework approach. Eight interviews were completed with members of the multidisciplinary ward team. Two themes were identified: (I) difficulties establishing relationships with people with dementia in hospital (subthemes: lack of time and resources, lack of confidence leading to fear and anxiety); (II) the benefits of a Namaste Care service in an acute hospital setting (subthemes: a reduction in agitated behavior; connecting and communicating with patients with dementia using the senses; a way of showing people with dementia they are cared for and valued). This small-scale study indicates that Namaste Case has the potential to improve the quality of life of people with advanced dementia being cared for in an acute hospital setting. However, further research is required to explore more specifically its benefits in terms of improved symptom management and wellbeing of people with dementia on acute hospitals wards.

  15. NRC's license renewal regulations

    International Nuclear Information System (INIS)

    Akstulewicz, Francis

    1991-01-01

    In order to provide for the continuity of the current generation of nuclear power plant operating licenses and at the same time ensure the health and safety of the public, and the quality of the environment, the US Nuclear Regulatory Commission (NRC) established a goal of developing and issuing regulations and regulatory guidance for license renewal in the early 1990s. This paper will discuss some of those activities underway to achieve this goal. More specifically, this paper will discuss the Commission's regulatory philosophy for license renewal and the two major license renewal rule makings currently underway. The first is the development of a new Part 54 to address procedural and technical requirements for license renewal; the second is a revision to existing Part 51 to exclude environmental issues and impacts from consideration during the license renewal process. (author)

  16. Medical surgical nurses describe missed nursing care tasks-Evaluating our work environment.

    Science.gov (United States)

    Winsett, Rebecca P; Rottet, Kendra; Schmitt, Abby; Wathen, Ellen; Wilson, Debra

    2016-11-01

    The purpose of the study was to explore the nurse work environment by evaluating the self-report of missed nursing care and the reasons for the missed care. A convenience sample of medical surgical nurses from four hospitals was invited to complete the survey for this descriptive study. The sample included 168 nurses. The MISSCARE survey assessed the frequency and reason of 24 routine nursing care elements. The most frequently reported missed care was ambulation as ordered, medications given within a 30 minute window, and mouth care. Moderate or significant reasons reported for the missed care were: unexpected rise in volume/acuity, heavy admissions/discharges, inadequate assistants, inadequate staff, meds not available when needed, and urgent situations. Identifying missed nursing care and reasons for missed care provides an opportunity for exploring strategies to reduce interruptions, develop unit cohesiveness, improve the nurse work environment, and ultimately leading to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Nursing in family environment: caring for person in mental suffering

    Directory of Open Access Journals (Sweden)

    Lucas Amaral Martins

    2013-01-01

    Full Text Available The study aims to describe the experience of nursing care to person in mental suffering (PMS in the family context. Developed by nursing academic during home attendance, in the 2008.2 semester. The results showed that: is undeniable the family function of the PMS care, becoming the main partner of the heath teams, the care in the perspective of psychosocial rehabilitation influences the attitudes, patterns of response and participation in treatment, resulting in the empowerment of PMS and family. It’s concluded that home attendance contributes to the process of psychosocial rehabilitation of the PMS and assessment of mental health services, subsidizing the formulation of public policies for the sector, especially, in regard to care in perspective of the whole human life.

  18. New 'patent accelerated care environment' aims to facilitate work flow, free up ED for acute care needs.

    Science.gov (United States)

    2012-02-01

    Faced with rising acuity levels and surging demand, Virginia Mason Medical Center modified the Clinical Decision Unit concept used in many EDs, and developed a new Patient Accelerated Care Environment (PACE) to care for observation patients, process patients for discharge, and to prepare patients for admission.The approach is designed to utilize ED beds for initial processing of patients, allowing resuscitative care if needed, and treating and releasing the patients with quick care needs. Using the Virginia Mason Production System, a methodology that is modeled after Toyota production techniques, developers designed an optimal work flow pattern and then built infrastructure to facilitate that process. All patients who present to the ED for care are seen by the ED team through a "team greet" approach. Approximately 35% to 40% of patients who come to the ED for care are transferred to the PACE unit. Patients assigned to the PACE unit typically remain there for 4 to 48 hours, depending on their care needs.

  19. Redesigning nursing work in long-term care environments.

    Science.gov (United States)

    Hall, L M; O'Brien-Pallas, L

    2000-01-01

    The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial.

  20. [Chronic home-care patients and their primary health care environment].

    Science.gov (United States)

    Bilbao Curiel, I; Gastaminza Santacoloma, A M; García García, J A; Quindimil Vázquez, J A; López Rivas, J L; Huidobro Fernández, L

    1994-03-15

    Describing the primary level of attention to chronic home patients (CHP), their quality or life and the one of their home carers. Descriptive transverse study. Teaching Unit of Family of Sestao (Vizcaya) urban environment. 197 CHP patients with subacute, chronic illnesses or in terminal stages or handicapped, that is to say, people who cannot attend the Medical Centre and needing constant home care (longer than 4 weeks) although they do not need to be in hospital at the moment. A questionnaire made up by the researching group. April-June 1992. The clinical histories and home interviews. Mean age (78 +/- 23) years old; 70% were women; average of health problems of patients (4.2 +/- 4); average of drug consumption by patients (3.6 +/- 4); average of one visit to each patient per two months; 75% did not need derivation. The average age of people looking after them was (58 +/- 28) years old and 77.3% of them were women. Their average QL index was (9 +/- 2.4) out of 10, 9.2% had a QL index between 4 and 7 although there was nobody under 3. We have found an old population, mostly women with an average of health problems of (4.24 +/- 4) and who are polymedicated. 9.4 of them are not looked after by anybody. Generally their homes are habitable enough. In 77.3% of the cases the carers are women and 65.6% do not receive any domiciliary help.

  1. Describing Nurse Leaders' and Direct Care Nurses' Perceptions of a Healthy Work Environment in Acute Care Settings, Part 2.

    Science.gov (United States)

    Huddleston, Penny; Gray, Jennifer

    2016-09-01

    The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool was developed as a simple screening tool to assess the characteristics of a healthy work environment (HWE) in critical care environments. The purposes of these 2 qualitative research studies are to explore the nurse leaders' and direct care nurses' perceptions of the meaning of a HWE, to describe the nurse leaders' and direct care nurses' perceptions of a HWE, and to define the characteristics of a HWE in acute care settings. Exploratory descriptive designs using focus groups and guided questions with tape-recorded interviews were used to define the characteristics of an HWE. The 6 original themes from AACN HWE standards and 2 new themes emerged as a result of the nurse leaders and direct care nurses defining the characteristics of a HWE, which included appropriate staffing, authentic leadership, effective decision making, meaningful recognition, skilled communication, true collaboration genuine teamwork, and physical and psychological safety. The qualitative statements from these 2 studies will be used in future studies to describe and develop HWE scales for nurse leaders and direct care nurses and to assess the psychometric properties of these new tools.

  2. Renewable enthusiasm

    International Nuclear Information System (INIS)

    Duffin, Tony

    2000-01-01

    A reduction in energy consumption by the energy intensive sectors will be rewarded by a tax credit. The advantages of renewable sources of energy in terms of reducing emissions of carbon dioxide are extolled. The Government will reward the use of renewables through exemption from the Climate Change Levy. Many major companies are now committed to renewables and Shell predict that 50% of world energy will come from renewables by 2050. World-wide there is now 10,000 MW of installed wind power and the annual rate of growth is more than 20%. Other renewables such as biomass, energy from waste, solar power, hydropower, wind power and tidal power are discussed. The Government would like to see 10% of the UK's electricity coming from renewables by 2010. (UK)

  3. Optimal model of congestion management in deregulated environment of power sector with promotion of renewable energy sources

    International Nuclear Information System (INIS)

    Sood, Yog Raj; Singh, Randhir

    2010-01-01

    In the competitive electricity market it becomes very much important to give special consideration for development of renewable energy sources (RESs) due to environmental and other social problems related with conventional generations. So this paper presents an optimal model of congestion management with special emphasis for promotion of RES in competitive electricity market. This paper presents a generalized optimal model of congestion management for deregulated power sector that dispatches the pool in combination with privately negotiated bilateral and multilateral contracts while maximizing social benefit. This model determines the locational marginal pricing (LMP) based on marginal cost theory. It also determines the size of non-firm transactions as well as pool demand and generations. Both firms as well as non-firm transactions are considered in this model. The proposed model has been applied to IEEE-30 bus test system with addition of some RES for analysis of the proposed model. The RES supplies its power to load either through the firm transaction or through power pool. The power from RES is not subjected to any curtailment in proposed model of congestion management. (author)

  4. Influence of the day care, home and neighbourhood environment on young children's physical activity and health

    DEFF Research Database (Denmark)

    Christian, Hayley; Maitland, Clover; Enkel, Stephanie

    2016-01-01

    to determine outdoor location of physical activity around the home and neighbourhood for a subsample (n=310). The day care environment will be objectively measured using a validated audit tool. Other potential individual, social and physical environmental influences on preschoolers' physical activity...... such as long day care. Research is required to determine how the design of day care outdoor (and indoor) spaces provides opportunities or constraints for physical activity. A significant evidence gap surrounds what objectively measured attributes of the home and neighbourhood environment influence preschoolers......' physical activity. The PLAY Spaces & Environments for Children's Physical Activity (PLAYCE) study will empirically investigate the relative and cumulative influence of the day care, home and neighbourhood environment on preschoolers' physical activity. METHODS AND ANALYSIS: The PLAYCE study is a cross...

  5. The Impact of the Nursing Practice Environment on Missed Nursing Care.

    Science.gov (United States)

    Hessels, Amanda J; Flynn, Linda; Cimiotti, Jeannie P; Cadmus, Edna; Gershon, Robyn R M

    2015-12-01

    Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.

  6. Differences in nursing practice environment among US acute care unit types: a descriptive study.

    Science.gov (United States)

    Choi, JiSun; Boyle, Diane K

    2014-11-01

    The hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients. To examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical-surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment. Cross-sectional study. 5322 nursing units in 519 US acute care hospitals. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test. In general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical-surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse-physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals. Findings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered

  7. US EPA CARE Grants/IGD: PERF_COMMUN_GRANTS_INT_MV

    Data.gov (United States)

    U.S. Environmental Protection Agency — This is a provisional dataset that contains point locations for the subset of Community Action for a Renewed Environment (CARE) grants given out by the US EPA. CARE...

  8. Another link to improving the working environment in acute care hospitals: registered nurses' spirit at work.

    Science.gov (United States)

    Urban, Ann-Marie; Wagner, Joan I

    2013-12-01

    Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.

  9. Posttreatment follow-up of radiation oncology patients in a managed care environment

    International Nuclear Information System (INIS)

    Steinberg, Michael L.; Rose, Christopher M.

    1996-01-01

    Purpose: Health care delivery in the United States is in the midst of a structural revolution called managed care. Demands for cost control within the managed care environment force radiation oncologists to defend the need and obligation to follow their patients. Methods and Materials: We have analyzed this follow-up requirement from six potential justifications: patient care, medical-legal, quality assurance, outcome measurement, cost, and improvement of care. Results: Practical recommendations for discussing the need for follow-up with the medical directors and primary care physicians of managed care entities are given. Follow-up without valid documentation of benefit is hard to justify in this era of managed care. Conclusions: Collaborative follow-up between the referring physician, the treating radiation oncologist, and the other oncologic specialists will allow for outcome measurement and improvement in practice without driving up cost or exposing the patient to undue risk.

  10. Child-care environment and dietary intake of 2- and 3-year-old children

    NARCIS (Netherlands)

    Gubbels, J.S.; Kremers, S.P.J.; Stafleu, A.; Dagnelie, P.C.; Vries, N.K.de; Thijs, C.

    2010-01-01

    Background: Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship

  11. The Context of Child Care for Toddlers: The "Experience Expectable Environment"

    Science.gov (United States)

    La Paro, Karen M.; Gloeckler, Lissy

    2016-01-01

    An experience expectable environment in child care classrooms is one in which teachers consistently provide positive and nurturing interactions within daily routines and activities to enhance children's learning. Growing numbers of children are being enrolled in child care at earlier ages and staying for longer periods of time each day which is…

  12. Nursing Workload and the Changing Health Care Environment: A Review of the Literature

    Science.gov (United States)

    Neill, Denise

    2011-01-01

    Changes in the health care environment have impacted nursing workload, quality of care, and patient safety. Traditional nursing workload measures do not guarantee efficiency, nor do they adequately capture the complexity of nursing workload. Review of the literature indicates nurses perceive the quality of their work has diminished. Research has…

  13. The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

    Science.gov (United States)

    Murman, D L

    2001-01-01

    This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

  14. Proceedings of World Renewable Energy Congress '99

    International Nuclear Information System (INIS)

    Kamaruzzaman Sopian; Mohd Yusof Othman; Baharuddin Yatim

    2000-01-01

    The congress discussed the following subjects, 1. The role of renewable energy in the next millenium; 2. Challenges in the commercialization of renewable energy; 3. The role and agenda for renewable energy towards sustainable development. Topics covered in the technical session were biomass conversion; solar thermal technologies and systems; solar photovoltaic s; renewable energy economics, financing and policy; renewable energy education; climate and the environment; energy and architecture; energy management; wind and hydro technologies and systems; hydrogen and fuel cell

  15. Promoting renewable energy technologies

    International Nuclear Information System (INIS)

    Grenaa Jensen, S.

    2004-06-01

    Technologies using renewable energy sources are receiving increasing interest from both public authorities and power producing companies, mainly because of the environmental advantages they procure in comparison with conventional energy sources. These technologies can be substitution for conventional energy sources and limit damage to the environment. Furthermore, several of the renewable energy technologies satisfy an increasing political goal of self-sufficiency within energy production. The subject of this thesis is promotion of renewable technologies. The primary goal is to increase understanding on how technological development takes place, and establish a theoretical framework that can assist in the construction of policy strategies including instruments for promotion of renewable energy technologies. Technological development is analysed by through quantitative and qualitative methods. (BA)

  16. Patient Data Synchronization Process in a Continuity of Care Environment

    Science.gov (United States)

    Haras, Consuela; Sauquet, Dominique; Ameline, Philippe; Jaulent, Marie-Christine; Degoulet, Patrice

    2005-01-01

    In a distributed patient record environment, we analyze the processes needed to ensure exchange and access to EHR data. We propose an adapted method and the tools for data synchronization. Our study takes into account the issues of user rights management for data access and of decreasing the amount of data exchanged over the network. We describe a XML-based synchronization model that is portable and independent of specific medical data models. The implemented platform consists of several servers, of local network clients, of workstations running user’s interfaces and of data exchange and synchronization tools. PMID:16779049

  17. Renewable energy education in Turkey

    Energy Technology Data Exchange (ETDEWEB)

    Acikgoz, Caglayan [Department of Chemical and Process Engineering, Faculty of Engineering, Bilecik University, P.O.11030, Bilecik (Turkey)

    2011-02-15

    Utilization of renewable energy sources and the application of environmentally sound energy technologies are essential to sustainable development and will help to secure the quality of living and the well-being of the future generations. Turkey presently has considerable renewable energy sources. The most important renewable sources are hydropower, wind, solar, geothermal, and biomass. The use of renewable energy as a topic to study energy and its forms permits a novel way to motivate students, particularly those who energy topics taking conscience with the environment. This paper presents the analysis and classification of renewable energy sources and how to find out their origin and a way to motivate students in energy topics related to renewable sources and also, the development of didactic competencies in special blended learning arrangements for educationalists, trainers and lecturers in adult education in the field of renewable energies in Turkey. (author)

  18. License renewal

    International Nuclear Information System (INIS)

    Newberry, S.

    1993-01-01

    This article gives an overview of the process of license renewal for nuclear power plants. It explains what is meant by license renewal, the significance of license renewal, and goes over key elements involved in the process of license renewal. Those key elements are NRC requirements embodied in 10 CFR Part 54 (Reactor Safety) and 10 CFR Part 51 (Environmental Issues). In addition Industry Reports must be developed and reviewed. License renewal is essentially the process of applying for a 20 year extension to the original 40 year operating license granted for the plant. This is a very long term process, which involves a lot of preparation, and compliance with regulatory rules and guidelines. In general it is a process which is expected to begin when plants reach an operating lifetime of 20 years. It has provisions for allowing the public to become involved in the review process

  19. Renewable Energy

    DEFF Research Database (Denmark)

    Sørensen, Bent Erik

    Bent Sorensen’s Renewable Energy: Physics, Engineering, Environmental Impacts, Economics and Planning, Fifth Edition, continues the tradition by providing a thorough and current overview of the entire renewable energy sphere. Since its first edition, this standard reference source helped put...... renewable energy on the map of scientific agendas. Several renewable energy solutions no longer form just a marginal addition to energy supply, but have become major players, with the promise to become the backbone of an energy system suitable for life in the sustainability lane. This volume is a problem...... structured around three parts in order to assist readers in focusing on the issues that impact them the most for a given project or question. PART I covers the basic scientific principles behind all major renewable energy resources, such as solar, wind, and biomass. PART II provides in-depth information...

  20. Home care nurses' experience of job stress and considerations for the work environment.

    Science.gov (United States)

    Samia, Linda W; Ellenbecker, Carol Hall; Friedman, Donna Haig; Dick, Karen

    2012-01-01

    Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.

  1. Nursing practice environment, quality of care, and morale of hospital nurses in Japan.

    Science.gov (United States)

    Anzai, Eriko; Douglas, Clint; Bonner, Ann

    2014-06-01

    The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. © 2013 Wiley Publishing Asia Pty Ltd.

  2. Marketing and the medical specialist in the managed care environment.

    Science.gov (United States)

    Treister, N W

    1997-01-01

    Marketing means more than just communicating or advertising to potential patients; marketing means identifying your customers and working to meet or exceed their expectations. There are five key areas of a marketing plan: (1) Establish the foundation, beginning with your mission statement; (2) Assess your marketing environment by internal and external research; (3) Target your efforts, looking at image and perception; (4) Develop your particular mix of product, price, place of distribution, and promotion; and (5) implement and evaluate your marketing process. This article discusses the importance of a marketing plan for the medical specialist and highlights the features unique to a practice working in a system of capitated reimbursement. Applying these principles will help to demonstrate added value, protect the fundamental role of the patient-physician relationship, ensure that our efforts are aligned with professional missions and goals, and ultimately increase profitability and professional success.

  3. Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.

    Science.gov (United States)

    Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H

    2011-12-01

    To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.

  4. Comparing the nutrition environment and practices of home- and centre-based child-care facilities.

    Science.gov (United States)

    Martyniuk, Olivia J M; Vanderloo, Leigh M; Irwin, Jennifer D; Burke, Shauna M; Tucker, Patricia

    2016-03-01

    To assess and compare the nutrition environment and practices (as they relate to pre-schoolers) of centre- and home-based child-care facilities. Using a cross-sectional study design, nineteen child-care facilities (ten centre-based, nine home-based) were assessed for one full day using the Environment and Policy Assessment and Observation (EPAO) tool (consisting of a day-long observation/review of the nutrition environment, practices and related documents). Specifically, eight nutrition-related subscales were considered. Child-care facilities in London, Ontario, Canada. Child-care facilities were recruited through directors at centre-based programmes and the providers of home-based programmes. The mean total nutrition environment EPAO scores for centre- and home-based facilities were 12·3 (sd 1·94) and 10·8 (sd 0·78) out of 20 (where a higher score indicates a more supportive environment with regard to nutrition), respectively. The difference between the total nutrition environment EPAO score for centre- and home-based facilities was approaching significance (P=0·055). For both types of facilities, the highest nutrition subscale score (out of 20) was achieved in the staff behaviours domain (centre mean=17·4; home mean=17·0) and the lowest was in the nutrition training and education domain (centre mean=3·6; home mean=2·0). Additional research is needed to confirm these findings. In order to better support child-care staff and enhance the overall nutrition environment in child care, modifications to food practices could be adopted. Specifically, the nutritional quality of foods/beverages provided to pre-schoolers could be improved, nutrition-related training for child-care staff could be provided, and a nutrition curriculum could be created to educate pre-schoolers about healthy food choices.

  5. Organizational ethics in Catholic health care: honoring stewardship and the work environment.

    Science.gov (United States)

    Magill, G

    2001-04-01

    Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.

  6. Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector

    Science.gov (United States)

    Aust, Birgit; Flyvholm, Mari-Ann

    2015-01-01

    Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more “good” work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a “good” work day may be useful for intervention research in other sectors. PMID:26380356

  7. Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector

    Directory of Open Access Journals (Sweden)

    Louise Hardman Smith

    2015-01-01

    Full Text Available Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more “good” work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees’ conceptualization of a “good” work day may be useful for intervention research in other sectors.

  8. Hospital nurses' work environment, quality of care provided and career plans.

    Science.gov (United States)

    Hinno, S; Partanen, P; Vehviläinen-Julkunen, K

    2011-06-01

    In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

  9. Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

    Science.gov (United States)

    Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

    2018-05-01

    Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with

  10. Renewable energy in Europe

    International Nuclear Information System (INIS)

    Deshaies, M.

    2009-01-01

    Europe's increasing demand for energy and its environmental preoccupations are creating a favourable environment for the development of renewable energy sources. This article stated that although many European countries have adopted voluntary policies since the 1990s to increase the use of renewable energy sources, they have not been developed in an equal or consistent manner. A table was included to show the consumption of renewable energies by country; the percentage of renewable energies in 1995 as compared to 2006; and the consumption of primary energy resources. Combined, Germany, Spain and Denmark produce 75 per cent of wind energy in Europe, while 75 per cent of Europe's hydroelectricity is produced in Norway, Sweden, France, Italy, Austria and Switzerland. Germany has also made significant contributions in developing biomass energy. The article emphasized that the development of renewable energy sources is limited by the fact that it cannot keep up with growing energy demands. In addition, renewable energies cannot yet replace all fossil fuel consumption in Europe because of the variation in development from one country to another. 1 ref., 2 tabs., 4 figs.

  11. The newborn intensive care unit environment of care: how we got here, where we're headed, and why.

    Science.gov (United States)

    White, Robert D

    2011-02-01

    The newborn intensive care unit (NICU) is a life-defining place for many infants, families, and caregivers. The place in which such events occur is often remembered for its sights, sounds, and smells, but the physical environment of the NICU is far more than a memory tag; it can directly influence the quality of the experience for all of its inhabitants. A growing body of evidence demonstrates the profound impact of the physical environment on growth and development of the neonatal brain. The value of skin-to-skin care is now established. Psychology, sociology, and occupational health provide additional insight into the effect of the NICU setting on families and caregivers. Together, these lines of evidence point to the need for individualized environments. Single-family rooms are a growing trend in the NICU because they allow for individualized environments. Careful planning can avoid pitfalls and bring benefit to babies, families, and caregivers alike. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Healing environments in cancer treatment and care. Relations of space and practice in hematological cancer treatment.

    Science.gov (United States)

    Høybye, Mette Terp

    2013-02-01

    Given the growing attention to the importance of design in shaping healing hospital environments this study extends the understanding of healing environments, beyond causal links between environmental exposure and health outcome by elucidating how environments and practices interrelate. The study was conducted as an ethnographic fieldwork from March 2011 to September 2011 at the Department of Haematology at Odense University Hospital, Denmark, systematically using participant observation and interviews as research strategies. It included 20 patients, four of who were followed closely over an extended time period. Through thematic analysis five key concepts emerged about the social dynamics of hospital environments: practices of self; creating personal space; social recognition; negotiating space; and ambiguity of space and care. Through these concepts, the study demonstrates how the hospital environment is a flow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients' sense of healing changes with the experience of progression in treatment and the capacity of the hospital space to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Healing environments are complex relations between practices, space and care, where recognition of the individual patient's needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive to the need for flexible spaces in hospitals that recognize the dynamics of healing, by providing individualized care, relating to the particular and changing needs of patients supporting their potential and their challenged condition with the best

  13. Renewable energy.

    Science.gov (United States)

    Destouni, Georgia; Frank, Harry

    2010-01-01

    The Energy Committee of the Royal Swedish Academy of Sciences has in a series of projects gathered information and knowledge on renewable energy from various sources, both within and outside the academic world. In this article, we synthesize and summarize some of the main points on renewable energy from the various Energy Committee projects and the Committee's Energy 2050 symposium, regarding energy from water and wind, bioenergy, and solar energy. We further summarize the Energy Committee's scenario estimates of future renewable energy contributions to the global energy system, and other presentations given at the Energy 2050 symposium. In general, international coordination and investment in energy research and development is crucial to enable future reliance on renewable energy sources with minimal fossil fuel use.

  14. INFLUENCE OF SOCIOECONOMIC AND DEMOGRAPHIC ENVIRONMENT ON PRIVATE HEALTH CARE PROVIDERS

    Directory of Open Access Journals (Sweden)

    Lana Kordić

    2013-02-01

    Full Text Available Health care systems face pressure to increase the quality of health care at the same time with pressure to reduce public spending. The attempt to overcome the gap between needs and opportunities can be resolved through the introduction of public-private partnerships. Goals of this study are to investigate variation of the number, form and efficiency of private providers of general/family medicine services in primary health care and the contribution of socioeconomic and demographic environment on those variations, among counties. Socioeconomic and demographic factors are identified as independent variables that influence the health care need and utilization and consequently the decision of private entities to engage in the provision of health care services. This study extended previous studies because it has introduced socioeconomic and demographic variables. This may shed same new lights on the relationship between private providers of health service and efficiency of providing health service in primary health care.

  15. Quotidian of accompanying family members in an environment of care: the emergence of hospital tribes

    Directory of Open Access Journals (Sweden)

    Silvia da Silva Santos Passos

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE Understand the quotidian relationships of accompanying family members in an environment of care, which are close to the metaphor of a tribe in hospital environment. METHODQualitative study with data gathered from semi-structured interviews and observations with 16 family members accompanying hospitalized individuals with dependence on self-care. Data were submitted to thematic analysis, and analyzed through the metaphor of "tribe" proposed by comprehensive sociology. RESULTS Family members build up social clusters around caring, where we find traits typical of tribes: emotional ambience; solidarity based on links of sympathy and mutual assistance; an affectual nebula in the process of interaction; a logic of fusion in tactile relations; and communion/religiosity in the process of connecting in a collective identity. CONCLUSION In the presence of tragedy, families build social clusters similar to tribes having care as a totem.

  16. Out-of-hospital emergency care providers' work and challenges in a changing care environment.

    Science.gov (United States)

    Mikkola, Riitta; Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

    2018-03-01

    Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training. © 2017 Nordic College of Caring Science.

  17. Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

    Science.gov (United States)

    Carroll, Tracy; Tonges, Mary; Ray, Joel

    2017-11-01

    This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

  18. Improving Quality of the Child Care Environment through a Consultancy Programme for Centre Directors

    Science.gov (United States)

    Helmerhorst, Katrien O. W.; Fukkink, Ruben G.; Riksen-Walraven, J. Marianne A.; Gevers Deynoot-Schaub, Mirjam J. J. M.; Tavecchio, Louis W. C.

    2017-01-01

    This study examined the effects of a newly developed on-site consultancy programme to improve global quality of the child care environment in non-parental child care centres for 0- to 4-year-old children as measured with the ITERS-R/ECERS-R. Using a randomised controlled trial with a pretest, posttest, and follow-up test, we compared 35…

  19. Design of the environment of care for safety of patients and personnel: does form follow function or vice versa in the intensive care unit?

    Science.gov (United States)

    Bartley, Judene; Streifel, Andrew J

    2010-08-01

    We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants.

  20. Healing environments in cancer treatment and care. Relations of space and practice in hematological cancer treatment

    DEFF Research Database (Denmark)

    Høybye, Mette Terp

    2013-01-01

    of the individual patient ’ s needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive...... these concepts, the study demonstrates how the hospital environment is a fl ow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients ’ sense of healing changes with the experience of progression in treatment and the capacity of the hospital space...... to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Discussion. Healing environments are complex relations between practices, space and care, where recognition...

  1. Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

    Science.gov (United States)

    Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

    2017-07-21

    Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and

  2. The Erosion of Rights to Abortion Care in the United States: A Call for a Renewed Anthropological Engagement with the Politics of Abortion.

    Science.gov (United States)

    Andaya, Elise; Mishtal, Joanna

    2017-03-01

    Women's rights to legal abortion in the United States are now facing their greatest social and legislative challenges since its 1973 legalization. Legislation restricting rights and access to abortion care has been passed at state and federal levels at an unprecedented rate. Given the renewed vigor of anti-abortion movements, we call on anthropologists to engage with this shifting landscape of reproductive politics. This article examines recent legislation that has severely limited abortion access and maps possible directions for future anthropological analysis. We argue that anthropology can provide unique contributions to broader abortion research. The study of abortion politics in the United States today is not only a rich opportunity for applied and policy-oriented ethnographic research. It also provides a sharply focused lens onto broader theoretical concerns in anthropology and new social formations across moral, medical, political, and scientific fields in 21st-century America. © 2016 by the American Anthropological Association.

  3. Occupational therapist care in the introduction of Alternative Communication features in hospital environment

    OpenAIRE

    Janaína Santos Nascimento; Juliana Mannini; Miryam Bonadiu Pelosi; Mariana Mapelli de Paiva

    2017-01-01

    Introduction: Alternative and Extended Communication (CAA) is an area of assistive technology, and its introduction in the hospital environment has contributed decisively to the care and integration of patients with speech or writing difficulties. However, in order for the use of CAA resources to be effective in this environment, actions are essential to prevent and control Hospital Infections (HI). Objective: To describe the strategies related to the control of HI, used for the i...

  4. Electric car with solar and wind energy may change the environment and economy: A tool for utilizing the renewable energy resource

    Science.gov (United States)

    Liu, Quanhua

    2014-01-01

    Energy and environmental issues are among the most important problems of public concern. Wind and solar energy may be one of the alternative solutions to overcome energy shortage and to reduce greenhouse gaseous emission. Using electric cars in cities can significantly improve the air quality there. Through our analyses and modeling on the basis of the National Centers for Environment Prediction data we confirm that the amount of usable solar and wind energy far exceeds the world's total energy demand, considering the feasibility of the technology being used. Storing the surplus solar and wind energy and then releasing this surplus on demand is an important approach to maintaining uninterrupted solar- and wind-generated electricity. This approach requires us to be aware of the available solar and wind energy in advance in order to manage their storage. Solar and wind energy depends on weather conditions and we know weather forecasting. This implies that solar and wind energy is predictable. In this article, we demonstrate how solar and wind energy can be forecasted. We provide a web tool that can be used by all to arrive at solar and wind energy amount at any location in the world. The tool is available at http://www.renewableenergyst.org. The website also provides additional information on renewable energy, which is useful to a wide range of audiences, including students, educators, and the general public.

  5. Deliberated opinion of the Environment Authority concerning the renewal of the authorization of exploitation of the ANDRA's underground research laboratory in Bure (Meuse)

    International Nuclear Information System (INIS)

    2010-01-01

    This report presents and discusses the documents provided by ANDRA for a renewal authorization request for a basic nuclear installation (INB), ECRIN, aimed at the confined warehousing of residues produced by uranium conversion (transformation into uranium tetrafluoride before its use and implementation as nuclear fuel). The report presents the location and the concerned activity, the different decantation and evaporation basins of the site, the objectives and characteristics of the COMURHEX II project. It indicates the different administrative procedures related to this project, and comments the projected works. It outlines the main environmental issues. It analyses and discusses the impact study which comes along with the request, and comprises an analysis of the initial condition (climate, flooding risk, wildlife, flora, landscapes, water, present impacts of site exploitation on the environment and health). It discusses the search for alternative solutions and the retained choice, the content of the dismantling plan, the impacts of the project (during construction and operation), the approach to risk management, follow-up measures, and the content of the non-technical abstract

  6. Bullying in Adolescent Residential Care: The Influence of the Physical and Social Residential Care Environment

    Science.gov (United States)

    Sekol, Ivana

    2016-01-01

    Background: To date, no study examined possible contributions of environmental factors to bullying and victimization in adolescent residential care facilities. Objective: By testing one part of the Multifactor Model of Bullying in Secure Setting (MMBSS; Ireland in "Int J Adolesc Med Health" 24(1):63-68, 2012), this research examined the…

  7. Environment project: 50 measures for a development of the high environmental quality renewable energies; Grenelle Environnement: 50 mesures pour un developpement des energies renouvelables a haute qualite environnementale

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-11-15

    This document presents the 50 measures decided by the government to develop the renewable energies in France and reach the 20% of participation to the energy production in 2020. Some measures concern all the renewable energies, they deal with the regulation, the administrative procedures of the building, others are specific to each energy. (A.L.B.)

  8. Conversation analysis as a method for investigating interaction in care home environments.

    Science.gov (United States)

    Chatwin, John

    2014-11-01

    This article gives an outline of how the socio-linguistic approach of conversation analysis can be applied to the analysis of carer-patient interaction in care homes. A single case study from a routine encounter in a residential care home is presented. This is used to show how the conversation analysis method works, the kinds of interactional and communication features it can expose, and what specific contribution this kind of micro-interactional approach may make to improving quality of care in these environments. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. A creative analysis of the role of practice development facilitators in a critical care environment

    Directory of Open Access Journals (Sweden)

    Tanya Heyns

    2017-10-01

    Full Text Available Practice development focuses on methods to address the quality of care and advance healthcare practices. The role of practice development facilitators to address challenges of delivering evidence-based person-centred care in the critical care environment was determined by using a nominal group technique. Eleven participants from public and private healthcare services reached consensus on seven clusters: theory-practice application, facilitation of learning, increasing collaboration, effective communication, facilitation of change, time management and role modelling. The clusters were visually represented as a hot air balloon. Competence as facilitators is of vital importance to ensure knowledge translation with the aim to improve quality.

  10. Patients’ experience of important factors in the healthcare environment in oncology care

    Directory of Open Access Journals (Sweden)

    Helle Wijk

    2013-08-01

    Full Text Available Background and objective. The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design. A qualitative design was adopted using focus group interviews. Setting and participants. The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results. Analysis of the patients’ perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients’ primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions. This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment.

  11. Sex differences in parental care: Gametic investment, sexual selection, and social environment.

    Science.gov (United States)

    Liker, András; Freckleton, Robert P; Remeš, Vladimir; Székely, Tamás

    2015-11-01

    Male and female parents often provide different type and amount of care to their offspring. Three major drivers have been proposed to explain parental sex roles: (1) differential gametic investment by males and females that precipitates into sex difference in care, (2) different intensity of sexual selection acting on males and females, and (3) biased social environment that facilitates the more common sex to provide more care. Here, we provide the most comprehensive assessment of these hypotheses using detailed parental care data from 792 bird species covering 126 families. We found no evidence for the gametic investment hypothesis: neither gamete sizes nor gamete production by males relative to females was related to sex difference in parental care. However, sexual selection correlated with parental sex roles, because the male share in care relative to female decreased with both extra-pair paternity and frequency of male polygamy. Parental sex roles were also related to social environment, because male parental care increased with male-biased adult sex ratios (ASRs). Taken together, our results are consistent with recent theories suggesting that gametic investment is not tied to parental sex roles, and highlight the importance of both sexual selection and ASR in influencing parental sex roles. © 2015 The Author(s). Evolution © 2015 The Society for the Study of Evolution.

  12. The relationship between prenatal care, personal alcohol abuse and alcohol abuse in the home environment

    Science.gov (United States)

    GREKIN, EMILY R.; ONDERSMA, STEVEN J.

