Combined effect of electrical stimulation and blade tenderization on some bovine muscles

Energy Technology Data Exchange (ETDEWEB)

Raccach, M.; Henrickson, R.L.

1979-01-01

The electrical stimulation (ES) period was a very important factor determining the tenderness of three bovine muscles: Biceps femoris (BF), Longissimus dorsi (LD), and Semimembranosus (SM). Tenderness (shear force values) increased in most cases with increasing the ES period. An ES period of 15 min was optimal for obtaining a tenderness equal to that obtained by conventional processing of beef. The shortest ES period used (1 min) was adequate in most cases to set the muscles in rigor mortis and in preventing cold shortening. The tenderness of blade tenderized muscles was in most cases independent from the ES period. Blade tenderization was very effective to tenderize the BF muscle followed in decreasing order of efficacy by the LD and SM muscles. The cooking times and cooking losses of the three muscles were not affected by either the ES period or by blade tenderization.

The Role of Quality in the Adjudication of Public Tenders

Directory of Open Access Journals (Sweden)

Geo Quinot

2014-08-01

Full Text Available The quality of the goods or services that government procures is obviously a very important consideration in deciding which supplier should be awarded a particular public tender. It follows that in the regulation of public procurement, particular attention should be given to the role of quality (also called functionality in the adjudication of public tenders and the final award decision. In South African public procurement law, the role of functionality in public tender adjudication has been a fairly controversial issue that has resulted in a continuing interaction between courts and law-makers on how and when quality should be assessed and should impact on the final award decision within the framework for public procurement found in section 217 of the Constitution. This contribution tracks the development of the role of functionality in public tender adjudication as prescribed by public procurement regulation since the enactment of the Preferential Procurement Policy Framework Act 5 of 2000, which spearheaded the development of contemporary public procurement regulation in South Africa. The analysis shows how the role of functionality has constantly changed since the enactment of the PPPFA and remains uncertain. This uncertainty relates to different interpretations of the constitutional requirements for public procurement primarily contained in section 217(1 of the Constitution. Whether functionality is used as a qualification criterion, an award criterion or both holds particular practical implications for both suppliers and contracting authorities. It is accordingly important to have certainty on this question. However, it cannot be said that the Constitution and section 217 in particular dictates one approach rather than another. The issue should thus be resolved with reference to the statutory scheme adopted under the PPPFA.

The beef tenderness model

African Journals Online (AJOL)

Kedibone KY. Modika

2015-07-29

Jul 29, 2015 ... The concept of meat tenderness is very complex and is biologically .... of feed additives (β-agonists) so that the animals can be harvested at a younger ...... in the rearing and processing of experimental animals and carcasses.

Relationships between sensory evaluations of beef tenderness, shear force measurements and consumer characteristics.

Science.gov (United States)

Van Wezemael, Lynn; De Smet, Stefaan; Ueland, Øydis; Verbeke, Wim

2014-07-01

The supply of tender beef is an important challenge for the beef industry. Knowledge about the profile of consumers who are more optimistic or more accurate in their tenderness evaluations is important for product development and beef marketing purposes. Central location tests of beef steaks were performed in Norway and Belgium (n=218). Instrumental and sensorial tenderness of three muscles from Belgian Blue and Norwegian Red cattle was reported. Consumers who are optimistically evaluating tenderness were found to be more often male, less food neophobic, more positive towards beef healthiness, and showed fewer concerns about beef safety. No clear profile emerged for consumers who assessed tenderness similar to shear force measurements, which suggests that tenderness is mainly evaluated subjectively. The results imply a window of opportunities in tenderness improvements, and allow targeting a market segment which is less critical towards beef tenderness. © 2013 Elsevier Ltd. All rights reserved.

Risk Pricing in Construction Tenders - How, Who, What

Directory of Open Access Journals (Sweden)

Marcus Tower

2012-11-01

Full Text Available Construction projects are most commonlyprocured in Australia by means of a traditionaldesign–tender–build model, whereby design islargely completed then contractors submittenders in a competitive environment.Construction contractors must consider riskswithin their tenders. This paper reports theresearch findings into pricing for risk incompetitive tenders by constructioncontractors. The research is based onstructured interviews with 10 contractingpersonnel; supplemented by 23 responses ofconstruction personnel from an online survey.Two common methods to price for risk are atrade-by-trade basis or an overall percentageor lump sum addition to the base estimate.Experience and intuition plays a significant rolein pricing for risk in tenders and the numberand type of people involved varies with projectsize, with greater involvement as project sizeincreases. The most significant risks priced intenders were: availability of resources; designor documentation errors; incomplete design;buildability issues; and inclement weather. Themost significant project factors considered bycontractors when pricing for risk in tenders are:value of liquidated damages; type ofcontract/procurement; completeness ofdocumentation; project complexity; and currentworkload. These risks and project factors areprimarily those over which the contractor haslimited or no control.

The beef tenderness model | Frylinck | South African Journal of ...

African Journals Online (AJOL)

age feedlot animals produced the most tender LL followed by the B-age pasture and A-age feedlot which was similar to the AB-age pasture. A-age pasture animals produced the least tender LL steaks. The calpain proteolytic system played a ...

Tender moments in the North Sea

Energy Technology Data Exchange (ETDEWEB)

Fox, C

1991-04-01

Described is tender-assisted drilling (TAD) on the UK North Sea Gannet field. The Gannet field is developed by Shell UK Exploration and Production (Shell Expro). In March 1990, Shell Expro awarded Sedco Forex the design and engineering contract to convert the semisubmersible drilling rig Sedco 704 into the Gannet TSV (Tender Support Vessel). The only semisubmersible TSV operation so far to have completed drilling in the North Sea has been in the Norwegian sector. The Odin field, operated by Esso Norge a/s, was developed using the converted drilling rig Treasure Hunter. 1 fig., 1 ill., 3 refs.

Renewable Energy Tenders and Community [Em]power[ment]: Latin America and the Caribbean

International Nuclear Information System (INIS)

Lucas, Hugo; Munoz Cabre, Miquel; Gomez, Juan Carlos; Leidreiter, Anna; Ranalder, Lea; Williamson, Laura E.; Adib, Rana; Lins, Christine; Ranalder, Lea; Mastny, Lisa; Acuna, Francisco; Arroyo, Tabare; Bayao, Joao; Bonotto, Adriano; Konzen, Gabriel; Vasconcellos Barral Ferreira, Thiago; Bayer, Benjamin; Bravo, Gonzalo; Furlano, Lukas; Camacho, Luis; Carrasco Gonzalez, Fidel; Coronado, Juan; Escobar, Rafael; Gamarra, Alba; Garcia, Henry; Goni, Sebastian; Raquet, Francis; Gsaenger, Stefan; Schenk, Fabian; Mitma, Riquel; Munozcano Alvarez, Luis Alfonso; Ramirez, Michelle; Rodriguez Aguilar, Jessica Susana; Ruiz Carmona, Oscar; Villarreal Singer, Diego; Oceransky, Sergio; Perez, Juan Esteban; Puig, Pep; Trujillo, Ramiro; Chavez, Sandra; Gonzalez, Alaide; Luna, Nestor; Moreno, Adrian