    2013-01-01

    Aims Nearly one-fourth of African-American women receive no prenatal care during the first trimester of pregnancy. The aim of the current study is to identify factors that underlie inadequate prenatal care among African-American women. Maternal alcohol abuse has been examined as one risk factor for inadequate prenatal care, but findings have been inconsistent, perhaps because (a) alcohol use during pregnancy is substantially under-reported and (b) studies have not considered the wider social network in which maternal alcohol use takes place. The current study attempts to clarify relationships between personal alcohol use, alcohol use in the home environment, and prenatal care in a sample of post-partum women. Methods Participants were 107 low-income, primarily African-American women. All participants completed a computer-based screening which assessed personal and environmental alcohol use, prenatal care and mental health. Findings Environmental alcohol use was related to delayed prenatal care while personal alcohol use was not. More specifically, after controlling for demographic variables, the presence of more than three person-episodes of binge drinking in a woman’s home environment increased the odds of seriously compromized prenatal care by a factor of seven. Conclusions Findings suggest the need to further assess environmental alcohol use and to examine the reliability of personal alcohol use measures. PMID:24391354

  13. Education of staff--a key factor for a safe environment in day care.

    Science.gov (United States)

    Sellström, E; Bremberg, S

    2000-05-01

    In order to create a safe environment in day-care settings, an understanding of factors within the organization of day care, factors which influence safety, is essential. Day-care directors in 83 daycare centres completed a mail-in survey that contained questions about professional experience, the day-care centre's organization of child safety measures and a battery of questions designed to evaluate the directors' perceptions and beliefs about child safety. The day-care directors also carried out a safety inspection at their centre. The results were analysed using the multivariate logistic regression technique. The existence of a continuing plan for continued staff education in child safety was shown to be the strongest predictor of few safety hazards in day-care centres. The day-care directors' perceptions and beliefs about injury prevention were of less importance. This study indicates that in order to promote safety in day-care settings, an on-going plan for continued staff education in child safety should be a matter of routine. The introduction of such a plan should be the concern of the individual day-care directors, policy-makers and managers at the local and national level, and health professionals working in this field.

  14. Predictors of Saudi nursing students' attitudes towards environment and sustainability in health care.

    Science.gov (United States)

    Cruz, J P; Alshammari, F; Felicilda-Reynaldo, R F D

    2018-02-09

    This study aimed to investigate the predictors of Saudi nursing students' attitudes towards the environment and sustainability in health care. With rising temperature and decreasing annual rainfall, Saudi Arabia is threatened by the harmful effects of climate change on its population. In response to these threats, the Ministry of Health adapted sustainable development and environmental preservation in their National E-Health strategy. To implement these policies successfully, healthcare practitioners should be educated on how climate change could impact human health negatively. A secondary analysis of 280 questionnaires from baccalaureate nursing students of a university in Hail City, Saudi Arabia, was completed. The New Ecological Paradigm (NEP) Scale and Sustainability Attitudes in Nursing Survey 2 (SANS-2) were used to investigate the predictors of student attitudes towards the environment and sustainable development in health care. The NEP score indicated moderate pro-environment attitudes, whereas the SANS-2 mean score showed very positive attitudes towards sustainability in health care. Learning about the environment and related issues in the nursing programme, raising climate change awareness and attending environment-related seminars and training positively influenced the environmental and sustainability attitudes of nursing students. Saudi nursing students moderately manifested pro-environment attitudes but exhibited extremely positive attitudes towards sustainability in health care. The results support the need to strengthen the education of nursing students about environmental and sustainability concepts and the inclusion of these topics in the nursing curricula. The study underscores the critical role of enriching the awareness of nursing students on environmental issues and concerns and sustainability in health care. The findings of this study can support the inclusion of course contents, which deal specifically with environmental health and

  15. People and renewable energy

    International Nuclear Information System (INIS)

    Rosenvald, Avo

    2002-01-01

    The use of renewable energy is tightly connected to solving social problems in Estonia by creating more new jobs. It is essential that Estonia should increase the use of biofuels. One of the biofuels, firewood, has been used already for centuries. For wider use of renewable energy in Estonia, it is not enough to rely only on enterprices. Rather, before any serious progress can take place, the state should create the appropriate legal environment. Due to its many social and environmental aspects, renewable energy is more important to the state than a sole enterprice. Unfortunately, Estonian government has been delaying its duties. Estonia has two resources that should be taken advantage of, fertile spare land and people still used to the country life. The country people would get work by growing different energy crops on the spare land. (author)

  16. Renewables vs fossil fuels

    Energy Technology Data Exchange (ETDEWEB)

    Adams, K. (Energy Research and Development Corporation (Australia))

    1992-01-01

    The paper examines some of the factors which will influence the future mix of energy from fossil fuels and renewable sources in Australia. Aspects covered include: the present energy situation; impact of environmental issues; potential for renewable energy; motivators for change; and research and development. It is concluded that the future for fossil fuels and renewable energy is dependent on a number of complex factors, many of which are currently unknown. The key factor is economic viability and that will be influenced by a range of factors such as policies of the Australian and overseas governments in relation to pollution and environment protection (reflected in the cost of meeting such requirements), exploration and production costs (also influenced by government policies), availability of supply, rate of technological development and the size of export markets. 8 refs., 2 figs., 1 tab.

  17. Renewable energy

    DEFF Research Database (Denmark)

    Olsen, Birgitte Egelund

    2016-01-01

    Renewable energy projects are increasingly confronted by local opposition, which delays and sometimes even prevents their implementation. This reflects the frequent gap between support for the general idea of renewables as a strategy for reducing carbon emissions, and acceptance of renewable energy...... installations in the local landscape. A number of countries have introduced financial incentives to promote community acceptance. The tool box of incentives is still limited but in recent years it has been expanded to address local concerns. Certain general characteristics can be identified, suggesting...... that there are at least three distinct categories of incentives: individual compensation, community benefits and ownership measures. Local opposition must be approached with caution, as financial incentives to promote local acceptance can be seen as buying consent or even ‘bribery’, stirring up further opposition....

  18. Family Child Care Learning Environments: Caregiver Knowledge and Practices Related to Early Literacy and Mathematics

    Science.gov (United States)

    Phillips, Beth M.; Morse, Erika E.

    2011-01-01

    This paper presents findings from a stratified-random survey of family child care providers' backgrounds, caregiving environments, practices, attitudes, and knowledge related to language, literacy, and mathematics development for preschool children. Descriptive results are consistent with prior studies suggesting that home-based providers are…

  19. Nurturing the Aesthetic: Learning to Care for the Environment in a Waldorf School

    Science.gov (United States)

    Grella, Melissa A.

    2015-01-01

    The purpose of the study was to explore the aesthetic foundation of the Waldorf pedagogy in order to understand how art and aesthetic experiences may develop care toward the environment. A form of humanistic education developed by Rudolf Steiner in the early twentieth century, Waldorf education is a learning model envisioned as a framework for…

  20. Quality of Child Care Using the Environment Rating Scales: A Meta-Analysis of International Studies

    Science.gov (United States)

    Vermeer, Harriet J.; van IJzendoorn, Marinus H.; Cárcamo, Rodrigo A.; Harrison, Linda J.

    2016-01-01

    The current study provides a systematic examination of child care quality around the globe, using the Environment Rating Scales (ERS). Additional goals of this study are to examine associations between ERS process quality and structural features (group size, caregiver-child ratio) that underpin quality and between ERS and more proximal aspects of…

  1. Pharmaceuticals and Personal Care Products in the Environment: What are the Big Questions?

    Science.gov (United States)

    Over the past 10-15 years, a significant amount of work has been done by the scientific, regulatory and business communities into effects and risks of pharmaceuticals and personal care products (PPCPs) in the environment. It is now timely to review the current knowledge and to...

  2. Global inequality and care of the environment: a political and ethical ...

    African Journals Online (AJOL)

    The inequality amongst nations of the earth, this paper argues, has enormous implication for environment and its care. While environmental pollution is caused by over-consumption of the earth's resources by the West, in the Derailed Countries or economically-less developed nations of the world, hunger and the search for ...

  3. Subsidies for renewable energy?

    International Nuclear Information System (INIS)

    Skytte, K.; Grenaa Jensen, S.; Morthorst, P.E.; Olsen, O.J.

    2004-01-01

    Ambitious Danish and European energy and environment objectives make a point of using renewable energy sources in the electricity supply. Denmark has been leading country in successful development and commercialization of wind turbines and is as yet one of the leading manufacturers of the world. Danish governments have successfully invested a lot in this development. Other countries have spent more money without achieving a similar success. The questions are why things have gone so well in Denmark and if the Danish success can be repeated for other renewable energy technologies. The starting point of this book is that a political decision on subsidizing the developmental process of a specific technology not in itself guarantees that the technology will turn out reliable and efficient enough to compete successfully in a liberalized electricity market. An understanding of this development is necessary in order to affect a technological development. This book goes through the development of different renewable energy technologies and two theories used for discussing the technological development: experience curves and innovation theory. Based on the discussions and a description of causal relations, an analytical model for different phases of renewable energy technologies' developmental progress and technological life cycle is made. The model is used for evaluating the subsidies for chosen renewable technologies in Denmark. With wind energy as example an analysis of what went well or badly, what might be done and which actions might be efficient is made. (BA)

  4. Implementing AORN recommended practices for a safe environment of care, part II.

    Science.gov (United States)

    Kennedy, Lynne

    2014-09-01

    Construction in and around a working perioperative suite is a challenge beyond merely managing traffic patterns and maintaining the sterile field. The AORN "Recommended practices for a safe environment of care, part II" provides guidance on building design; movement of patients, personnel, supplies, and equipment; environmental controls; safety and security; and control of noise and distractions. Whether the OR suite evolves through construction, reconstruction, or remodeling, a multidisciplinary team of construction experts and health care professionals should create a functional plan and communicate at every stage of the project to maintain a safe environment and achieve a well-designed outcome. Emergency preparedness, a facility-wide security plan, and minimization of noise and distractions in the OR also help enhance the safety of the perioperative environment. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  5. SOCIAL REPRESENTATIONS OF THE CARE OF THE ENVIRONMENT OF THE PRESERVICE

    Directory of Open Access Journals (Sweden)

    Irma Yazmina Araiza-Delgado

    2014-07-01

    Full Text Available Today, one of the major challenges facing society is the care of the environment, and for this reason the thematic becomes important for the education system that aims to educate citizens to be able to engage harmoniously into the environment where they are embedded. Therefore, this is research´s aims to understand the social representations of the school student teachers Normal Ricardo Flores Magon regarding the care of the environment, starting from the course Environmental Education for Sustainability and was conducted from a qualitative perspective, to gather information were used the survey and the portfolio of the students as instruments. The results were: the persistence of an anthropocentric paradigm therefore is responsibility to the teacher’s trainers of educators to change this view where prevails a critical and self-centered approach.

  6. Perceptions of Field Instructors: What Skills are Critically Important inManaged Care and Privatized Environments?

    Directory of Open Access Journals (Sweden)

    Michael N. Kane

    2000-12-01

    Full Text Available There is an increasing demand for social work practitioners to work in managed care and privatized environments. In an attempt to build social work curriculum and identify important competencies needed in contemporary service environments, researchers investigated South Florida field instructors’ (N=79 perceptions of necessary knowledge and skill to work in environments affected by privatization and managed care. This study’s findings indicate that field instructors (98% identified documentation as the most critically important skill for any social work position. Additionally, respondents identified intervention evaluation (95%, time focused and needs-based assessments strategies (94%, and evaluation of progress through outcome measures (94% as other critically important skills for current and future practitioners.

  7. A review of chronic pain impact on patients, their social environment and the health care system.

    Science.gov (United States)

    Dueñas, María; Ojeda, Begoña; Salazar, Alejandro; Mico, Juan Antonio; Failde, Inmaculada

    2016-01-01

    Chronic pain (CP) seriously affects the patient's daily activities and quality of life, but few studies on CP have considered its effects on the patient's social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient's daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient's life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

  8. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment.

    Science.gov (United States)

    Ohtake, Patricia J; Lazarus, Marcilene; Schillo, Rebecca; Rosen, Michael

    2013-02-01

    Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. A one-group, pretest-posttest, quasi-experimental design was used. Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Students' confidence in their technical, behavioral, and cognitive skill performance increased from "somewhat confident" to "confident" following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations of the study were the small sample from one university and a control group was not included. Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high

  9. Renewable energy and our environment

    International Nuclear Information System (INIS)

    Suter, P.; Kesselring, P.

    1993-01-01

    The weak points of environmental balance sheets are indicated: lack of transparency, too narrow system limits, neglect of important pollutants, outdated state of the art, unsuitable energy mix and incorrect weighting of pollutants. tabs., 4 refs

  10. Integrated care reform in urban China: a qualitative study on design, supporting environment and implementation.

    Science.gov (United States)

    Qian, Yi; Hou, Zhiyuan; Wang, Wei; Zhang, Donglan; Yan, Fei

    2017-10-25

    Initiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China. Up to date no research has analyzed in-depth the experiences of these initiatives based on perspectives from various stakeholders. This study analyzed the integrated care pilot in Hangzhou City by investigating stakeholders' perspectives on its design features and supporting environment, their acceptability of this pilot, and further identifying the enabling and constraining factors that may influence the implementation of the integrated care reform. The qualitative study was carried out based on in-depth interviews and focus group discussions with 50 key informants who were involved in the policy-making process and implementation. Relevant policy documents were also collected for analysis. The pilot in Hangzhou was established as a CHC-led delivery system based on cooperation agreement between CHCs and hospitals to deliver primary and specialty care together for patients with chronic diseases. An innovative learning-from-practice mentorship system between specialists and general practitioners was also introduced to solve the poor capacity of general practitioners. The design of the pilot, its governance and organizational structure and human resources were enabling factors, which facilitated the integrated care reform. However, the main constraining factors were a lack of an integrated payment mechanism from health insurance and a lack of tailored information system to ensure its sustainability. The integrated care pilot in Hangzhou enabled CHCs to play as gate-keeper and care coordinator for the full continuum of services across the health care providers. The government put integrated care a priority, and constructed an efficient design, governance and organizational structure to enable its implementation. Health insurance should play a proactive role, and

  11. Online social network use by health care providers in a high traffic patient care environment.

    Science.gov (United States)

    Black, Erik; Light, Jennifer; Paradise Black, Nicole; Thompson, Lindsay

    2013-05-17

    The majority of workers, regardless of age or occupational status, report engaging in personal Internet use in the workplace. There is little understanding of the impact that personal Internet use may have on patient care in acute clinical settings. The objective of this study was to investigate the volume of one form of personal Internet use-online social networking (Facebook)-generated by workstations in the emergency department (ED) in contrast to measures of clinical volume and severity. The research team analyzed anonymous network utilization records for 68 workstations located in the emergency medicine department within one academic medical center for 15 consecutive days (12/29/2009 to 1/12/2010). This data was compared to ED work index (EDWIN) data derived by the hospital information systems. Health care workers spent an accumulated 4349 minutes (72.5 hours) browsing Facebook, staff cumulatively visited Facebook 9369 times and spent, on average, 12.0 minutes per hour browsing Facebook. There was a statistically significant difference in the time spent on Facebook according to time of day (19.8 minutes per hour versus 4.3 minutes per hour, P<.001). There was a significant, positive correlation between EDWIN scores and time spent on Facebook (r=.266, P<.001). Facebook use constituted a substantive percentage of staff time during the 15-day observation period. Facebook use increased with increased patient volume and severity within the ED.

  12. Renewable Energy

    NARCIS (Netherlands)

    Turkenburg, W.C.; Arent, D.; Bertani, R.; Faaij, A.P.C.; Hand, M.; Krewitt, W.; Larson, E.D.; Lund, J.; Mehos, M.; Merrigan, T.; Mitchell, C.; Moreira, J.R.; Sinke, W.C.; Sonntag-O'Brien, V.; Thresher, B.; Sark, W.G.J.H.M. van; Usher, E.

    2012-01-01

    This chapter presents an in-depth examination of major renewable energy technologies, including their installed capacity and energy supply in 2009 , the current state of market and technology development, their economic and financial feasibility in 2009 and in the near future, as well as major

  13. Strategic alliance: adapting to the business environment in long-term care.

    Science.gov (United States)

    Mara, Cynthia Massie; Ziegenfuss, James T

    2002-01-01

    This article is addressed to long-term-care administrators and planners as well as purchasers of long-term care. Believing the current and future business environment will force continued adaptation in long-term-care organizations, the authors utilize nine categories to map pressures for change: cultural, technological, educational, political, legal, natural resource, demographic, sociologic, and economic. Long-term-care organizations, especially those that are not-for-profit, are becoming members of alliances as one way of addressing these pressures. This article describes and presents a case example of a composite alliance to demonstrate the advantages of membership in a strategic alliance. We also present examples of ways in which alliance members use strategic partnerships to improve their ability to manage these forces.

  14. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model.

    Science.gov (United States)

    Dubowitz, Howard; Feigelman, Susan; Lane, Wendy; Kim, Jeongeun

    2009-03-01

    Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment

  15. Point-of-Care Ultrasound for Pulmonary Concerns in Remote Spaceflight Triage Environments.

    Science.gov (United States)

    Johansen, Benjamin D; Blue, Rebecca S; Castleberry, Tarah L; Antonsen, Erik L; Vanderploeg, James M

    2018-02-01

    With the development of the commercial space industry, growing numbers of spaceflight participants will engage in activities with a risk for pulmonary injuries, including pneumothorax, ebullism, and decompression sickness, as well as other concomitant trauma. Medical triage capabilities for mishaps involving pulmonary conditions have not been systematically reviewed. Recent studies have advocated the use of point-of-care ultrasound to screen for lung injury or illness. The operational utility of portable ultrasound systems in disaster relief and other austere settings may be relevant to commercial spaceflight. A systematic review of published literature was conducted concerning the use of point-of-care pulmonary ultrasound techniques in austere environments, including suggested examination protocols for triage and diagnosis. Recent studies support the utility of pulmonary ultrasound examinations when performed by skilled operators, and comparability of the results to computed tomography and chest radiography for certain conditions, with important implications for trauma management in austere environments. Pulmonary injury and illness are among the potential health risks facing spaceflight participants. Implementation of point-of-care ultrasound protocols could aid in the rapid diagnosis, triage, and treatment of such conditions. Though operator-dependent, ultrasound, with proper training, experience, and equipment, could be a valuable tool in the hands of a first responder supporting remote spaceflight operations.Johansen BD, Blue RS, Castleberry TL, Antonsen EL, Vanderploeg JM. Point-of-care ultrasound for pulmonary concerns in remote spaceflight triage environments. Aerosp Med Hum Perform. 2018; 89(2):122-129.

  16. Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

    Science.gov (United States)

    Sciurba, Frank C; Criner, Gerard J; Strange, Charlie; Shah, Pallav L; Michaud, Gaetane; Connolly, Timothy A; Deslée, Gaëtan; Tillis, William P; Delage, Antoine; Marquette, Charles-Hugo; Krishna, Ganesh; Kalhan, Ravi; Ferguson, J Scott; Jantz, Michael; Maldonado, Fabien; McKenna, Robert; Majid, Adnan; Rai, Navdeep; Gay, Steven; Dransfield, Mark T; Angel, Luis; Maxfield, Roger; Herth, Felix J F; Wahidi, Momen M; Mehta, Atul; Slebos, Dirk-Jan

    Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation. To determine the effectiveness and safety of endobronchial coil treatment. Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015. Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung. The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications. Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in

  17. Transcultural comparison of hospital and hospice as caring environments for dying patients.

    Science.gov (United States)

    Gates, M F

    1991-01-01

    Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served.

  18. [Psychosocial stress environment and health workers in public health: Differences between primary and hospital care].

    Science.gov (United States)

    García-Rodríguez, Antonio; Gutiérrez-Bedmar, Mario; Bellón-Saameño, Juan Ángel; Muñoz-Bravo, Carlos; Fernández-Crehuet Navajas, Joaquín

    2015-01-01

    To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. Cross-sectional study with stratified random sampling. Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  19. Renewable energy technology acceptance in Peninsular Malaysia

    International Nuclear Information System (INIS)

    Kardooni, Roozbeh; Yusoff, Sumiani Binti; Kari, Fatimah Binti

    2016-01-01

    Despite various policies, renewable energy resources have not been developed in Malaysia. This study investigates the factors that influence renewable energy technology acceptance in Peninsular Malaysia and attempts to show the impact of cost and knowledge on the perceived ease of use and perceived usefulness of renewable energy technology. The results show that cost of renewable energy has an indirect effect on attitudes towards using renewable energy through the associated impact on the perceived ease of use and perceived usefulness. The results also indicate that public knowledge in Peninsular Malaysia does not affect perceived ease of use, although the positive impact of knowledge on perceived usefulness is supported. Furthermore, our results show that the current business environment in Peninsular Malaysia does not support the adoption of renewable energy technology, and thus, renewable energy technology is not commercially viable in Peninsular Malaysia. Additionally, the population of Peninsular Malaysia associates the use of renewable energy with a high level of effort and therefore has a negative attitude towards the use of renewable energy technology. There is, therefore, a definite need to pay more attention to the role of public perception and awareness in the successes and failures of renewable energy policy. - Highlights: • Public acceptance is an essential element in the diffusion of renewable energy. • Perceived ease of use and perceived usefulness affect intention to use renewables. • It is important to reduce the cost of renewable energy, particularly for end users. • Renewable energy policies should address issues of public perception and awareness.

  20. Pharmaceuticals and personal care products (PPCPs in the freshwater aquatic environment

    Directory of Open Access Journals (Sweden)

    Anekwe Jennifer Ebele

    2017-03-01

    Full Text Available Pharmaceuticals and personal care products (PPCPs are a unique group of emerging environmental contaminants, due to their inherent ability to induce physiological effects in human at low doses. An increasing number of studies has confirmed the presence of various PPCPs in different environmental compartments, which raises concerns about the potential adverse effects to humans and wildlife. Therefore, this article reviews the current state-of-knowledge on PPCPs in the freshwater aquatic environment. The environmental risk posed by these contaminants is evaluated in light of the persistence, bioaccumulation and toxicity criteria. Available literature on the sources, transport and degradation of PPCPs in the aquatic environment are evaluated, followed by a comprehensive review of the reported concentrations of different PPCP groups in the freshwater aquatic environment (water, sediment and biota of the five continents. Finally, future perspectives for research on PPCPs in the freshwater aquatic environment are discussed in light of the identified research gaps in current knowledge.

  1. What Is the Role of Ethics Consultation in the Moral Habitability of Health Care Environments?

    Science.gov (United States)

    Austin, Wendy

    2017-06-01

    Ethics consultation has traditionally focused on the provision of expert guidance to health care professionals when challenging quandaries arise in clinical cases. Its role, however, is expanding as demands on health care organizations are negatively impacting their moral habitability. A sign of this impact can be seen in the moral distress experienced by staff and administrators, such that some leave their positions and their organizations. Ethics consultation, more broadly conceived, can be a major asset in ensuring that ethical practice is meaningfully supported, that moral distress is mitigated, and that the organizational environment is morally habitable. © 2017 American Medical Association. All Rights Reserved.

  2. Restorative green outdoor environments at acute care hospitals - case studies in Denmark

    DEFF Research Database (Denmark)

    Abdul Shukor, Shureen Faris Binti

    The PhD thesis is based on research which was conducted between 2009 and 2012. It deals with green outdoor environments (GOEs) at acute care hospitals in the capital region of Denmark. The aim of this PhD study is to gain deeper knowledge about the design and use of GOEs which supports mental...... the buildings. The majority of users are satisfied with the existing GOEs and the results gained from the PRS indicate that they regard the GOEs as having potential for mental restoration. The important contributions of this PhD study are that it highlights the importance of having GOE at acute care hospitals...

  3. Structural characteristics of hospitals and nurse-reported care quality, work environment, burnout and leaving intentions.

    Science.gov (United States)

    Lindqvist, Rikard; Smeds Alenius, Lisa; Griffiths, Peter; Runesdotter, Sara; Tishelman, Carol

    2015-03-01

    To investigate whether hospital characteristics not readily susceptible to change (i.e. hospital size, university status, and geographic location) are associated with specific self-reported nurse outcomes. Research often focuses on factors within hospitals (e.g. work environment), which are susceptible to change, rather than on structural factors in their own right. However, numerous assumptions exist about the role of structural factors that may lead to a sense of pessimism and undermine efforts at constructive change. Data was derived from survey questions on assessments of work environment and satisfaction, intention to leave, quality of care and burnout (measured by the Maslach Burnout Inventory), from a population-based sample of 11 000 registered nurses in Sweden. Mixed model regressions were used for analysis. Registered nurses in small hospitals were slightly more likely to rank their working environment and quality of nursing care better than others. For example 23% of staff in small hospitals were very satisfied with the work environment compared with 20% in medium-sized hospitals and 21% in large hospitals. Registered nurses in urban areas, who intended to leave their job, were more likely to seek work in another hospital (38% vs. 32%). While some structural factors were related to nurse-reported outcomes in this large sample, the associations were small or of questionable importance. The influence of structural factors such as hospital size on nurse-reported outcomes is small and unlikely to negate efforts to improve work environment. © 2013 John Wiley & Sons Ltd.

  4. Parents' Perceived Satisfaction of Care, Communication and Environment of the Pediatric Intensive Care Units at a Tertiary Children's Hospital.

    Science.gov (United States)

    Abuqamar, Maram; Arabiat, Diana H; Holmes, Sandra

    2016-01-01

    This study aims to identify parental perceptions on pediatric intensive care-related satisfaction within three domains: environment, child's care provided and communication. In addition, it aims to identify whether parent's socio-demographics and child's clinical variables predict parents' perceived satisfaction. In this study, a total of 123 parents whose child received care in the PICU of a tertiary children's hospital in Amman completed the Arabic version of the parents satisfaction survey (PSS). A cross-sectional, descriptive-correlational design was used to collect data. All data were collected between June and October of 2013. Central tendency measures and percentages of replies for each domain revealed that at least 7 items were rated poorly satisfied. More than half of the parents were not satisfied with the noise level of the PICU, the time nurses spent at the child's bedside, as well as the way the healthcare team prepare them for the child's admission. Almost 90% of the parents believed that the nurses ignored their child's needs by not listening to parents and by responding slowly to child's needs. Stepwise regression analysis showed that that the number of hospital admissions, health insurance and the severity of illness was the main predictor of parents' satisfaction. In conclusion, the availability of health care professionals, the support and the information they share with the child's parents are all significant to parent's satisfaction and hence to better quality of care. Targeting the domains of low satisfaction reported by the parents could increase parent's satisfaction and achieve quality improvement required for this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Evaluation and comparison of health care Work Environment Scale in military settings.

    Science.gov (United States)

    Maloney, J P; Anderson, F D; Gladd, D L; Brown, D L; Hardy, M A

    1996-05-01

    The purpose of this study was to describe health care providers' perceptions of their work environment at a large U.S. Army medical center, and to compare the findings to other military medical centers. The sample (N = 112) consisted of the professional nursing staff working on the nine inpatient units. The Work Environmental Scale (WES) was used to measure perceptions of the workplace relative to gender, position (head nurses, staff nurses, and agency nurses), specialty nursing (intensive care unit [ICU] versus non-ICU), education (MSN, BSN, and ADN), and patterns of differences between the WES subscales of four military medical centers. Results of the study indicate that there were no significant gender differences. Head nurses, non-ICU nurses, and MSN nurses perceived their environment more positively. There were significant differences in the WES subscales between the military hospitals. Implications for nursing using the WES were recommended.

  6. U.S. academic medical centers under the managed health care environment.

    Science.gov (United States)

    Guo, K

    1999-06-01

    This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U.S. health care system through their missions of conducting cutting-edge biomedical research, pursuing clinical and technological innovations, providing state-of-the-art medical care and producing highly qualified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical science. To survive the threats of managed care in the health care environment, academic medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 108 CEOs in all the academic medical centers in the U.S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

  7. Influence of work environment on the quality of benefits provided by primary health care nurses

    Directory of Open Access Journals (Sweden)

    Katarzyna Tomaszewska

    2017-08-01

    Full Text Available The work of a nurse plays a significant role in the treatment, rehabilitation and promotion of patient health. It is particularly important in the patient's home environment. The variety of benefits provided requires specific skills, abilities as well as the need for constant updating of knowledge. What is more, an environmental nurse working alone in the patient's home for his or her patients is often an authority. The quality of nursing is considered from the very beginning of its professional development. It is one of the elements of health care but no less important than others. It refers to the direct relationship between the patient and the nurse. It is dependent on many factors, primarily from the working environment. Purpose of research The aim of the study was to find nurses' opinions about the impact of the working environment on the quality of services provided within the primary care Material and methods For the purposes of this paper, a questionnaire consisting of 20 questions was used. The study was conducted among 128 family nurses of the Podkarpackie Voivodeship from January to April 2017. All persons were informed about the purpose of the study. They were voluntary and anonymous. For the purpose of this paper, hypotheses were used for questions on nominal scales: V Kramer (2x3, 4x5, etc., Phi (2x2. Tb - Kendall or Tc tests were used for the order scales. Statistical analysis was performed using the SPSS program and all compounds were statistically significant when p <0.05. Results and conclusions: 128 nurses participated in the study. The average age of the respondents was nearly 41 years +/- 9 years. 15.6% of the respondents provided individual nursing care, 21.1% as part of a group nursing practice, and 30.5% were employed in non-public health care facilities. The remaining 25.8% in public outpatient clinics of primary care. The results of the research indicate significant variation in the working conditions of nurses in the

  8. Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings.

    Science.gov (United States)

    Anskär, Eva; Lindberg, Malou; Falk, Magnus; Andersson, Agneta

    2018-03-07

    Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of

  9. Patient-centred improvements in health-care built environments: perspectives and design indicators.

    Science.gov (United States)

    Douglas, Calbert H; Douglas, Mary R

    2005-09-01

    To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs. Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients. The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires. The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space

  10. Interface design for health care environments: the role of cognitive science.

    OpenAIRE

    Patel, V. L.; Kushniruk, A. W.

    1998-01-01

    An important challenge in the development of computer-based health care environments is the design of effective user interfaces. In this paper we consider a number of aspects of interface design related to the study of human-computer interaction from a cognitive perspective. It is argued that user interfaces must be designed with consideration of the information requirements, cognitive capabilities and limitations of the end users. Greater concern for fundamental research in design of user in...

  11. Campus Retrofitting (CARE) Methodology: A Way to Co-Create Future Learning Environments

    DEFF Research Database (Denmark)

    Nenonen, Suvi; Eriksson, Robert; Niemi, Olli

    2016-01-01

    (CARE)- methodology for user-centric and co- creative campus retrofitting processes. The campus development research in Nordic countries and co-creation in retrofitting processes are discussed. The campus retrofitting cases in different countries are described by emphasising especially the methods...... of resources in form of both teachers and university facilities is challenged by development of integration of learning, teaching and the spaces where it takes place. The challenges are shared among users and owners of campus, where retrofitting is needed too. This paper aims to describe Campus Retrofitting...... they used. Based on the analysis of the methods the framework for Campus retrofitting (CARE) - methodology is presented and discussed. CARE-methodology is a tool to capture new logic to learning environment design. It has three key activities: co-creating, co-financing and co-evaluating. The integrated...

  12. How Nurse Work Environments Relate to the Presence of Parents in Neonatal Intensive Care.

    Science.gov (United States)

    Hallowell, Sunny G; Rogowski, Jeannette A; Lake, Eileen T

    2017-09-25

    Parental presence in the neonatal intensive care unit (NICU) is essential for families to participate in infant care and prepare them to transition from hospital to home. Nurses are the principal caregivers in the NICU. The nurse work environment may influence whether parents spend time with their hospitalized infants. To examine the relationship between the NICU work environment and parental presence in the NICU using a national data set. We conducted a cross-sectional, observational study of a national sample of 104 NICUs, where 6060 nurses reported on 15,233 infants cared for. Secondary analysis was used to examine associations between the Practice Environment Scale of the Nursing Work Index (PES-NWI) (subscale items and with a composite measure) and the proportion of parents who were present during the nurses' shift. Parents of 60% (SD = 9.7%) of infants were present during the nurses' shift. The PES-NWI composite score and 2 domains-Nurse Participation in Hospital Affairs and Manager Leadership and Support-were significant predictors of parental presence. A 1 SD higher score in the composite or either subscale was associated with 2.5% more parents being present. Parental presence in the NICU is significantly associated with better nurse work environments. NICU practices may be enhanced through enhanced leadership and professional opportunities for nurse managers and staff. Future work may benefit from qualitative work with parents to illuminate their experiences with nursing leaders and nurse-led interventions in the NICU and design and testing of interventions to improve the NICU work environment.

  13. The Multisensory Environment (MSE) in Dementia Care: Examining Its Role and Quality From a User Perspective.

    Science.gov (United States)

    Collier, Lesley; Jakob, Anke

    2017-10-01

    Multisensory environments (MSEs) for people with dementia have been available over 20 years but are used in an ad hoc manner using an eclectic range of equipment. Care homes have endeavored to utilize this approach but have struggled to find a design and approach that works for this setting. Study aims were to appraise the evolving concept of MSEs from a user perspective, to study the aesthetic and functional qualities, to identify barriers to staff engagement with a sensory environment approach, and to identify design criteria to improve the potential of MSE for people with dementia. Data were collected from 16 care homes with experience of MSE using ethnographic methods, incorporating semi-structured interviews, and observations of MSE design. Analysis was undertaken using descriptive statistics and thematic analysis. Observations revealed equipment that predominantly stimulated vision and touch. Thematic analysis of the semi-structured interviews revealed six themes: not knowing what to do in the room, good for people in the later stages of the disease, reduces anxiety, it's a good activity, design and setting up of the space, and including relatives and care staff. Few MSEs in care homes are designed to meet needs of people with dementia, and staff receive little training in how to facilitate sessions. As such, MSEs are often underused despite perceived benefits. Results of this study have been used to identify the design principles that have been reviewed by relevant stakeholders.

  14. Job satisfaction, work environment and successful ageing: Determinants of delaying retirement among acute care nurses.

    Science.gov (United States)

    Wargo-Sugleris, Michele; Robbins, Wendie; Lane, Christianne Joy; Phillips, Linda R

    2018-04-01

    To determine the relationships between job satisfaction, work environment and successful ageing and how these factors relate to Registered Nurses' intent to retire. Although little studied, retention of older nurses by delaying early retirement, before age 65, is an important topic for research. Qualitative and quantitative studies have indicated that job satisfaction work environment and successful ageing are key motivators in acute care Registered Nurses retention and/or delaying retirement. This study was designed to provide information to administrators and policy makers about retaining older, experienced RNs longer and more productively. This was a correlational, descriptive, cross-sectional study. An online survey of acute care Registered Nurses (N = 2,789) aged 40 years or older working in Florida was conducted from September - October 2013. Participants completed items related to job satisfaction, work environment, successful ageing and individual characteristics. Hypotheses derived from the modified Ellenbecker's Job Retention Model were tested using regression analysis. Job satisfaction scores were high. Highest satisfaction was with scheduling issues and co-workers; lowest with advancement opportunities. Successful ageing scores were also high with 81% reporting excellent or good health. Work environment explained 55% of the variance in job satisfaction. Years to retirement were significantly associated with successful ageing (p income (p job satisfaction and delay of retirement in older nurses and further studies in these areas are warranted to expand on this knowledge. © 2017 John Wiley & Sons Ltd.

  15. Pharmaceuticals and personal care products in the aquatic environment as a new issue of environmental health

    Directory of Open Access Journals (Sweden)

    Aneta Koszowska

    2015-03-01

    Full Text Available Pharmaceuticals and Personal Care Products PPCPs are different chemical substances biologically active. They are part of drugs, supplements and cosmetics. An increasing interest in the field of PPCPs is observed recently. High sensitivity analysis methods allowed to detect PPCPs in natural environment in the world . Because of their complex chemical structure these compounds are not completely removed and discharged into the sewage for treatment and as such unchanged or intermediate metabolites may cause pollution of surface and deep water. It is estimated that they may accumulate in living organisms. PPCPs problem becomes a serious challenge for many scientific disciplines. The aim of the study is to present the problem of the occurrence of PPCPs in water environment as a new environmental health hazard. This study presents selected groups of PPCPs as the examples of research in the field of PPCPS and their presence in the environment. Moreover new prospects of removing these substances from water are shown.

  16. The influence of social environment on the smoking status of women employed in health care facilities

    Directory of Open Access Journals (Sweden)

    Dragana Nikšić

    2013-04-01

    Full Text Available Introduction: Bosnia and Herzegovina has a high prevalence of smoking among women, especially among health care professionals. The goal of this study is to investigate the influence of the social environment of women employed in health institutions in relation to the cigarettes smoking habits.Methods: The study included 477 women employed in hospitals, outpatient and public health institutions in Sarajevo Canton Bosnia and Herzegovina. We used a modifi ed questionnaire assessing smoking habits of medical staff in European hospitalsResults: The results showed that 50% of women are smokers, with the highest incidence among nurses (58.1% and administrative staff (55.6%. The social environment is characterized by a high incidence of colleagues (60.1% and friends who are smokers (54.0% at the workplace and in the family (pConclusion: Workplace and social environment support smoking as an acceptable cultural habit and is contributing to increasing rates of smoking among women.

  17. Strategic planning and radiology practice management in the new health care environment.

    Science.gov (United States)

    Sharpe, Richard E; Mehta, Tejas S; Eisenberg, Ronald L; Kruskal, Jonathan B

    2015-01-01

    Current comprehensive health care reform in the United States demands that policy makers, insurers, providers, and patients work in reshaping the health care system to deliver care that is both more affordable and of higher quality. A tectonic shift is under way that runs contrary to the traditional goal of radiology groups to perform and interpret large numbers of imaging examinations. In fact, radiology service requisitions now must be evaluated for their appropriateness, possibly resulting in a reduction in the number of imaging studies performed. To be successful, radiology groups will have to restructure their business practices and strategies to align with the emerging health care paradigm. This article outlines a four-stage strategic framework that has aided corporations in achieving their goals and that can be readily adapted and applied by radiologists. The four stages are (a) definition and articulation of a purpose, (b) clear definition of strategic goals, (c) prioritization of specific strategic enablers, and (d) implementation of processes for tracking progress and enabling continuous adaptation. The authors provide practical guidance for applying specific tools such as analyses of strengths, weaknesses, opportunities, and threats (so-called SWOT analyses), prioritization matrices, and balanced scorecards to accomplish each stage. By adopting and applying these tools within the strategic framework outlined, radiology groups can position themselves to succeed in the evolving health care environment. RSNA, 2015

  18. The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study.

    Science.gov (United States)

    Potter, Rachel; Sheehan, Bart; Cain, Rebecca; Griffin, James; Jennings, Paul A

    2018-05-08

    Forty percent of residents living in care homes in the United Kingdom have significant depressive symptoms. Care homes can appear to be depressing places, but whether the physical environment of homes directly affects depression in care home residents is unknown. This study explores the relationship between the physical environment and depressive symptoms of older people living in care homes. In a prospective cohort study the physical environment of 50 care homes were measured using the Sheffield Care Environment Assessment Matrix (SCEAM) and depressive symptoms of 510 residents measured using the Geriatric Depression Scale (GDS-15). The study was supplemented with semi-structured interviews with residents living in the care homes. Quantitative data were analyzed using multi-level modeling, and qualitative data analyzed using a thematic framework approach. The overall physical environment of care homes (overall SCEAM score) did not predict depressive symptoms. Controlling for dependency, social engagement, and home type, having access to outdoor space was the only environmental variable to significantly predict depressive symptoms. Residents interviewed reported that access to outdoor space was restricted in many ways: locked doors, uneven foot paths, steep steps, and needing permission or assistance to go outside. We provide new evidence to suggest that access to outdoor space predicts depressive symptoms in older people living in care home. Interventions aimed at increasing access to outdoor spaces could positively affect depressive symptoms in older people.

  19. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces

    Science.gov (United States)

    2014-01-01

    Background Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. Methods During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. Results A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Conclusion Allowing nurses greater choice of clinic

  20. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces.

    Science.gov (United States)

    Munyewende, Pascalia Ozida; Rispel, Laetitia Charmaine; Chirwa, Tobias

    2014-05-15

    Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Allowing nurses greater choice of clinic to work in, the prevention of violence

  1. Impact of critical care environment on burnout, perceived quality of care and safety attitude of the nursing team.

    Science.gov (United States)

    Guirardello, Edinêis de Brito

    2017-06-05

    assess the perception of the nursing team about the environment of practice in critical care services and its relation with the safety attitude, perceived quality of care and burnout level. cross-sectional study involving 114 nursing professionals from the intensive care unit of a teaching hospital. The following instruments were used: Nursing Work Index-Revised, Maslach Burnout Inventory and the Safety Attitude Questionnaire. the professionals who perceived greater autonomy, good relationships with the medical team and better control over the work environment presented lower levels of burnout, assessed the quality of care as good and reported a positive perception on the safety attitude for the domain job satisfaction. the findings evidenced that environments favorable to these professionals' practice result in lower levels of burnout, a better perceived quality of care and attitudes favorable to patient safety. avaliar a percepção da equipe de enfermagem sobre o ambiente da prática em unidades de cuidados críticos e sua relação com atitude de segurança, percepção da qualidade do cuidado e nível de burnout. estudo transversal com a participação de 114 profissionais de enfermagem da unidade de terapia intensiva de um hospital de ensino. Foram utilizados os instrumentos: Nursing Work Index-Revised, Inventário de Burnout de Maslach e o Questionário de Atitudes de Segurança. os profissionais que perceberam maior autonomia, boas relações com a equipe médica e melhor controle sobre o ambiente de trabalho, apresentaram menores níveis de burnout, avaliaram como boa a qualidade do cuidado e relataram uma percepção positiva da atitude de segurança para o domínio satisfação no trabalho. os achados evidenciaram que ambientes favoráveis à prática desses profissionais resultam em menores níveis de burnout, melhor percepção da qualidade do cuidado e atitudes favoráveis à segurança do paciente. evaluar la percepción del equipo de enfermer

  2. The renewable alternative

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This chapter discusses renewable energy sources as an alternative to a fossil fuel based economy. The topics discussed in the chapter include the historic aspects and current status of use of renewable energy, status of the renewable energy industry, market barriers to renewable energy, research and development and commercialization of renewable energy, the environmental and social costs associated with renewable energy, valuing future costs and benefits of energy use, and the potential market of renewable energy

  3. Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates.

    Science.gov (United States)

    Al-Maaitah, Rowaida; AbuAlRub, Raeda F; Al Blooshi, Sumaya

    2018-04-01

    To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. The study used an exploratory descriptive design with a qualitative part using two focus group interviews. The sample size was 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of Nursing Work Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and Administrative Work. The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance. © 2018 Wiley Periodicals, Inc.

  4. Renewable Energy Symposium

    International Nuclear Information System (INIS)

    2016-01-01

    Representatives of state universities, public institutions and Costa Rican private sector, and American experts have exposed projects or experiences about the use and generation of renewable energy in different fields. The thematics presented have been about: development of smart grids and design of electrical energy production systems that allow money saving and reducing emissions to the environment; studies on the use of non-traditional plants and agricultural waste; sustainable energy model in the process of coffee production; experiments from biomass for the fabrication of biodiesel, biogas production and storage; and the use of non-conventional energy. Researches were presented at the Renewable Energy Symposium, organized by the Centro de Investigacion en Estructuras Microscopicas and support of the Vicerrectoria de Investigacion, both from the Universidad de Costa Rica [es

  5. The horror of stigma: psychosis and mental health care environments in twenty-first-century horror film (part I).

    Science.gov (United States)

    Goodwin, John

    2014-07-01

    This paper explores the manner in which modern horror films present stigmatizing depictions of psychosis and mental health care environments. Horror films will often include stigmatizing representations of psychosis and mental health care environments. Cinematic techniques can create stigmatizing depictions of psychosis and mental health care environments. Misinformation is often communicated. Due to these stigmatizing representations, people experiencing mental ill health may be rejected by the public. Stigma is a serious problem affecting the mental health services. It is important for practitioners to understand where stigma arises in order to challenge beliefs and attitudes.

  6. Relationships among leadership practices, work environments, staff communication and outcomes in long-term care.

    Science.gov (United States)

    Tourangeau, Ann; Cranley, Lisa; Spence Laschinger, Heather K; Pachis, Jaime

    2010-11-01

    To examine the role that work relationships have on two long-term care outcomes: job satisfaction and turnover intention. It is easy to overlook the impact that human relations have in shaping work environments that are conducive to organizational effectiveness. Employee job satisfaction and retention are important organizational outcomes. Six hundred and seventy-five nursing and other staff from 26 long-term care facilities were surveyed about their work environments, work group relationships, observed leadership practices, organizational support, job satisfaction and turnover intention. Higher job satisfaction was associated with lower emotional exhaustion burnout, higher global empowerment, higher organizational support, higher psychological empowerment, stronger work group cohesion and higher personal accomplishment. Higher turnover intention was associated with lower job satisfaction, higher emotional exhaustion burnout, more outside job opportunities, weaker work group cohesion, lower personal accomplishment and higher depersonalization. No relationship was found between leadership practices and job satisfaction or turnover intention. Stronger work group relationships, stronger sense of personal accomplishment and lower emotional exhaustion have direct effects on increasing job satisfaction and lowering turnover intention. To retain long-term care staff, attention should be paid to fostering positive work group cohesion, supporting and acknowledging staff accomplishments and minimizing staff burnout. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  7. Nurse Knowledge, Work Environment, and Turnover in Highly Specialized Pediatric End-of-Life Care.

    Science.gov (United States)

    Lindley, Lisa C; Cozad, Melanie J

    2017-07-01

    To examine the relationship between nurse knowledge, work environment, and registered nurse (RN) turnover in perinatal hospice and palliative care organizations. Using nurse intellectual capital theory, a multivariate analysis was conducted with 2007 National Home and Hospice Care Survey data. Perinatal hospice and palliative care organizations experienced a 5% turnover rate. The professional experience of advanced practice nurses (APNs) was significantly related to turnover among RNs (β = -.032, P < .05). Compared to organizations with no APNs professional experience, clinical nurse specialists and nurse practitioners significantly reduced RN turnover by 3 percentage points. No other nurse knowledge or work environment variables were associated with RN turnover. Several of the control variables were also associated with RN turnover in the study; Organizations serving micropolitan (β = -.041, P < .05) and rural areas (β = -.037, P < .05) had lower RN turnover compared to urban areas. Organizations with a technology climate where nurses used electronic medical records had a higher turnover rate than those without (β = .036, P < .05). The findings revealed that advanced professional experience in the form of APNs was associated with reductions in RN turnover. This suggests that having a clinical nurse specialist or nurse practitioner on staff may provide knowledge and experience to other RNs, creating stability within the organization.

  8. Environment Biological and Health Care Efforts Influenced of Lymfatic Filariasis Incidence, Sarmi Distric

    Directory of Open Access Journals (Sweden)

    Mina Sipayung

    2014-05-01

    District Sarmi is the most endemic area of filariasis in Papua which has rate of microfilaria (mf (47.06% up to the year 2012. In the Province Papua filarial worm is Wuchereria bancrofti and is transmitted through the bite of a mosquito vectors. Lymphatic filariasis does not cause death, but in chronic cases it causes disability, psychosocial problems, stigma, and decreased productivity. This study was aimed to analyze environment biological and health care efforts that influence the incidence of lymphatic filariasis. This study used case-control method. Samples comprised 32 case samples (mf + and 32 control samples (mf-. Primary data were collected through interviews and observation. Data were analyzed using Chi-Square and continued with multivariate Logistic Regression. Statistical analysis obtained indicated two variables on the incidence of lymphatic filariasis limfatik in District Sarmi (health care efforts pvalue = 0.002, OR: 7.779, as well as the biological environment pvalue= 0.008, OR: 5.841. Significant variables were health services with sub-variables promotion, prevention and the environmental biology. Suggestion: Mosquito bites should be avoided, the vector should be controlled through mutual cooperation and health promotion should be implemented. Keywords: Wuchereria bancrofti, lymphatic filariasis, vector, health care,                         Sarmi Distric

  9. Focusing on patient safety in the Neonatal Intensive Care Unit environment

    Directory of Open Access Journals (Sweden)

    Ilias Chatziioannidis

    2017-02-01

    Full Text Available Patient safety in the Neonatal Intensive Care Unit (NICU environment is an under-researched area, but recently seems to get high priority on the healthcare quality agenda worldwide. NICU, as a highly sensitive and technological driven environment, signals the importance for awareness in causation of mistakes and accidents. Adverse events and near misses that comprise the majority of human errors, cause morbidity often with devastating results, even death. Likewise in other organizations, errors causes are multiple and complex. Other high reliability organizations, such as air force and nuclear industry, offer examples of how standardized/homogenized work and removal of systems weaknesses can minimize errors. It is widely accepted that medical errors can be explained based on personal and/or system approach. The impact/effect of medical errors can be reduced when thorough/causative identification approach is followed by detailed analysis of consequences and prevention measures. NICU’s medical and nursing staff should be familiar with patient safety language, implement best practices, and support safety culture, maximizing efforts for reducing errors. Furthermore, top management commitment and support in developing patient safety culture is essential in order to assure the achievement of the desirable organizational safety outcomes. The aim of the paper is to review patient safety issues in the NICU environment, focusing on development and implementation of strategies, enhancing high quality standards for health care.

  10. Local environment but not genetic differentiation influences biparental care in ten plover populations.

    Directory of Open Access Journals (Sweden)

    Orsolya Vincze

    Full Text Available Social behaviours are highly variable between species, populations and individuals. However, it is contentious whether behavioural variations are primarily moulded by the environment, caused by genetic differences, or a combination of both. Here we establish that biparental care, a complex social behaviour that involves rearing of young by both parents, differs between closely related populations, and then test two potential sources of variation in parental behaviour between populations: ambient environment and genetic differentiation. We use 2904 hours behavioural data from 10 geographically distinct Kentish (Charadrius alexandrinus and snowy plover (C. nivosus populations in America, Europe, the Middle East and North Africa to test these two sources of behavioural variation. We show that local ambient temperature has a significant influence on parental care: with extreme heat (above 40 °C total incubation (i.e. % of time the male or female incubated the nest increased, and female share (% female share of incubation decreased. By contrast, neither genetic differences between populations, nor geographic distances predicted total incubation or female's share of incubation. These results suggest that the local environment has a stronger influence on a social behaviour than genetic differentiation, at least between populations of closely related species.

  11. Perceptions of pregnant teenagers with regard to the antenatal care clinic environment.

    Science.gov (United States)

    James, Sindiwe; Rall, Nadine; Strümpher, Juanita

    2012-10-12

    Pregnancy in teenagers seems to be a challenge that might contribute to a struggle to fulfil the objectives of the Millennium Development Goals directly related to women's reproductive health and neonatal care. The challenge becomes worse as midwives and nurses find it difficult to fully supervise all these pregnancies, because teenagers stay away or default from clinic attendance. The purpose of the study was to explore and describe the perceptions of pregnant teenagers of the antenatal care (ANC) clinic environment and to recommend guidelines to midwifery operational managers for strategies to create teenager-friendly ANC clinic environments. The study applied a qualitative research design with explorative, descriptive and contextual research approaches. The ethical principles that guided this study were respect for the person, beneficence and justice. Semi-structured interviews utilising a predetermined interview schedule with a central open-ended question to address the study objectives were used. Data were collected from pregnant teenagers attending ANC clinics in Nelson Mandela Metropolitan Municipality. Participants were unanimous in that they perceived the clinic environment as causing discomfort to them. Different reasons attributed to this experience were related to their young age. The age difference between themselves and other women attending the clinic made participants perceive themselves as inferior and as being treated as such at the clinic. They found this embarrassing and recommended having their own waiting area and additional midwives at the clinic so that they would not be subjected to humiliating scrutiny and disapproval from older pregnant women. Pregnant teenagers' recall of their experiences of the ANC clinic environment suggests that they perceive themselves as not being adequately cared for, as judged, and as forced to be in an environment that is insensitive to their needs. As a result some of their peers stayed away from the clinic and

  12. Which leadership for renewable energies?

    International Nuclear Information System (INIS)

    Chaumien, Marielle

    2016-02-01

    This publication first outlines that France is late in deploying renewable energies by 2020. It comments the application of the Energy multi-year plan (PPE), evokes the content of a report by the French Court of Auditors about costs and means of implementation of transition (with notably the issue of maintenance of nuclear plants). It also shows that European Union is not a leader in renewable energies any more, that some European countries are changing sides, that figures and trends must be carefully compared with those in the field of fossil and nuclear energies, that all energies are not all the same, that jobs and system integration are also important, that investments and attractiveness of countries in renewable energies must be assessed, and that a mobilisation on small scale and consumer-based renewable energies is required. Ten recommendations are made for France to support the EU leadership development

  13. ïSCOPE: Safer care for older persons (in residential environments: A study protocol

    Directory of Open Access Journals (Sweden)

    Barnard Debbie

    2011-07-01

    Full Text Available Abstract Background The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life. Aims Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012 proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life. Methods/design The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility are led by healthcare aides (non-regulated caregivers and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking. Discussion There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement

  14. Environment

    DEFF Research Database (Denmark)

    Valentini, Chiara

    2017-01-01

    The term environment refers to the internal and external context in which organizations operate. For some scholars, environment is defined as an arrangement of political, economic, social and cultural factors existing in a given context that have an impact on organizational processes and structures....... For others, environment is a generic term describing a large variety of stakeholders and how these interact and act upon organizations. Organizations and their environment are mutually interdependent and organizational communications are highly affected by the environment. This entry examines the origin...... and development of organization-environment interdependence, the nature of the concept of environment and its relevance for communication scholarships and activities....

  15. Comparative characteristics of the home care nursing services used by community-dwelling older people from urban and rural environments.

    Science.gov (United States)

    Borowiak, Ewa; Kostka, Tomasz

    2013-06-01

    To compare home care nursing services use by community-dwelling older people from urban and rural environments in Poland. In the current literature, there is a lack of data based on multidimensional geriatric assessment concerning the provision of care delivered by nurses for older people from urban and rural environments. Cross-sectional random survey. Between 2006-2010, a random sample of 935 older people (over 65 years of age) from an urban environment and 812 from a neighbouring rural environment were interviewed in a cross-sectional survey. The rural dwellers (82·8%) nominated their family members as care providers more often than the city inhabitants (51·2%). Home nursing care was provided to 4·1% of people in the city and 6·5% in the county. Poststroke condition, poor nutritional status, and low physical activity level, as well as low scores for activities of daily living, instrumental activities of daily living, and Mini-Mental State Examination values, were all determinants of nursing care, both in urban and rural areas. In the urban environment, additional predictors of nursing care use were age, presence of ischaemic heart disease, diabetes and respiratory disorders, number of medications taken, and a high depression score. Poor functional status is the most important determinant of nursing care use in both environments. In the urban environment, a considerable proportion of community-dwelling elders live alone. In the rural environment, older people usually have someone available for potential care services. The main problem seems to be seeking nursing care only in advanced deterioration of functional status. © 2012 Blackwell Publishing Ltd.

  16. Development of ISO 13606 archetypes for the standardisation of data registration in the Primary Care environment.

    Science.gov (United States)

    Barros Castro, Jesús; Lamelo Alfonsín, Alejandro; Prieto Cebreiro, Javier; Rimada Mora, Dolores; Carrajo García, Lino; Vázquez González, Guillermo

    2015-01-01

    On daily procedures, companies and organizations produce a wide quantity of data. Medical information doubles every five years approximately, and most of this information has no structure and cannot be utilised. Information obtained during Primary Health Care (PC) consultations is expected to be standardized and organised following instructions made by archetype 13606 of the International Organization for Standardization (ISO) in order to guarantee the Continuity of Care as well as the potential use of these data for secondary purposes, such as investigation or statistics. This study was designed to investigate the feasibility of representing the information collected in Primary Care consultations in a structured and normalized way. A key difference to other approaches is that the intended solution is, to the best of our knowledge, the first one to register all the information collected in this area. The participation of the Primary Health Care service (PC) from Complejo Hospitalario Universitario de A Coruña (CHUAC) has been of vital importance in this project as it has provided the necessary clinical knowledge and it has allowed us to verify the effectiveness obtained in actual environments. The archetypes developed can be reused in a wide range of projects. As an example of use, we have used these archetypes to create an intelligent system that generates organised reports based on the information dictated on a medical consultation which, afterwards, can be analysed from an analytical point of view.

  17. Self care of patients with chronic venous ulcers in the home environment.

    Directory of Open Access Journals (Sweden)

    Thiago Gonçalves do Nascimento Piropo

    2012-01-01

    Full Text Available The venous ulcer is a skin lesion that affects the lower third of the legs. Is associated with chronic venous insufficiency, is the leading cause of ulcers of the lower limbs. Can interfere with the quality of life of patients, because it generates negative repercussions on social and economic sphere. The aim of this study was to identify self-care in the home environment of patients with venous ulcers, to assess the occurrence of alternative therapy use and verifythe involvement of domestic trauma. Methodologically, this study takes a quantitative and qualitative analytical cross-sectional held at the Clinical School of Physiotherapy, State University of Southwest Bahia / UESB / Jequié-BA, from January 2007 to September 2008. Data were collected through a questionnaire and semi-structured interviews. The results showed that 100% of the participants played self care of their injuries, including with respect to occlusion and bandages when needed. However, 6.25% said they had not received adequate information to perform self-care. Concluded that it is necessary to interact and produce a mechanism between education and health assistance for the development of the practice of self-care in family life at home.

  18. Blessed alienation: the Christian monastery as a caring and restorative environment.

    Science.gov (United States)

    Eriksson, Nadya T; Wiklund-Gustin, Lena

    2014-02-01

    Being mentally ill is often associated with experiencing alienation from society because sensations are not easily shared with others. Modern health care leads us to pose many questions. Some sufferers search and find their way to monasteries as they did centuries ago. We interviewed six persons staying in a monastery to understand the meaning of health and care in a monastic environment in contemporary Sweden. We analyzed the transcripts by means of a hermeneutic approach and discovered that the helping effect of the monastery was based on its contradictory/paradoxical structure that corresponded to the lifeworld of a person suffering from mental illness. The monastery was a place where one could be different but equal, and simultaneously provided freedom within boundaries, calmness and intensity, privacy and relations, demands and confirmation. This facilitated experiences of health and wholeness, necessary to manage the challenges of recovery.

  19. Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in western Kenya.

    Directory of Open Access Journals (Sweden)

    Lukoye Atwoli

    Full Text Available The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs and posttraumatic stress disorder (PTSD among orphaned and separated children in Uasin Gishu County, western Kenya.A total of 1565 (55.5% male orphaned and separated adolescents aged 10-18 years (mean 13.8 years, sd 2.2, were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children's Institutions (CCIs, and 73 on the street. Posttraumatic stress symptom (PTSS scores and PTSD were assessed using the Child PTSD Checklist.Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8%, then households (15.0% and CCIs (11.5%. PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse.This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households. Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support.

  20. Comparison of Methods of Sampling for Toxocara Species and Fecal Coliforms in an Outdoor Day Care Environment

    Directory of Open Access Journals (Sweden)

    Hélène Carabin

    1998-01-01

    Full Text Available OBJECTIVE: To compare three sampling methods and to pretest methods for the determination of fecal coliform (FC counts and Toxocara species from sand in the day care outdoor environment.

  1. A review of chronic pain impact on patients, their social environment and the health care system

    Directory of Open Access Journals (Sweden)

    Dueñas M

    2016-06-01

    Full Text Available María Dueñas,1 Begoña Ojeda,2 Alejandro Salazar,2 Juan Antonio Mico,3 Inmaculada Failde,2 1Nursing Faculty “Salus Infirmorum”, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 2Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 3Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Mental Health, CIBERSAM, Institute of Health Carlos III, University of Cádiz, Cádiz, Spain Abstract: Chronic pain (CP seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives. Keywords: pain, everyday problems, social relationships, family environment, health services

  2. Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

    Science.gov (United States)

    Paquet, Maxime; Courcy, François; Lavoie-Tremblay, Mélanie; Gagnon, Serge; Maillet, Stéphanie

    2013-05-01

    Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.

  3. Transgenerational effects of social environment on variations in maternal care and behavioral response to novelty.

    Science.gov (United States)

    Champagne, Frances A; Meaney, Michael J

    2007-12-01

    Cross-fostering studies in the rat have illustrated the importance of the postnatal environment in mediating the transmission of maternal licking/grooming (LG) from mother to offspring. The authors addressed the question of how postweaning social conditions can alter the patterns of maternal behavior. Juvenile female offspring of high LG and low LG mothers were placed in either standard, enriched, or impoverished postweaning environments for 50 consecutive days and then mated and observed with their own litters. Analysis of LG behavior indicated that the effect of postweaning environment was dependent on the level of postnatal mother-infant interaction. Postweaning isolation reduced exploratory behavior, maternal LG, and oxytocin receptor binding in the offspring of high LG mothers, whereas social enrichment enhanced exploration, LG behavior, and oxytocin receptor binding of low LG offspring. These effects were also transmitted to the next generation of offspring. Thus, maternal LG and the neural mechanisms that regulate this behavior exhibited a high degree of plasticity in response to changes in environment both within and beyond the postnatal period, with implications for the transmission of behavioral response to novelty and maternal care across generations.

  4. The impact of the hospital work environment on social support from physicians in breast cancer care.

    Science.gov (United States)

    Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole

    2014-09-01

    Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. The influence of social environment on the smoking status of women employed in health care facilities

    Directory of Open Access Journals (Sweden)

    Dragana Nikšić

    2013-04-01

    Full Text Available Introduction: Bosnia and Herzegovina has a high prevalence of smoking among women, especially among health care professionals. The goal of this study is to investigate the influence of the social environment of women employed in health institutions in relation to the cigarettes smoking habits.Methods: The study included 477 women employed in hospitals, outpatient and public health institutions in Sarajevo Canton Bosnia and Herzegovina. We used a modifi ed questionnaire assessing smoking habits of medical staff in European hospitalsResults: The results showed that 50% of women are smokers, with the highest incidence among nurses (58.1% and administrative staff (55.6%. The social environment is characterized by a high incidence of colleagues (60.1% and friends who are smokers (54.0% at the workplace and in the family (p<0.005. One third of women (27.8%, mainly non-smokers, states that the work environment supports employees smoking (p=0.003.Conclusion: Workplace and social environment support smoking as an acceptable cultural habit and is contributing to increasing rates of smoking among women.

  6. The Central Role of Physician Leadership for Driving Change in Value-Based Care Environments.

    Science.gov (United States)

    Lustig, Adam; Ogden, Michael; Brenner, Robert W; Penso, Jerry; Westrich, Kimberly D; Dubois, Robert W

    2016-10-01

    In 2013, it was reported that about 1 of every 3 U.S. adults has hypertension. Of these 70 million individuals, approximately 50% have their blood pressure under control. Achieving hypertension control, especially in at-risk populations, requires a multipronged approach that includes lifestyle modifications and pharmacological treatment. As provider groups, hospital systems, and integrated delivery networks optimize their care processes to promote population health activities in support of the accountable care organization (ACO) model of care, managing hypertension and other chronic diseases will be essential to their success. A critical aspect of managing populations in an ACO environment is optimization of care processes among providers to increase care efficiency and improve patient outcomes. Launched in 2013, Measure Up/Pressure Down is a 3-year campaign developed by the American Medical Group Foundation (AMGF) to reduce the burden of high blood pressure. The goal of the campaign is for participating medical groups, health systems, and other organized systems of care to achieve hypertension control for 80% of their patients with high blood pressure by 2016, according to national standards. The role of physician leadership at Cornerstone Health Care (CHC) and Summit Medical Group (SMG) in facilitating organizational change to improve hypertension management through the implementation of the Measure Up/Pressure Down national hypertension campaign is examined. Using patient stratification via its electronic health record, SMG identified 16,000 patients with hypertension. The baseline percentage of hypertension control for this patient population was 66%. Within 7 months, SMG was able to meet the 80% goal set forth by the AMGF's Measure Up/Pressure Down campaign. CHC diagnosed 25,312 patients with hypertension. The baseline percentage of hypertension control for this subgroup of patients was 51.5% when the initiative was first implemented. To date, the organization

  7. A grounded theory of humanistic nursing in acute care work environments.

    Science.gov (United States)

    Khademi, Mojgan; Mohammadi, Eesa; Vanaki, Zohreh

    2017-12-01

    Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment. To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting. Data were collected from interviews and observations in 2009-2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred. Participants and research context: In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling. Ethical considerations: The research was approved by the Ethics Committee of the university and hospitals. The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation-education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others' needs, resulting in "success and accomplishment" of nurse/nursing manager and patient/family. This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses' professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses' rights are violated.

  8. Nutrition Care Process Implementation: Experiences in Various Dietetics Environments in Sweden.

    Science.gov (United States)

    Lövestam, Elin; Boström, Anne-Marie; Orrevall, Ylva

    2017-11-01

    The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently being implemented by nutrition and dietetics practitioners all over the world. Several advantages have been related to this implementation, such as consistency and clarity of dietetics-related health care records and the possibility to collect and research patient outcomes. However, little is known about dietitians' experiences of the implementation process. The aim of this qualitative study was to explore Swedish dietitians' experiences of the NCP implementation process in different dietetics environments. Thirty-seven Swedish dietitians from 13 different dietetics workplaces participated in seven focus group discussions that were audiotaped and carefully transcribed. A thematic secondary analysis was performed, after which all the discussions were re-read, following the implementation narrative from each workplace. In the analysis, The Promoting Action on Research Implementation in Health Services implementation model was used as a framework. Main categories identified in the thematic analysis were leadership and implementation strategy, the group and colleagues, the electronic health record, and evaluation. Three typical cases are described to illustrate the diversity of these aspects in dietetics settings: Case A represents a small hospital with an inclusive leadership style and discussion-friendly culture where dietitians had embraced the NCP/NCPT implementation. Case B represents a larger hospital with a more hierarchical structure where dietitians were more ambivalent toward NCP/NCPT implementation. Case C represents the only dietitian working at a small multiprofessional primary care center who received no dietetics-related support from management or colleagues. She had not started NCP/NCPT implementation. The diversity of dietetics settings and their different prerequisites should be considered in the development of NCP/NCPT implementation strategies. Tailored

  9. Exploring the Influence of Nursing Work Environment and Patient Safety Culture on Missed Nursing Care in Korea.

    Science.gov (United States)

    Kim, Kyoung-Ja; Yoo, Moon Sook; Seo, Eun Ji

    2018-04-20

    This study aimed to explore the influence of nurse work environment and patient safety culture in hospital on instances of missed nursing care in South Korea. A cross-sectional design was used, in which a structured questionnaire was administered to 186 nurses working at a tertiary university hospital. Data were analyzed using descriptive statistics, t-test or ANOVA, Pearson correlation and multiple regression analysis. Missed nursing care was found to be correlated with clinical career, nursing work environment and patient safety culture. The regression model explained approximately 30.3 % of missed nursing care. Meanwhile, staffing and resource adequacy (β = -.31, p = .001), nurse manager ability, leadership and support of nurses (β = -.26, p = .004), clinical career (β = -.21, p = .004), and perception on patient safety culture within unit (β = -.19, p = .041) were determined to be influencing factors on missed nursing care. This study has significance as it suggested that missed nursing care is affected by work environment factors within unit. This means that missed nursing care is a unit outcome affected by nurse work environment factors and patient safety culture. Therefore, missed nursing care can be managed through the implementation of interventions that promote a positive nursing work environment and patient safety culture. Copyright © 2018. Published by Elsevier B.V.

  10. The physical environment, activity and interaction in residential care facilities for older people: a comparative case study.

    Science.gov (United States)

    Nordin, Susanna; McKee, Kevin; Wallinder, Maria; von Koch, Lena; Wijk, Helle; Elf, Marie

    2017-12-01

    The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long-term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed-method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents' affective states. Field notes and walk-along interviews were also used. Findings indicate that the design of the physical environment influenced the residents' activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently. © 2016 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

  11. Utilization of renewable energy in architectural design

    Institute of Scientific and Technical Information of China (English)

    TIAN Lei; QIN Youguo

    2007-01-01

    Renewable energy does not simply equal to using a photovoltaic (PV) board.In addition to heating,ventilation and air conditioning (HVAC) engineering considerations,the design approaches of architects are crucial to the utilization condition and methods of renewable energy.Through profound comprehension of the relationship between renewable energy utilization and design approaches,we can achieve a dual-standard of building environment performance and esthetics.

  12. A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments

    NARCIS (Netherlands)

    van Lonkhuijzen, L.; Dijkman, A.; van Roosmalen, J.; Zeeman, G.; Scherpbier, A.

    Background Training of healthcare workers can play an important role in improving quality of care, and reducing maternal and perinatal mortality and morbidity. Objectives To assess the effectiveness of training programmes aimed at improving emergency obstetric care in low-resource environments.

  13. Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment

    Directory of Open Access Journals (Sweden)

    Naoko Muramatsu

    2017-04-01

    Full Text Available Home care aides (HCAs, predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise (p = 0.027. Almost all (98% HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs.

  14. Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

    Science.gov (United States)

    Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

    2017-04-05

    Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.

  15. Renewable sources of energy

    International Nuclear Information System (INIS)

    Wojas, K.

    1996-01-01

    The author takes a look at causes of the present interest in the renewable, natural sources of energy. These are: the fuel deposits becoming exhausted, hazard to environment (especially carbon dioxide) and accessibility of these sources for under-developed countries. An interrelation is shown between these sources and the energy circulations connected with atmosphere and ocean systems. The chief ones from among them that are being used now are discussed, i.e. solar radiation, wind, water waves energy, tides, geothermal heat, and the like. Problems of conversion of the forms of these kinds of energy are also given a mention. (author)

  16. Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study.

    Science.gov (United States)

    Backhaus, Ramona; Rossum, Erik van; Verbeek, Hilde; Halfens, Ruud J G; Tan, Frans E S; Capezuti, Elizabeth; Hamers, Jan P H

    2017-01-01

    A lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes. To examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes. Cross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems. Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands. Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards. Ward rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward. Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards. In general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement 'In the event that a family member had to be admitted to a nursing home now, I would recommend this ward'. A better team climate was related to better perceived quality of care in both ward types (p≤0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p=0.028). In

  17. [Nursing interventions on the physical environment of Neonatal Intensive Care Units].

    Science.gov (United States)

    Miquel Capó Rn, I

    2016-01-01

    The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  18. The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report.

    Science.gov (United States)

    Pickworth, Thomas; Jerath, Angela; DeVine, Rita; Kherani, Nazmin; Wąsowicz, Marcin

    2013-01-01

    The use of volatile-based sedation within critical care environments has been limited by difficulties of drug administration and safety concerns over environment pollution and staff exposure in an intensive care unit (ICU) with no scavenging. The aim of this study was to develop a simple scavenging system to be used with the Anesthesia Conserving Device (AnaConDa(®)) and to determine whether or not ambient concentrations of residual anesthetic are within current acceptable limits. The scavenging system consists of two Deltasorb(®) canisters attached to the ICU ventilator in series. AnaConDa is a miniature vaporizer designed to provide volatile-based sedation within an ICU. The first ten patients recruited into a larger randomized trial assessing outcomes after elective coronary graft bypass surgery were sedated within the cardiac ICU using either isoflurane or sevoflurane. Sedation was guided by the Sedation Agitation Scale, resulting in an end-tidal minimum anesthetic concentration of volatile agent ranging from 0.1-0.3. At one hour post ICU admission, infrared photometric analysis was used to assess environmental contamination at four points along the ventilator circuit and scavenging system and around the patient's head. All measurements taken within the patient's room were below 1 part per million, which satisfies criteria for occupational exposure. This study shows that volatile agents can be administered safely within critical care settings using a simple scavenging system. Our scavenging system used in conjunction with the AnaConDa device reduced the concentration of environmental contamination to a level that is acceptable to Canadian standards and standards in most Western countries and thus conforms to international safety standards. The related clinical trial was registered at www.clinicaltrials.gov (NCT01151254).