2017-01-01

. The main renewable energy markets in Latin America and the Caribbean are dominated by tendering processes, a trend that is likely to continue in the coming years. But whereas tenders are predicated on competition, community-driven projects are based on collaboration. Participating in tendering processes - and winning - requires, among others, significant expertise and access to large reserves of capital, which smaller actors do not have to the same degree as large, specialist renewable energy developers. Under the tendering process, even if their projects are financially viable, actors that take a one-project approach - including community-driven renewable energy projects - are penalised against large developers, which can distribute the costs and risks of tendering to several projects. Tenders can be modified to favour a diversity of actors and community-driven renewable energy projects through the use of various tendering design options. Applying these design options often results in a trade-off between the primary objective - contracting the cheapest electricity from renewables - and the secondary objective of promoting a diversity of actors. As one solution, in the accession process following the tender, community-driven projects can be offered a power purchase agreement at a tariff based on the result of the tender. The accession process captures both the efficiency of tenders and the effectiveness of feed-in tariffs for community projects. Setting limits, in time and quantity, for the implementation of the accession process is necessary to ensure its dynamic efficiency. The accession process would be greatly strengthened and accelerated by the establishment of ambitious, but realistic, mid- and long-term targets for community-driven renewable energy projects. Complementing the accession process, it is proposed that a community power authority be established, with the roles of providing technical, legal and business support; assigning official &apos

Relationship between non-genital tender point tenderness and intra-vaginal muscle pain intensity: Ratings in women with provoked vestibulodynia and implications for treatment

Science.gov (United States)

PHILLIPS, Nancy; BROWN, Candace; BACHMANN, Gloria; WAN, Jim; WOOD, Ronald; ULRICH, Dagny; BACHOUR, Candi; FOSTER, David

2016-01-01

Background Vulvodynia is a chronic vulvar pain disorder and fibromyalgia is a chronic widespread musculoskeletal pain disorder; both of unknown etiology. Association of these conditions is well documented. Intra-vaginal algometer measurement of tenderness to pressure applied to the pelvic floor muscles helps to define vulvodynia associated with musculoskeletal factors. Women with both vulvodynia and fibromyalgia might have increased pelvic muscle pain compared to women with vulvodynia alone, defining the possible link of these two conditions. Objective 1) correlate pain intensity during the non-genital tender point tenderness examination to pain intensity with the vaginal algometer in women with provoked vestibulodynia, 2) determine whether subjects with provoked vestibulodynia and fibromyalgia had higher pain intensity scores with the vaginal algometer than those without fibromyalgia. Study Design Ninety-two subjects referred for vulvar pain were confirmed to have provoked vestibulodynia using the cotton swab test. A diagnosis of fibromyalgia was made if pain was present (Numerical rating scale> 1) in at least 11 sites of the 18-point non-genital tender point tenderness exam. Vaginal pain sensitivity was measured using an intra-vaginal pressure algometer, where 0.1, 0.3, and 0.5 kg/cm2 forces were applied digitally in random assignment by force and location to the right and left iliococcygeus muscle regions and the posterior vaginal wall. Both tender point tenderness and algometer pain intensity were reported on a 0 (no pain) to 10 (worse pain) numeric rating scale. Correlations were computed between the composite pain intensity (total of rating scale from each pressure threshold at specified site) of non-genital and those of iliococcygeus regions and the posterior vaginal wall. Independent t-tests were used to determine differences in iliococcygeus regions and the posterior vaginal algometer pain ratings and presence or absence of fibromyalgia. The significance

Italian water service's competitive tendering: does any tender design exist?

International Nuclear Information System (INIS)

Antonioli, B.

2006-01-01

During the last two decades, the procurement of public services has been engaged a process of intensive change, both at the local and national level, particularly in Europe. In Italy, recent developments of legislative framework are aimed to adopt competitive tenders both for service's concession or private partner selection. Economists and operators generally agree about the effectiveness of auctions for the concession's contracting out. Otherwise, the agreement is weaker if the question is how to prepare the auction: bidding market a la Demsetz, beauty contests or hybrid forms? In other words, more attention should be devoted to the analysis of reference market and to auction's design. The aim of this paper is to verify, starting from the analysis of auction realized between 1998 and 2005, the real designing of the auctions other than the presence of an idea of industrial policy for water services. Results highlights that tenders are few, poorly designed and scarcely effective. To be more precise, results remark the lack of foresight of industrial policy and, more generally, the necessity to reflect on the real possibility of the competition for thc market in the water sector, characterized by an high degree of economical and social complexity [it

Danish Public Construction Counselling Selection and Assignment Criteria in European Tendering

DEFF Research Database (Denmark)

Larsen, Jesper Kranker; Ussing, Lene Faber; Brunø, Thomas Ditlev

2014-01-01

One of the largest customers in the Danish construction industry is public agencies that own and develop projects. For some of the counselling services, they recur to be put out in European tendering. The aim is to find which selection and assignment criteria are used most in public tendering. How...... projects use selection and assignment criteria for counselling services and finally if there is significant use of selection and assignment methods in public counselling. The method is based on 74 public counselling tenders from the European Tenders Electronic Daily database from January 2010 to March 2013...

Comparative proteomics reveals the physiological differences between winter tender shoots and spring tender shoots of a novel tea (Camellia sinensis L.) cultivar evergrowing in winter.

Science.gov (United States)

Liu, Shengjie; Gao, Jiadong; Chen, Zhongjian; Qiao, Xiaoyan; Huang, Hualin; Cui, Baiyuan; Zhu, Qingfeng; Dai, Zhangyan; Wu, Hualing; Pan, Yayan; Yang, Chengwei; Liu, Jun

2017-11-20

A recently discovered tea [Camellia sinensis (L.) O. Kuntze] cultivar can generate tender shoots in winter. We performed comparative proteomics to analyze the differentially accumulated proteins between winter and spring tender shoots of this clonal cultivar to reveal the physiological basis of its evergrowing character during winter. We extracted proteins from the winter and spring tender shoots (newly formed two leaves and a bud) of the evergrowing tea cultivar "Dongcha11" respectively. Thirty-three differentially accumulated high-confidence proteins were identified by matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF / TOF MS). Among these, 24 proteins had increased abundance while nine showed were decreased abundance in winter tender shoots as compared with the spring tender shoots. We categorized the differentially accumulated proteins into eight critical biological processes based on protein function annotation including photosynthesis, cell structure, protein synthesis & destination, transporters, metabolism of sugars and polysaccharides, secondary metabolism, disease/defense and proteins with unknown functions. Proteins with increased abundance in winter tender shoots were mainly related to the processes of photosynthesis, cytoskeleton and protein synthesis, whereas those with decreased abundance were correlated to metabolism and the secondary metabolism of polyphenolic flavonoids. Biochemical analysis showed that the total contents of soluble sugar and amino acid were higher in winter tender shoots while tea polyphenols were lower as compared with spring tender shoots. Our study suggested that the simultaneous increase in the abundance of photosynthesis-related proteins rubisco, plastocyanin, and ATP synthase delta chain, metabolism-related proteins eIF4 and protease subunits, and the cytoskeleton-structure associated proteins phosphatidylinositol transfer protein and profilin may be because of the adaptation of the

Semisubmersible rigs attractive for tender-assisted drilling

Energy Technology Data Exchange (ETDEWEB)

Tranter, P. (Sedco Forex, Aberdeen (United Kingdom))

1994-09-19

Tender-assisted drilling (TAD) involves the use of tender support vessel (TSV) during the drilling phase of platform development to provide drilling utilities to the platform-mounted drilling package. The TSV provides facilities such as mud mixing, storage, pumping, bulk storage, hotel accommodations, and power. Thus, the platform topsides and jacket weight and size can be smaller and less expensive. The paper discusses the advantages and disadvantages of TAD, then describes the TAD vessel, semisubmersible, platform cost savings, accommodations, drilling and workovers, and field experience.

Relationship between nongenital tender point tenderness and intravaginal muscle pain intensity: ratings in women with provoked vestibulodynia and implications for treatment.

Science.gov (United States)

Phillips, Nancy; Brown, Candace; Bachmann, Gloria; Wan, Jim; Wood, Ronald; Ulrich, Dagny; Bachour, Candi; Foster, David

2016-12-01

Vulvodynia is a chronic vulvar pain disorder and fibromyalgia is a chronic widespread musculoskeletal pain disorder, both of unknown etiology. Association of these conditions is well documented. Intravaginal algometer measurement of tenderness to pressure applied to the pelvic floor muscles helps define vulvodynia associated with musculoskeletal factors. Women with both vulvodynia and fibromyalgia might have increased pelvic muscle pain compared to women with vulvodynia alone, defining the possible link of these 2 conditions. We sought to: (1) correlate pain intensity during the nongenital tender point tenderness examination to pain intensity with the vaginal algometer in women with provoked vestibulodynia, and (2) determine whether subjects with provoked vestibulodynia and fibromyalgia had higher pain intensity scores with the vaginal algometer than those without fibromyalgia. In all, 92 subjects referred for vulvar pain were confirmed to have provoked vestibulodynia using the cotton swab test. A diagnosis of fibromyalgia was made if pain was present (numeric rating scale >1) in at least 11 sites of the 18-point nongenital tender point tenderness exam. Vaginal pain sensitivity was measured using an intravaginal pressure algometer, where 0.1, 0.3, and 0.5 kg/cm 2 forces were applied digitally in random assignment by force and location to the right and left iliococcygeus muscle regions and the posterior vaginal wall. Both tender point tenderness and algometer pain intensity were reported on a 0 (no pain) to 10 (worse pain) numeric rating scale. Correlations were computed between the composite pain intensity (total of rating scale from each pressure threshold at specified site) of nongenital and those of iliococcygeus regions and the posterior vaginal wall. Independent t tests were used to determine differences in iliococcygeus regions and the posterior vaginal algometer pain ratings and presence or absence of fibromyalgia. The significance level was at P pain

Assessment of Computer Software Usage for Estimating and Tender ...

African Journals Online (AJOL)

It has been discovered that there are limitations to the use of computer software packages in construction operations especially estimating and tender analysis. The objectives of this research is to evaluate the level of computer software usage for estimating and tender analysis while also assessing the challenges faced by ...

Approval Procedure for Technical Specifications for Procurement by Quotation and Tender

International Nuclear Information System (INIS)

Shaharum Ramli; Izhar Abu Hussin; Ying, K.K.

2015-01-01

Technical specifications for procurement requires the approval of the Jawatankuasa Penyemak Spesifikasi Teknikal Tender/ Sebutharga Agensi Nuklear Malaysia. This paper provides guidance for those who have to prepare a technical specification. In addition, the technical specification online library is introduced to facilitate them to re-use old technical specifications for new procurements or to make those the bases for drafting new specifications. (author)

Visual evaluation of beef tenderness by using surface structural ...

African Journals Online (AJOL)

Very low negative correlations were observed between colour and shear force (r = −0.242). Therefore, although it may be possible to judge meat colour by visual analysis, it does not appear possible to predict tenderness by colour judgment. There is potential for an experienced eye to predict tenderness by observing visual ...

31 CFR 309.9 - Tenders; acceptance by the Secretary of the Treasury.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Tenders; acceptance by the Secretary... TREASURY BILLS § 309.9 Tenders; acceptance by the Secretary of the Treasury. At the time fixed for closing... acceptable prices offered and will make public announcement thereof those submitting tenders will be advised...

Grounds for dispensing with public tender procedures in Government Contracting

Directory of Open Access Journals (Sweden)

P Bolton

2006-01-01

Full Text Available The Constitution of the Republic of South Africa1 provides that organs of state must comply with five principles when procuring goods or services: procurement procedures must be fair, equitable, transparent, competitive and cost-effective. In short, this means that organs of state should make use of competition when procuring goods or services. They should shop around and attract the maximum number of contractors who will participate in such competition. The aim should be the attainment of value for money, meaning, public money should be spent in an effective and efficient manner. Those who participate in competitions should also be treated fairly and without bias. In principle, no preferences should be afforded to different contractors; all contracting parties should have equal access to competition; some contractors should not be afforded more time for the preparation and submission of quotes or tenders than others; and the same information should be made available to all contracting parties. Government procurement procedures should further be transparent, meaning public or open. Thus, organs of state should not contract behind closed doors – government contracts should, as a rule, be advertised. Depending on the nature and value of a particular contract, the use of a public call for tenders is generally the best way to ensure compliance with the principles in the Constitution. By nature, a pubic call for tenders is open, it assists in the prevention of fraud and favouritism, and it ensures that the maximum number of contractors is approached to compete for a contract.Organs of state can also compare prices and quality and can contract with whoever offers the best deal. Most legislation therefore proceeds on the basis that procurement takes place by way of tendering. Generally, contracts above R200 000 are subject to public tender procedures. In certain instances, however, a public call for tenders may be inappropriate regardless of the high

Calls for Tender and Market Surveys Roles and Procedures

CERN Document Server

Annila, L

2000-01-01

ST division has implemented certain procedures to handle the calls for tender and market surveys. In January 1998, the division leader set up the 'call-for-tender co-ordination office' to check and approve each technical document leaving the division. The mandate of the call-for-tender co-ordination office is to check the quality of the documents, in order for these documents to be as clear as possible in terms of both content and structure. The role of this office is to contribute positively and give service to the people writing the documents, and not to give negative criticism. The aim of this paper is to present the mandate of the office, how papers are processed, and to draw up a first result summary.