  19. Knowledge, attitudes, and environment: what primary care providers say about pre-school vision screening.

    Science.gov (United States)

    Marsh-Tootle, Wendy L; Funkhouser, Ellen; Frazier, Marcela G; Crenshaw, Katie; Wall, Terry C

    2010-02-01

    To evaluate knowledge, attitudes, and environment of primary care providers, and to develop a conceptual framework showing their impact on self-reported pre-school vision screening (PVS) behaviors. Eligible primary care providers were individuals who filed claims with Medicaid agencies in Alabama, South Carolina, or Illinois, for at least eight well child checks for children aged 3 or 4 years during 1 year. Responses were obtained on-line from providers who enrolled in the intervention arm of a randomized trial to improve PVS. We calculated a summary score per provider per facet: (1) for behavior and knowledge, each correct answer was assigned a value of +1; and (2) for attitudes and environment, responses indicating support for PVS were assigned a value of +1, and other responses were assigned -1. Responses were available from 53 participants (43 of 49 enrolled pediatricians, 8 of 14 enrolled family physicians, one general physician, and one nurse practitioner). Recognizing that amblyopia often presents without outward signs was positively related to good PVS: [odds ratio (OR) = 3.9; p = 0.06]. Reporting that "preschool VS interrupts patient flow" posed a significant barrier (OR = 0.2; p = 0.05). Providers with high summed scores on attitudes (OR = 6.0; p = 0.03), or knowledge and attitudes (OR = 11.4; p attitudes or environment, and "good" PVS behavior (p = 0.04). PVS is influenced by positive attitudes, especially when combined with knowledge about amblyopia. Interventions to improve PVS should target multiple facets, emphasizing (1) asymptomatic children are at risk for amblyopia, (2) specific evidence-based tests have high testability and sensitivity for amblyopia in pre-school children, and (3) new tests minimize interruptions to patient flow.

  20. Renewing governance.

    Science.gov (United States)

    Loos, Gregory P

    2003-01-01

    Globalization's profound influence on social and political institutions need not be negative. Critics of globalization have often referred to the "Impossible Trinity" because decision-making must 1. respect national sovereignty, 2. develop and implement firm regulation, and 3. allow capital markets to be as free as possible. To many, such goals are mutually exclusive because history conditions us to view policy-making and governance in traditional molds. Thus, transnational governance merely appears impossible because current forms of governance were not designed to provide it. The world needs new tools for governing, and its citizens must seize the opportunity to help develop them. The rise of a global society requires a greater level of generality and inclusion than is found in most policy bodies today. Politicians need to re-examine key assumptions about government. States must develop ways to discharge their regulatory responsibilities across borders and collaborate with neighboring jurisdictions, multilateral bodies, and business. Concepts such as multilateralism and tripartism show great promise. Governments must engage civil society in the spirit of shared responsibility and democratic decision-making. Such changes will result in a renewal of the state's purpose and better use of international resources and expertise in governance.

  1. Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores.

    Science.gov (United States)

    Chaiyachati, Krisda H; Hom, Jeffrey K; Hubbard, Rebecca A; Wong, Charlene; Grande, David

    2018-03-01

    Worse health outcomes among those living in poverty are due in part to lower rates of health insurance and barriers to care. As the Affordable Care Act reduced financial barriers, identifying persistent barriers to accessible health care continues to be important. We examined whether the built environment as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access) is associated with having a usual source of care among low-income adults, newly enrolled in Medicaid. We received responses from 312 out of 1000 new Medicaid enrollees in Philadelphia, a large, densely populated urban area, who were surveyed between 2015 and 2016 to determine if they had identified a usual source of outpatient primary care. Respondents living at an address with a low Walk Scores (< 70) had 84% lower odds of having a usual source of care (OR 0.16, 95% CI 0.04-0.61). Transit scores were not associated with having a usual source of care. Walk Score may be a tool for policy makers and providers of care to identify populations at risk for worse primary care access.

  2. Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores

    Directory of Open Access Journals (Sweden)

    Krisda H. Chaiyachati

    2018-03-01

    Full Text Available Worse health outcomes among those living in poverty are due in part to lower rates of health insurance and barriers to care. As the Affordable Care Act reduced financial barriers, identifying persistent barriers to accessible health care continues to be important. We examined whether the built environment as reflected by Walk Score™ (a measure of walkability to neighborhood resources and Transit Score™ (a measure of transit access is associated with having a usual source of care among low-income adults, newly enrolled in Medicaid. We received responses from 312 out of 1000 new Medicaid enrollees in Philadelphia, a large, densely populated urban area, who were surveyed between 2015 and 2016 to determine if they had identified a usual source of outpatient primary care. Respondents living at an address with a low Walk Scores (<70 had 84% lower odds of having a usual source of care (OR 0.16, 95% CI 0.04–0.61. Transit scores were not associated with having a usual source of care. Walk Score may be a tool for policy makers and providers of care to identify populations at risk for worse primary care access.

  3. Effectiveness of hand hygiene depends on the patient's health condition and care environment.

    Science.gov (United States)

    Okada, Junko; Yamamizu, Yukiko; Fukai, Kiyoko

    2016-10-01

    The present authors examined how patient hand contamination was associated with underlying disease and treatment environment in order to determine effective hand hygiene methods. Samples were collected from inpatients (45 with hematological malignancies, 48 postoperative), outpatients (48 undergoing hemodialysis, 55 on chemotherapy), and 44 individuals living in nursing homes. All participants provided informed consent for study participation. All subjects performed hand hygiene. Before and after hand hygiene, samples of bacteria were collected from the palm of the hand onto agar media. Bacteria were counted and bacterial strains were identified. The authors then collected smear samples from the contralateral palm and measured adenosine triphosphate (ATP) levels. Patient hand contamination was the highest in hemodialysis patients, followed by residents of nursing homes, postoperative patients, patients with cancer receiving chemotherapy, and patients of hematological malignancies. Regardless of the underlying disease and treatment environment, patients were able to reduce the number of bacterial colonies and ATP by proper hand hygiene. Compared with wet wipes, hand washing seemed to remove bacteria more effectively. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 30 subjects, none of whom were patients of hematological malignancies. Of these, 19 tested negative for MRSA after performing proper hand hygiene. Patient hand contamination is affected by underlying disease and care environment, but can be reduced by encouraging proper hand washing. Proper patient hand hygiene can reduce MRSA on patients' hands, and thus may serve as an effective tool for prevention of healthcare-associated infections. © 2016 Japan Academy of Nursing Science.

  4. An integrated healthcare system for personalized chronic disease care in home-hospital environments.

    Science.gov (United States)

    Jeong, Sangjin; Youn, Chan-Hyun; Shim, Eun Bo; Kim, Moonjung; Cho, Young Min; Peng, Limei

    2012-07-01

    Facing the increasing demands and challenges in the area of chronic disease care, various studies on the healthcare system which can, whenever and wherever, extract and process patient data have been conducted. Chronic diseases are the long-term diseases and require the processes of the real-time monitoring, multidimensional quantitative analysis, and the classification of patients' diagnostic information. A healthcare system for chronic diseases is characterized as an at-hospital and at-home service according to a targeted environment. Both services basically aim to provide patients with accurate diagnoses of disease by monitoring a variety of physical states with a number of monitoring methods, but there are differences between home and hospital environments, and the different characteristics should be considered in order to provide more accurate diagnoses for patients, especially, patients having chronic diseases. In this paper, we propose a patient status classification method for effectively identifying and classifying chronic diseases and show the validity of the proposed method. Furthermore, we present a new healthcare system architecture that integrates the at-home and at-hospital environment and discuss the applicability of the architecture using practical target services.

  5. Occupational therapist care in the introduction of Alternative Communication features in hospital environment

    Directory of Open Access Journals (Sweden)

    Janaína Santos Nascimento

    2017-03-01

    Full Text Available Introduction: Alternative and Extended Communication (CAA is an area of assistive technology, and its introduction in the hospital environment has contributed decisively to the care and integration of patients with speech or writing difficulties. However, in order for the use of CAA resources to be effective in this environment, actions are essential to prevent and control Hospital Infections (HI. Objective: To describe the strategies related to the control of HI, used for the introduction of CAA resources on a in a university hospital. Method: It presents as methodological strategy the experience report, the descriptive and exploratory mode, based on the experience of five therapists occupational - four residents and a supervisor professor -, during the introductory work of CAA resource at a university hospital, from June 2012 to July 2014. Results: The main precautions adopted were: to laminate the printed boards; to wrap with plastic film computers, tablets, communicators, tablet pen, mouse and driver; protect with plastic bags support materials for activities such as table and inclined plane, and transport by means of a plastic cart. After the materials use, they were placed in plastic bags and sent for cleaning and disinfection the purge. Conclusion: The data showed the complexity of the use of CAA resources in the hospital environment by occupational therapists, and the need for training of professionals involved in actions by Hospital Infection Control Committees team (CCIH.

  6. Nursing leadership in intensive care units and its relationship to the work environment

    Directory of Open Access Journals (Sweden)

    Alexandre Pazetto Balsanelli

    2015-02-01

    Full Text Available AIM: To establish whether there is any relationship between the work environment and nursing leadership at intensive care units (ICUs.METHOD: Correlational study conducted at four ICUs in southern São Paulo (SP, Brazil. The study population was comprised of 66 pairs (nurses and nursing technicians established by lottery. The nurses responded to three instruments: 1 characterization; 2 a validated Portuguese version of the Nursing Work Index Revised (B-NWI-R; and 3 Grid & Leadership in Nursing: ideal behavior. The nursing technicians responded to 1 characterization and to 2 Grid and Leadership in Nursing: actual behavior, relative to the corresponding randomly-assigned nurse. The data were analyzed by means of analysis of variance (ANOVA at p ≤ 0.05.RESULTS: The work environment was not associated with actual nursing leadership (p = 0.852. The public or private nature of the institutions where the investigated ICUs were located had no significant effect on leadership (p = 0.437. Only the nurse-physician relationship domain stood out (p = 0.001.CONCLUSION: The choice of leadership styles by nurses should match the ICU characteristics. Leadership skills could be developed, and the work environment did not exert any influence on the investigated population.

  7. The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes.

    Science.gov (United States)

    Nakanishi, Miharu; Tei-Tominaga, Maki

    2018-05-08

    Background : Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods : A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results : Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions : Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

  8. The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes

    Directory of Open Access Journals (Sweden)

    Miharu Nakanishi

    2018-05-01

    Full Text Available Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional, presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

  9. Renewable energies for Amapa's sustainable development

    International Nuclear Information System (INIS)

    Marques, Ana Claudia S.; Di Lascio, Marco Alfredo; Freitas, Marcos Aurelio V.

    1999-01-01

    The generation of energy requires huge quantities of fuels which produce significant amounts of waste that are given back to the environment, causing remarkable damage. In order to avoid or at least reduce this damage, society is devoting research to other means of energy generation, free from that king of consequences - renewable energies. The article overviews of Amapa, Brazilian state, energy renewable sources

  10. Creating Welcoming Spaces for Lesbian, Gay, Bisexual, and Transgender (LGBT) Patients: An Evaluation of the Health Care Environment.

    Science.gov (United States)

    McClain, Zachary; Hawkins, Linda A; Yehia, Baligh R

    2016-01-01

    Health outcomes are affected by patient, provider, and environmental factors. Previous studies have evaluated patient-level factors; few focusing on environment. Safe clinical spaces are important for lesbian, gay, bisexual, and transgender (LGBT) communities. This study evaluates current models of LGBT health care delivery, identifies strengths and weaknesses, and makes recommendations for LGBT spaces. Models are divided into LGBT-specific and LGBT-embedded care delivery. Advantages to both models exist, and they provide LGBT patients different options of healthcare. Yet certain commonalities must be met: a clean and confidential system. Once met, LGBT-competent environments and providers can advocate for appropriate care for LGBT communities, creating environments where they would want to seek care.

  11. Renewable Selections

    Science.gov (United States)

    Pye, Linda

    2009-01-01

    Studies show that well designed interiors can influence education profoundly. Awareness of the importance of sustainability and its role within the learning environment is growing. Research indicates a possible link between sustainable facilities and better learning outcomes. Education is one of the fastest growing markets for green buildings and…

  12. Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

    Science.gov (United States)

    Jangland, Eva; Teodorsson, Therese; Molander, Karin; Muntlin Athlin, Åsa

    2018-06-01

    To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. A focused ethnographic approach. A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery. © 2017 John Wiley & Sons Ltd.

  13. Assessment of Physical Environment of Iran’s Neonatal Tertiary Care Centers from the Perspective of the Neonatal Individualized Developmental Care

    Directory of Open Access Journals (Sweden)

    Mostajab Razavi Nejad

    2017-12-01

    Full Text Available Background: Globally,it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU. This study aimed to evaluate the physical environment of hospital and nursery in Iran’s tertiary care centers. Methods: This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics. Results: In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants’ bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants’ beds. The total mean score of the physical environment of hospital and NICU was 39.77. Conclusion: According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions.

  14. Integrating heterogeneous databases in clustered medic care environments using object-oriented technology

    Science.gov (United States)

    Thakore, Arun K.; Sauer, Frank

    1994-05-01

    The organization of modern medical care environments into disease-related clusters, such as a cancer center, a diabetes clinic, etc., has the side-effect of introducing multiple heterogeneous databases, often containing similar information, within the same organization. This heterogeneity fosters incompatibility and prevents the effective sharing of data amongst applications at different sites. Although integration of heterogeneous databases is now feasible, in the medical arena this is often an ad hoc process, not founded on proven database technology or formal methods. In this paper we illustrate the use of a high-level object- oriented semantic association method to model information found in different databases into an integrated conceptual global model that integrates the databases. We provide examples from the medical domain to illustrate an integration approach resulting in a consistent global view, without attacking the autonomy of the underlying databases.

  15. Environment surveillance of filamentous fungi in two tertiary care hospitals in China.

    Science.gov (United States)

    Hao, Zhen-feng; Ao, Jun-hong; Hao, Fei; Yang, Rong-ya; Zhu, He; Zhang, Jie

    2011-07-05

    Invasive fungal infections have constituted an increasingly important cause of morbidity and mortality in immunocompromised patients. In this study, a surveillance project was conducted in three different intensive care units of two large tertiary hospitals in China. A one-year surveillance project was conducted in two tertiary hospitals which located in northern China and southwest China respectively. Air, surfaces and tap water were sampled twice a month in a central intensive care unit, a bone marrow transplant unit, a neurosurgery intensive care unit and a live transplant department. Environmental conditions such as humidity, temperature and events taking place, for example the present of the visitors, healthcare staff and cleaning crew were also recorded at the time of sampling. The air fungal load was 91.94 cfu/m(3) and 71.02 cfu/m(3) in the southwest China hospital and the northern China hospital respectively. The five most prevalent fungi collected from air and surfaces were Penicillium spp., Cladospcrium spp., Alternaria spp., Aspergillus spp. and Saccharomyces spp. in the southwest China hospital, meanwhile Penicillium spp., Fusarium spp., Aspergillus spp., Alternaria spp. and Cladospcrium spp. in the northern China hospital. The least contaminated department was intensive care units, and the heaviest contaminated department was neurosurgery intensive care unit. Seventy-three percent of all surfaces examined in the northern China hospital and eighty-six percent in the southwest China hospital yielded fungi. Fifty-four percent of water samples from the northern China hospital and forty-nine percent from the southwest China hospital yielded fungi. These findings suggested that the fungus exist in the environment of the hospital including air, surface and water. Air and surface fungal load fluctuated over the year. Air fungal load was lower in winter and higher in summer and autumn, but seldom exceeded acceptable level. The higher values were created during

  16. Psychosocial work environment factors and weight change: a prospective study among Danish health care workers.

    Science.gov (United States)

    Gram Quist, Helle; Christensen, Ulla; Christensen, Karl Bang; Aust, Birgit; Borg, Vilhelm; Bjorner, Jakob B

    2013-01-17

    Lifestyle variables may serve as important intermediate factors between psychosocial work environment and health outcomes. Previous studies, focussing on work stress models have shown mixed and weak results in relation to weight change. This study aims to investigate psychosocial factors outside the classical work stress models as potential predictors of change in body mass index (BMI) in a population of health care workers. A cohort study, with three years follow-up, was conducted among Danish health care workers (3982 women and 152 men). Logistic regression analyses examined change in BMI (more than +/- 2 kg/m(2)) as predicted by baseline psychosocial work factors (work pace, workload, quality of leadership, influence at work, meaning of work, predictability, commitment, role clarity, and role conflicts) and five covariates (age, cohabitation, physical work demands, type of work position and seniority). Among women, high role conflicts predicted weight gain, while high role clarity predicted both weight gain and weight loss. Living alone also predicted weight gain among women, while older age decreased the odds of weight gain. High leadership quality predicted weight loss among men. Associations were generally weak, with the exception of quality of leadership, age, and cohabitation. This study of a single occupational group suggested a few new risk factors for weight change outside the traditional work stress models.

  17. Nurses' perceptions of the organizational attributes of their practice environment in acute care hospitals.

    Science.gov (United States)

    Hinno, Saima; Partanen, Pirjo; Vehviläinen-Julkunen, Katri; Aaviksoo, Ain

    2009-12-01

    The aim of the present study was to examine Estonian nurses' thinking with regard to how they perceive their autonomy, control over practice, teamwork and organizational support in regional, central and general hospitals. BACKGROUND; Despite the well-documented fact that there is a need to improve nurses' working environments in hospitals to promote safe patient care, in Europe broader studies on this topic have not received priority thus far. A nationally representative stratified random sample of 478 acute care hospital nurses was surveyed using the Nursing Work Index-Revised (NWI-R) instrument in 2005/2006. Nurses perceived their autonomy, control over practice and organizational support remarkably lower than nurse-physician relationships. Age and tenure were highly related to the nurses' perceptions. The Estonian nurses' ambivalent perceptions of the organizational attributes reflected the effects ascribed to hospital reforms. There is an urgent need for nurse managers to be particularly alert and attentive with regard to nurses who have been practising the profession for more than a decade. Support for their practice should be provided with the long-term goal of assuring the retention of those experienced nurses. Continuous monitoring of nurses' perceptions should be used systematically as a tool for staffing decisions at the hospital level.

  18. Feng shui And Emotional Response in the Critical care Environment (FARCE) study.

    Science.gov (United States)

    Charles, R; Glover, S; Bauchmüller, K; Wood, D

    2017-12-01

    The aim of this study was to investigate the relationship between nursing staff emotions and their surrounding environment, using the ancient system of feng shui. Two orientations of critical care bed spaces (wind and water groups, respectively) were mapped using a western bagua. Energy or 'chi' scores for nine emotions were calculated based on the positive or negative flow of chi in each of the two groups. During a two-week period, nursing staff were allocated to work in a bed space in either the wind or water groups; nursing staff who were not allocated to a study bed space acted as a control group. Participating nursing staff completed a questionnaire, ranking nine emotional states and their overall inner harmony, using a 11-point chi scale. In total, 108 questionnaires were completed. Critical bed space orientation according to feng shui principles was not related to nurse-reported chi scores or inner harmony (p > 0.05 for all measurements). There was also poor correlation between the bagua-predicted and reported chi scores for both the wind and water groups (R 2  = 0.338 and 0.093, respectively). The use of feng shui to guide the layout of critical care bed spaces does not improve the emotional well-being of nursing staff. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  19. Creating trauma-informed correctional care: a balance of goals and environment

    Directory of Open Access Journals (Sweden)

    Niki A. Miller

    2012-03-01

    Full Text Available Background : Rates of posttraumatic stress disorder and exposure to violence among incarcerated males and females in the US are exponentially higher than rates among the general population; yet, abrupt detoxification from substances, the pervasive authoritative presence and sensory and environmental trauma triggers can pose a threat to individual and institutional stability during incarceration. Objective : The authors explore the unique challenges and promises of trauma informed correctional care and suggest strategies for administrative support, staff development, programming and relevant clinical approaches. Method : A review of literature includes a comparison of gendered responses and the implications for men's facilities, and the compatibility of trauma recovery goals and forensic programming goals. Results : Trauma informed care demonstrates promise in increasing offender responsivity to evidence-based cognitive behavioral programming that reduces criminal risk factors and supporting integrated programming for offenders with substance abuse and co-occurring disorders. Conclusions : Incorporating trauma recovery principles into correctional environments requires an understanding of criminal justice priorities, workforce development and specific approaches to screening, assessment and programming that unify the goals of clinical and security staff.

  20. Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

    Science.gov (United States)

    Parro Moreno, Ana; Serrano Gallardo, Pilar; Ferrer Arnedo, Carmen; Serrano Molina, Lucía; de la Puerta Calatayud, M Luisa; Barberá Martín, Aurora; Morales Asencio, José Miguel; de Pedro Gómez, Joan

    2013-11-01

    To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Cross-sectional, analytical, observational study. Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  1. Learning to care for older patients: hospitals and nursing homes as learning environments.

    Science.gov (United States)

    Huls, Marije; de Rooij, Sophia E; Diepstraten, Annemie; Koopmans, Raymond; Helmich, Esther

    2015-03-01

    A significant challenge facing health care is the ageing of the population, which calls for a major response in medical education. Most clinical learning takes place within hospitals, but nursing homes may also represent suitable learning environments in which students can gain competencies in geriatric medicine. This study explores what students perceive as the main learning outcomes of a geriatric medicine clerkship in a hospital or a nursing home, and explicitly addresses factors that may stimulate or hamper the learning process. This qualitative study falls within a constructivist paradigm: it draws on socio-cultural learning theory and is guided by the principles of constructivist grounded theory. There were two phases of data collection. Firstly, a maximum variation sample of 68 students completed a worksheet, giving brief written answers on questions regarding their geriatric medicine clerkships. Secondly, focus group discussions were conducted with 19 purposively sampled students. We used template analysis, iteratively cycling between data collection and analysis, using a constant comparative process. Students described a broad range of learning outcomes and formative experiences that were largely distinct from their learning in previous clerkships with regard to specific geriatric knowledge, deliberate decision making, end-of-life care, interprofessional collaboration and communication. According to students, the nursing home differed from the hospital in three aspects: interprofessional collaboration was more prominent; the lower resources available in nursing homes stimulated students to be creative, and students reported having greater autonomy in nursing homes compared with the more extensive educational guidance provided in hospitals. In both hospitals and nursing homes, students not only learn to care for older patients, but also describe various broader learning outcomes necessary to become good doctors. The results of our study, in particular the

  2. The particular role of the biomass in the use of renewable energies in developing countries to fight against poverty and improve the environment

    International Nuclear Information System (INIS)

    Girard, Ph.; Bal, J.L.; Courillon, M.

    2002-01-01

    The biomass deserves a special place in the energy sector of developing countries, for the following reasons: it constitutes the main source of energy for household supply in many tropical countries; unlike other renewable energies, resource management is essential; the transition from household uses of the biomass towards fossil energies is unavoidable and related to the increasing income of the population and diminishing poverty; the transition will be done through wood carbonization and in the same time, the impact on the forest can be reduced; in order to maintain the place of rural economy and the value of the forest, the transition needs to be done towards modern uses of the energy biomass, which transition will not be done naturally. Those are the aspects discussed in this documents, with the purpose of offering a few leads for a better use of that sector in the fight against poverty in developing countries. (authors)

  3. WORKING ENVIRONMENT AND JOB SATISFACTION AMONG HEALTH PROFESSIONAL WORKING AT A TERTIARY CARE HOSPITAL OF PAKISTAN.

    Science.gov (United States)

    Aziz, Imrana; Kumar, Ramesh; Rathore, Anita; Lal, Manohr

    2015-01-01

    Work environment is believed to be a major factor for better performance of human resource for health in any organization. This study concentrated on multiple factors involved in job satisfaction was appraised to critique their efficient significance in calculation of the health professional liking. Factors included job matched with workers' skills/experience, incentives, supervision, administrator support; convenient work load, training, appreciation, low pay and job protection were major contributors in job satisfaction. A mix method study was done in 2014; an initial descriptive cross sectional survey was done followed by qualitative approach. Eighteen in-depth interviews with health care providers were conducted after taking written consent. Nodes, sub-nodes and final themes were generated during qualitative data analysis. Main findings and themes were, generated after making the nodes and sub-nodes from the most frequent responses. These themes were; absence of work pressure, work place safety, social support, learning opportunities, and employee influence on conditions and recognition individual or team efforts. Work environment is a major contributing factor towards job satisfaction among the health workers.

  4. Pharmaceuticals and personal care products in the aquatic environment in China: a review.

    Science.gov (United States)

    Bu, Qingwei; Wang, Bin; Huang, Jun; Deng, Shubo; Yu, Gang

    2013-11-15

    Pharmaceuticals and personal care products (PPCPs) have been detected as contaminants of emerging concern ubiquitously in the aquatic environment in China and worldwide. A clear picture of PPCP contamination in the Chinese aquatic environment is needed to gain insight for both research and regulatory needs (e.g. monitoring, control and management). The occurrence data of 112 PPCPs in waters and sediments in China has been reviewed. In most cases, the detected concentration of these PPCPs in waters and sediments were at ng/L and ng/g levels, which were lower than or comparable to those reported worldwide. A screening level risk assessment (SLERA) identified six priority PPCPs in surface waters, namely erythromycin, roxithromycin, diclofenac, ibuprofen, salicylic acid and sulfamethoxazole. The results of SLERA also revealed that the hot spots for PPCP pollution were those river waters affected by the megacities with high density of population, such as Beijing, Tianjin, Guangzhou and Shanghai. Limitations of current researches and implications for future research in China were discussed. Some regulatory issues were also addressed. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Physical therapists' perception of workplace ethics in an evolving health-care delivery environment: a cross-sectional survey.

    Science.gov (United States)

    Cantu, Roberto

    2018-03-30

    Physical therapists are trained and obligated to deliver optimal health care and put patients first above all else. In the changing health-care environment, health-care organizations are grappling with controlling cost and increasing revenues. Moral distress may be created when physical therapists' desire to provide optimal care conflicts with their organization's goals to remain financially viable or profitable. Moral distress has been associated with low perception of ethical environment, professional burnout, and high turnover in organizations. This study identified groups who may be vulnerable to low perception of organizational ethical environment and identified self-reported strategies to remedy these perceptions. An ethics environment questionnaire was mailed to a random sample of 1200 physical therapists in Georgia. Respondents (n = 340) were analyzed by age, workplace setting, and position in organization. Therapists working in skilled nursing/assisted living environments scored the lowest on the questionnaire and voiced concerns regarding their ethical work environments. Owners and executives perceived their organizations to be more ethical than front-line clinicians. Respondent concerns included high productivity standards, aggressive coding/billing policies, decreased reimbursement, and increased insurance regulation. Possible solutions included more frequent communication between management and clinicians about ethics, greater professional autonomy, and increased training in business ethics and finance.

  6. Renewable energy prospects for implementation

    CERN Document Server

    Jackson, Tim

    1993-01-01

    Renewable Energy: Prospects for Implementation contains papers that were originally commissioned by the journal Energy Policy for a series on renewable energy appearing between January 1991 to September 1992. In view of the fast-changing demands on conventional energy supply to meet environmental imperatives, it seemed timely to reproduce here a selection of those papers with a new introduction and a revised concluding chapter by the Editor of the series, Dr Tim Jackson, a research fellow with the Stockholm Environment Institute. The book is organized into four parts. The papers in Part I

  7. Fusion fuel and renewables

    International Nuclear Information System (INIS)

    Entler, Slavomir

    2015-01-01

    It is shown that fusion fuel meets all aspects applied when defining renewables. A table of definitions of renewables is presented. The sections of the paper are as follows: An industrial renewable source; Nuclear fusion; Current situation in research; Definitions of renewable sources; Energy concept of nuclear fusion; Fusion fuel; Natural energy flow; Environmental impacts; Fusion fuel assessment; Sustainable power; and Energy mix from renewables. (P.A.)

  8. Developing graduate student competency in providing culturally sensitive end of life care in critical care environments - a pilot study of a teaching innovation.

    Science.gov (United States)

    Northam, Holly L; Hercelinskyj, Gylo; Grealish, Laurie; Mak, Anita S

    2015-11-01

    Australia's immigration policy has generated a rich diverse cultural community of staff and patients in critical care environments. Many different cultural perspectives inform individual actions in the context of critical care, including the highly sensitive area of end of life care, with nurses feeling poorly prepared to provide culturally sensitive end of life care. This article describes and evaluates the effectiveness of an educational innovation designed to develop graduate-level critical care nurses' capacity for effective interpersonal communication, as members of a multi-disciplinary team in providing culturally sensitive end-of-life care. A mixed method pilot study was conducted using a curriculum innovation intervention informed by The Excellence in Cultural Experiential Learning and Leadership Program (EXCELL),(1) which is a higher education intervention which was applied to develop the nurses' intercultural communication skills. 12 graduate nursing students studying critical care nursing participated in the study. 42% (n=5) of the participants were from an international background. Information about students' cultural learning was recorded before and after the intervention, using a cultural learning development scale. Student discussions of end of life care were recorded at Week 2 and 14 of the curriculum. The quantitative data was analysed using descriptive statistical analysis and qualitative data was thematically analysed. Students demonstrated an increase in cultural learning in a range of areas in the pre-post surveys including understandings of cultural diversity, interpersonal skills, cross cultural interactions and participating in multicultural groups. Thematic analysis of the end of life discussions revealed an increase in the levels of nurse confidence in approaching end of life care in critical care environments. The EXCELL program provides an effective and supportive educational framework to increase graduate nurses' cultural learning

  9. The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes.

    Science.gov (United States)

    Real, Kevin; Bardach, Shoshana H; Bardach, David R

    2017-12-01

    Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians ("techs") and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.

  10. Maternal-by-environment but not genotype-by-environment interactions in a fish without parental care.

    Science.gov (United States)

    Vega-Trejo, Regina; Head, Megan L; Jennions, Michael D; Kruuk, Loeske E B

    2018-01-01

    The impact of environmental conditions on the expression of genetic variance and on maternal effects variance remains an important question in evolutionary quantitative genetics. We investigate here the effects of early environment on variation in seven adult life history, morphological, and secondary sexual traits (including sperm characteristics) in a viviparous poeciliid fish, the mosquitofish Gambusia holbrooki. Specifically, we manipulated food availability during early development and then assessed additive genetic and maternal effects contributions to the overall phenotypic variance in adults. We found higher heritability for female than male traits, but maternal effects variance for traits in both sexes. An interaction between maternal effects variance and rearing environment affected two adult traits (female age at maturity and male size at maturity), but there was no evidence of trade-offs in maternal effects across environments. Our results illustrate (i) the potential for pre-natal maternal effects to interact with offspring environment during development, potentially affecting traits through to adulthood and (ii) that genotype-by-environment interactions might be overestimated if maternal-by-environment interactions are not accounted for, similar to heritability being overestimated if maternal effects are ignored. We also discuss the potential for dominance genetic variance to contribute to the estimate of maternal effects variance.

  11. The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review.

    Science.gov (United States)

    Neylon, Samantha; Bulsara, Caroline; Hill, Anne-Marie

    2017-06-01

    To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited. © 2017 AJA Inc.

  12. Dimensions of the local health care environment and use of care by uninsured children in rural and urban areas.

    Science.gov (United States)

    Gresenz, Carole Roan; Rogowski, Jeannette; Escarce, José J

    2006-03-01

    Despite concerted policy efforts, a sizeable percentage of children lack health insurance coverage. This article examines the impact of the health care safety net and health care market structure on the use of health care by uninsured children. We used the Medical Expenditure Panel Survey linked with data from multiple sources to analyze health care utilization among uninsured children. We ran analyses separately for children who lived in rural and urban areas and assessed the effects on utilization of the availability of safety net providers, safety net funding, supply of primary care physicians, health maintenance organization penetration, and the percentage of people who are uninsured, controlling for other factors that influence use. Fewer than half of uninsured children had office-based visits to health care providers during the year, 8% of rural and 10% of urban children visited the emergency department at least once, and just over half of children had medical expenditures or charges during the year. Among uninsured children in rural areas, living closer to a safety net provider and living in an area with a higher supply of primary care physicians were positively associated with higher use and medical expenditures. In urban areas, the supply of primary care physicians and the level of safety net funding were positively associated with uninsured children's medical expenditures, whereas the percentage of the population that was uninsured was negatively associated with use of the emergency department. Uninsured children had low levels of utilization over a range of different health care provider types and settings. The availability of safety net providers in the local area and the safety net's capacity to serve the uninsured influence access to care among children. Possible measures for ensuring access to health care among uninsured children include increasing the density of safety net providers in rural areas, enhancing funding for the safety net, and policies

  13. Relationships between work outcomes, work attitudes and work environments of health support workers in Ontario long-term care and home and community care settings.

    Science.gov (United States)

    Berta, Whitney; Laporte, Audrey; Perreira, Tyrone; Ginsburg, Liane; Dass, Adrian Rohit; Deber, Raisa; Baumann, Andrea; Cranley, Lisa; Bourgeault, Ivy; Lum, Janet; Gamble, Brenda; Pilkington, Kathryn; Haroun, Vinita; Neves, Paula

    2018-03-22

    Our overarching study objective is to further our understanding of the work psychology of Health Support Workers (HSWs) in long-term care and home and community care settings in Ontario, Canada. Specifically, we seek novel insights about the relationships among aspects of these workers' work environments, their work attitudes, and work outcomes in the interests of informing the development of human resource programs to enhance elder care. We conducted a path analysis of data collected via a survey administered to a convenience sample of Ontario HSWs engaged in the delivery of elder care over July-August 2015. HSWs' work outcomes, including intent to stay, organizational citizenship behaviors, and performance, are directly and significantly related to their work attitudes, including job satisfaction, work engagement, and affective organizational commitment. These in turn are related to how HSWs perceive their work environments including their quality of work life (QWL), their perceptions of supervisor support, and their perceptions of workplace safety. HSWs' work environments are within the power of managers to modify. Our analysis suggests that QWL, perceptions of supervisor support, and perceptions of workplace safety present particularly promising means by which to influence HSWs' work attitudes and work outcomes. Furthermore, even modest changes to some aspects of the work environment stand to precipitate a cascade of positive effects on work outcomes through work attitudes.

  14. Using Bacteria to Store Renewable Energy (Text Version) | News | NREL

    Science.gov (United States)

    Using Bacteria to Store Renewable Energy (Text Version) Using Bacteria to Store Renewable Energy is a text version of the video entitled "Using Bacteria to Store Renewable Energy." ; Bacteria from some of the Earth's harshest environments now have a new home at NREL. [A natural spring has

  15. Renewable energies and public policies; Energies renouvelables et politiques publiques

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    This report presents the full texts of the allocution delivered during the colloquium on the renewable energies and the public policies. It takes stock on the strategical environment and the political will of the renewable energies, the tracks of development in France and the necessity of a law on the renewable energies. (A.L.B.)

  16. 40 CFR 73.26 - Conservation and renewable energy reserve.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Conservation and renewable energy... renewable energy reserve. The Administrator will allocate 300,000 allowances to the Conservation and Renewable Energy Reserve subaccount of the Acid Rain Data System. Allowances from this Reserve will be...

  17. Using resource dependency theory to measure the environment in health care organizational studies: a systematic review of the literature.

    Science.gov (United States)

    Yeager, Valerie A; Menachemi, Nir; Savage, Grant T; Ginter, Peter M; Sen, Bisakha P; Beitsch, Leslie M

    2014-01-01

    Studies using the resource dependency theory (RDT) perspective commonly focus on one or more of the following environmental dimensions: munificence, dynamism, and complexity. To date, no one has reviewed the use of this theory in the health care management literature and there exists no consensus on how to operationalize the market environment in health care settings. The purpose of this review is to examine and summarize the ways in which RDT has been applied in empirical studies of the external environments of health care organizations. In so doing, we identify gaps in the literature and examine the extent to which previous empirical findings aligned with hypothesized relationships based on RDT. We conducted a systematic review of the peer-reviewed literature using a bibliographic search of PubMed and ABI/Inform databases. To identify all health care studies that incorporated the RDT perspective, the words "healthcare" or "health care" were searched in combination with any of the following words: resource dependency theory, uncertainty perspective, environment, munificence, dynamism, and complexity. We also performed a hand search of the reference lists of all manuscripts identified in the initial search to identify additional articles. Twenty studies were included in this review. Wide variability existed in the number of variables used to measure the environment, the environmental constructs measured, and the specific variables used to operationalizethe environmental constructs. Of the 198 tests examining the relationship between environmental variables and the outcome of interest, 26.8% resulted in findings that supported the RDT-predicted hypotheses. The RDT literature is limited to studies of hospitals, nursing homes, and medical practices. There is little consensus on how to measure or operationalize the environment in these studies. No previous studies have measured the environment for other health care settings such as ambulatory surgery centers, public

  18. The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

    Science.gov (United States)

    Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

    2013-10-25

    A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster

  19. The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia.

    Science.gov (United States)

    Zapata-Diomedi, Belen; Herrera, Ana Maria Mantilla; Veerman, J Lennert

    2016-11-01

    Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Nurses' Perceptions of Pediatric Intensive Care Unit Environment and Work Experience After Transition to Single-Patient Rooms.