48 CFR 47.104-5 - Citation of Government rate tenders.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Citation of Government rate tenders. 47.104-5 Section 47.104-5 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TRANSPORTATION General 47.104-5 Citation of Government rate tenders. When 49 U...

A basis for modelling the costs of supplier selection: the economic tender quantity

NARCIS (Netherlands)

de Boer, L.; van Dijkhuizen, G.C.; Telgen, Jan

2000-01-01

In this paper, we consider the decision a purchaser must make regarding the number of suppliers that should be invited to submit a tender for a certain purchase. On the one hand, the costs of sending invitations to tender, the costs of evaluating the tenders received, and the costs of communicating

Liquefied natural gas tender crashworthiness research

Science.gov (United States)

2015-03-23

Research is being conducted to develop technical : information needed to formulate effective natural gas fuel : tender crashworthiness standards. This research is being : performed for the Federal Railroad Administrations (FRAs) : Office of Res...

17 CFR 240.14e-5 - Prohibiting purchases outside of a tender offer.

Science.gov (United States)

2010-04-01

...(s); (iv) The intention of the offeror to make purchases pursuant to the foreign tender offer(s) is... consideration paid outside of the tender offer that is greater than the tender offer price; and (G) Purchases or... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Prohibiting purchases outside...

Co-operative bidding of SMEs in health care sector.

Science.gov (United States)

Mezgár, István; Kovács, György; Bonfatti, Fabio

2002-01-01

Tendering become an important process for customers in the health care sector to select products and services from the market for the lowest price, with the highest quality and with the shortest delivery time. The number of SMEs (Small and Medium-sized Enterprises) delivering products or services for the health care sector is increasing, but they have usually limited capital and expertise to participate in tenders. The paper introduces a possible solution for this problem, when SMEs form special groups, so called Smart Bidding Organisations (SBO), to prepare a bid for the tender jointly. The SBO appears for the customer (tender issuer) as a single enterprise and the bidding procedure will be faster and less expensive in this way.

Sexual Activity and Physical Tenderness in Older Adults: Cross-Sectional Prevalence and Associated Characteristics.

Science.gov (United States)

Freak-Poli, Rosanne; Kirkman, Maggie; De Castro Lima, Gustavo; Direk, Nese; Franco, Oscar H; Tiemeier, Henning

2017-07-01

Despite a common misconception, older adults engage in sexual behavior. However, there is limited sexual behavior research in older adults, which is often restricted to small samples, to cohorts recruiting adults from 45 years old, and to questions regarding only sexual intercourse. To assess the cross-sectional prevalence of and characteristics associated with sexual activity and physical tenderness in community-dwelling older adults. From the Rotterdam Study, sexual activity and physical tenderness were assessed in 2,374 dementia-free, community-dwelling men and women at least 65 years old from 2009 through 2012 in the Netherlands. Analyses were stratified by sex and partner status. Sexual activity and physical tenderness (eg, fondling or kissing) in the last 6 months. Potential associated characteristics included measurements of demographics, socioeconomic position, health behavior, and health status. The vast majority of partnered participants (men, n = 858; women, n = 724) had experienced physical tenderness in the previous 6 months (83.7% of men and 82.9% of women) and nearly half had engaged in sexual activity (49.5% and 40.4% respectively). Very few unpartnered women (n = 675) had engaged in sexual activity (1.3%) or physical tenderness (5.2%), whereas prevalence rates were slightly higher for unpartnered men (n = 117; 13.7% or 17.1%). Engaging in sexual behavior was generally associated with younger age, greater social support, healthier behaviors, and better physical and psychological health. Findings show that older adults engage in sexual activity. It is important not to assume that an older person is not interested in sexual pleasure or that an older person is unhappy with not having a sexual partner. Offering an opportunity for open discussion of sexuality and medical assistance without imposing is a difficult balance. We encourage health care professionals to proactively address sexuality and extend knowledge about safe sex and sexual function

Nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis.

Science.gov (United States)

Mader, Reuven; Novofastovski, Irina; Rosner, Ehud; Adawi, Muhammad; Herer, Paula; Buskila, Dan

2010-09-01

To investigate the degree of nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis (DISH). We assessed these variables' correlation with their clinical, radiographic, and constitutional measurements and with metabolic syndrome (MS). Eighty-seven patients with DISH were compared with 65 controls without DISH. Examination of nonarticular tenderness was performed by thumb palpation. Tenderness was scored for the 18 fibromyalgia tender points (TP), and 4 control points. Nonarticular tenderness was expressed by the number of TP and by the total tenderness score (TTS). The Short Health Assessment Questionnaire (HAQ II) was administered to all participants. Clinical and laboratory data were collected from all patients. Patients were classified as having MS by both the National Cholesterol Education Program and World Health Organization definitions. There was a statistically significant difference in TTS between controls and patients with DISH. The mean tenderness of many individual TP was significantly higher in the DISH group compared with the control group. TP counts, TTS, and body mass index (BMI) positively correlated with the HAQ II. There was a linear trend in intensity of T-spine bony bridges (BB) and the total number of TP as well as many individual TP. Patients with DISH were more likely to be affected by MS. No correlation was found between TP count, TTS, and MS. Patients with DISH have a lower pain threshold than patients who do not have DISH. TP count and TTS correlate with the functional status, BMI, waist circumference, and high-grade BB. No correlation was observed between pain threshold and MS.

Pain sensitivity and pericranial tenderness in children with tension-type headache: a controlled study

DEFF Research Database (Denmark)

Soee, ABL; Skov, L; Kreiner, S

2013-01-01

To compare tenderness and pain sensitivity in children (aged 7-17 years) with tension-type headache (TTH) and healthy controls using total tenderness score (TTS), pressure pain threshold (PPT), and pain perceived at suprapressure pain threshold (supraPPT).......To compare tenderness and pain sensitivity in children (aged 7-17 years) with tension-type headache (TTH) and healthy controls using total tenderness score (TTS), pressure pain threshold (PPT), and pain perceived at suprapressure pain threshold (supraPPT)....

Tenderness of pre- and post rigor lamb longissimus muscle.

Science.gov (United States)

Geesink, Geert; Sujang, Sadi; Koohmaraie, Mohammad

2011-08-01

Lamb longissimus muscle (n=6) sections were cooked at different times post mortem (prerigor, at rigor, 1dayp.m., and 7 days p.m.) using two cooking methods. Using a boiling waterbath, samples were either cooked to a core temperature of 70 °C or boiled for 3h. The latter method was meant to reflect the traditional cooking method employed in countries where preparation of prerigor meat is practiced. The time postmortem at which the meat was prepared had a large effect on the tenderness (shear force) of the meat (PCooking prerigor and at rigor meat to 70 °C resulted in higher shear force values than their post rigor counterparts at 1 and 7 days p.m. (9.4 and 9.6 vs. 7.2 and 3.7 kg, respectively). The differences in tenderness between the treatment groups could be largely explained by a difference in contraction status of the meat after cooking and the effect of ageing on tenderness. Cooking pre and at rigor meat resulted in severe muscle contraction as evidenced by the differences in sarcomere length of the cooked samples. Mean sarcomere lengths in the pre and at rigor samples ranged from 1.05 to 1.20 μm. The mean sarcomere length in the post rigor samples was 1.44 μm. Cooking for 3 h at 100 °C did improve the tenderness of pre and at rigor prepared meat as compared to cooking to 70 °C, but not to the extent that ageing did. It is concluded that additional intervention methods are needed to improve the tenderness of prerigor cooked meat. Copyright © 2011 Elsevier B.V. All rights reserved.