    Science.gov (United States)

    Kudchadkar, Sapna R; Beers, M Claire; Ascenzi, Judith A; Jastaniah, Ebaa; Punjabi, Naresh M

    2016-09-01

    The architectural design of the pediatric intensive care unit may play a major role in optimizing the environment to promote patients' sleep while improving stress levels and the work experience of critical care nurses. To examine changes in nurses' perceptions of the environment of a pediatric critical care unit for promotion of patients' sleep and the nurses' work experience after a transition from multipatient rooms to single-patient rooms. A cross-sectional survey of nurses was conducted before and after the move to a new hospital building in which all rooms in the pediatric critical care unit were single-patient rooms. Nurses reported that compared with multipatient rooms, single-patient private rooms were more conducive to patients sleeping well at night and promoted a more normal sleep-wake cycle (P noise in single-patient rooms (33%) than in multipatient rooms (79%; P pediatric intensive care unit environment for promoting patients' sleep and the nurses' own work experience. ©2016 American Association of Critical-Care Nurses.

  1. Deploying Renewables -- principles for effective policies

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-09-29

    Renewable energy can play a fundamental role in tackling climate change, environmental degradation and energy security. As these challenges have become ever more pressing, governments and markets are seeking innovative solutions. Yet, what are the key factors that will determine the success of renewable energy policies? How can current policies be improved to encourage greater deployment of renewables? What impact can more effective policies have on renewables' share in the future global energy mix and how soon? This publication addresses these questions. Responding to the Gleneagles G8 call for a clean and secure energy future, it highlights key policy tools to fast-track renewables into the mainstream. This analysis illustrates good practices by applying the combined metrics of effectiveness and efficiency to renewable energy policies in the electricity, heating and transport sectors. It highlights significant barriers to accelerating renewables penetration, and argues that the great potential of renewables can be exploited much more rapidly and to a much larger extent if good practices are adopted. Carefully designed policy frameworks, customised to support technologies at differing stages of maturity, will deliver a strong portfolio of renewable energy technologies. The document provides recommendations on key principles for policy design as a template for decision makers.

  2. Development of a Physical Environmental Observational Tool for Dining Environments in Long-Term Care Settings.

    Science.gov (United States)

    Chaudhury, Habib; Keller, Heather; Pfisterer, Kaylen; Hung, Lillian

    2017-11-10

    This paper presents the first standardized physical environmental assessment tool titled Dining Environment Audit Protocol (DEAP) specifically designed for dining spaces in care homes and reports the results of its psychometric properties. Items rated include: adequacy of lighting, glare, personal control, clutter, staff supervision support, restraint use, and seating arrangement option for social interaction. Two scales summarize the prior items and rate the overall homelikeness and functionality of the space. Ten dining rooms in three long-term care homes were selected for assessment. Data were collected over 11 days across 5 weeks. Two trained assessors completed DEAP independently on the same day. Interrater-reliability was completed for lighting, glare, space, homelike aspects, seating arrangements and the two summary scales, homelikeness and functionality of the space. For categorical measures, measure responses were dichotomized at logical points and Cohen's Kappa and concordance on ratings were determined. The two overall rating scales on homelikeness and functionality of space were found to be reliable intraclass correlation coefficient (ICC) (~0.7). The mean rating for homelikeness for Assessor 1 was 3.5 (SD 1.35) and for functionality of the room was 5.3. (SD 0.82; median 5.5). The findings indicate that the tool's interrater-reliability scores are promising. The high concordance on the overall scores for homelikeness and functionality is indicative of the strength of the individual items in generating a reliable global assessment score on these two important aspects of the dining space. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. [Radiology in managed care environment: opportunities for cost savings in an HMO].

    Science.gov (United States)

    Schmidt, C; Mohr, A; Möller, J; Levin-Scherz, J; Heller, M

    2003-09-01

    A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these

  4. Radiology in managed care environment: Opportunities for cost savings in an HMO

    International Nuclear Information System (INIS)

    Schmidt, C.; Heller, M.

    2003-01-01

    Purpose: A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. Materials and methods: We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were documented in Microsoft Excel trademark and analyzed by non-parametric tests using SPSS trademark 8.0 (Statistical Package for the Social Sciences) for Windows trademark . Results: The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. (orig.) [de

  5. Renewable target in sight

    International Nuclear Information System (INIS)

    Anon

    2000-01-01

    Australia's renewable energy industry is expecting several billion dollars of investment over the next 10 years following passage in December last year of the Renewable Energy Electricity) Act 2000 through Federal Parliament. The Act requires an additional 9500GWh of Australia's electricity production to be sourced from renewables by the year 2010. It also establishes a market for the 'green' component of the energy separate from the electricity itself, through a Renewable Energy Certificate (REC), whereby an accredited generator of renewable energy is able to issue one REC for each megawatt-hour of renewable energy generated

  6. Renewable energy annual 1996

    International Nuclear Information System (INIS)

    1997-03-01

    This report presents summary data on renewable energy consumption, the status of each of the primary renewable technologies, a profile of each of the associated industries, an analysis of topical issues related to renewable energy, and information on renewable energy projects worldwide. It is the second in a series of annual reports on renewable energy. The renewable energy resources included in the report are biomass (wood and ethanol); municipal solid waste, including waste-to-energy and landfill gas; geothermal; wind; and solar energy, including solar thermal and photovoltaic. The report also includes various appendices and a glossary

  7. Renewable energy annual 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    This report presents summary data on renewable energy consumption, the status of each of the primary renewable technologies, a profile of each of the associated industries, an analysis of topical issues related to renewable energy, and information on renewable energy projects worldwide. It is the second in a series of annual reports on renewable energy. The renewable energy resources included in the report are biomass (wood and ethanol); municipal solid waste, including waste-to-energy and landfill gas; geothermal; wind; and solar energy, including solar thermal and photovoltaic. The report also includes various appendices and a glossary.

  8. Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencing.

    Science.gov (United States)

    Price, James R; Cole, Kevin; Bexley, Andrew; Kostiou, Vasiliki; Eyre, David W; Golubchik, Tanya; Wilson, Daniel J; Crook, Derrick W; Walker, A Sarah; Peto, Timothy E A; Llewelyn, Martin J; Paul, John

    2017-02-01

    Health-care workers have been implicated in nosocomial outbreaks of Staphylococcus aureus, but the dearth of evidence from non-outbreak situations means that routine health-care worker screening and S aureus eradication are controversial. We aimed to determine how often S aureus is transmitted from health-care workers or the environment to patients in an intensive care unit (ICU) and a high-dependency unit (HDU) where standard infection control measures were in place. In this longitudinal cohort study, we systematically sampled health-care workers, the environment, and patients over 14 months at the ICU and HDU of the Royal Sussex County Hospital, Brighton, England. Nasal swabs were taken from health-care workers every 4 weeks, bed spaces were sampled monthly, and screening swabs were obtained from patients at admission to the ICU or HDU, weekly thereafter, and at discharge. Isolates were cultured and their whole genome sequenced, and we used the threshold of 40 single-nucleotide variants (SNVs) or fewer to define subtypes and infer recent transmission. Between Oct 31, 2011, and Dec 23, 2012, we sampled 198 health-care workers, 40 environmental locations, and 1854 patients; 1819 isolates were sequenced. Median nasal carriage rate of S aureus in health-care workers at 4-weekly timepoints was 36·9% (IQR 35·7-37·3), and 115 (58%) health-care workers had S aureus detected at least once during the study. S aureus was identified in 8-50% of environmental samples. 605 genetically distinct subtypes were identified (median SNV difference 273, IQR 162-399) at a rate of 38 (IQR 34-42) per 4-weekly cycle. Only 25 instances of transmission to patients (seven from health-care workers, two from the environment, and 16 from other patients) were detected. In the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct

  9. The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

    Science.gov (United States)

    2013-01-01

    Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be

  10. The importance of management information systems in a managed care environment.

    Science.gov (United States)

    Porro, M R; Brill, K R

    1995-06-01

    Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up.

  11. [Health care strategies for mental health problems in the prison environment, the Spanish case in a European context].

    Science.gov (United States)

    Arroyo-Cobo, J M

    2011-01-01

    A review was carried out of scientific literature on health care strategies for mental health problems in the prison environment. Data is given about the main activities put into practice by prison administrations as a response to the worrying information that has come to light in recent epidemiological studies on mental disorders in prison, with figures that, when compared to the general population, give results of double the number of cases of Common Mental Illness (CMI) and four times the number of cases of Severe Mental Illness (SMI) amongst prison inmates. A review was made of the most important bibliographical databases containing health care policies for mental health problems in prison published by prison administrations in the last 10 years. This information was completed with other data obtained from an analysis of the indicators available in Health Care Coordination on its health care strategies for mental health in centres run by the Secretary General of Prisons, in Spain. There is little in the way of scientific literature that clearly states health care policies for mental illness in the prison environment. Those that do tend to agree with a number of affirmations that include the obligation to offer a therapeutic response of equal quality to that received by patients in the community, the need for a multi-disciplinary team responsible for caring for this type of patient, along with a coordinated effort between the medical, social, legal and prison administrations that at a given time have to care for them.

  12. The renewable energy development framework - II. The foundations of renewable energy development: Economic foundations of renewable energies; International foundations of renewable energies; European foundations of renewable energy development; Foundations of renewable energy development in internal law

    International Nuclear Information System (INIS)

    Combes Motel, Pascale; Thebaut, Matthieu; Loic Grard; Michallet, Isabelle

    2012-01-01

    A first article analysis the reasons for the development of renewable energies (economic and environmental reasons, European commitments in terms of production objectives), how these renewable energies can be developed (acceptation by the population, administrative, technological, and financial constraints, political instruments related to market, taxes and purchase prices). A second article proposes a discussion about the way international law deals with renewable energies as far as texts as well as actors are concerned. The third article describes the European ambitions regarding renewable energies as a product of national perspectives (national action plans and projects) as well as of European perspectives (financing, integrated actions). The last article presents and comments various legal texts dealing with the development of renewable energies in France (texts concerning the right to energy, the environment law, planning tools, incentive measures)

  13. Best practices: an electronic drug alert program to improve safety in an accountable care environment.

    Science.gov (United States)

    Griesbach, Sara; Lustig, Adam; Malsin, Luanne; Carley, Blake; Westrich, Kimberly D; Dubois, Robert W

    2015-04-01

    The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events. Once the medication safety concern is identified, it is reviewed to evaluate whether an alert warrants sending prescribers a communication that identifies individual patients or a general communication to all physicians describing the safety concern. Instead of basing its decisions regarding clinician notification about drug alerts on subjective criteria, the Marshfield Clinic's DSAP uses an internally developed scoring system. The scoring system includes criteria developed from previous drug alerts, such as level of evidence, size of population affected, severity of adverse event identified or targeted, litigation risk, available alternatives, and potential for duration of medication use. Each of the 6 criteria is assigned a weight and is scored based upon the content and severity of the alert received.  In its first 12 months, the program targeted 6 medication safety concerns involving the following medications: topiramate, glyburide, simvastatin, citalopram, pioglitazone, and lovastatin. Baseline and follow-up prescribing data were gathered on the targeted medications. Follow-up review of prescribing data demonstrated that the DSAP provided quality up-to-date safety information that led to changes in drug therapy and to decreases in potential adverse drug events. In aggregate, nearly 10,000 total

  14. The physical environment and patients' activities and care: A comparative case study at three newly built stroke units.

    Science.gov (United States)

    Anåker, Anna; von Koch, Lena; Sjöstrand, Christina; Heylighen, Ann; Elf, Marie

    2018-04-20

    To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. This work is a comparative descriptive case study. Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  15. Financing renewable energy: Obstacles and solutions

    Energy Technology Data Exchange (ETDEWEB)

    Brown, M.H.

    1994-06-01

    The majority of renewable energy technology projects now being developed use long term project financing to raise capital. The financial community scrutinizes renewables more closely than some conventionally fueled electric generation facilities because it perceives renewables as risky and expensive. Renewables pay for this perceived risk through higher interest charges and other more restrictive loan covenants. Risks that are not eliminated in the power sales agreement or through some other means generally result in higher project costs during financing. In part, this situation is a product of the private placement market and project finance process in which renewable energy facilities must function. The project finance process attracts banks and institutional lenders as well as equity investors (often pension funds) who do not want to place their capital at great risk. Energy project finance exists on the basis of a secure revenue stream and a thorough understanding of electric generation technology. Renewables, like all energy projects, operating in uncertain regulatory environments are often difficult to finance. In the uncertain regulatory environment in which renewables now operate, investors and lenders are nervous about challenges to existing contracts between independent power producers and utilities. Challenges to existing contracts could foretell challenges to contracts in the future. Investors and lenders now look to state regulatory environments as an indicator of project risk. Renewable energy technology evolves quickly. Yet, often the information about technological evolution is not available to those who invest in the energy projects. Or, those who have invested in new renewable energy technology in the past have lost money and are nervous about doing so in the future - even though technology may have improved. Inadequate or unfavorable information is a barrier to the development of renewables.

  16. How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

    Science.gov (United States)

    2014-01-01

    Background Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. Methods A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. Results The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. Conclusions According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and

  17. Issues - I. Renewable energies and urban planning law - Urban planning law and renewable energies: I love you, neither I

    International Nuclear Information System (INIS)

    Gregory Kalfleche

    2012-01-01

    After having noticed that fossil energies must still be used beside renewable energies, and that renewable energies have some negative impacts on landscape and on the environment, the author highlights the fact that the French urban planning law gives a strong support to small renewable energy production units. In a second part, he shows that despite a commitment for the development of renewable energies, urban planning law mostly remains a constraint as far as the development of large units is concerned

  18. Marine Renewable Energy Seascape

    Directory of Open Access Journals (Sweden)

    Alistair G.L. Borthwick

    2016-03-01

    Full Text Available Energy production based on fossil fuel reserves is largely responsible for carbon emissions, and hence global warming. The planet needs concerted action to reduce fossil fuel usage and to implement carbon mitigation measures. Ocean energy has huge potential, but there are major interdisciplinary problems to be overcome regarding technology, cost reduction, investment, environmental impact, governance, and so forth. This article briefly reviews ocean energy production from offshore wind, tidal stream, ocean current, tidal range, wave, thermal, salinity gradients, and biomass sources. Future areas of research and development are outlined that could make exploitation of the marine renewable energy (MRE seascape a viable proposition; these areas include energy storage, advanced materials, robotics, and informatics. The article concludes with a sustainability perspective on the MRE seascape encompassing ethics, legislation, the regulatory environment, governance and consenting, economic, social, and environmental constraints. A new generation of engineers is needed with the ingenuity and spirit of adventure to meet the global challenge posed by MRE.

  19. Analysis of Nature and Technique representations in the energy sector in France and in the United Kingdom: Study and symbolic comparison of the Man relation to His environment in the nuclear energy and in the renewable energy

    International Nuclear Information System (INIS)

    Guerin, Dalya

    2013-01-01

    This thesis is dealing with the reality of an environmental utopia of cooperation between Nature and Technique in the energy sector, in the renewables in the United-Kingdom and in the nuclear energy in France. In a first part, we have established that energy systems, through cooperation projects between Nature and Technique, offered an interesting map of the competition, and more and more of the cooperation, between Nature and Technique in the studied discourses and practices, and especially in France. The second part of this work was about to show to what extent any resistances to these visions of Nature and Technique were stronger in France rather than in the United-Kingdom, because these visions, as we have seeing in the first part, were more explicit in France. In the last part of this research, the aim was to demonstrate to what extent these representations of Nature and Technique cooperating meant the meeting of technological ideologies, belonging to the energy field, and of utopian visions of environment. We managed to show that, in the United-Kingdom, this utopian vision of the environment was more understood as a chance for energy actors in a project of a wave power plant, instead of France, where these utopian visions of the environment were a threat for the technological ideology, embodied by the nuclear energy. (author)

  20. Trends in nutrition and exercise counseling among adolescents in the health care environment.

    Science.gov (United States)

    Peart, Tasha; Crawford, Patricia B

    2012-01-01

    Obesity is a serious health threat, particularly among racial/ethnic minorities and those who are uninsured, yet little is known about the implementation of nutrition or exercise counseling or the combination of both among these groups. Trends in counseling by race/ethnicity and types of insurance were examined. Trend analyses were conducted with the California Health Interview Surveys among those ages 12-17 for the period 2003-2009. Race/Ethnicity: Receipt of both counseling methods declined from 2003-2009 for all racial/ethnic groups, except Hispanics and Whites, for whom increases in counseling began after 2007. Hispanics and African Americans generally reported higher levels of nutrition than exercise counseling, while Whites generally reported higher levels of exercise than nutrition counseling for the study period. INSURANCE TYPE: Receipt of both counseling methods appeared to decline from 2003-2009 among all insurance types, although after 2007, a slight increase was observed for the low-cost/free insurance group. Those with private health insurance generally received more exercise counseling than nutrition counseling over the study period. Counseling among all racial/ethnic groups and insurance types is warranted, but particularly needed for African Americans, American Indian/Alaska Natives, and the uninsured as they are at highest risk for developing obesity. Institutional and policy changes in the health care environment will be beneficial in helping to promote obesity-related counseling.

  1. Pharmaceuticals and Personal Care Products in Municipal Wastewater and the Marine Receiving Environment Near Victoria Canada

    Directory of Open Access Journals (Sweden)

    Jeremy Krogh

    2017-12-01

    Full Text Available Concerns over the fate of pharmaceuticals and personal care products (PPCP within the environment have been growing with the advent of more precise analytical methods. The discharge of municipal wastewater has been identified as a significant source of these contaminants, particularly where wastewater treatment is minimal. Here we present results from a comprehensive monitoring regime located around Victoria, BC, Canada. Samples were collected between 2009 and 2016 from a variety of sources including marine water, sediment and biota adjacent to two major untreated sewage outfalls, as well as the sewage itself. PPCP concentrations within the untreated sewage were high, and the sediment surrounding the outfalls showed corresponding contamination. However, this contamination dropped quickly with distance from the outfall such that by 800 m distance most PPCPs were below detection limits. Tissue samples of resident Northern Horse mussels (Modiolus modiolus collected adjacent to one of the major sewage outfalls showed high single sample concentrations of the antimicrobial triclosan (317 ng g−1 dry weight, the antibiotic ciprofloxacin (176 ng g−1 dry weight, as well as the antidepressant sertraline (84.1 ng g−1 dry weight. Reference stations from around the region showed very low concentrations of contamination with almost all PPCP concentrations being below detection limits. Within the sewage, concentrations were largely stable overtime, with the exception of triclosan and triclocarban which both showed declines over the study period.

  2. The evolutionary puzzle of egg size, oxygenation and parental care in aquatic environments.

    Science.gov (United States)

    Braga Goncalves, Ines; Ahnesjö, Ingrid; Kvarnemo, Charlotta

    2015-08-22

    Offspring fitness generally improves with increasing egg size. Yet, eggs of most aquatic organisms are small. A common but largely untested assumption is that larger embryos require more oxygen than they can acquire through diffusion via the egg surface, constraining egg size evolution. However, we found no detrimental effects of large egg size on embryo growth and survival under hypoxic conditions. We tested this in the broad-nosed pipefish, Syngnathus typhle, whose males provide extensive care (nourishment, osmoregulation and oxygenation) to their young in a brood pouch on their bodies. We took advantage of this species' pronounced variation in egg size, correlating positively with female size, and tested the effect of hypoxia (40% dissolved oxygen) versus fully oxygenated (100%) water on embryo size and survival of large versus small eggs after 18 days of paternal brooding. Egg size did not affect embryo survival, regardless of O2 treatment. While hypoxia affected embryo size negatively, both large and small eggs showed similar reductions in growth. Males in hypoxia ventilated more and males with large eggs swam more, but neither treatment affected their position in the water column. Overall, our results call into question the most common explanation for constrained egg size evolution in aquatic environments. © 2015 The Author(s).

  3. Relationship marketing of health care plans: retaining corporate customers in a competitive environment.

    Science.gov (United States)

    Choong, P

    2000-01-01

    Corporate employers have become major purchasers of health care. They are gatekeepers who decide whether to retain or drop an insurance company from the choice set offered to employees as well as whether to include new insurers into this choice set. If marketers of health maintenance organizations are to maintain their market share in this competitive environment, they need to understand issues considered important to corporate employers. This paper identifies the key drivers of satisfaction among corporate employers and shows the impact these key drivers have on overall satisfaction. More importantly, it demonstrates both theoretically and empirically that the impact of performance attributes on satisfaction is asymmetrical. Positive performances of attributes are shown to have smaller impacts on satisfaction than negative performances. The theoretical underpinnings of these phenomena are shown to lie in prospect theory. Finally, quantitative indicators are computed to aid managerial decision-making. Marketing managers of health insurance companies will optimize returns on their investment by understanding this asymmetric effect and eliminate existing deficiencies.

  4. Trends in Nutrition and Exercise Counseling among Adolescents in the Health Care Environment

    Directory of Open Access Journals (Sweden)

    Tasha Peart

    2012-01-01

    Full Text Available Purpose. Obesity is a serious health threat, particularly among racial/ethnic minorities and those who are uninsured, yet little is known about the implementation of nutrition or exercise counseling or the combination of both among these groups. Trends in counseling by race/ethnicity and types of insurance were examined. Methods. Trend analyses were conducted with the California Health Interview Surveys among those ages 12–17 for the period 2003–2009. Results. Race/Ethnicity: Receipt of both counseling methods declined from 2003–2009 for all racial/ethnic groups, except Hispanics and Whites, for whom increases in counseling began after 2007. Hispanics and African Americans generally reported higher levels of nutrition than exercise counseling, while Whites generally reported higher levels of exercise than nutrition counseling for the study period. Insurance Type: Receipt of both counseling methods appeared to decline from 2003–2009 among all insurance types, although after 2007, a slight increase was observed for the low-cost/free insurance group. Those with private health insurance generally received more exercise counseling than nutrition counseling over the study period. Conclusions. Counseling among all racial/ethnic groups and insurance types is warranted, but particularly needed for African Americans, American Indian/Alaska Natives, and the uninsured as they are at highest risk for developing obesity. Institutional and policy changes in the health care environment will be beneficial in helping to promote obesity-related counseling.

  5. Renewable Energy Certificates (RECs)

    Science.gov (United States)

    Renewable Energy Certificates (RECs), are tradable, non-tangible energy commodities in the United States that represent proof that 1 megawatt-hour (MWh) of electricity was generated from an eligible renewable energy resource.

  6. Online driver's license renewal.

    Science.gov (United States)

    2015-09-01

    The Kentucky Department of Vehicle Regulation is exploring the possibility of developing and implementing online : drivers license renewal. The objective of this project was to: 1) evaluate online drivers license and REAL ID renewal : programs ...

  7. Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System.

    Science.gov (United States)

    Moreno-Casbas, María Teresa; Alonso-Poncelas, Emma; Gómez-García, Teresa; Martínez-Madrid, María José; Escobar-Aguilar, Gema

    2018-03-19

    To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  8. Effects of Home Environment and Center-Based Child Care Quality on Children's Language, Communication, and Literacy Outcomes

    Science.gov (United States)

    Pinto, Ana Isabel; Pessanha, Manuela; Aguiar, Cecilia

    2013-01-01

    This study examined the joint effects of home environment and center-based child care quality on children's language, communication, and early literacy development, while also considering prior developmental level. Participants were 95 children (46 boys), assessed as toddlers (mean age = 26.33 months; Time 1) and preschoolers (mean age = 68.71…

  9. Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

    Science.gov (United States)

    Spence Laschinger, Heather K; Fida, Roberta

    2015-05-01

    A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

  10. Environment-related health disorders. Experience and perspectives in the care of patients with environment-related health disorders; Umweltbezogene Gesundheitsstoerungen. Erfahrungen und Perspektiven umweltmedizinischer Patientenversorgung

    Energy Technology Data Exchange (ETDEWEB)

    Hornberg, C.; Malsch, A.K.F. [Bielefeld Univ. (Germany); Weissbach, W. [Universitaetsklinikum Aachen (Germany); Wiesmueller, G.A.

    2004-08-15

    Environmental medicine outpatient clinics, counseling centers, and practicing physicians have observed environment-related health disorders in patient groups of mixed age as well as for groups consisting only of adults or children. Practicing physicians suspected correlations between environmental factors and health disorders in 36-45% of cases, environmental medicine outpatient clinics and counseling centers in 4-34% for mixed-age groups, 0-24% for adults, and 9-13% for children. A comparison of these data is difficult due to differences in data acquisition, evaluation methods, and descriptive statistics used. Furthermore, data on children are insufficient. Patient-oriented environmental medicine faces a number of problems regarding determination of exposure, effects, and susceptibility, including a lack of scientifically verified cause-and-effect models as well as incorrect diagnoses, attributions, and conclusions. In view of the scope and intensity of environment-related health disorders, the topic cannot be ignored. A functioning program of environmental medicine counseling and patient care is needed for practicing physicians, universities and/or the public sector to deliver effective primary medical care in this field. As always, the building blocks of environmental medicine counseling are medical history, physical examination, differential diagnosis, human biomonitoring, and on-site inspection with environmental monitoring while also taking gender differences into account. Uniform basic documentation procedures and health science analyses will help to optimize patient care in environmental medicine. The value of a diagnostic algorithm in the care of patients with environment-related health disorders is beyond dispute. Last but not least, quality assurance and control are a sine qua non of patient-oriented environmental medicine. (orig.)

  11. Influence of Maternal Care on Behavioural Development of Domestic Dogs (Canis Familiaris Living in a Home Environment

    Directory of Open Access Journals (Sweden)

    Giovanna Guardini

    2017-12-01

    Full Text Available Maternal care has been shown to affect the development of the brain, behaviour, social skills and emotional systems of the young of many mammalian species including dogs. The aim of the present study was to determine the effects of maternal care on the behavioural responses of family dog puppies towards environmental and social stimuli. In order to do this, maternal care (licking puppy’s ano-genital area, licking the puppy, nursing and mother-puppy contact during the first three weeks after birth was assessed in 12 litters of domestic dog puppies reared in home environments (total = 72 puppies. The behavioural responses of puppies were assessed in an arena and an isolation test, which were performed when the puppies were two-month old. Data were analysed using principal components analysis and projection to latent structures regression. A systematic relationship was found between maternal care and behaviour in both tests. In the arena test, maternal care was found to be positively associated with approach to the stranger, attention oriented to the stranger, time spent near the enclosure, yawning, whining and yelping (R2Y = 0.613, p = 8.2 × 10−9. Amount of maternal care was negatively associated with the number of squares crossed and the time spent individually playing with the rope. In the isolation test, the amount of maternal care was positively associated with standing posture, paw lifting, and howling, and it was negatively associated with yawning, lying down and nose licking (R2Y = 0.507, p = 0.000626. These results suggest that the amount of maternal care received during early life influences the pattern of behavioural responses and coping strategies of puppies at two-months of age. On the basis of these findings it could be speculated that early maternal care contributes to adaption to the environment in which family puppies are developing, with particular regard to social relationships with people.

  12. Influence of Maternal Care on Behavioural Development of Domestic Dogs (Canis Familiaris) Living in a Home Environment.

    Science.gov (United States)

    Guardini, Giovanna; Bowen, Jon; Mariti, Chiara; Fatjó, Jaume; Sighieri, Claudio; Gazzano, Angelo

    2017-12-05

    Maternal care has been shown to affect the development of the brain, behaviour, social skills and emotional systems of the young of many mammalian species including dogs. The aim of the present study was to determine the effects of maternal care on the behavioural responses of family dog puppies towards environmental and social stimuli. In order to do this, maternal care (licking puppy's ano-genital area, licking the puppy, nursing and mother-puppy contact) during the first three weeks after birth was assessed in 12 litters of domestic dog puppies reared in home environments (total = 72 puppies). The behavioural responses of puppies were assessed in an arena and an isolation test, which were performed when the puppies were two-month old. Data were analysed using principal components analysis and projection to latent structures regression. A systematic relationship was found between maternal care and behaviour in both tests. In the arena test, maternal care was found to be positively associated with approach to the stranger, attention oriented to the stranger, time spent near the enclosure, yawning, whining and yelping (R²Y = 0.613, p = 8.2 × 10 -9 ). Amount of maternal care was negatively associated with the number of squares crossed and the time spent individually playing with the rope. In the isolation test, the amount of maternal care was positively associated with standing posture, paw lifting, and howling, and it was negatively associated with yawning, lying down and nose licking (R²Y = 0.507, p = 0.000626). These results suggest that the amount of maternal care received during early life influences the pattern of behavioural responses and coping strategies of puppies at two-months of age. On the basis of these findings it could be speculated that early maternal care contributes to adaption to the environment in which family puppies are developing, with particular regard to social relationships with people.

  13. Resilient Renewable Energy Microgrids

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Katherine H [National Renewable Energy Laboratory (NREL), Golden, CO (United States); DiOrio, Nicholas A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Butt, Robert S [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Cutler, Dylan S [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Richards, Allison [Unaffiliated

    2017-11-14

    This presentation for the Cable-Tec Expo 2017 offers information about how renewable microgrids can be used to increase resiliency. It includes information about why renewable energy battery diesel hybrids microgrids should be considered for backup power, how to estimate economic savings of microgrids, quantifying the resiliency gain of microgrids, and where renewable microgrids will be successful.

  14. Nurses' Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai.

    Science.gov (United States)

    Wang, Ying; Dong, Weizhen; Mauk, Kristen; Li, Peiying; Wan, Jin; Yang, Guang; Fang, Lyuying; Huan, Wan; Chen, Chun; Hao, Mo

    2015-01-01

    To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction. China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area. A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests. The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494). Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

  15. Nurses' Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai.

    Directory of Open Access Journals (Sweden)

    Ying Wang

    Full Text Available To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction.China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area.A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests.The average overall IWS (part B score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494.Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

  16. Nurses’ Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai

    Science.gov (United States)

    Wang, Ying; Dong, Weizhen; Mauk, Kristen; Li, Peiying; Wan, Jin; Yang, Guang; Fang, Lyuying; Huan, Wan; Chen, Chun; Hao, Mo

    2015-01-01

    Aim To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses’ job satisfaction. Background China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses’ working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses’ job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area. Methods A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests. Results The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494). Conclusion Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved. PMID:26380980

  17. Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

    Science.gov (United States)

    Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

    2018-05-09

    In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

  18. The Relationship between Prenatal Care, Personal Alcohol Abuse and Alcohol Abuse in the Home Environment

    Science.gov (United States)

    Grekin, Emily R.; Ondersma, Steven J.

    2009-01-01

    Aims: Nearly one-fourth of African-American women receive no prenatal care during the first trimester of pregnancy. The aim of the current study is to identify factors that underlie inadequate prenatal care among African-American women. Maternal alcohol abuse has been examined as one risk factor for inadequate prenatal care, but findings have been…

  19. The Application of Virtual Intensive Care Unit Principles in the Aeromedical Evacuation Environment Can Improve Patient Safety, Lead to Better Patient Outcomes and Deliver Integrated Medical Care

    Science.gov (United States)

    2016-02-01

    hospital environment. Delivery of care to multiple patients of varying acuities in a confined space, multitasking , time urgency, long duty hours, complex... pilot alerts your team that the maximum time on the ground to retrieve the patients is 30 minutes due to hostilities in the area. As you arrive at...minute window the pilot gave you. Immediately your team divides up and beings to prepare each patient for flight. You spend the entire time prepping the

  20. Mapping of renewable energies

    International Nuclear Information System (INIS)

    Boulanger, V.

    2013-01-01

    Germany is the champion of green energy in Europe: the contribution of renewable energies to electricity generation reached about 20% in 2011. This article describes the situation of renewable energies in Germany in 2011 with the help of 2 maps, the first one gives the installed electrical generation capacity for each region and for each renewable energy source (wind power, hydro-electricity, biomass, photovoltaic energy and biogas) and the second one details the total number of jobs (direct and indirect) for each renewable energy source and for each region. In 2011 about 372000 people worked in the renewable energy sector in Germany. (A.C.)

  1. Effects of the neonatal intensive care unit environment on preterm infant oral feeding

    Directory of Open Access Journals (Sweden)

    Pickler RH

    2013-04-01

    Full Text Available Rita H Pickler,1 Jacqueline M McGrath,2 Barbara A Reyna,3 Heather L Tubbs-Cooley,1 Al M Best4, Mary Lewis,3 Sharon Cone,3 Paul A Wetzel51Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; 2School of Nursing, University of Connecticut and Connecticut Children's Medical Center, Hartford, CT, USA; 3VCU Medical Center, Children's Hospital of Richmond, Richmond, VA, USA; 4School of Dentistry, 5School of Engineering, Virginia Commonwealth University, Richmond, VA, USAObjective: To examine the effect of neonatal intensive care unit environmental characteristics (perceived levels of light and sound, and time of day in open unit wards and single-family rooms (SFRs on oral feeding outcomes in preterm infants.Design: Data were collected at each scheduled oral feeding for 87 preterm infants from the first oral feeding until discharge. Data included the prescribed volume of feeding and the volume consumed, the infant's level of wakefulness before feeding, and the nurse's perception of light and sound.Results: Data were collected on 5111 feedings in the ward unit and 5802 in the SFR unit from feedings involving 87 preterm infants. Light and sound were rated significantly lower in the SFR (χ2 = 139 and 1654.8, respectively. Feeding times of 9 am, 12 noon, and 3 pm were associated with the highest perceived levels of light and sound, regardless of unit design (P < 0.0001. Moderate light levels and feeding times of 12, 3, and 6 am were associated with improved feeding outcomes. Infants consumed a greater proportion of their prescribed feeding volume when fed in the open ward and when awake before feeding.Conclusion: Further study on the clinical effects of unit design is needed, as is study on the effects of environmental stimuli, so that interventions can be appropriately developed and tailored for infants needing the most support for optimal development.Keywords: NICU design, clinical outcomes, environment

  2. The nocturnal acoustical intensity of the intensive care environment: an observational study.

    Science.gov (United States)

    Delaney, Lori J; Currie, Marian J; Huang, Hsin-Chia Carol; Lopez, Violeta; Litton, Edward; Van Haren, Frank

    2017-01-01

    The intensive care unit (ICU) environment exposes patients to noise levels that may result in substantial sleep disruption. There is a need to accurately describe the intensity pattern and source of noise in the ICU in order to develop effective sound abatement strategies. The objectives of this study were to determine nocturnal noise levels and their variability and the related sources of noise within an Australian tertiary ICU. An observational cross-sectional study was conducted in a 24-bed open-plan ICU. Sound levels were recorded overnight during three nights at 5-s epochs using Extech (SDL 600) sound monitors. Noise sources were concurrently logged by two research assistants. The mean recorded ambient noise level in the ICU was 52.85 decibels (dB) (standard deviation (SD) 5.89), with a maximum noise recording at 98.3 dB (A). All recorded measurements exceeded the WHO recommendations. Noise variability per minute ranged from 9.9 to 44 dB (A), with peak noise levels >70 dB (A) occurring 10 times/hour (SD 11.4). Staff were identified as the most common source accounting for 35% of all noise. Mean noise levels in single-patient rooms compared with open-bed areas were 53.5 vs 53 dB ( p  = 0.37), respectively. Mean noise levels exceeded those recommended by the WHO resulting in an acoustical intensity of 193 times greater than the recommended and demonstrated a high degree of unpredictable variability, with the primary noise sources coming from staff conversations. The lack of protective effects of single rooms and the contributing effects that staffs have on noise levels are important factors when considering sound abatement strategies.

  3. "Recognize Our Humanity": Immigrant Youth Voices on Health Care in Arizona's Restrictive Political Environment.

    Science.gov (United States)

    Gómez, Sofía; Castañeda, Heide

    2018-02-01

    The "DACAmented Voices in Healthcare" project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These "DACAmented" youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family's health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.