Improving Tenderness of Spent Layer Hens Meat Using Papaya Leaves (Carica papaya

Directory of Open Access Journals (Sweden)

H. O. Abdalla, N. N. A. Ali, F. S. Siddig and S. A. M. Ali*

2013-01-01

Full Text Available Two experiments were performed to study the use of papaya leaves as a meat tenderizer. The first experiment was to evaluate the effect of papaya dry leaves added to hen’s diet before slaughter. Spent hens (n=48 were used, half of them were fed a concentrate ration containing10% dried papaya leaves powder (DPLP while others received layer ration (Control, for 10 days. The second experiment involved a comparison between papaya leaves juice (PLJ, fresh papaya leaves (FPL and vinegar solution (VS as marinades applied to meat for one or two hours before cooking. Spent layer hens (n=42 were used for tenderness evaluation method. After slaughtering and preparing the chickens two methods of cooking were used (oven and moist cooking. The cooked parts (breast, thigh and drumstick were subjected to a panel test evaluation according to a designed questionnaire. Addition of dried papaya leaves powder to spent layer hens ration significantly (P≤0.05 increased the level of meat tenderness. Moist cooking had significantly (P≤0.05 improved meat tenderization compared to oven cooking. Meat treated with fresh papaya leaves had significantly (P≤0.05 improved tenderness. It was concluded that wrapping the tough meat of spent layer hens with fresh papaya leaves for one hour and moist cooking improve tenderness of meat.

An analysis of project selection and assignment criteria of Danish tenders in Europe

Directory of Open Access Journals (Sweden)

Jasper Kranker Larsen

2013-12-01

Full Text Available Public construction agencies are one of the largest developers within the Danish construction industry, where such agencies own and develop new public construction projects. Most of these projects are put out in European tender. This study analyses the selection and assignment criteria employed by these agencies in different types of public sector projects. Some of the objectives pursued by the study include the determination of 1/ the selection and assignment criteria mostly used in Danish public tenders 2/ how different types of projects use selection and assignment criteria in the bidding process, and 3/ any significant difference between the use of selection and assignment criteria in Danish public construction projects. The study uses a quantitative research approach where 157 Danish public tender cases were selected from the European Tenders Electronic Daily database between the period: January 2010 to March 2013. Fisher's Exact Test was conducted to determine if there was any significant use of some selection and assignment criteria. The findings of the study showed that invited tenders with pre-qualification and lowest price in 69.8% of the tenders are the most used selection and assignment criteria, with little regard to project type.

41 CFR 102-117.55 - What are the advantages and disadvantages of using a rate tender?

Science.gov (United States)

2010-07-01

... and disadvantages of using a rate tender? 102-117.55 Section 102-117.55 Public Contracts and Property... the advantages and disadvantages of using a rate tender? (a) Using a rate tender is an advantage when... volume to obtain favorable rates. (b) Using a rate tender may be a disadvantage when: (1) You have...

PS-109 Barriers and facilitators to implementing drug changes caused by drug tenders and shortages

DEFF Research Database (Denmark)

Rishøj, Rikke Mie; Christrup, Lona Louring; Clemmensen, Marianne H

2015-01-01

. Purpose To identify barriers and facilitators for implementing drug changes due to drug tenders and shortages in Danish public hospitals. Material and methods Six focus group interviews were conducted at three hospitals in different regions of the country. At each hospital two focus group interviews were...... thematically through content analysis. Results Barriers Identified included: frequent changes of labelling, packages and drug names. Furthermore, implementing drug changes requires extra resources and finance. Technologies such as computerised physician order entry and barcode scanning systems were perceived...... as potential facilitators, but also as barriers in cases where the quality and implementation of the systems were not adequate. Facilitators included: hospital pharmacy services and lower drug prices. Furthermore recommendations on generic prescription, optimisation of the tendering process and support...

Gertrude Stein’s Tender Buttons (1911)

DEFF Research Database (Denmark)

Balle, Søren Hattesen

Gertrude Stein’s book of prose poems Tender Buttons has been characterized as a modernist literary work by most of its critics. As a distinctive feature of its modernist poetics critics in particular emphasize Stein’s denial of representation through verbal abstraction and autotelism. This paper......, however, intends to read Tender Buttons somewhat differently by suggesting that the poems may be viewed as an example of a displaced Rabbinic hermeneutics in the sense given the term by Susan Handelman. Inasmuch as Stein refuses to name the many objects properly that the titles of the poems introduce...... and instead – to employ her own term – “abuses” their names by way of wordplay, punning, syntactical ambiguity, and semantic disruption, she impersonates a secular Reb Stein, who stays faithful to the Scripture by sacred contempt of representation and obedience to (the play of) the letter. Perhaps...

Evaluation of tendered prices of natural mineral water, juice and non-alcoholic beer (public procurement research

Directory of Open Access Journals (Sweden)

Nataša Pomazalová

2011-01-01

Full Text Available The purpose of this paper is to evaluate tender prices of chosen beverages according to public procurement based on secondary data analysis. The empirical results of analysis (t-test and F-test show that average annual prices of these beverages are different and collected data are not included in the same sample. Tender prices are different in each year of observed years, although are based on public tender. Important evidence is that for the public tenders in the abroad is obligatory use of the Czech public procurement law. According to this act the base evaluation criterion is the lowest offered price. Data were collected during the years 2005–2009. This study deals with empirical approach, variability of prices of chosen beverages based on public tenders between the Czech Republic (Ministry of Defence and local suppliers in Kosovo. Results show low variability of prices, which are based on public tender and legal approach, regulated public procurement. The research conclusion is the fact, that tender prices for piece of non-alcoholic beverage are less than 10 % from annual mean (pcs./CZK of tendered prices.

Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.

Science.gov (United States)

Ackland, Helen M; Wolfe, Rory; Cameron, Peter A; Cooper, D James; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Rosenfeld, Jeffrey V; Liew, Susan M

2012-11-01

considerably. As long term morbidity is common in this population, a history of resolved neurologic deficit may require greater intervention to mitigate costs. Additionally, adequate communication between acute and community care providers is essential in order to expedite the recovery process through early return to normal daily activities. Copyright © 2012 Elsevier Ltd. All rights reserved.