  4. Renewable energy annual 1995

    International Nuclear Information System (INIS)

    1995-12-01

    The Renewable Energy Annual 1995 is the first in an expected series of annual reports the Energy Information Administration (EIA) intends to publish to provide a comprehensive assessment of renewable energy. This report presents the following information on the history, status, and prospects of renewable energy data: estimates of renewable resources; characterizations of renewable energy technologies; descriptions of industry infrastructures for individual technologies; evaluations of current market status; and assessments of near-term prospects for market growth. An international section is included, as well as two feature articles that discuss issues of importance for renewable energy as a whole. The report also contains a number of technical appendices and a glossary. The renewable energy sources included are biomass (wood), municipal solid waste, biomass-derived liquid fuels, geothermal, wind, and solar and photovoltaic

  5. Renewable energy annual 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-01

    The Renewable Energy Annual 1995 is the first in an expected series of annual reports the Energy Information Administration (EIA) intends to publish to provide a comprehensive assessment of renewable energy. This report presents the following information on the history, status, and prospects of renewable energy data: estimates of renewable resources; characterizations of renewable energy technologies; descriptions of industry infrastructures for individual technologies; evaluations of current market status; and assessments of near-term prospects for market growth. An international section is included, as well as two feature articles that discuss issues of importance for renewable energy as a whole. The report also contains a number of technical appendices and a glossary. The renewable energy sources included are biomass (wood), municipal solid waste, biomass-derived liquid fuels, geothermal, wind, and solar and photovoltaic.

  6. VT Renewable Energy Sites - Renewable Energy Professionals

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The Renewable Energy Atlas of Vermont and this dataset were created to assist town energy committees, the Clean Energy Development Fund and other...

  7. A care improvement program acting as a powerful learning environment to support nursing students learning facilitation competencies.

    Science.gov (United States)

    Jukema, Jan S; Harps-Timmerman, Annelies; Stoopendaal, Annemiek; Smits, Carolien H M

    2015-11-01

    Change management is an important area of training in undergraduate nursing education. Successful change management in healthcare aimed at improving practices requires facilitation skills that support teams in attaining the desired change. Developing facilitation skills in nursing students requires formal educational support. A Dutch Regional Care Improvement Program based on a nationwide format of change management in healthcare was designed to act as a Powerful Learning Environment for nursing students developing competencies in facilitating change. This article has two aims: to provide comprehensive insight into the program components and to describe students' learning experiences in developing their facilitation skills. This Dutch Regional Care Improvement Program considers three aspects of a Powerful Learning Environment: self-regulated learning; problem-based learning; and complex, realistic and challenging learning tasks. These three aspects were operationalised in five distinct areas of facilitation: increasing awareness of the need for change; leadership and project management; relationship building and communication; importance of the local context; and ongoing monitoring and evaluation. Over a period of 18 months, 42 nursing students, supported by trained lecturer-coaches, took part in nine improvement teams in our Regional Care Improvement Program, executing activities in all five areas of facilitation. Based on the students' experiences, we propose refinements to various components of this program, aimed at strengthenin the learning environment. There is a need for further detailed empirical research to study the impact this kind of learning environment has on students developing facilitation competencies in healthcare improvement. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. The role of social environment on parental care: offspring benefit more from the presence of female than male helpers.

    Science.gov (United States)

    Brouwer, Lyanne; van de Pol, Martijn; Cockburn, Andrew

    2014-03-01

    Investment in offspring depends on the costs and benefits to the carer, which can vary with sex and social status. Investment also depends on the effort of others by allowing for compensation (load-lightening), with biparental care studies showing that this depends on the state and type of the other carer. By contrast, studies on cooperative breeders have solely focussed on the effects of group size rather than its composition (i.e. social environment). Here we propose and provide the first test of the 'Social Environment' hypothesis, that is, how the characteristics (here the sex) of other helpers present in the group affect parental care and how this in turn affects offspring fitness in cooperatively breeding red-winged fairy-wrens (Malurus elegans). Breeders provisioned nestlings at a higher rate than helpers, but there was no sex difference in provisioning rate. Compensation to increasing group size varied little with sex and status, but strongly depended on social environment. All group members reduced their provisioning rates in response to an increasing number of male (load-lightening), but not female helpers (additive care). As a result, nestlings received more food and grew faster in the presence of female helpers. The increased nestling growth did convey a fitness advantage due to a higher post-fledging survival to adulthood. Our study provides the first evidence that parental care can depend on social environment. This could be an important overlooked aspect to explain variation in parental care in cooperative breeders in general and in particular the enormous variation between the sexes, which we reveal in a literature overview. © 2013 The Authors. Journal of Animal Ecology © 2013 British Ecological Society.

  9. Environment

    International Nuclear Information System (INIS)

    McIntyre, A.D.; Turnbull, R.G.H.

    1992-01-01

    The development of the hydrocarbon resources of the North Sea has resulted in both offshore and onshore environmental repercussions, involving the existing physical attributes of the sea and seabed, the coastline and adjoining land. The social and economic repercussions of the industry were equally widespread. The dramatic and speedy impact of the exploration and exploitation of the northern North Sea resources in the early 1970s, on the physical resources of Scotland was quickly realised together with the concern that any environmental and social damage to the physical and social fabric should be kept to a minimum. To this end, a wide range of research and other activities by central and local government, and other interested agencies was undertaken to extend existing knowledge on the marine and terrestrial environments that might be affected by the oil and gas industry. The outcome of these activities is summarized in this paper. The topics covered include a survey of the marine ecosystems of the North Sea, the fishing industry, the impact of oil pollution on seabirds and fish stocks, the ecology of the Scottish coastline and the impact of the petroleum industry on a selection of particular sites. (author)

  10. Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.

    Science.gov (United States)

    Jeon, Yun-Hee; Simpson, Judy M; Li, Zhicheng; Cunich, Michelle M; Thomas, Tamsin H; Chenoweth, Lynn; Kendig, Hal L

    2015-07-01

    To evaluate the effectiveness of a leadership and management program in aged care. Double-blind cluster randomized controlled trial. Twelve residential and community-aged care sites in Australia. All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0

  11. Renewable energy- Indian initiatives, incentives and opportunities

    International Nuclear Information System (INIS)

    Prabhakara, B.R.

    1995-01-01

    Under the new strategy and action plan of 1993, the Ministry of Non-conventional Energy Sources is consolidating and strengthening technology development and commercialization by providing a market orientation and creating a favourable policy environment. The goals have been re-defined, which now aim at generating 2000 MW of power from renewables by 1997. The Ministry has already moved away to a large extent from budgetary subsidies to all forms of renewable energy production and application

  12. Energy efficiency. Care with power. Protecting the environment actively; E wie Energieeffizienz. Mit Strom bewusst umgehen. Die Umwelt aktiv schuetzen

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-01-15

    This manual gives practical advice and informs about legal regulations, financial incentives and low-cost energy conservation techniques, assembled by power suppliers. Everybody is able to save energy in his own household and utilize it meaningfully without emissions: One buys energy saving appliances, heats carefully his rooms, houses and flats are insulated according to EnEV (German energy saving ordinance). Furtheron advices are given for ovens, refrigerators etc. not only to utilize power carefully as also to save money and to protect simultaneously the environment. (GL)

  13. The need of a win-win regulation regarding the harmonization of advantages for the renewable energy sector and the concerns about the environment

    Directory of Open Access Journals (Sweden)

    Moraru Dan

    2015-06-01

    Full Text Available The main theme of this paper is the evolution of theories and suppositions regarding environment and growth. The sustainable green growth and the sustainable green capitalism concepts have attracted the interest and imagination of policy makers and industry, and also stimulated many exciting new ideas and practical actions such as the “triple bottom line” which refers to harmonizing and balancing out the three interests that are linked with sustainable business: economic, environmental and social ones. The policy has to create a workable association between what the government can ensure and not tax and what it cannot ensure and must tax. In this manner we get a win-win regulation meaning that both sides win. National and supranational policies are part of the macro-level governance and very relevant for the sustainable development of the EU Member States and for the stability of the EU itself.

  14. Psychosocial Work Environment, Stress Factors and Individual Characteristics among Nursing Staff in Psychiatric In-Patient Care

    Directory of Open Access Journals (Sweden)

    Tuvesson Hanna

    2014-01-01

    Full Text Available The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics—Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience—are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff’s perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.

  15. An integrative review of nurses' prosocial behaviours contributing to work environment optimization, organizational performance and quality of care.

    Science.gov (United States)

    Feather, Janice; McGillis Hall, Linda; Trbovich, Patricia; Baker, G Ross

    2018-04-22

    To rigorously review the literature on the prosocial workplace behaviours of nurses. Prosocial workplace behaviours, predominantly organisational citizenship behaviours have been theoretically and empirically found to promote individual and group level performance in various industries. However, little consensus exists in the literature regarding the impact of nurses' workplace behaviours on the work environment and organisational performance. An integrative literature review was conducted on studies between 1980 and 2016. Nineteen articles were included related to nurses' prosocial behaviours and performance. A positive relationship was noted between workplace behaviours and individual level performance and unit level performance. Albeit multifactorial, leadership and the social structure of the work environment are important factors contributing to the workplace behaviour-performance relationship. Prosocial behaviours influence the social functioning of the work environment and offer insights into the delivery of quality care. Nurse managers should recognize the influence of leadership style and characteristics in the work environment that encourage employee participation in prosocial behaviours. These additional voluntary efforts by nursing staff may improve organisational effectiveness and quality of care. Inclusion of these behaviours in performance reviews and as cultural norms may help to foster a more collaborative work environment. © 2018 John Wiley & Sons Ltd.

  16. Operating environment and USA nursing homes' participation in the subacute care market: a longitudinal analysis.

    Science.gov (United States)

    Weech-Maldonado, Robert; Qaseem, Amir; Mkanta, William

    2009-02-01

    We examined the impact of environmental factors on USA nursing homes' participation in the subacute care market. Findings suggest that the Balanced Budget Act of 1997 did not have a significant impact in the participation of nursing homes in the subacute care market from 1998 to 2000. However, there was a declining trend in the participation of nursing homes in the subacute care market after the implementation of Medicare prospective payment system (PPS). Furthermore, nursing homes with a higher proportion of Medicare residents were more likely to exit the subacute care market after PPS. Results also suggest that nursing homes have responded strategically to the environmental demand for subacute care services. Nursing homes located in markets with higher Medicare managed care penetration were more likely to offer subacute care services. Environmental munificence was also an important predictor of nursing home innovation into subacute care. Nursing homes in states with higher Medicaid reimbursement and those in less competitive markets were more likely to participate in the subacute care market.

  17. Renewable Substitutability Index: Maximizing Renewable Resource Use in Buildings

    OpenAIRE

    Srinivasan, Ravi; Campbell, Daniel; Wang, Wei

    2015-01-01

    In order to achieve a material and energy balance in buildings that is sustainable in the long run, there is an urgent need to assess the renewable and non-renewable resources used in the manufacturing process and to progressively replace non-renewable resources with renewables. Such progressive disinvestment in the non-renewable resources that may be substituted with renewable resources is referred to as “Renewable Substitutability” and if implemented, this process will lead to a paradigm sh...

  18. Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment?

    Science.gov (United States)

    Boulos, David; Zamorski, Mark A

    2015-12-07

    Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. Administrative data were used to identify a retrospective cohort of 30,513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8-21 months, aHR 2.47=(95% CI 1.28 to 4.76)). Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome

  19. Care workers health in Swiss nursing homes and its association with psychosocial work environment: A cross-sectional study.

    Science.gov (United States)

    Dhaini, Suzanne R; Zúñiga, Franziska; Ausserhofer, Dietmar; Simon, Michael; Kunz, Regina; De Geest, Sabina; Schwendimann, Rene

    2016-01-01

    Previous studies have demonstrated poor health of care workers in nursing homes. Yet, little is known about the prevalence of physical and mental health outcomes, and their associations with the psychosocial work environment in nursing homes. (1) To explore the prevalence of physical and mental health outcomes of care workers in Swiss nursing homes, (2) their association with psychosocial work environment. This is a secondary data analysis of the cross-sectional Swiss Nursing Home Human Resources Project (SHURP). We used survey data on socio-demographic characteristics and work environment factors from care workers (N=3471) working in Swiss nursing homes (N=155), collected between May 2012 and April 2013. GEE logistic regression models were used to estimate the relationship between psychosocial work environment and physical and mental health outcomes, taking into account care workers' age. Back pain (19.0%) and emotional exhaustion (24.2%) were the most frequent self-reported physical and mental health. Back pain was associated with increased workload (odds ratios (OR) 1.52, confidence interval (CI) 1.29-1.79), conflict with other health professionals and lack of recognition (OR 1.72, CI 1.40-2.11), and frequent verbal aggression by residents (OR 1.36, CI 1.06-1.74), and inversely associated with staffing adequacy (OR 0.69, CI 0.56-0.84); emotional exhaustion was associated with increased workload (OR 1.96, CI 1.65-2.34), lack of job preparation (OR 1.41, CI 1.14-1.73), and conflict with other health professionals and lack of recognition (OR 1.68, CI 1.37-2.06), and inversely associated with leadership (OR 0.70, CI 0.56-0.87). Physical and mental health among care workers in Swiss nursing homes is of concern. Modifying psychosocial work environment factors offer promising strategies to improve health. Longitudinal studies are needed to conduct targeted assessments of care workers health status, taking into account their age, along with the exposure to all four

  20. One University Making a Difference in Graduate Education: Caring in the Online Learning Environment.

    Science.gov (United States)

    Brown, Cynthia J; Wilson, Carol B

    2016-12-01

    As online education gains momentum, strategies to promote student engagement, develop social presence, and create a virtual community are essential for students' successful learning. A university with a philosophy grounded in caring developed two strategies for the graduate online education setting. These two strategies intentionally promote caring for self and others as a means to foster engagement, social presence, and a vibrant online community. One strategy was online Caring Groups, that is, small groups of four to five nursing students created each semester in one of the students' required courses in the online setting. The second strategy was the creation of two Caring Connections online sites, one for master of science in nursing students and one for doctorate in education nursing students. The sites were developed external to required courses to provide support for the online students throughout the graduate programs. Each site provides an ongoing space for students and faculty to post and discuss inspirational quotes, self-care tips, music, and photographs. The online Caring Groups and Caring Connections sites will be described, including how they were created, how they are used by students, how faculty support students, lessons learned, and how Caring Groups are integrated into the curriculum. © The Author(s) 2016.

  1. Adding Value to Total Joint Arthroplasty Care in an Academic Environment: The Utah Experience.

    Science.gov (United States)

    Pelt, Christopher E; Anderson, Mike B; Erickson, Jill A; Gililland, Jeremy M; Peters, Christopher L

    2018-06-01

    Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models. The changes that occurred at our institution are described. Real-time data and knowledgeable personnel working behind the scenes, while physicians provide clinical care, help move clinical pathway redesigns. Engaged physicians are essential to the successful implementation of value creation and care pathway redesign that can lead to improvements in value. An investment of money and resources toward added infrastructure and personnel is often needed to realize large-scale improvements. Alignment of providers, payers, and hospital administration, including by means of gainsharing programs, can lead to improvements. Although significant care pathway redesign efforts may realize substantial initial cost savings, savings may be asymptotic in nature, which calls into question the likely sustainability of programs that incentivize or penalize payments based on historical targets. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Cosmet'eau -Changes in the personal care product consumption practices: from whistle-blowers to impacts on aquatic environments

    OpenAIRE

    Bressy , Adèle; Carré , Catherine; Caupos , Émilie; de Gouvello , Bernard; Deroubaix , José-Frédéric; Deutsch , Jean-Claude; Mailler , Romain; Marconi , Anthony; Neveu , Pascale; Paulic , Laurent; Pichon , Sébastien; Rocher , Vincent; Severin , Irina; SOYER , Mathilde; Moilleron , Régis

    2016-01-01

    International audience; The Cosmet'eau project (2015-2018) investigates the " changes in the personal care product (PCP) consumption practices: from whistle-blowers to impacts on aquatic environments. " In this project, the example of PCPs will be used to understand how public health concerns related to micropollutants can be addressed by public authorities – including local authorities –, industries and consumers. The project aims to characterize the possible changes in PCP consumption pract...

  3. Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach.

    Science.gov (United States)

    Van Bogaert, Peter; Clarke, Sean; Willems, Riet; Mondelaers, Mieke

    2013-07-01

    To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff. Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied. A cross-sectional design with a survey. A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010-April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables. An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables. In psychiatric hospitals as in general hospitals, nurse-physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers. © 2012 Blackwell Publishing Ltd.

  4. Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

  5. Policies for Renewable Heat

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    This paper builds on IEA publications, Deploying Renewables, Principles for Effective Policies and Deploying Renewables, Best and Future Policy Practice, that discuss the 'integrated policy approach,' whereby renewable energy technologies require different support policies at different stages of their maturity pathways. The paper discusses how the integrated policy approach applies to renewable heat. It attempts to provide guidance for policy-makers on renewable heat throughout the different phases of the policy lifecycle, allowing for the specific challenges of renewable heat and needs of the many stakeholders involved. Stimulating a market for heat involves challenges that are different and, often, more difficult to overcome than in the electricity and transport sectors.

  6. Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

    Science.gov (United States)

    Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

    2016-01-01

    Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The

  7. Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care

    Directory of Open Access Journals (Sweden)

    Eva Öhman

    2016-12-01

    Full Text Available Abstract Background Clinical learning takes place in complex socio-cultural environments that are workplaces for the staff and learning places for the students. In the clinical context, the students learn by active participation and in interaction with the rest of the community at the workplace. Clinical learning occurs outside the university, therefore is it important for both the university and the student that the student is given opportunities to evaluate the clinical placements with an instrument that allows evaluation from many perspectives. The instrument Clinical Learning Environment and Supervision (CLES was originally developed for evaluation of nursing students’ clinical learning environment. The aim of this study was to adapt and validate the CLES instrument to measure medical students’ perceptions of their learning environment in primary health care. Methods In the adaptation process the face validity was tested by an expert panel of primary care physicians, who were also active clinical supervisors. The adapted CLES instrument with 25 items and six background questions was sent electronically to 1,256 medical students from one university. Answers from 394 students were eligible for inclusion. Exploratory factor analysis based on principal component methods followed by oblique rotation was used to confirm the adequate number of factors in the data. Construct validity was assessed by factor analysis. Confirmatory factor analysis was used to confirm the dimensions of CLES instrument. Results The construct validity showed a clearly indicated four-factor model. The cumulative variance explanation was 0.65, and the overall Cronbach’s alpha was 0.95. All items loaded similarly with the dimensions in the non-adapted CLES except for one item that loaded to another dimension. The CLES instrument in its adapted form had high construct validity and high reliability and internal consistency. Conclusion CLES, in its adapted form, appears

  8. China's renewables law

    International Nuclear Information System (INIS)

    Zhu Li

    2005-01-01

    The paper discusses China's Renewable Energy Promotion Law which will come into force in January 2006. The law shows China's commitment to renewable energy sources. The target is to raise the country's energy consumption from renewables to 10% by 2020. Data for current capacity, and expected capacity by 2020, are given for wind power, solar power, biomass and hydroelectric power. The financial and technological hurdles which China must overcome are mentioned briefly

  9. Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

    Science.gov (United States)

    Locatelli, Sara M; LaVela, Sherri L

    2015-01-01

    Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.

  10. Contribution of the psychosocial work environment to psychological distress among health care professionals before and during a major organizational change.

    Science.gov (United States)

    Lavoie-Tremblay, Melanie; Bonin, Jean-Pierre; Lesage, Alain D; Bonneville-Roussy, Arielle; Lavigne, Geneviève L; Laroche, Dominique

    2010-01-01

    The aim of this study was to investigate the relationships between 4 dimensions of the psychosocial work environment (psychological demands, decision latitude, social support, and effort-reward) among health care professionals as well as their psychological distress during a reorganization process. A correlational descriptive design was used for this quantitative study. A total of 159 health care professionals completed the questionnaire at T1, and 141 at T2. First, before the work reorganization, effort-reward imbalance was the sole variable of the psychological work environment that significantly predicted psychological distress. Second, the high overall level of psychological distress increased during the process of organizational change (from T1 to T2). Finally, effort-reward imbalance, high psychological demands, and low decision latitude were all significant predictors of psychological distress at T2, during the organizational change. In conclusion, to reduce the expected negative outcomes of restructuring on health care practitioners, managers could increase the number of opportunities for rewards, carefully explain the demands, and clarify the tasks to be performed by each of the employees to reduce their psychological burden and increase their perceptions of autonomy.

  11. Financing investments in renewable energy: the impacts of policy design

    International Nuclear Information System (INIS)

    Wiser, Ryan H.; Pickle, Steven J.

    1998-01-01

    The costs of electric power projects utilising renewable energy technologies (RETs) are highly sensitive to financing terms. Consequently, as the electricity industry is restructured and new renewables policies are created, it is important for policymakers to consider the impacts of renewables policy design on RET financing. This paper reviews the power plant financing process for renewable energy projects, estimates the impact of financing terms on levelised energy costs, and provides insights to policymakers on the important nexus between renewables policy design and financing. We review five case studies of renewable energy policies, and find that one of the key reasons that RET policies are not more effective is that project development and financing processes are frequently ignored or misunderstood when designing and implementing renewable energy policies. The case studies specifically show that policies that do no provide long-term stability or that have negative secondary impacts on investment decisions will increase financing costs, sometimes dramatically reducing the effectiveness of the program. Within U.S. electricity restructuring proceedings, new renewable energy policies are being created, and restructuring itself is changing the way RETs are financed. As these new policies are created and implemented, it is essential that policymakers acknowledge the financing difficulties faced by renewables developer and pay special attention to the impacts of renewables policy design on financing. As shown in this paper, a renewables policy that is carefully designed can reduce renewable energy costs dramatically by providing revenue certainty that will, in turn, reduce financing risk premiums. (Author)

  12. Physical Activity Practices, Policies and Environments in Washington State Child Care Settings: Results of a Statewide Survey.

    Science.gov (United States)

    Tandon, Pooja S; Walters, Kelly M; Igoe, Bridget M; Payne, Elizabeth C; Johnson, Donna B

    2017-03-01

    Objectives Child care is an important setting for the promotion of physical activity (PA) in early childhood. The purpose of this study was to examine the associations between specific PA environments and recommended practices in child care settings as well as the degree to which child care settings met recommended standards for total PA time. Methods In 2013, all programs licensed to care for children ages 2-5 in WA state were surveyed about their PA related practices. Logistic regression was used to determine odds of meeting best-practice standards for outdoor time and PA. Results The response rate was 45.8 % from centers (692/1511) and 32.1 % from homes (1281/3991). Few programs reported meeting best-practice standards for the amount of time children spend being physically active (centers: 12.1 %, homes: 20.1 %) and outdoor time (centers: 21.8 %, homes: 21.7 %). Programs where children go outside regardless of weather and those reporting more adult-led PA had higher odds of meeting best-practice standards for both PA and outdoor time. Meeting best-practice standards for outdoor time was the strongest predictor of meeting best-practice standards for total PA time [centers: OR 15.9 (9.3-27.2), homes: OR 5.2 (3.8-7.1)]. Conclusions for Practice There is considerable room for improvement in licensed child care settings in WA to meet best-practice standards for young children's outdoor and PA time. Initiatives that create policies and environments encouraging outdoor play and adult-led PA in child care have the potential to increase physical activity in substantial numbers of young children.

  13. The renewable chemicals industry

    DEFF Research Database (Denmark)

    Christensen, Claus H.; Rass-Hansen, J.; Marsden, Charlotte Clare

    2008-01-01

    per kilogram of desired product to illustrate in which processes the use of renewable resources lead to the most substantial reduction of CO2 emissions. The steps towards a renewable chemicals industry will most likely involve intimate integration of biocatalytic and conventional catalytic processes......The possibilities for establishing a renewable chemicals industry featuring renewable resources as the dominant feedstock rather than fossil resources are discussed in this Concept. Such use of biomass can potentially be interesting from both an economical and ecological perspective. Simple...

  14. Economic and environmental effects under resource scarcity and substitution between renewable and non-renewable resources

    International Nuclear Information System (INIS)

    Silva, Susana; Soares, Isabel; Afonso, Oscar

    2013-01-01

    We build a general equilibrium model with renewable (non-polluting) and non-renewable (polluting) resources to analyze the interaction and compatibility between economic growth and a cleaner environment. The study is in two phases: (i) resource extraction/production costs are constant; (ii) resource producers invest in knowledge to reduce extraction/production costs, endogenizing technical change. With constant costs, there is a permanent trade-off between economic growth and a cleaner environment. With endogenous technical change, it is possible to harmonize more output and less emissions by replacing non-renewable resources for renewable ones. We also conduct a sensitivity analysis to explore three specific policy actions. With constant costs, the best policy action is the imposition of a higher renewable resources standard, while with endogenous technical change, under certain conditions, all policy interventions may benefit both the economy and the environment. - Highlights: ► Our general equilibrium model includes renewable and non-renewable resources. ► Under constant resource production costs emissions grow at the same rate as output. ► Resource producers can invest in knowledge to reduce production costs. ► Under decreasing costs, lower emissions are compatible with stable output growth. ► Empirical results differ under constant costs and under endogenous technical change

  15. Job Satisfaction and Work Environment of Primary Health Care Nurses in Ekiti State, Nigeria: an Exploratory Study

    Directory of Open Access Journals (Sweden)

    Sunday Joseph Ayamolowo

    2013-01-01

    Full Text Available Background: Job satisfaction, quality of work environment and morale of health practitioners is beginning to receive attention worldwide.Objectives: This study examined the nature of the work environment of community health nurses, and determined the level of job satisfaction among these nurses. It further explored the relationship between work environment and job satisfaction of these nurses, and perceived factors in the work environment that would increase their job satisfaction. Methods: A descriptive cross-sectional design was employed. The study was conducted in public primary health care facilities in Ekiti State, Nigeria. All the 216 nurses in these facilities were recruited but only 161 nurses responded to the instrument administered. A 58- item semi-structured questionnaire was used to survey nurses currently practicing in the above health setting. Data analysis was done using descriptive and inferential statistics.Results: Findings from the study revealed the mean score of nurses’ perception of their work environment to be 64.65±19.77. Forty four percent (44% of the nurses perceived their WE as of an average quality while 31% reported high quality WE. A majority (67.1% of the nurses had low degree of job satisfaction while only few nurses (3.1% reported high degree of satisfaction with job. A significant positive strong correlation was found between overall work environment and the general job satisfaction of the nurses(r = 0.55, p = < 0.01. “Provisions of modern equipment for work” and “increment/prompt payment of salary” were the most prominent factors in work environment that the nurses perceived as capable of increasing their job satisfaction (54.7% and 49.7% respectively. The least reported factor was “recommendation when one does a good job” (1.9%.Conclusion: The study concluded that a healthy work environment for nurses in the primary health care settings is an important factor in improving work satisfaction

  16. A Phenomenological Study of the Work Environment in Long-Term Care Facilities for the Older Adults.

    Science.gov (United States)

    Choi, Sandy Pin Pin; Yeung, Cheryl Chi Yan; Lee, Joseph Kok Long

    2018-05-01

    Attempts to meet the increasing demand for long-term care (LTC) services have been hindered by acute staff shortages and high turnover. Distinct from previous studies, a descriptive phenomenological approach with van Kaam's controlled explication method was adopted in this study, to delineate how attributes of the LTC work environment shape the workforce crisis. Individual interviews were conducted with 40 LTC workers from 10 facilities in Hong Kong. The results suggest that the work environment in LTC facilities is not only characterized by organization- and job-related attributes that influence staff outcomes but also is a socially constructed concept with derogatory connotations that can influence staff recruitment and retention. Concerted efforts from facility administrators and policy makers are needed to improve the quality of the work environment. Future initiatives should focus on developing a vision and strategic plan to facilitate the rise of the LTC sector as a profession.

  17. Towards Modern Traffic Management in Central Europe in Care of the Environment

    Directory of Open Access Journals (Sweden)

    Hansjorg Kuster

    2012-10-01

    Full Text Available A plea to adopt the most modem transportation techniquefor reasonable coping with the dramatically increasing trafficneeds in modern Europe and careful prese1vation of the environmentalvalues.

  18. Health care logistics and space: accounting for the physical build environment

    NARCIS (Netherlands)

    Boucherie, Richardus J.; Hans, Elias W.; Hartmann, Timo; Larqoque, C.; Himmelspach, J.; Pasupathy, R.; Rose, O.; Uhrmacher, A.M.

    2012-01-01

    Planning and scheduling of health care processes has improved considerably using operations research techniques. Besides analytical and optimization tools, a substantial amount of sophisticated discrete event simulation tools supporting (re-)design of existing logistical processes in and around

  19. WHERE HAS THE COMPASSION GONE FROM THE RESIDENTIAL AGED CARE ENVIRONMENT?

    Science.gov (United States)

    Oliver, Kim

    2017-02-01

    Would working in residential aged care be your dream job as a newly qualified nurse, probably not, but why not? Montayre (2015) suggests that although nurses don't like to talk about it, or even less, what the real problem is perceived to be with this practice area, residential aged care nursing is thought to be less exciting, monotonous, and requiring less skill than other areas such as emergency nursing, or medical nursing.

  20. Co-Designing Ambient Assisted Living (AAL Environments: Unravelling the Situated Context of Informal Dementia Care

    Directory of Open Access Journals (Sweden)

    Amy S. Hwang

    2015-01-01

    Full Text Available Ambient assisted living (AAL aims to help older persons “age-in-place” and manage everyday activities using intelligent and pervasive computing technology. AAL research, however, has yet to explore how AAL might support or collaborate with informal care partners (ICPs, such as relatives and friends, who play important roles in the lives and care of persons with dementia (PwDs. In a multiphase codesign process with six (6 ICPs, we envisioned how AAL could be situated to complement their care. We used our codesigned “caregiver interface” artefacts as triggers to facilitate envisioning of AAL support and unpack the situated, idiosyncratic context within which AAL aims to assist. Our findings suggest that AAL should be designed to support ICPs in fashioning “do-it-yourself” solutions that complement tacitly improvised care strategies and enable them to try, observe, and adapt to solutions over time. In this way, an ICP could decide which activities to entrust to AAL support, when (i.e., scheduled or spontaneous and how a system should provide support (i.e., using personalized prompts based on care experience, and when adaptations to system support are needed (i.e., based alerting patterns and queried reports. Future longitudinal work employing participatory, design-oriented methods with care dyads is encouraged.

  1. Dehydration of Older Patients in Institutional Care and the Home Environment.

    Science.gov (United States)

    Lešnik, Amadeus; Piko, Nejc; Železnik, Danica; Bevc, Sebastjan

    2017-11-01

    Dehydration in older adults is an important clinical problem associated with more comorbidities, longer hospital stays, and higher mortality rates. However, in daily clinical practice, no single gold standard marker of hydration status in older adults is available. The aim of the current study was to define the fluid balance status in older adults residing in institutional care or the home. Four hundred ten patients (192 from institutional care and 218 from home care) 65 and older from the region of lower Styria (Slovenia) were included in the study. Serum osmolality, electrolytes, and blood urea nitrogen to creatinine (BUN:Cr) ratio were used to identify dehydration. Statistically significant differences were found between groups in serum osmolality and BUN:Cr ratio. Moreover, dehydration (defined as increased serum osmolality) was significantly more common in patients in institutional care than home care (51% versus 41.3%, respectively). The results confirm that dehydration is a common clinical problem in older adults, especially in those from institutional care. Although many methods of determining hydration status in older adults have been proposed, no gold standard exists, making hydration evaluation difficult in this population. [Res Gerontol Nurs. 2017; 10(6):260-266.]. Copyright 2017, SLACK Incorporated.

  2. Marine renewable energy policy in China and recommendations for improving implementation

    Science.gov (United States)

    Wang, Haifeng; Wang, Ji; Liu, Yuxin; Chen, Libo

    2018-02-01

    Renewable energy is the effective solution for the harmonious coexistence of human and environment as well as for the sustainable development. Marine renewable energy as one of the renewable energies, potentially offer fewer environmental risks and thus community acceptance than other renewable energy developments. Government support is the key and initial power for developing marine renewable energy. To promote the development and utilization of marine renewable energy, the Chinese government has established the special funding plan for marine renewable energy, and released “the 13th Five-years Plan (2016-2020) for marine renewable energy”. This paper describes the mechanisms established by the marine renewable Energy policy in China, and provides a comparative analysis of the Chinese marine renewable energy policy framework. We provides some policy recommendations for future development of marine renewable energy in China.

  3. Unsatisfied basic needs of older patients in emergency care environments - obstacles to an active role in decision making.

    Science.gov (United States)

    Nydén, Kristoffer; Petersson, Martin; Nyström, Maria

    2003-03-01

    Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.

  4. Neighborhood Environment and Disparities in Health Care Access Among Urban Medicare Beneficiaries With Diabetes: A Retrospective Cohort Study.

    Science.gov (United States)

    Ryvicker, Miriam; Sridharan, Sridevi

    2018-01-01

    Older adults' health is sensitive to variations in neighborhood environment, yet few studies have examined how neighborhood factors influence their health care access. This study examined whether neighborhood environmental factors help to explain racial and socioeconomic disparities in health care access and outcomes among urban older adults with diabetes. Data from 123 233 diabetic Medicare beneficiaries aged 65 years and older in New York City were geocoded to measures of neighborhood walkability, public transit access, and primary care supply. In 2008, 6.4% had no office-based "evaluation and management" (E&M) visits. Multilevel logistic regression indicated that this group had greater odds of preventable hospitalization in 2009 (odds ratio = 1.31; 95% confidence interval: 1.22-1.40). Nonwhites and low-income individuals had greater odds of a lapse in E&M visits and of preventable hospitalization. Neighborhood factors did not help to explain these disparities. Further research is needed on the mechanisms underlying these disparities and older adults' ability to navigate health care. Even in an insured population living in a provider-dense city, targeted interventions may be needed to overcome barriers to chronic illness care for older adults in the community.

  5. Empowerment, environment and person-centred care: A qualitative study exploring the hospital experience for adults with cognitive impairment.

    Science.gov (United States)

    Prato, Laura; Lindley, Lyndsay; Boyles, Miriam; Robinson, Louise; Abley, Clare

    2018-01-01

    It is acknowledged that there are many challenges to ensuring a positive hospital experience for patients with cognitive impairment. The study ('Improving hospital care for adults with cognitive impairment') aimed to explore the positive and negative experiences of older adults with cognitive impairment (dementia and delirium) and their relatives and/or carers, during an acute hospital stay, from admission to discharge, using a qualitative, case study methodology. Six participants with cognitive impairment, eight relatives and 59 members of the health care team were recruited. Data was collected via ethnographic, observational periods at each stage of the hospital journey and through the use of semi-structured interviews with relatives, carers and health care staff including: medical staff; nursing staff; physiotherapists and ward managers. Interpretive phenomenological analysis was used to facilitate data analysis. 52 hours 55 minutes of ethnographic observations and 18 interviews with ward staff and relatives were undertaken. Three superordinate themes emerged from the data as crucial in determining the quality of the hospital experience: valuing the person; activities of empowerment and disempowerment and the interaction of environment with patient well-being. Whether the patient's hospital experience was positive or negative was powerfully influenced by family involvement and ward staff actions and communication. Participants identified a requirement for a ward based activity service for patients with cognitive impairment. Further research must be undertaken focusing on the development of ward based activities for patients with cognitive impairment, alongside a move towards care which explores measures to improve and expand relative involvement in hospital care.

  6. The crucial role of the micro caregiving environment: Factors associated with attachment styles in alternative care in Chile.

    Science.gov (United States)

    Garcia Quiroga, Manuela; Hamilton-Giachritsis, Catherine

    2017-08-01

    The distribution of attachment styles has been shown to differ between groups of children living with their parents and children placed in alternative care (AC), defined as residential or foster. However, this is the first study in Latin America to explore possible factors affecting the quality of attachment in children living in both residential and foster care. Two groups of children (N=57) were compared: one group living in Residential Homes (RC) and the other in Foster Care (FC) in Chile. Children's, caregivers' and structural factors (e.g., child: caregiver ratios) and their links with attachment styles were investigated. The micro caregiving environment (i.e., the specific individual child caregiver relationship), especially the caregivers' engagement, sensitivity, disciplinary control and affection, as well as some structural factors (i.e., child: caregiver ratios), were linked to attachment security in children. Specifically, better emotional caregiving and lower child-caregiver ratios were associated with higher rates of secure attachment. The association between quality of care (as measured by the HOME inventory) and attachment styles seems to be influenced by caregiver relationships (as measured by CCSERSS). Caregiver relationship factors (i.e., affection, engagement and sensitivity) directly impact the quality of the attachment children establish with them while living in AC. However, the relationships that caregivers establish with children under their care can be facilitated by good quality structural factors, particularly child-caregiver ratios. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Assessment of nutrition and physical activity environments in family child care homes: modification and psychometric testing of the Environment and Policy Assessment and Observation

    Directory of Open Access Journals (Sweden)

    Amber E. Vaughn

    2017-08-01

    Full Text Available Abstract Background Early care and education (ECE settings play an important role in shaping the nutrition and physical activity habits of young children. Increasing research attention is being directed toward family child care homes (FCCHs specifically. However, existing measures of child care nutrition and physical activity environments are limited in that they have been created for use with center-based programs and require modification for studies involving FCCHs. This paper describes the modification of the Environment and Policy Assessment and Observation (EPAO for use in FCCHs. Methods The EPAO underwent a through modification process that incorporated an updated format for the data collection instrument, assessment of emerging best practices, tailoring to the FCCH environment, and creation of a new scoring rubric. The new instrument was implemented as part of a larger randomized control trial. To assess inter-rater reliability, observations on 61 different days were performed independently by two data collectors. To assess construct validity, associations between EPAO scores and measures of children’s dietary intake (Healthy Eating Index (HEI score and physical activity (accelerometer-measured minutes per hour of moderate to vigorous physical activity, MVPA were examined. Results The modified EPAO assesses 38 nutrition and 27 physical activity best practices, which can be summarized into 7 nutrition-related and 10 physical activity-related environmental sub- scores as well as overall nutrition and overall physical activity scores. There was generally good agreement between data collectors (ICC > 0.60. Reliability was slightly lower for feeding practices and physical activity education and professional development (ICC = 0.56 and 0.22, respectively. Child HEI was significantly correlated with the overall nutrition score (r = 0.23, foods provided (r = 0.28, beverages provided (r = 0.15, nutrition education and professional

  8. Assessment of nutrition and physical activity environments in family child care homes: modification and psychometric testing of the Environment and Policy Assessment and Observation.

    Science.gov (United States)

    Vaughn, Amber E; Mazzucca, Stephanie; Burney, Regan; Østbye, Truls; Benjamin Neelon, Sara E; Tovar, Alison; Ward, Dianne S

    2017-08-29

    Early care and education (ECE) settings play an important role in shaping the nutrition and physical activity habits of young children. Increasing research attention is being directed toward family child care homes (FCCHs) specifically. However, existing measures of child care nutrition and physical activity environments are limited in that they have been created for use with center-based programs and require modification for studies involving FCCHs. This paper describes the modification of the Environment and Policy Assessment and Observation (EPAO) for use in FCCHs. The EPAO underwent a through modification process that incorporated an updated format for the data collection instrument, assessment of emerging best practices, tailoring to the FCCH environment, and creation of a new scoring rubric. The new instrument was implemented as part of a larger randomized control trial. To assess inter-rater reliability, observations on 61 different days were performed independently by two data collectors. To assess construct validity, associations between EPAO scores and measures of children's dietary intake (Healthy Eating Index (HEI) score) and physical activity (accelerometer-measured minutes per hour of moderate to vigorous physical activity, MVPA) were examined. The modified EPAO assesses 38 nutrition and 27 physical activity best practices, which can be summarized into 7 nutrition-related and 10 physical activity-related environmental sub- scores as well as overall nutrition and overall physical activity scores. There was generally good agreement between data collectors (ICC > 0.60). Reliability was slightly lower for feeding practices and physical activity education and professional development (ICC = 0.56 and 0.22, respectively). Child HEI was significantly correlated with the overall nutrition score (r = 0.23), foods provided (r = 0.28), beverages provided (r = 0.15), nutrition education and professional development (r = 0.21), and nutrition policy (r

  9. Renewable energy--traditional biomass vs. modern biomass

    International Nuclear Information System (INIS)

    Goldemberg, Jose; Teixeira Coelho, Suani

    2004-01-01

    Renewable energy is basic to reduce poverty and to allow sustainable development. However, the concept of renewable energy must be carefully established, particularly in the case of biomass. This paper analyses the sustainability of biomass, comparing the so-called 'traditional' and 'modern' biomass, and discusses the need for statistical information, which will allow the elaboration of scenarios relevant to renewable energy targets in the world

  10. Photovoltaics and renewable energies in Europe

    International Nuclear Information System (INIS)

    Jaeger-Waldau, Arnulf

    2007-01-01

    Photovoltaics and renewable energies are growing at a much faster pace than the rest of the economy in Europe and worldwide. This and the dramatic oil price increases in 2005 have led to a remarkable re-evaluation of the renewable energy sector by politics and financing institutions. Despite the fact that there are still discrepancies between the European Union and the USA, as to how to deal with climate change, renewable energies will play an important role for the implementation of the Kyoto Protocol and the worldwide introduction of tradable Green Certificates. Apart from the electricity sector, renewable energy sources for the generation of heat and the use of environment friendly biofuels for the transport sector will become more and more important in the future. (author)

  11. Renewable energy sources: resistance to change

    International Nuclear Information System (INIS)

    Dubreuil, Th.; Audrain-Demey, G.; Attal, J.Ph.; Lormeteau, B.

    2011-01-01

    This paper is the summary of a conference day organised by the students of the 'environment and sustainable development law' Master of Nantes university (France). This interdisciplinary meeting brought together professionals of renewable energy industries who could testify about the resistance of both politicians and the public opinion against the energy transition towards renewable sources. Legal, political, sociological and cultural considerations are put forward to explain this resistance. The French specificity, with an over-representation of nuclear energy, a constraining legal framework for renewable energies, a regional opposition to renewable energy projects (NIMBY syndrome), and a lack of trust in the political class and in its representatives are as many factors that have contributed to build this French 'cultural exception'. (J.S.)

  12. From organizational awareness to organizational competency in health care social work: the importance of formulating a "profession-in-environment" fit.

    Science.gov (United States)

    Spitzer, William; Silverman, Ed; Allen, Karen

    2015-01-01

    Today's health care environments require organizational competence as well as clinical skill. Economically driven business paradigms and the principles underlying the Patient Protection and Affordable Care Act of 2010 emphasize integrated, collaborative care delivered using transdisciplinary service models. Attention must be focused on achieving patient care goals while demonstrating an appreciation for the mission, priorities and operational constraints of the provider organization. The educational challenge is to cultivate the ability to negotiate "ideology" or ideal practice with the practical realities of health care provider environments without compromising professional ethics. Competently exercising such ability promotes a sound "profession-in-environment" fit and enhances the recognition of social work as a crucial patient care component.

  13. Marine Renewable Energies

    DEFF Research Database (Denmark)

    Azzellino, Arianna; Conley, Daniel; Vicinanza, Diego

    2013-01-01

    Countries with coastlines may have valuable renewable energy resources in the form of tides, currents, waves, and offshorewind.The potential to gather energy from the sea has recently gained interest in several nations, so Marine Renewable Energy Installations (hereinafter MREIs) will likely become...

  14. Renewable Resources in SA

    CSIR Research Space (South Africa)

    Mushwana, C

    2015-02-01

    Full Text Available Renewable energy is derived form natural resources that are replenished at a faster rate than they are consumed, and thus cannot be depleted. Solar, wind, geothermal, hydro, and some forms of biomass are common sources of renewable energy. Almost 90...

  15. Renewable Energy in Alaska

    Energy Technology Data Exchange (ETDEWEB)

    2013-03-01

    This report examines the opportunities, challenges, and costs associated with renewable energy implementation in Alaska and provides strategies that position Alaska's accumulating knowledge in renewable energy development for export to the rapidly growing energy/electric markets of the developing world.

  16. Renewable Energy Technology

    Science.gov (United States)

    Daugherty, Michael K.; Carter, Vinson R.

    2010-01-01

    In many ways the field of renewable energy technology is being introduced to a society that has little knowledge or background with anything beyond traditional exhaustible forms of energy and power. Dotson (2009) noted that the real challenge is to inform and educate the citizenry of the renewable energy potential through the development of…

  17. Renewable energy export network

    International Nuclear Information System (INIS)

    Anon

    2000-01-01

    A Renewable Energy Exporters Network (REEN) has recently been established, following a meeting of renewable energy exporters and government agencies on 30 October 2000. REEN will assist the Australian renewable energy industry to take advantage of the opportunities offered by the burgeoning global market for renewable energy goods and services. Recent estimates of the significant potential global growth is renewable energy demand have reinforced the industry and Government's view that, in the medium to long-term, growth in the Australian renewable energy industry will largely depend on capturing export market share. Expanding the export market was identified as a crucial component in the Renewable Energy Action Agenda, developed jointly by industry and Government and released in June 2000. It was estimated that, for the industry to achieve its vision of sales of $4 billion per year by 2010, exports would need to comprise approximately 50% of the forecast growth in sales. As such, the need for a specific export strategy for the Australian renewable energy industry was recognised in the Action Agenda, and the establishment of the REEN is one of the first initiatives undertaken as part of the Renewable Energy Export Strategy. The REEN comprises approximately 50 export-ready renewable energy companies, the Department of Industry, Science and Resources, Austrade, and Stage Government agencies such as NSW's Sustainable Energy Development Authority. The Export Network will operate electronically, with face-to-face meetings held as appropriate. The Department of Industry, Science and Resources will facilitate the Export Network and has published a website at www.isr.gov.au/industry/reen. The site includes: a members directory; a discussion forum; information on opportunities to showcase Australian renewable; energy products and services; and Iinks to sites containing information that may be useful to renewable energy exporters. Other actions that are being undertaken as

  18. Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design.

    Science.gov (United States)

    Fortinsky, Richard H; Gitlin, Laura N; Pizzi, Laura T; Piersol, Catherine Verrier; Grady, James; Robison, Julie T; Molony, Sheila

    2016-07-01

    Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Nuclear plant license renewal

    International Nuclear Information System (INIS)

    Gazda, P.A.; Bhatt, P.C.

    1991-01-01

    During the next 10 years, nuclear plant license renewal is expected to become a significant issue. Recent Electric Power Research Institute (EPRI) studies have shown license renewal to be technically and economically feasible. Filing an application for license renewal with the Nuclear Regulatory Commission (NRC) entails verifying that the systems, structures, and components essential for safety will continue to perform their safety functions throughout the license renewal period. This paper discusses the current proposed requirements for this verification and the current industry knowledge regarding age-related degradation of structures. Elements of a license renewal program incorporating NRC requirements and industry knowledge including a schedule are presented. Degradation mechanisms for structural components, their significance to nuclear plant structures, and industry-suggested age-related degradation management options are also reviewed

  20. New renewable energy sources

    International Nuclear Information System (INIS)

    2001-06-01

    This publication presents a review of the technological, economical and market status in the field of new renewable energy sources. It also deals briefly with the present use of energy, external conditions for new renewable energy sources and prospects for these energy sources in a future energy system. The renewable energy sources treated here are ''new'' in the sense that hydroelectric energy technology is excluded, being fully developed commercially. This publication updates a previous version, which was published in 1996. The main sections are: (1) Introduction, (2) Solar energy, (3) Bio energy, (4) Wind power, (5) Energy from the sea, (6) Hydrogen, (7) Other new renewable energy technologies and (8) New renewable s in the energy system of the future

  1. Renewable energy resources

    DEFF Research Database (Denmark)

    Ellabban, Omar S.; Abu-Rub, Haitham A.; Blaabjerg, Frede

    2014-01-01

    Electric energy security is essential, yet the high cost and limited sources of fossil fuels, in addition to the need to reduce greenhouse gasses emission, have made renewable resources attractive in world energy-based economies. The potential for renewable energy resources is enormous because...... they can, in principle, exponentially exceed the world's energy demand; therefore, these types of resources will have a significant share in the future global energy portfolio, much of which is now concentrating on advancing their pool of renewable energy resources. Accordingly, this paper presents how...... renewable energy resources are currently being used, scientific developments to improve their use, their future prospects, and their deployment. Additionally, the paper represents the impact of power electronics and smart grid technologies that can enable the proportionate share of renewable energy...

  2. Conquest and Care for the Preservation of Nature and Environment in the Novel Amba by Laksmi Pamuntjak: Study Ecocriticism

    Directory of Open Access Journals (Sweden)

    Wiyatmi Wiyatmi

    2017-02-01

    Full Text Available This study aims to analyse (1 how the characters in the novel Amba by Laksmi Pamuntjak conquest and care for the preservation of nature and environment, and (2 the depiction of nature and the environment in relation to the overall story of Amba using ecocriticism  perspective. The results are as follows. First, the nature and the environment of Buru are described as an arena to be conquered by the main character (Bhishma, who was a political prisoner in the New Order era. In addition, the preservation of nature and environment of Buru Island also should be protected from exploitation, especially by outsiders who came to the island of Buru. Second, the depiction of nature and the environment in Amba is related to the creation of the setting of story (place and time,  i.e. Buru Island as political prisoners’ detention place in the New Order era, between 1969–2006. From the perspective of ecocriticism  these findings demonstrate how an island that was secluded so used to dispose of political prisoners have experienced the dynamics of an arena which was originally a natural and fierce, eventually turned into an island that invites entrants to explore and exploit natural wealth, so must be preserved.

  3. Shifting patterns of practice: nurse practitioners in a managed care environment.

    Science.gov (United States)

    Johnson, Rosemary

    2005-01-01

    The purpose of this qualitative study was to uncover patterns across nurse practitioner (NP) experiences that contribute to understanding their perceptions of managed care, how it affects daily practice, and how NPs respond to a changing managed care workplace. In-depth interviews were conducted with 14 NPs representing primary care, specialty, and independent practices. Over an 18-month period, data collection and analysis occurred simultaneously using standard methods of purposive sampling, constant comparison, memoing, and member checks. This study illuminates the tension NPs experience between a business and a professional ethic and the strategies they use to reconcile this difference with core nursing values. Type of setting, workplace dynamics, and length of time in practice contributed to variation in NP perspectives.

  4. Preparing for the unexpected: violence in the home care environment, one agency's story.

    Science.gov (United States)

    Browning, Sarah Via; Clark, Rebecca Culver; Glick, Roger E

    2013-06-01

    Home care and hospice agencies, bound by regulations, prepare for emergencies and disasters by creating policies and protocols for management of emergency situations, perhaps conducting table top or other types of drills, and discussing hazards likely to impact home care. Is this preparation merely an exercise to meet a requirement, or is it life-saving preparation? For one home care agency, the emergency exercise saved the day as the scenario enacted in the drill was actually lived out a few weeks after the exercise-a scenario the agency leaders hoped they would never face. This account explores how the agency prepared to meet the emergent situation and details lessons learned in the aftermath.

  5. Educating Medical Laboratory Technologists: Revisiting Our Assumptions in the Current Economic and Health-Care Environment

    Directory of Open Access Journals (Sweden)

    Regina Linder

    2012-08-01

    Full Text Available Health care occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stakeholders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships.

  6. The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care.

    Science.gov (United States)

    Tuvesson, Hanna; Wann-Hansson, Christine; Eklund, Mona

    2011-06-16

    The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

  7. The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

    Directory of Open Access Journals (Sweden)

    Wann-Hansson Christine

    2011-06-01

    Full Text Available Abstract Background The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. Methods 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. Results The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. Conclusions The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

  8. Sensitizing health-care workers and trainees to create a nondiscriminatory health-care environment for surgical care of HIV-Infected patients

    Directory of Open Access Journals (Sweden)

    Deeptiman James

    2018-01-01

    Full Text Available Background: Occupational risk of human immunodeficiency virus (HIV transmission creates barriers in the surgical health care of patients with HIV infection. Poor awareness, prevalent misconceptions, and associated stigma lead to discrimination against HIV-infected patients. This study was carried out to assess effectiveness of a “HIV awareness program” (HAP to educate and motivate health-care workers to provide equitable and ethical health care to HIV-infected patients. Methodology: An interventional study was conducted at a secondary level mission hospital in Central India from April 2014 to August 2015. Change in knowledge, awareness, and attitude following a multimedia “HAP” was analyzed with a “pre- and posttest design.” Seventy-four staffs and trainees participated in the program. Z-test and t-test were used to check the statistical significance of the data. Results: The mean pretest score was 19.31 (standard deviation [SD]: 6.0, 95% confidence interval [CI]: 17.923–20.697 and the mean posttest score was 30.84 (SD: 4.8, 95% CI: 29.714–31.966. This difference was statistically significant at the 5% level with P < 0.001. Conclusions: “HAP” was effective in changing the knowledge, awareness, and attitude of the staffs and trainees of the secondary hospital toward surgical care of HIV-infected patients.

  9. Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

    Science.gov (United States)

    Dyson, Kate; Kruger, Estie; Tennant, Marc

    2012-12-01

    This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  10. Renewable Electricity Futures: Exploration of a U.S. Grid with 80% Renewable Electricity

    Science.gov (United States)

    Mai, Trieu

    2013-04-01

    Renewable Electricity Futures is an initial investigation of the extent to which renewable energy supply can meet the electricity demands of the contiguous United States over the next several decades. This study explores the implications and challenges of very high renewable electricity generation levels: from 30% up to 90% (focusing on 80%) of all U.S. electricity generation from renewable technologies in 2050. At such high levels of renewable electricity penetration, the unique characteristics of some renewable resources, specifically geographical distribution and variability and un-certainty in output, pose challenges to the operability of the nation's electric system. The study focuses on key technical implications of this environment from a national perspective, exploring whether the U.S. power system can supply electricity to meet customer demand on an hourly basis with high levels of renewable electricity, including variable wind and solar generation. The study also identifies some of the potential economic, environmental, and social implications of deploying and integrating high levels of renewable electricity in the U.S. The full report and associated supporting information is available at: http://www.nrel.gov/analysis/refutures/.

  11. Airborne particles in indoor environment of homes, schools, offices and aged care facilities: The main routes of exposure.

    Science.gov (United States)

    Morawska, L; Ayoko, G A; Bae, G N; Buonanno, G; Chao, C Y H; Clifford, S; Fu, S C; Hänninen, O; He, C; Isaxon, C; Mazaheri, M; Salthammer, T; Waring, M S; Wierzbicka, A

    2017-11-01

    It has been shown that the exposure to airborne particulate matter is one of the most significant environmental risks people face. Since indoor environment is where people spend the majority of time, in order to protect against this risk, the origin of the particles needs to be understood: do they come from indoor, outdoor sources or both? Further, this question needs to be answered separately for each of the PM mass/number size fractions, as they originate from different sources. Numerous studies have been conducted for specific indoor environments or under specific setting. Here our aim was to go beyond the specifics of individual studies, and to explore, based on pooled data from the literature, whether there are generalizable trends in routes of exposure at homes, schools and day cares, offices and aged care facilities. To do this, we quantified the overall 24h and occupancy weighted means of PM 10 , PM 2.5 and PN - particle number concentration. Based on this, we developed a summary of the indoor versus outdoor origin of indoor particles and compared the means to the WHO guidelines (for PM 10 and PM 2.5 ) and to the typical levels reported for urban environments (PN). We showed that the main origins of particle metrics differ from one type of indoor environment to another. For homes, outdoor air is the main origin of PM 10 and PM 2.5 but PN originate from indoor sources; for schools and day cares, outdoor air is the source of PN while PM 10 and PM 2.5 have indoor sources; and for offices, outdoor air is the source of all three particle size fractions. While each individual building is different, leading to differences in exposure and ideally necessitating its own assessment (which is very rarely done), our findings point to the existence of generalizable trends for the main types of indoor environments where people spend time, and therefore to the type of prevention measures which need to be considered in general for these environments. Copyright © 2017 The

  12. Renewable energy for rural electrification

    Energy Technology Data Exchange (ETDEWEB)

    Strebkov, D. [All Russian Research Institute for Electrification of the Agriculture, Moscow (Russian Federation); Bezrukich, P. [Ministry for Fuel and Energy of Russian Federation, Moscow (Russian Federation); Kozlov, V. [Intersolarcenter Association, Moscow (Russian Federation)

    1997-12-31

    In spite of quite good centralized power supply system, rural electrification level across Russia vary widely: in some regions there are densely populated communities which lack power, while in the other the most pressing need is to electrify dispersed, isolated villages or homes. The main objective of the Russian project `Renewable energy for rural electrification` is the elaboration and application of new technologies of rural electrification in order to ensure the sustainable development of unelectrified areas of the Russia. The long-term objective of the project are: to improve the living standards of people in rural areas, who lack centralized energy supply systems, by introducing a new system for generation, transmission and distribution of electric power on the base of renewable energy systems; to provide a reliable cost-effective electric service for electrified and uncertified communities; to reduce the consumption of organic fuel in power generation systems; to support the military industry in converting their activity into the renewable energy sector; and to protect the environment

  13. Renewable energy for rural electrification

    Energy Technology Data Exchange (ETDEWEB)

    Strebkov, D [All Russian Research Institute for Electrification of the Agriculture, Moscow (Russian Federation); Bezrukich, P [Ministry for Fuel and Energy of Russian Federation, Moscow (Russian Federation); Kozlov, V [Intersolarcenter Association, Moscow (Russian Federation)

    1998-12-31

    In spite of quite good centralized power supply system, rural electrification level across Russia vary widely: in some regions there are densely populated communities which lack power, while in the other the most pressing need is to electrify dispersed, isolated villages or homes. The main objective of the Russian project `Renewable energy for rural electrification` is the elaboration and application of new technologies of rural electrification in order to ensure the sustainable development of unelectrified areas of the Russia. The long-term objective of the project are: to improve the living standards of people in rural areas, who lack centralized energy supply systems, by introducing a new system for generation, transmission and distribution of electric power on the base of renewable energy systems; to provide a reliable cost-effective electric service for electrified and uncertified communities; to reduce the consumption of organic fuel in power generation systems; to support the military industry in converting their activity into the renewable energy sector; and to protect the environment

  14. Tax Exemption Issues Facing Academic Health Centers in the Managed Care Environment.

    Science.gov (United States)

    Jones, Darryll K.

    1997-01-01

    Traditional characteristics of academic health centers are outlined, and conflicts with managed care are identified. Operating strategies designed to resolve the conflicts are discussed in light of tax statutes and regulations, Internal Revenue Service interpretations, and case law. Detailed references are included to provide a complete resource…

  15. Building a high quality medical data architecture for multiple uses in an integrated health care environment

    NARCIS (Netherlands)

    William Goossen; Irene Krediet; Frank Boterenbrood

    2014-01-01

    Objective: The aim was to create a reliable information provisioning system in healthcare for both care and research processes, based on existing data standards and standardized electronic messages. The research question is: How can a Clinical Data Ware House (CDWH) be developed for standardized

  16. Microfluidic point-of-care diagnostics for resource-poor environments

    Science.gov (United States)

    Laksanasopin, Tassaneewan; Chin, Curtis D.; Moore, Hannah; Wang, Jennifer; Cheung, Yuk Kee; Sia, Samuel K.

    2009-05-01

    Point-of-care (POC) diagnostics have tremendous potential to improve human health in remote and resource-poor settings. However, the design criteria for diagnostic tests appropriate in settings with limited infrastructure are unique and challenging. Here we present a custom optical reader which quantifies silver absorbance from heterogeneous immunoassays. The reader is simple and low-cost and suited for POC diagnostics.

  17. Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people.

    Science.gov (United States)

    McCormack, Brendan; Dewing, Jan; Breslin, Liz; Coyne-Nevin, Ann; Kennedy, Kate; Manning, Mary; Peelo-Kilroe, Lorna; Tobin, Catherine; Slater, Paul

    2010-06-01

    To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the 'Person-Centred Nursing Index'. Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on 'technical' aspects of care, to one where 'intimate' aspects of care were more highly valued. The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships. © 2010 Blackwell Publishing Ltd.

  18. Nurses' use of mobile devices to access information in health care environments in australia: a survey of undergraduate students.

    Science.gov (United States)

    Mather, Carey; Cummings, Elizabeth; Allen, Penny

    2014-12-10

    The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (PStudents continued to access nursing, medical, professional development, and study-related information away from the workplace. Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients.

  19. Development of a Questionnaire to Assess Nursing Competencies for the Care of People with Psychiatric Disabilities in a Hospital Environment.

    Science.gov (United States)

    Feng, Danjun; Li, Hongyao; Meng, Lu; Zhong, Gengkun

    2018-02-19

    The recovery of people with psychiatric disabilities requires high-quality nursing care. However, the existing research on the nursing competencies needed for caring for people with psychiatric disabilities have been based on a narrow competency framework. By adopting a broader competency framework, this study aimed to find the competencies needed for the nursing care of people with psychiatric disabilities in a hospital environment. Accordingly, a questionnaire will be developed to measure these competences. First, a literature review and interviews with psychiatrists, psychiatric nurses, and people with psychiatric disabilities were conducted to develop the pool of competency items. Second, a pilot study was conducted to review the initial pool of items. Finally, a survey of 581 psychiatric nurses was used to conduct a series of principal component analyses to explore the structure of the questionnaire. The 17-item questionnaire included 5 factors, which accounted for 68.60% of the total variance: sense of responsibility, vocational identification, agreeableness, cooperation capacity, and carefulness; the Cronbach's alpha coefficients were 0.85, 0.85, 0.74, 0.80, and 0.77, respectively. Most of the competencies belonged to attitudes, values, and traits, which were overlooked in previous studies. The questionnaire has satisfactory internal reliability and structural validity, and could contribute some to the selection of the psychiatric workforce.

  20. Exploring the Requisite Skills and Competencies of Pharmacists Needed for Success in an Evolving Health Care Environment.

    Science.gov (United States)

    McLaughlin, Jacqueline E; Bush, Antonio A; Rodgers, Philip T; Scott, Mollie Ashe; Zomorodi, Meg; Pinelli, Nicole R; Roth, Mary T

    2017-08-01

    Objective. To identify and describe the core competencies and skills considered essential for success of pharmacists in today's rapidly evolving health care environment. Methods. Six breakout groups of 15-20 preceptors, pharmacists, and partners engaged in a facilitated discussion about the qualities and characteristics relevant to the success of a pharmacy graduate. Data were analyzed using qualitative methods. Peer-debriefing, multiple coders, and member-checking were used to promote trustworthiness of findings. Results. Eight overarching themes were identified: critical thinking and problem solving; collaboration across networks and leading by influence; agility and adaptability; initiative and entrepreneurialism; effective oral and written communication; accessing and analyzing information; curiosity and imagination; and self-awareness. Conclusion. This study is an important step toward understanding how to best prepare pharmacy students for the emerging health care needs of society.

  1. Renewing Our Commitment to Kids: Collaborative Consultation

    Science.gov (United States)

    Strickler, Amy; Pfeifer, Doug; Cameron, Alex; Robinson, Anna; Price, Camile; David, Megan

    2014-01-01

    Children with serious emotional and behavioral problems often present challenges that far exceed what seems to be manageable. Despite the best intentions and efforts, youth move through multiple failed services because of the lack of progress, the "failure to adjust," and a presumed need for a higher level of care. Renewing Our…

  2. Renewables in the Midwest

    International Nuclear Information System (INIS)

    Wager, J.S.

    1994-01-01

    Over the past three years, the Union of Concerned Scientists (UCS) has evaluated the potential for using renewable energy for electricity in the Midwest, and has been carrying out a multifaceted effort to expand the use of renewables in the region. The UCS study presents a strategy for developing renewable-electric technologies and resources in 12 midwestern states. UCS analysts used a geographic information system (GIS) to create data-bases of renewable resources, land uses, vegetation cover, terrain elevation and locations of utility transmission lines, and to analyze and present information on a .6 mi x .6 mi (1 km x 1 km) grid scale. In addition, UCS developed a model to calculate the net employment impact of renewable versus conventional electricity technologies on a state-by-state basis. In evaluating the costs and benefits of renewable energy sources, UCS analysts explored a cost assessment that accounted for the impact of pollution from fossil fuels on energy resource cost. Researchers also considered the risks associated with fuel-price volatility, environmental regulation, construction lead times and other uncertainties. Finally, UCS researchers suggested steps to remove the institutional, regulatory and legislative barriers that inhibit renewable energy development, and proposed policies to expand the use of the region's renewable resources. The UCS analysis showed that wind is currently the least expensive renewable resource. UCS also found numerous opportunities to expand biomass-electric generation in the near term, such as converting small coal-fired power plants to wood fuel, making greater use of logging residues and co-firing a small percentage of biomass with fossil fuel at large power plants

  3. Trends in monitoring pharmaceuticals and personal-care products in the aquatic environment by use of passive sampling devices

    Science.gov (United States)

    Mills, G.A.; Vrana, B.; Allan, I.; Alvarez, D.A.; Huckins, J.N.; Greenwood, R.

    2007-01-01

    The use of passive sampling in monitoring pharmaceuticals and personal-care products (PPCPs) in the aquatic environment is discussed. The utility of passive sampling methods for monitoring the fraction of heavy metals and the biologically available fraction of non-polar organic priority pollutants is recognized and these technologies are being used in surveys of water quality. These devices are used to measure the dissolved fraction and they can yield information that can be used in the development of risk assessments models. These devices can also be used to locate illegal dumping and to monitor specific sources of input of PPCPs into the environment, or to monitor the effectiveness of water treatment processes in the removal of these compounds from wastewater. These devices can provide representative information at low cost which necessitate a combination of laboratory calibration and field studies for emerging pollutants.

  4. Transforming the patient care environment with Lean Six Sigma and realistic evaluation.

    Science.gov (United States)

    Black, Jason

    2009-01-01

    Lean Six Sigma (LSS) is a structured methodology for transforming processes, but it does not fully consider the complex social interactions that cause processes to form in hospital organizations. By combining LSS implementations with the concept of Realistic Evaluation, a methodology that promotes change by assessing and considering the individual characteristics of an organization's social environment, successful and sustainable process improvement is more likely.

  5. Restorative Justice Pedagogy in the ESL Classroom: Creating a Caring Environment to Support Refugee Students

    Science.gov (United States)

    Ogilvie, Greg; Fuller, David

    2016-01-01

    For many years the Canadian government has been committed to resettling refugees. Recently, this commitment has been expanded, as more than 25,000 Syrian refugees have been admitted into Canada. As refugee students struggle to adapt to a new environment, English as a second language (ESL) educators are called upon to play a significant role in the…

  6. Work Environment and Workplace Bullying among Korean Intensive Care Unit Nurses

    Directory of Open Access Journals (Sweden)

    Seonyoung Yun, MSN, RN

    2014-09-01

    Conclusion: These findings indicate that the better the nursing work environment, the less workplace bullying nurses will experience. Further research needs to be done to identify factors that influence bullying in the nurses and to develop an intervention that prevents workplace bullying.

  7. Assessment and determinants of airborne bacterial and fungal concentrations in different indoor environments: Homes, child day-care centres, primary schools and elderly care centres

    Science.gov (United States)

    Madureira, Joana; Paciência, Inês; Rufo, João Cavaleiro; Pereira, Cristiana; Teixeira, João Paulo; de Oliveira Fernandes, Eduardo

    2015-05-01

    Until now the influence of risk factors resulting from exposure to biological agents in indoor air has been far less studied than outdoor pollution; therefore the uncertainty of health risks, and how to effectively prevent these, remains. This study aimed (i) to quantify airborne cultivable bacterial and fungal concentrations in four different types of indoor environment as well as to identify the recovered fungi; (ii) to assess the impact of outdoor bacterial and fungal concentrations on indoor air; (iii) to investigate the influence of carbon dioxide (CO2), temperature and relative humidity on bacterial and fungal concentrations; and (iv) to estimate bacterial and fungal dose rate for children (3-5 years old and 8-10 years old) in comparison with the elderly. Air samples were collected in 68 homes, 9 child day-care centres, 20 primary schools and 22 elderly care centres, in a total of 264 rooms with a microbiological air sampler and using tryptic soy agar and malt extract agar culture media for bacteria and fungi growth, respectively. For each building, one outdoor representative location were identified and simultaneously studied. The results showed that child day-care centres were the indoor microenvironment with the highest median bacterial and fungal concentrations (3870 CFU/m3 and 415 CFU/m3, respectively), whereas the lowest median concentrations were observed in elderly care centres (222 CFU/m3 and 180 CFU/m3, respectively). Indoor bacterial concentrations were significantly higher than outdoor concentrations (p < 0.05); whereas the indoor/outdoor ratios for the obtained fungal concentrations were approximately around the unit. Indoor CO2 levels were associated with the bacterial concentration, probably due to occupancy and insufficient ventilation. Penicillium and Cladosporium were the most frequently occurring fungi. Children's had two times higher dose rate to biological pollutants when compared to adult individuals. Thus, due to children

  8. Damn renewable energies

    International Nuclear Information System (INIS)

    Gay, Michel

    2017-01-01

    In this book, the author describes how renewable energies have been developed in a way he considers as scandalous, whereas they are a technical, financial and ecological dead end. He also explains how ecologists (notably the ADEME) manipulate figures to make believe that these energies could be an answer to the needs of France, of Europe and of humanity. In a first chapter, he criticises the influence of a so-called green ideology on the design of energy transition. In the second one, he denounces twelve tales about energy transition. In the next chapters, he denounces the sham of renewable energies, and finally tells some unfortunate renewable experiments

  9. Renewable energies - Alain Chardon

    International Nuclear Information System (INIS)

    Anon.

    2012-01-01

    In an interview, the chairman of Cleantechs and Decarbonate, Capgemini Consulting, comments the challenge of the struggle against global warming, discusses the role of gas on the way towards a de-carbonated economy, the cost of renewable energies compared to that of fossil and nuclear energies. He outlines other brakes upon the development of renewable energies, discusses the political issues and the challenge of meeting European objectives with respect with the share of renewable energies in the energy mix and the electricity mix by 2020

  10. TV-Based Caring Videophone System for the Elderly in the Smart Home Environment

    Directory of Open Access Journals (Sweden)

    Jingshuang Shen

    2013-01-01

    Full Text Available A novel videophone system for the elderly-care application is proposed. Based on the detailed analysis of the elderly’s physical and psychological characteristics, a TV-based caring videophone system for the elderly is developed: an embedded multimedia device is designed to implement the interactive video and audio processing and IP-based communication, in which TV is adopted as the display terminal to achieve a low-cost but high-quality service. Considering the user’s convenience, many personalized designs, such as photo-based address book, photo-click-dialing, and touch pad based remote controller, are developed to make the proposed videophone system more intuitive and easy to use for the elderly. Based on Support Vector Machine (SVM algorithms, an evaluation model is also developed with the data collected from the embedded multimedia device. It is useful to evaluate the physical and psychological health of the elderly.

  11. Marketing environment dynamics and implications for pricing strategies: the case of home health care.

    Science.gov (United States)

    Ponsford, B J; Barlow, D

    1999-01-01

    This research reviews the factors affecting the pricing or rate schedules of home health care agencies. A large number of factors affect costs and thus rate structures. The major factors include reimbursement structures with accompanying discount structures, administrative burdens, and risks. Channel issues include bargaining power, competition, and size. Staffing issues affect pricing and product through the provider level, productivity, and quality outcomes. Physician and patient issues include quality concerns and choices. These factors are discussed in light of overall marketing strategy and the interaction of pricing with other marketing controllables such as product, place/distribution, and promotion. Economic and accounting principles are also reviewed with consideration to understanding direct and indirect costs in order to enable negotiators to effectively price health care services.

  12. Beyond communication: the role of standardized protocols in a changing health care environment.

    Science.gov (United States)

    Vardaman, James M; Cornell, Paul; Gondo, Maria B; Amis, John M; Townsend-Gervis, Mary; Thetford, Carol

    2012-01-01

    Communication errors have grave consequences in health care settings. The situation-background-assessment-recommendation (SBAR) protocol has been theorized to improve communication by creating a common language between nurses and physicians in acute care situations. This practice is gaining acceptance across the health care field. However, as yet, there has been little investigation of the ways in which SBAR may have an impact on how health care professionals operate beyond the creation of a common language. The purposes of the study were to explore the implementation of the SBAR protocol and investigate the potential impact of SBAR on the day-to-day experiences of nurses. We performed a qualitative case study of 2 hospitals that were implementing the SBAR protocol. We collected data from 80 semistructured interviews with nurses, nurse manager, and physicians; observation of nursing and other hospital activities; and documents that pertained to the implementation of the SBAR protocol. Data were analyzed using a thematic approach. Our analysis revealed 4 dimensions of impact that SBAR has beyond its use as a communication tool: schema formation, development of legitimacy, development of social capital, and reinforcement of dominant logics. The results indicate that SBAR may function as more than a tool to standardize communication among nurses and physicians. Rather, the findings indicate that SBAR may aid in schema development that allows rapid decision making by nurses, provide social capital and legitimacy for less-tenured nurses, and reinforce a move toward standardization in the nursing profession. Our findings further suggest that standardized protocols such as SBAR may be a cost-effective method for hospital managers and administrators to accelerate the socialization of nurses, particularly new hires.