A critical analysis of the tender points in fibromyalgia.

Science.gov (United States)

Harden, R Norman; Revivo, Gadi; Song, Sharon; Nampiaparampil, Devi; Golden, Gary; Kirincic, Marie; Houle, Timothy T

2007-03-01

To pilot methodologies designed to critically assess the American College of Rheumatology's (ACR) diagnostic criteria for fibromyalgia. Prospective, psychophysical testing. An urban teaching hospital. Twenty-five patients with fibromyalgia and 31 healthy controls (convenience sample). Pressure pain threshold was determined at the 18 ACR tender points and five sham points using an algometer (dolorimeter). The patients "algometric total scores" (sums of the patients' average pain thresholds at the 18 tender points) were derived, as well as pain thresholds across sham points. The "algometric total score" could differentiate patients with fibromyalgia from normals with an accuracy of 85.7% (P pain across sham points than across ACR tender points, sham points also could be used for diagnosis (85.7%; Ps tested vs other painful conditions. The points specified by the ACR were only modestly superior to sham points in making the diagnosis. Most importantly, this pilot suggests single points, smaller groups of points, or sham points may be as effective in diagnosing fibromyalgia as the use of all 18 points, and suggests methodologies to definitively test that hypothesis.

Effect of the callipyge phenotype and cooking method on tenderness of several major lamb muscles.

Science.gov (United States)

Shackelford, S D; Wheeler, T L; Koohmaraie, M

1997-08-01

We conducted three experiments to determine the effects of the callipyge phenotype on the tenderness of several major lamb muscles and to determine the effect of method of cookery on the tenderness of callipyge lamb at 7 d postmortem. In Exp. 1, chops from normal (n = 23) and callipyge (n = 16) carcasses were open-hearth-broiled. Warner-Bratzler shear force values of longissimus, gluteus medius, semimembranosus, biceps femoris, semitendinosus, adductor, and quadriceps femoris were 123, 44, 28, 26, 19, 16, and 13% greater, respectively, for callipyge (P lamb carcasses (n = 60). Callipyge chops were less tender than normal chops (P cooking method, callipyge samples were less juicy than normal samples (P < .05). These data demonstrate that the callipyge phenotype will likely reduce consumer satisfaction due to reduced tenderness and juiciness; however, reduced tenderness in callipyge leg muscles could be prevented by ovenroasting.

Pacific Fleet Submarine Tender Optimization

Science.gov (United States)

2013-06-01

worker(s) waits at DG Tender travel (FCB = USS Frank Cable, ESL = USS Emory S. Land) Day 1 FCB waits at GUAM Day 1 ESL ...Day 5 FCB waits at GUAM Day 6 FCB waits at GUAM Day 6 ESL waits at SINGAPORE Day 7 FCB waits...at GUAM Day 7 ESL waits at SINGAPORE Day 8 FCB waits at GUAM Day 8 ESL waits at SINGAPORE Day 9

An analysis of project selection and assignment criteria of danish tenders in europe

DEFF Research Database (Denmark)

Larsen, Jesper Kranker; Ussing, Lene Faber; Brunø, Thomas Ditlev

2013-01-01

, and 3/ any significant difference between the use of selection and assignment criteria in Danish public construction projects. The study uses a quantitative research approach where 157 Danish public tender cases were selected from the European Tenders Electronic Daily database between the period...

A camera specification for tendering purposes

International Nuclear Information System (INIS)

Lunt, M.J.; Davies, M.D.; Kenyon, N.G.

1985-01-01

A standardized document is described which is suitable for sending to companies which are being invited to tender for the supply of a gamma camera. The document refers to various features of the camera, the performance specification of the camera, maintenance details, price quotations for various options and delivery, installation and warranty details. (U.K.)

17 CFR 240.14e-2 - Position of subject company with respect to a tender offer.

Science.gov (United States)

2010-04-01

... disclosing that the subject company: (1) Recommends acceptance or rejection of the bidder's tender offer; (2... accordance with such laws, regulations and policies. (d) Exemption for cross-border tender offers. The... with respect to a tender offer. 240.14e-2 Section 240.14e-2 Commodity and Securities Exchanges...

Injection of marinade with actinidin increases tenderness of porcine M. biceps femoris and affects myofibrils and connective tissue

DEFF Research Database (Denmark)

Christensen, M.; Torngren, M. A.; Gunvig, A.

2009-01-01

BACKGROUND: Marination of beef muscles with brine solutions containing proteolytic enzymes from fruit extracts has been shown to tenderize meat. However, the effect of marination with actinidin on tenderness of pork muscles has not been investigated. Tenderness and eating quality of porcine M. bi...... indicate that actinidin tenderizes pork M. biceps femoris by affecting both the myofibrils and connective tissue....

Tendering and relationships in strategic logistics service provider selection for global supply chain organisations

DEFF Research Database (Denmark)

Tambo, Torben

of private enterprise purchase additionally relate to the acceptance of some level of dialogue before, during and after the tender due date. Tendering is viewed as an extreme case of relationship management, where newcomers and existing suppliers are put on an equal footing, decades of incorporated...... have an impact. During the tendering process, innovation, knowledge management and operational procedures in interaction with the business relationships are often overlooked and need active management and proper contingency planning. This paper contributes to a deeper understanding of both sides...

Fine-mapping of a QTL influencing pork tenderness on porcine chromosome 2

Directory of Open Access Journals (Sweden)

Beever Jonathan E

2007-10-01

Full Text Available Abstract Background In a previous study, a quantitative trait locus (QTL exhibiting large effects on both Instron shear force and taste panel tenderness was detected within the Illinois Meat Quality Pedigree (IMQP. This QTL mapped to the q arm of porcine chromosome 2 (SSC2q. Comparative analysis of SSC2q indicates that it is orthologous to a segment of human chromosome 5 (HSA5 containing a strong positional candidate gene, calpastatin (CAST. CAST polymorphisms have recently been shown to be associated with meat quality characteristics; however, the possible involvement of other genes and/or molecular variation in this region cannot be excluded, thus requiring fine-mapping of the QTL. Results Recent advances in porcine genome resources, including high-resolution radiation hybrid and bacterial artificial chromosome (BAC physical maps, were utilized for development of novel informative markers. Marker density in the ~30-Mb region surrounding the most likely QTL position was increased by addition of eighteen new microsatellite markers, including nine publicly-available and nine novel markers. Two newly-developed markers were derived from a porcine BAC clone containing the CAST gene. Refinement of the QTL position was achieved through linkage and haplotype analyses. Within-family linkage analyses revealed at least two families segregating for a highly-significant QTL in strong positional agreement with CAST markers. A combined analysis of these two families yielded QTL intervals of 36 cM and 7 cM for Instron shear force and taste panel tenderness, respectively, while haplotype analyses suggested further refinement to a 1.8 cM interval containing CAST markers. The presence of additional tenderness QTL on SSC2q was also suggested. Conclusion These results reinforce CAST as a strong positional candidate. Further analysis of CAST molecular variation within the IMQP F1 boars should enhance understanding of the molecular basis of pork tenderness, and thus

Tender point count, pain, and mobility in the older population: the mobilize Boston study.