  13. Enhancing mHealth Technology in the PCMH Environment to Activate Chronic Care Patients

    Science.gov (United States)

    2017-09-01

    Summary of Diabetes Self-Care Activities SUS, System Usability Scale Type 2 Diabetes User-Centered Design Research TATRC, Telemedicine and Advanced...Activities SUS, System Usability Scale Type 2 Diabetes User-Centered Design Research TATRC, Telemedicine and Advanced Technology Research Center...included in the study. Major Task 3: Conduct 4-5 days of user-centered design research ( qualitative ) with research participants – each site

  14. Social environment, bases social markers and health care system in Shida Kartli region.

    Science.gov (United States)

    Raminashvili, D; Gvanceladze, T; Kajrishvili, M; Zarnadze, I; Zarnadze, Sh

    2009-10-01

    Difficult social conditions are accompanied by poor health status and limited access to quality social services. Accessibility to the health care is one of the important patient right universally. Although formally in place, health services are deprived of any means to assist the population. From 1600 respondents 58,8% paid for medical bills on their own, and 8.7% of respondents had health insurance that covered medical and health expenses. Almost every fifth respondent (18.5%) had access to supplemental financial support from friends and relatives. The vast majority of respondents considered the care received from medical services providers as being positive. 17.8% of respondents evaluated it as having been "very good", and every second out of five respondents (42.7%) evaluated it as having been "good". Every twentieth patient (5.2%) evaluated it as "poor" and 3.7% -"very bad", 29% of respondents are affiliated with various governmental programs. Social-economic situation influenced on the accessibility to the medical care. An effective of social policy is the system of prevention of risk factors.

  15. The challenge of managing laboratory information in a managed care environment.

    Science.gov (United States)

    Friedman, B A

    1996-04-01

    This article considers some of the major changes that are occurring in pathology and pathology informatics in response to the shift to managed care in the United States. To better understand the relationship between information management in clinical laboratories and managed care, a typology of integrated delivery systems is presented. Following this is a discussion of the evolutionary trajectory for the computer networks that serve these large consolidated healthcare delivery organizations. The most complex of these computer networks is a community health information network. Participation in the planning and deployment of community health information networks will be important for pathologists because information management within pathology will be inexorably integrated into the larger effort by integrated delivery systems to share clinical, financial, and administrative data on a regional basis. Finally, four laboratory information management challenges under managed care are discussed, accompanied by possible approaches to each of them. The challenges presented are (1) organizational integration of departmental information systems such as the laboratory information system; (2) weakening of the best-of-breed approach to laboratory information system selection; (3) the shift away from the centralized laboratory paradigm; and (4) the development of rule-based systems to monitor and control laboratory utilization.

  16. Transient cultivation and fallow land in forests. Measurements of the specific activity of the carbon in organic matter fractions for the purpose of studying the renewal of the store of organic matter in an equatorial forest environment

    International Nuclear Information System (INIS)

    Turenne, J.F.; Rapaire, J.L.

    1979-01-01

    Different conditions of forest-type fallow land and of clearings in the equatorial forests of the Amazon region provide a basis for determining the nature, the direction and the magnitude of the transformations of the organic matter of the soil when cultivated, using the variations in the specific activity of atmospheric carbon. Calculations of the renewal rates of surface horizon organic matter show that there are two groups of products, (a) humin, a labile fraction with a high renewal rate, and (b) humic and fulvic products with a lower renewal rate. The effect of clearing is generally to retard these renewal rates. The dynamics which become established in forest fallow land mainly involve the fulvic products, and the return to forest equilibrium can be considered to occur between 60 and 100 years after clearing. (author)

  17. Diversification of health care services: the effects of ownership, environment, and strategy.

    Science.gov (United States)

    Shortell, S M; Morrison, E M; Hughes, S L; Friedman, B S; Vitek, J L

    1987-01-01

    The present findings suggest that the trend toward greater diversification of hospital services is likely to be most strongly influenced by state Medicaid policies and certain hospital characteristics. Increasing Medicaid eligibility and payment levels is likely to have a positive effect on services diversification. Growth in the number of inpatient services provided and a more severe case mix are also likely to be involved with greater service diversification. Affiliation with a not-for-profit hospital system is likely to be associated with more diversified hospital services but not affiliation with an investor-owned system. There is also some indication that the overall portfolio of services which a hospital offers in regard to market share and market growth characteristics influences diversification. Specifically, a low market share portfolio is likely to be associated with less diversification. Competition is likely to be associated with more diversification; particularly for hospitals belonging to systems. The effect of competition on hospital strategy and services diversification is a particularly important area for further investigation. Increasing Medicaid payment and eligibility levels are also likely to have a positive effect on the provision of services which are usually unprofitable. Raising such levels is likely to be particularly beneficial to inner-city hospitals who are already providing a greater number of such services. However, the present data suggest that investor-owned hospitals are least likely to provide such services. Increasing Medicaid eligibility levels is also likely to be associated with fewer services for which charity care has to be provided. State regulation in the form of rate review and certificate of need is likely to be associated with more services for which hospitals provide some charity care. But such policies alone do not deal with the larger issue of how to finance care for the medically indigent. Present data suggest the

  18. Patients′ perception of the quality of malaria treatment in primary health care centers of Jos and Environs

    Directory of Open Access Journals (Sweden)

    N S Jimam

    2015-01-01

    Full Text Available Background: Though the fight against malaria continued to be on the increased, the disease still remains a major public health problem in many developing countries, especially in the rural areas. The extent of drug use and its effect is affected among other things by the pattern in which these drugs are prescribed by the health workers. Patients′ assessment of the quality of care depends on their ability to judge whether health care providers are adhering to the defined standard of care, hence it is necessary to assess the views of patients regarding the quality of care they received from the primary health care (PHC centers. Aim: This study aimed at evaluating consumer′s perception of the quality of malaria treatment in PHC centers of Jos and environs. Materials and Methods: Nine PHC centers were selected by multi-stage random sampling, five from Jos North and four from Jos South Local Government Areas of Plateau State. Patients of both sexes within the age range of 18 years and above who visited the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. A semi-structured interviewer questionnaire which was adapted from previous health survey studies was administered to all the 249 eligible participants. The data collected were analyzed using the Statistical Package for Social Sciences (SPSS version 20.0 software programmer. Results: The result showed that there were no consistently significant differences (P > 0.05 regarding patient satisfaction between male and female patients across selected items in the various domains, that is, irrespective of respondents′ sex, their perception of the quality of health services rendered by PHCs was similar. Conclusion: It was therefore concluded that there was similar satisfaction level between the male and the female, though some key health services were not readily available in the

  19. Preterm infant thermal care: differing thermal environments produced by air versus skin servo-control incubators.

    Science.gov (United States)

    Thomas, K A; Burr, R

    1999-06-01

    Incubator thermal environments produced by skin versus air servo-control were compared. Infant abdominal skin and incubator air temperatures were recorded from 18 infants in skin servo-control and 14 infants in air servo-control (26- to 29-week gestational age, 14 +/- 2 days postnatal age) for 24 hours. Differences in incubator and infant temperature, neutral thermal environment (NTE) maintenance, and infant and incubator circadian rhythm were examined using analysis of variance and scatterplots. Skin servo-control resulted in more variable air temperature, yet more stable infant temperature, and more time within the NTE. Circadian rhythm of both infant and incubator temperature differed by control mode and the relationship between incubator and infant temperature rhythms was a function of control mode. The differences between incubator control modes extend beyond temperature stability and maintenance of NTE. Circadian rhythm of incubator and infant temperatures is influenced by incubator control.

  20. FY2012 CoC Competition Grants (New and Renewal)

    Data.gov (United States)

    Department of Housing and Urban Development — This report displays the FY2012 renewal and new homeless assistance projects awarded by HUD for the FY2012 Continuum of Care (CoC) Program competition. Approximately...

  1. Parental child-care practices of Slovenian preschoolers' mothers and fathers: The Family Environment Questionnaire

    OpenAIRE

    Maja Zupančič; Anja Podlesek; Tina Kavčič

    2004-01-01

    The paper reviews evidence on the construct validity and reliability of the newly developed Family Environment Questionnaire (FEQ), and presents data on the structure of socialisation practices the Slovenian parents use in daily interactions with their three-year-old children. The FEQ is a parent report measure designed to provide an assessment of individual differences in parental practices that are representative among the parents of preschool children in the given cultural community. Facto...

  2. Remote physiological monitoring in an austere environment: a future for battlefield care provision?

    Science.gov (United States)

    Smyth, Matthew J; Round, J A; Mellor, A J

    2018-05-14

    Wearable technologies are making considerable advances into the mainstream as they become smaller and more user friendly. The global market for such devices is forecasted to be worth over US$5 billion in 2018, with one in six people owning a device. Many professional sporting teams use self-monitoring to assess physiological parameters and work rate on the pitch, highlighting the potential utility for military command chains. As size of device reduces and sensitivity improves, coupled with remote connectivity technology, integration into the military environment could be relatively seamless. Remote monitoring of personnel on the ground, giving live updates on their physiological status, would allow commanders or medical officers the ability to manage their soldiers appropriately and improve combat effectiveness. This paper explores a proof of concept for the use of a self-monitoring system in the austere high altitude environment of the Nepalese Himalayas, akin to those experienced by modern militaries fighting in remote locations. It also reviews, in part, the historical development of remote monitoring technologies. The system allowed for physiological recordings, plotted against GPS position, to be remotely monitored in Italy. Examples of the data recorded are given and the performance of the system is discussed, including limitations, potential areas of development and how systems like this one could be integrated into the military environment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Renewable energy in Taiwan

    International Nuclear Information System (INIS)

    Chen, Falin; Lu, Shyi-Min; Wang, Eric; Tseng, Kuo-Tung

    2010-01-01

    With limited indigenous conventional energy resources, Taiwan imports over 99% of its energy supply from foreign countries, mostly from the Middle East. Developing independent renewable energy resources is thus of priority concern for the Taiwanese government. A medium subtropical island surrounded by the Pacific Ocean, Taiwan has enormous potential to develop various renewable energies, such as solar energy, biomass energy, wind power, geothermal energy, hydropower, etc. However, owing to the importance of conventional fossil energy in generating exceptionally cheap electricity, renewable energy has not yet fully developed in Taiwan, resulting from a lack of market competition. Consequently, numerous promotional and subsidy programs have recently been proclaimed by the Taiwanese government, focused on the development of various renewables. This study reviews the achievements, polices and future plans in this area. (author)

  4. The value of renewables

    International Nuclear Information System (INIS)

    Koch, H.J.

    2001-01-01

    The article extols the virtues of renewable energy sources. Based largely on the outcome of an IAE meeting in May 2001, the author has outlined an approach for accelerating the development of renewables. The article quotes several statements made by the IAE with respect to the need for a secure supply of affordable energy, sustainable development, diversification, the value of renewables and challenges confronting developers of renewables. The article is presented under the sub-headings of: (i) harnessing energy market forces; (ii) understanding costs in the context of diversification; (iii) economic performance; (iv) environmental protection; (v) an IAE action plan and (vi) conclusions. The author was once the IAE's director for energy efficiency, technology and R and D

  5. Biotechnology for renewable chemicals

    DEFF Research Database (Denmark)

    Borodina, Irina; Kildegaard, Kanchana Rueksomtawin; Jensen, Niels Bjerg

    2014-01-01

    The majority of the industrial organic chemicals are derived from fossil sources. With the oil and gas resources becoming limiting, biotechnology offers a sustainable alternative for production ofchemicals from renewable feedstocks. Yeast is an attractive cell factory forsustainable production...

  6. Foundations for renewables

    Energy Technology Data Exchange (ETDEWEB)

    Neidlein, H.C. [German Agency Scherer Schnell Walser und Partner (Germany)

    2007-07-01

    In Germany, 77 foundations promote renewable energy technology with around Euro 25 million annually. The most important internationally active foundations, however, can be found in the Anglo-Saxon countries. (orig.)

  7. Renewable resources - future possibilities

    International Nuclear Information System (INIS)

    Thomas, Martin H.

    1998-01-01

    The paper describes the Australian Cooperative Research Centre for Renewable Energy and Related Greenhouse Gas Abatement Technologies (ACRE), its technologies, commercial relationships and markets. The relevance of ACRE to developing country communities which lack reliable, adequate power supplies, is discussed. The opportunities for mutual collaboration between Australia and the developing countries in the application of renewable energy have never been stronger. Renewable energy promises real advantages to those who deploy it wisely, as well as significant job creation. Education at all level together with operational training, public awareness of what is possible and increased system reliability, are also vital ingredients for acceptance of these new technologies. They underpin successful commercialisation. The author concludes with the hope for a united international cooperative approach to the development of the renewable energy industry. (author)

  8. Renewable Heating And Cooling

    Science.gov (United States)

    Renewable heating and cooling is a set of alternative resources and technologies that can be used in place of conventional heating and cooling technologies for common applications such as water heating, space heating, space cooling and process heat.

  9. Renewable Energy Tracking Systems

    Science.gov (United States)

    Renewable energy generation ownership can be accounted through tracking systems. Tracking systems are highly automated, contain specific information about each MWh, and are accessible over the internet to market participants.

  10. Renewable energy in Taiwan

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Falin; Lu, Shyi-Min; Wang, Eric; Tseng, Kuo-Tung [Institute of Applied Mechanics, National Taiwan University, Taipei 10617 (China)

    2010-09-15

    With limited indigenous conventional energy resources, Taiwan imports over 99% of its energy supply from foreign countries, mostly from the Middle East. Developing independent renewable energy resources is thus of priority concern for the Taiwanese government. A medium subtropical island surrounded by the Pacific Ocean, Taiwan has enormous potential to develop various renewable energies, such as solar energy, biomass energy, wind power, geothermal energy, hydropower, etc. However, owing to the importance of conventional fossil energy in generating exceptionally cheap electricity, renewable energy has not yet fully developed in Taiwan, resulting from a lack of market competition. Consequently, numerous promotional and subsidy programs have recently been proclaimed by the Taiwanese government, focused on the development of various renewables. This study reviews the achievements, polices and future plans in this area. (author)

  11. Renewable Substitutability Index: Maximizing Renewable Resource Use in Buildings

    Science.gov (United States)

    In order to achieve a material and energy balance in buildings that is sustainable in the long run, there is an urgent need to assess the renewable and non-renewable resources used in the manufacturing process and to progressively replace non-renewable resources with renewables. ...

  12. License renewal process

    International Nuclear Information System (INIS)

    Fable, D.; Prah, M.; Vrankic, K.; Lebegner, J.

    2004-01-01

    The purpose of this paper is to provide information about license renewal process, as defined by Nuclear Regulatory Commission (NRC). The Atomic Energy Act and NRC regulations limit commercial power reactor licenses to an initial 40 years but also permit such licenses to be renewed. This original 40-year term for reactor licenses was based on economic and antitrust considerations not on limitations of nuclear technology. Due to this selected time period; however, some structures and components may have been engineered on the basis of an expected 40-year service life. The NRC has established a timely license renewal process and clear requirements codified in 10 CFR Part 51 and 10 CFR Part 54, that are needed to assure safe plant operation for extended plant life. The timely renewal of licenses for an additional 20 years, where appropriate to renew them, may be important to ensuring an adequate energy supply during the first half of the 21st Century. License renewal rests on the determination that currently operating plants continue to maintain adequate levels of safety, and over the plant's life, this level has been enhanced through maintenance of the licensing bases, with appropriate adjustments to address new information from industry operating experience. Additionally, NRC activities have provided ongoing assurance that the licensing bases will continue to provide an acceptable level of safety. This paper provides additional discussion of license renewal costs, as one of key elements in evaluation of license renewal justifiability. Including structure of costs, approximately value and two different approaches, conservative and typical. Current status and position of Nuclear Power Plant Krsko, related to license renewal process, will be briefly presented in this paper. NPP Krsko is designed based on NRC Regulations, so requirements from 10 CFR 51, and 10 CFR 54, are applicable to NPP Krsko, as well. Finally, this paper will give an overview of current status of

  13. Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital.

    Science.gov (United States)

    Roberts, Helen C

    2018-05-01

    This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff.

  14. Processes of Strategic Renewal,

    OpenAIRE

    Harald Aadne, John; Mahnke, Volker

    2010-01-01

    We discuss strategic renewal from a competence perspective. We argue that the management of speed and timing in this process is viewed distinctively when perceived through a cognitive lens. Managers need more firmly grounded process-understanding. The key idea of this paper is to dynamically conceptualize key activities of strategic renewal, and possible sources of break-down as they relate to the managment of speed and timing. Based on a case from the media industry, we identi...

  15. Promoting renewable energy technologies

    DEFF Research Database (Denmark)

    Olsen, O.J.; Skytte, K.

    2004-01-01

    % of its annual electricity production. In this paper, we present and discuss the Danish experience as a case of promoting renewable energy technologies. The development path of the two technologies has been very different. Wind power is considered an outright success with fast deployment to decreasing...... technology and its particular context, it is possible to formulate some general principles that can help to create an effective and efficient policy for promoting new renewable energy technologies....

  16. Creating an environment for caring using lean principles of the Virginia Mason Production System.

    Science.gov (United States)

    Nelson-Peterson, Dana L; Leppa, Carol J

    2007-06-01

    As healthcare leaders search for viable options to cut costs, increase efficiencies, and improve the product that they offer to customers, many are looking at different business models to adopt. At the same time, an aging workforce of nurses feel the pressure of being overworked and understaffed, resulting in both decreased job and patient satisfaction. Virginia Mason Medical Center in Seattle, Wash, has implemented the Virginia Mason Production System, using proven concepts adapted from the Toyota Production System that effectively eliminate "muda" or waste, in workplace processes. The authors discuss the application of the Virginia Mason Production System and how it has resulted in increased time for nurses to care for their patients.

  17. Enhancing mHealth Technology in the PCMH Environment to Activate Chronic Care Patients

    Science.gov (United States)

    2016-09-01

    9. Appendices…………………………………………………………… 16 Abstract for AMSUS Poster #1 Abstract for AMSUS Poster #2 Power Point sample slides from the mCare product... transfer ? (Not applicable for this reporting period)  What was the impact on society beyond science and technology? Phase II research will make an...and process requirements (e.g. interface with wireless communication providers, visualization capabilities and options, data analytic structure) while

  18. The big hurt: Trauma system funding in today's health care environment.

    Science.gov (United States)

    Geehan, Douglas

    2010-01-01

    Trauma systems provide effective care of the injured patient but require major financial costs in readiness and availability of the extensive trauma team and specialized equipment. Traditional billing and collection practices do not fully recoup these costs. Effective use of the standard billing system is vital to the stability of a trauma system; however, a system wide funding mechanism provides an optimal, stable foundation. Efforts to provide sustainable trauma system funding are ongoing. Numerous state initiatives have been successful in funding trauma systems but a universal solution has yet to be found.

  19. Decision Criteria for Distributed Versus Non-Distributed Information Systems in the Health Care Environment

    Science.gov (United States)

    McGinnis, John W.

    1980-01-01

    The very same technological advances that support distributed systems have also dramatically increased the efficiency and capabilities of centralized systems making it more complex for health care managers to select the “right” system architecture to meet their particular needs. How this selection can be made with a reasonable degree of managerial comfort is the focus of this paper. The approach advocated is based on experience in developing the Tri-Service Medical Information System (TRIMIS) program. Along with this technical standards and configuration management procedures were developed that provided the necessary guidance to implement the selected architecture and to allow it to change in a controlled way over its life cycle.

  20. Carbon credit of renewable energy projects in Malaysia

    Science.gov (United States)

    Lim, X.; Lam, W. H.; Shamsuddin, A. H.

    2013-06-01

    The introduction of Clean Development Mechanism (CDM) to Malaysia improves the environment of the country. Besides achieving sustainable development, the carbon credit earned through CDM enhances the financial state of the nation. Both CDM and renewable energy contribute to the society by striving to reduce carbon emission. Most of the CDM projects are related to renewable energy, which recorded 69% out of total CDM projects. This paper presents the energy overview and status of renewable energies in the country. Then, the renewable energy will be related to the CDM.

  1. RENEWABLE ENERGY INVESTMENTS DURING 2004-2015 PERIOD

    Directory of Open Access Journals (Sweden)

    Brîndușa COVACI

    2016-12-01

    Full Text Available The article presents important considerations on the renewable energy investments from world and European level. The paper points out Europe's position in the current world context. Research is an exploratory one, being supported by statistical interpretations made by the author based on analysis of the "Global Trends in the renewable energy sector" report (2016, United Nations Environment Programme in collaboration with Bloomberg under the auspices of the School of Finance and Management in Frankfurt. Conceptually, the paper presents the most important points of the oscillation investments in the renewable energy sector worldwide. The level of investment in the renewable energy sector offers an accurate picture of the extent of decarbonisation.

  2. Carbon credit of renewable energy projects in Malaysia

    International Nuclear Information System (INIS)

    Lim, X; Lam, W H; Shamsuddin, A H

    2013-01-01

    The introduction of Clean Development Mechanism (CDM) to Malaysia improves the environment of the country. Besides achieving sustainable development, the carbon credit earned through CDM enhances the financial state of the nation. Both CDM and renewable energy contribute to the society by striving to reduce carbon emission. Most of the CDM projects are related to renewable energy, which recorded 69% out of total CDM projects. This paper presents the energy overview and status of renewable energies in the country. Then, the renewable energy will be related to the CDM.

  3. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  4. An industry-wide commitment to the environment. Vastuu huomisesta - Responsible Care-ohjelmalla rakennetaan tulevaisuutta

    Energy Technology Data Exchange (ETDEWEB)

    Salo, L.

    1992-01-01

    As part of its ongoing effort to further enhance its environmental, health, and safety effort. Neste committed itself to the international chemical industry's Responsible Care programme last year. Neste's involvement with the programme will supplement the Corporation's internal environmental and safety operating principles Neste's Responsible Care work is based around a set of 10 guiding principles set out by the European Chemical Industry Federation (CEFIC). In addition to corporate-level targets, divisions and units have drawn up more detailed and specific coals for their own operations. Neste Chemicals' production plants, for example have developed action plans covering the next 3-5 years. A network of divisional RC coordinators and unit or site-specific RC contact personnel has also been established Progress will be measured by indicators covering areas such as emission levels, energy use, amount of recycled waste, noise, and training Concrete benefits have already been achieved thanks simply to the start of the systematic measurement and collation of RC-related information.

  5. Health facility environment as humanization strategy care in the pediatric unit: systematic review

    Directory of Open Access Journals (Sweden)

    Juliane Portella Ribeiro

    2014-06-01

    Full Text Available Objective: To identify and analyze the production of knowledge about the strategies that health care institutions have implemented to humanize care of hospitalized children. Method: This is a systematic review conducted in the Virtual Health Library - Nursing and SciELO, using the seven steps proposed by the Cochrane Handbook. Results: 15 studies were selected, and strategies that involved relationship exchanges were used between the health professional, the hospitalized child and their families, which may be mediated by leisure activities, music and by reading fairy tales. We also include the use of the architecture itself as a way of providing welfare to the child and his/her family, as well as facilitating the development of the work process of health professionals. Conclusion: Investments in research and publications about the topic are necessary, so that, the National Humanization Policy does not disappear and that the identified strategies in this study do not configure as isolated and disjointed actions of health policy.

  6. Deploying Renewables: Principles for Effective Policies. Executive Summary [Russian Version

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    Renewable energy can play a fundamental role in tackling climate change, environmental degradation and energy security. As these challenges have become ever more pressing, governments and markets are seeking innovative solutions. Yet, what are the key factors that will determine the success of renewable energy policies? How can current policies be improved to encourage greater deployment of renewables? What impact can more effective policies have on renewables’ share in the future global energy mix and how soon? Deploying Renewables: Principles for Effective Policies addresses these questions. Responding to the Gleneagles G8 call for a clean and secure energy future, it highlights key policy tools to fast-track renewables into the mainstream. This analysis illustrates good practices by applying the combined metrics of effectiveness and efficiency to renewable energy policies in the electricity, heating and transport sectors. It highlights significant barriers to accelerating renewables penetration, and argues that the great potential of renewables can be exploited much more rapidly and to a much larger extent if good practices are adopted. Carefully designed policy frameworks, customised to support technologies at differing stages of maturity, will deliver a strong portfolio of renewable energy technologies. Deploying Renewables: Principles for Effective Policies provides recommendations on key principles for policy design as a template for decision makers.

  7. Nutrition and Physical Activity Environments of Home-Based Child Care: What Hispanic Providers Have to Say.

    Science.gov (United States)

    Tovar, Alison; Mena, Noereem Z; Risica, Patricia; Gorham, Gemma; Gans, Kim M

    2015-10-01

    It is important to understand the perceptions and beliefs of family child care providers (FCCPs) regarding which factors influence children's physical activity (PA), screen-time (ST), and dietary behaviors in order to develop and implement appropriate obesity prevention interventions. The aim of this qualitative study was to explore the aforementioned perceptions and beliefs of FCCPs in Rhode Island. Four focus groups (n = 30) were held with FCCPs. Providers were female, Hispanic, and Spanish speaking. Providers were asked about different aspects of feeding, PA, and ST behaviors. Themes were coded using NVivo10 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Content analysis was used to analyze final themes. Providers understood the importance of providing opportunities for healthy eating and PA for the children they cared for, but there was room for improvement, especially with regard to certain feeding and ST practices. Several barriers were evident, including the lack of physical infrastructure for PA, cultural beliefs and practices related to child feeding, and difficulties working with parents to provide consistent messages across environments. Given that FCCPs are aware of the importance of healthy eating and PA, there is a need to address the specific barriers they face, and operationalize some of their knowledge into practical everyday actions. This formative work will inform the development of a culturally relevant, multicomponent intervention for ethnically diverse FCCPs to improve the food and PA environments of their homes, which should, in turn, improve the dietary, PA, and ST behaviors of the 2- to 5-year-old children they care for.

  8. Staff Nurse Perceptions of Open-Pod and Single Family Room NICU Designs on Work Environment and Patient Care.

    Science.gov (United States)

    Winner-Stoltz, Regina; Lengerich, Alexander; Hench, Anna Jeanine; OʼMalley, Janet; Kjelland, Kimberly; Teal, Melissa

    2018-06-01

    Neonatal intensive care units have historically been constructed as open units or multiple-bed bays, but since the 1990s, the trend has been toward single family room (SFR) units. The SFR design has been found to promote family-centered care and to improve patient outcomes and safety. The impact of the SFR design NICU on staff, however, has been mixed. The purposes of this study were to compare staff nurse perceptions of their work environments in an open-pod versus an SFR NICU and to compare staff nurse perceptions of the impact of 2 NICU designs on the care they provide for patients/families. A prospective cohort study was conducted. Questionnaires were completed at 6 months premove and again at 3, 9, and 15 months postmove. A series of 1-way analyses of variance were conducted to compare each group in each of the 8 domains. Open-ended questions were evaluated using thematic analysis. The SFR design is favorable in relation to environmental quality and control of primary workspace, privacy and interruption, unit features supporting individual work, and unit features supporting teamwork; the open-pod design is preferable in relation to walking. Incorporating design features that decrease staff isolation and walking and ensuring both patient and staff safety and security are important considerations. Further study is needed on unit design at a microlevel including headwall design and human milk mixing areas, as well as on workflow processes.

  9. Retaining nurses in a changing health care environment: The role of job embeddedness and self-efficacy.

    Science.gov (United States)

    Vardaman, James M; Rogers, Bryan L; Marler, Laura E

    2018-04-11

    Because nurses are on the front lines of care delivery, they are subject to frequent changes to their work practices. This change-laden environment puts nurses at higher risk for turnover. Given the frequent disruption to the way nurses perform their jobs, change-related self-efficacy (CSE), or confidence that one can handle change, may be vital to their retention. The purpose of this article is to examine the roles of CSE and job embeddedness in reducing turnover intentions among nurses. Specifically, this article tests a model in which CSE is the intervening mechanism through which job embeddedness influences turnover intentions. Drawing on a sample of 207 nurses working in the medical/surgical unit of a major metropolitan hospital in the United States, this study employs OLS regression to test for direct effects of job embeddedness and CSE on turnover intentions and bias-corrected bootstrapping to test for the indirect effects of job embeddedness on turnover intentions through CSE. Results show that CSE is directly linked to turnover intentions, and the effects of job embeddedness on turnover intentions become fully manifest through CSE. Improved nurse retention may lead to stable patient care and less disruption in service delivery. Improved retention also benefits health care organizations financially, as costs of replacing a nurse can exceed 100% of the salary for the position. Given the shortage of nurses in some geographic areas, retention remains an important goal.

  10. Evaluation of health care services provided for older adults in primary health care centers and its internal environment. A step towards age-friendly health centers.

    Science.gov (United States)

    Alhamdan, Adel A; Alshammari, Sulaiman A; Al-Amoud, Maysoon M; Hameed, Tariq A; Al-Muammar, May N; Bindawas, Saad M; Al-Orf, Saada M; Mohamed, Ashry G; Al-Ghamdi, Essam A; Calder, Philip C

    2015-09-01

    To evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol) was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly.

  11. Evaluation of health care services provided for older adults in primary health care centers and its internal environment. A step towards age-friendly health centers

    Directory of Open Access Journals (Sweden)

    Adel A. Alhamdan

    2015-09-01

    Full Text Available Objectives: To evaluate the health care services provided for older adults by primary health care centers (PHCCs in Riyadh, Kingdom of Saudi Arabia (KSA, and the ease of use of these centers by older adults. Methods: Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. Results: Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. Conclusions: Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly.

  12. 2016 Renewable Energy Data Book

    Energy Technology Data Exchange (ETDEWEB)

    2017-12-29

    The 2016 Renewable Energy Data Book provides facts and figures on energy and electricity use, renewable electricity in the United States, global renewable energy development, wind power, solar power, geothermal power, biopower, hydropower, marine and hydrokinetic power, hydrogen, renewable fuels, and clean energy investment.

  13. 2015 Renewable Energy Data Book

    Energy Technology Data Exchange (ETDEWEB)

    Beiter, Philipp [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-11-01

    The Renewable Energy Data Book for 2015 provides facts and figures on energy and electricity use, renewable electricity in the United States, global renewable energy development, wind power, solar power, geothermal power, biopower, hydropower, marine and hydrokinetic power, hydrogen, renewable fuels, and clean energy investment.

  14. 2015 Renewable Energy Data Book

    Energy Technology Data Exchange (ETDEWEB)

    Beiter, Philipp; Tian, Tian

    2016-11-01

    The 2015 Renewable Energy Data Book provides facts and figures on energy and electricity use, renewable electricity in the United States, global renewable energy development, wind power, solar power, geothermal power, biopower, hydropower, marine and hydrokinetic power, hydrogen, renewable fuels, and clean energy investment.

  15. 2014 Renewable Energy Data Book

    Energy Technology Data Exchange (ETDEWEB)

    Beiter, Philipp

    2015-11-01

    The Renewable Energy Data Book for 2014 provides facts and figures on energy and electricity use, renewable electricity in the United States, global renewable energy development, wind power, solar power, geothermal power, biopower, hydropower, marine and hydrokinetic power, hydrogen, renewable fuels, and clean energy investment.

  16. Burnout and work environments of public health nurses involved in mental health care.

    Science.gov (United States)

    Imai, H; Nakao, H; Tsuchiya, M; Kuroda, Y; Katoh, T

    2004-09-01

    (1) To examine whether prevalence of burnout is higher among community psychiatric nurses working under recently introduced job specific work systems than among public health nurses (PHNs) engaged in other public health services. (2) To identify work environment factors potentially contributing to burnout. Two groups were examined. The psychiatric group comprised 525 PHNs primarily engaged in public mental health services at public health centres (PHCs) that had adopted the job specific work system. The control group comprised 525 PHNs primarily engaged in other health services. Pines' Burnout Scale was used to measure burnout. Respondents were classified by burnout score into three groups: A (mentally stable, no burnout); B (positive signs, risk of burnout); and C (burnout present, action required). Groups B and C were considered representative of "burnout". A questionnaire was also prepared to investigate systems for supporting PHNs working at PHCs and to define emergency mental health service factors contributing to burnout. Final respondents comprised 785 PHNs. Prevalence of burnout was significantly higher in the psychiatric group (59.2%) than in the control group (51.5%). Responses indicating lack of job control and increased annual frequency of emergency overtime services were significantly correlated with prevalence of burnout in the psychiatric group, but not in the control group. Prevalence of burnout is significantly higher for community psychiatric nurses than for PHNs engaged in other services. Overwork in emergency services and lack of job control appear to represent work environment factors contributing to burnout.

  17. A Knowledge-Based Approach to Automatic Detection of Equipment Alarm Sounds in a Neonatal Intensive Care Unit Environment.

    Science.gov (United States)

    Raboshchuk, Ganna; Nadeu, Climent; Jancovic, Peter; Lilja, Alex Peiro; Kokuer, Munevver; Munoz Mahamud, Blanca; Riverola De Veciana, Ana

    2018-01-01

    A large number of alarm sounds triggered by biomedical equipment occur frequently in the noisy environment of a neonatal intensive care unit (NICU) and play a key role in providing healthcare. In this paper, our work on the development of an automatic system for detection of acoustic alarms in that difficult environment is presented. Such automatic detection system is needed for the investigation of how a preterm infant reacts to auditory stimuli of the NICU environment and for an improved real-time patient monitoring. The approach presented in this paper consists of using the available knowledge about each alarm class in the design of the detection system. The information about the frequency structure is used in the feature extraction stage, and the time structure knowledge is incorporated at the post-processing stage. Several alternative methods are compared for feature extraction, modeling, and post-processing. The detection performance is evaluated with real data recorded in the NICU of the hospital, and by using both frame-level and period-level metrics. The experimental results show that the inclusion of both spectral and temporal information allows to improve the baseline detection performance by more than 60%.

  18. Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

    Science.gov (United States)

    Lee, Yuna S H; Stone, Patricia W; Pogorzelska-Maziarz, Monika; Nembhard, Ingrid M

    Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.

  19. RFID technology in health environment opportunities and challenges for modern cancer care.

    Science.gov (United States)

    Safdari, Reza; Maserat, Elham; Maserat, Elnaz

    2012-01-01

    Cancers are significant contributors to the mortality and health care expenditures. Cancer can be reduced and monitored by new information technology. Radio frequency identification or RFID is a wireless identification technology. The use of this technology can be employed for identifying and tracking clinical staff, patients, supplies, medications and equipments. RFID can trace and manage chemotherapy drugs. There are different types of RFID. Implantable RFID allowing a chip to be embedded under the skin and that store the cancer patient's identifier. These are concerns about applications of RFID. Privacy, security and legal issues are key problems. This paper describes capabilities, benefits and confidentiality aspects in radio frequency identification systems and solutions for overcoming challenges.

  20. Strategic Planning for Health Care Cost Controls in a Constantly Changing Environment.

    Science.gov (United States)

    Hembree, William E

    2015-01-01

    Health care cost increases are showing a resurgence. Despite recent years' comparatively modest increases, the projections for 2015 cost increases range from 6.6% to 7%--three to four times larger than 2015's expected underlying inflation. This resurgence is just one of many rapidly changing external and internal challenges health plan sponsors must overcome (and this resurgence advances the date when the majority of employers will trigger the "Cadillac tax"). What's needed is a planning approach that is effective in overcoming all known and yet-to-be-discovered challenges, not just affordability. This article provides detailed guidance in adopting six proven strategic planning steps. Following these steps will proactively and effectively create a flexible strategic plan for the present and future of employers' health plans that will withstand all internal and external challenges.