Science.gov (United States)

Eggermont, Laura H P; Shmerling, Robert H; Leveille, Suzanne G

2010-01-01

Prevalence of tender points (TP), and widespread pain and fibromyalgia, as well as the relationship between TP and widespread pain and mobility, was examined in 585 community-dwelling older adults (mean age 78.2 years, 63.4% female). Pain was based on location (none, single site, multisite, widespread). Mobility was measured by the Short Physical Performance Battery (SPPB), gait speed, and self-reported (S-R) mobility difficulty. Tender-point count and health characteristics (ie, BMI, chronic conditions, analgesic use, number of medications, depression, and blocks walked per week) were assessed. Several participants had 3 or more TP (22.1%) although prevalence of criteria-based fibromyalgia was low (.3%). Mobility was more limited in persons with higher tender-point counts. After adjustment for pain and other risk factors, higher tender-point count was associated with poorer SPPB performance (score < 10, aOR = 1.09 per TP, 95%CI, 1.01-1.17), and slow gait speed (< .784m/sec, aOR = 1.14 per TP, 95%CI, 1.05-1.24), but not with S-R mobility difficulty. S-R mobility difficulty was associated with more disseminated pain (multisite pain, aOR = 2.01, 95%CI, 1.21-3.34; widespread pain, aOR = 2.47, 95%CI, 1.09-5.62). These findings portray a significant mobility burden related to tender-point count and multisite and widespread pain in the older population. Future studies using longitudinal methods are warranted. Higher tender-point count, multisite pain, and widespread pain are common in community-dwelling older adults and associated with mobility problems. Both the manual tender-point exam and the McGill Pain Map may provide important yet different information about risks for mobility disability in older individuals. Copyright 2010 American Pain Society. All rights reserved.

Evaluating the Impact of Risk on Contractor’s Tender Figure in Public Buildings Projects in Northern Nigeria

Directory of Open Access Journals (Sweden)

L. O. Oyewobi

2012-01-01

Full Text Available It has become almost impossible to have projects completed within the initial cost and time in Nigeria; this is as a result of many factors the construction industry is being plagued with ranging from estimating risk to time and cost overruns. The construction industry is widely associated with a high degree of risk and uncertainty due to the nature of its operating heterogeneous environment. The paper aimed at evaluating the impact of estimating risk on contractor’s tender sum with a view of ensuring efficient delivery of projects in the Northern part of Nigeria. A survey was conducted using questionnaire and a total of four headings of risk factors were identified. Research findings showed defects in design, inflation, contractor’s competence and political uncertainty as well as changes in government had greatest impact on contractor’s tender figure whereas likely trend in wages rates over the period, excessive approval procedure in administration government department, unavailability of sufficient amount of unskilled labor and technical manpower and resources of the company were the most significant factors to be considered by contractors when estimating the pricing risk. The paper recommends that construction professionals should identify and adequately quantify project estimating risk factors. Adding a risk premium to quotation and time estimation has to be supported by governmental owner organizations and other agencies in the local construction sector. Competent contractors should be allowed to tender so as to see the incidence of these estimating risks as an important aspect that requires attention while evaluating contractor’s tender sum.

Contractor’s mistakes during tendering

Science.gov (United States)

Kamil, A. I. M.; Othman, N.; Adnan, H.; Zaki, ZA M.

2018-02-01

The occurrence of overrun in cost and time in a project that is usually caused by contractors, will generally make peopleput the blameonthem. This happensas a result of the lack of knowledge possessed by the contractors in determining the solution to be undertakendue totheir mistakes, especially when it comes to tendering process as what had happened in the cases that were reported in Supreme Court of Canada. This paper aims to identify the types of mistakes, factors that contribute to the mistakes and the responsiveness to the mistakes so that the contractor will be able to manage and control the mistakes, as well as the solution, along with preventing them from happening, and in making decision whether or notthey may withdraw from the bidding when the fault has been discovered or whether they should request for leniency from the client for a second chance in re-submitting the bid after the discovered inaccuracy. This research has been done based on cases that were related to the contractor’s mistakes during tendering which were collected from the Supreme Courts of Canada. The data have been analysed and interpreted by legal methodology, in which the result shows that the ability level of the contractors to respond to the mistake is unsatisfactory,and the fault is continuouslybeingmade. The findings are expected to educate and provide awareness to the contractors relating to the matters discussed.

A bench-top hyperspectral imaging system to classify beef from Nellore cattle based on tenderness

Science.gov (United States)

Nubiato, Keni Eduardo Zanoni; Mazon, Madeline Rezende; Antonelo, Daniel Silva; Calkins, Chris R.; Naganathan, Govindarajan Konda; Subbiah, Jeyamkondan; da Luz e Silva, Saulo

2018-03-01

The aim of this study was to evaluate the accuracy of classification of Nellore beef aged for 0, 7, 14, or 21 days and classification based on tenderness and aging period using a bench-top hyperspectral imaging system. A hyperspectral imaging system (λ = 928-2524 nm) was used to collect hyperspectral images of the Longissimus thoracis et lumborum (aging n = 376 and tenderness n = 345) of Nellore cattle. The image processing steps included selection of region of interest, extraction of spectra, and indentification and evalution of selected wavelengths for classification. Six linear discriminant models were developed to classify samples based on tenderness and aging period. The model using the first derivative of partial absorbance spectra (give wavelength range spectra) was able to classify steaks based on the tenderness with an overall accuracy of 89.8%. The model using the first derivative of full absorbance spectra was able to classify steaks based on aging period with an overall accuracy of 84.8%. The results demonstrate that the HIS may be a viable technology for classifying beef based on tenderness and aging period.

Tender Notices | About IASc | Indian Academy of Sciences

Indian Academy of Sciences (India)

... Tender for works related to expansion to main building of Indian Academy of ... for building Hostel Block at Indian Academy of Sciences Fellows Residency, ... the Three Science Academies of India on the teaching of the theory of evolution

41 CFR 102-117.35 - What are the advantages and disadvantages of using GSA's tender of service?

Science.gov (United States)

2010-07-01

... and disadvantages of using GSA's tender of service? 102-117.35 Section 102-117.35 Public Contracts and...-117.35 What are the advantages and disadvantages of using GSA's tender of service? (a) It is an... damage claims. (b) It is a disadvantage to use GSA's tender of service when: (1) You want an agreement...

Specifying process requirements for holistic care.

Science.gov (United States)

Poulymenopoulou, M; Malamateniou, F; Vassilacopoulos, G

2013-09-01

Holistic (health and social) care aims at providing comprehensive care to the community, especially to elderly people and people with multiple illnesses. In turn, this requires using health and social care resources more efficiently through enhanced collaboration and coordination among the corresponding organizations and delivering care closer to patient needs and preferences. This paper takes a patient-centered, process view of holistic care delivery and focuses on requirements elicitation for supporting holistic care processes and enabling authorized users to access integrated patient information at the point of care when needed. To this end, an approach to holistic care process-support requirements elicitation is presented which is based on business process modeling and places particular emphasis on empowering collaboration, coordination and information sharing among health and social care organizations by actively involving users and by providing insights for alternative process designs. The approach provides a means for integrating diverse legacy applications in a process-oriented environment using a service-oriented architecture as an appropriate solution for supporting and automating holistic care processes. The approach is applied in the context of emergency medical care aiming at streamlining and providing support technology to cross-organizational health and social care processes to address global patient needs.

Modified-atmosphere storage under subatmospheric pressure and beef quality: II. Color, drip, cooking loss, sarcomere length, and tenderness

NARCIS (Netherlands)

Smulders, F.J.M.; Hiesberger, J.; Hofbauer, P.; Dogl, B.; Dransfield, E.

2006-01-01

Beef has a requirement for refrigerated storage up to 14 d to achieve adequate aging and a tender product. To achieve this aging with little spoilage and no surface drying, vacuum packaging is attractive, because it is inherently simple and offers a clear indication to the packer when the process

The Role Of Transparency In Tenders In Order To Maintain The Public Interest And The Rights Of Suppliers

Directory of Open Access Journals (Sweden)

Reza Tajarlou

2017-09-01

Full Text Available The public tenders are very important instrument which the public sector uses to the allocation of great part of public expenditure for Welfare of citizens. Due to the the lack of resources and the optimal use of it in line with the public interest and the rights of tenderers tenders play a key role in the public sector operations they can be defined as an instrument to increase the effectiveness of the public sector as a whole. But with the conflict of interests of the public and private sector there needs to be transparency so that the rights of the parties to maintain and public confidence in the state increase. Transparency in Tenders cause the Suppliers that win the bids are those with the best product at the best price targeted at achieving the best outcome. This paper examines the concept and types of tenders for the effects of transparency in government tenders.

Tender frequency and market concentration in balancing power markets

International Nuclear Information System (INIS)

Knaut, Andreas; Obermueller, Frank; Weiser, Florian

2017-01-01

Balancing power markets ensure the short-term balance of supply and demand in electricity markets and their importance may increase with a higher share of fluctuating renewable electricity production. While it is clear that shorter tender frequencies, e.g. daily or hourly, are able to increase the efficiency compared to a weekly procurement, it remains unclear in which respect market concentration will be affected. Against this background, we develop a numerical electricity market model to quantify the possible effects of shorter tender frequencies on costs and market concentration. We find that shorter time spans of procurement are able to lower the costs by up to 15%. While market concentration decreases in many markets, we - surprisingly - identify cases in which shorter time spans lead to higher concentration.

Tender frequency and market concentration in balancing power markets

Energy Technology Data Exchange (ETDEWEB)

Knaut, Andreas; Obermueller, Frank; Weiser, Florian

2017-01-15

Balancing power markets ensure the short-term balance of supply and demand in electricity markets and their importance may increase with a higher share of fluctuating renewable electricity production. While it is clear that shorter tender frequencies, e.g. daily or hourly, are able to increase the efficiency compared to a weekly procurement, it remains unclear in which respect market concentration will be affected. Against this background, we develop a numerical electricity market model to quantify the possible effects of shorter tender frequencies on costs and market concentration. We find that shorter time spans of procurement are able to lower the costs by up to 15%. While market concentration decreases in many markets, we - surprisingly - identify cases in which shorter time spans lead to higher concentration.

Tendering specification and contracting

International Nuclear Information System (INIS)

Koch, E. von

1975-01-01

The lecture tendering, specification and contracting is prepared in two parts: This first part deals with technical aspects while part two features the commercial and legal situation in the partnership of two: the supplier of the fuel bundles and the utility. In this lecture a look is given on the way how a supplier can offer its fuel and some certain points are mentioned which are important to compare the bid of one competitor to the other. The major points are summarized which are or at least should be in an offer so as to find out which offer is the best. (orig./FW) [de

Provider category and quality of care in the Norwegian nursing home industry

Directory of Open Access Journals (Sweden)

Astri Drange Hole

2016-02-01

Full Text Available This paper examines empirically if there is a link between quality of care in the Norwegian nursing home industry and exposure of the industry to competition. Exposing public care to competition implies that the responsibility for providing care services is shared between public authorities and private actors. In Norway, exposure to competition means tender competition. Suppliers bid for a contract issued by the Norwegian authorities for a limited number of years. Quality of care in an institution is the major competitive factor. The provider categories of elderly care are: 1 care provided by institutions run by municipalities, 2 care provided by institutions run by private companies, which have won a tender competition, 3 care provided by institutions run by private companies owned by private families, voluntary religious or idealistic organizations. Nurse-to-patient ratio is used as a proxy for quality of care. The regression analysis indicates a relationship between quality of care and exposure to competition. The quality of care in provider category 2 is significantly lower than in provider category 1, but there are more variations in the quality of care in provider category 1 than in provider category 2. We find the lowest quality of care in provider category 1. There is also a relationship between the quality of care in an institution and the educational level of the staff, the location, the workforce, and the size of an institution. Finally, there is a relationship between the quality of care in an institution and the real and the required capacity, and the financial status in a region.

32 CFR 732.16 - Emergency care requirements.

Science.gov (United States)

2010-07-01

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

Determinants of Ownership Concentration and Tender Offer Law in the Chilean Stock Market

OpenAIRE

Morales, Marco

2009-01-01

This paper analyzes econometrically the determinants of ownership concentration in the Chilean stock market, with particular attention to the e¤ects of the Tender Offer Law (OPA law). Even though the central pourpose of OPAs Law is achieved, the tender offer mechanism increases the ownership concentration. The main reason for this effect has to do with the "residual OPA" obligation considered by the law.

Muscle fatigue in relation to forearm pain and tenderness among professional computer users

DEFF Research Database (Denmark)

Thomsen, GF; Johnson, PW; Svendsen, Susanne Wulff

2007-01-01

ABSTRACT: BACKGROUND: To examine the hypothesis that forearm pain with palpation tenderness in computer users is associated with increased extensor muscle fatigue. METHODS: Eighteen persons with pain and moderate to severe palpation tenderness in the extensor muscle group of the right forearm...... response was not explained by differences in the MVC or body mass index. CONCLUSION: Computer users with forearm pain and moderate to severe palpation tenderness had diminished forearm extensor muscle fatigue response. Additional studies are necessary to determine whether this result reflects an adaptive...... and twenty gender and age matched referents without such complaints were enrolled from the Danish NUDATA study of neck and upper extremity disorders among technical assistants and machine technicians. Fatigue of the right forearm extensor muscles was assessed by muscle twitch forces in response to low...

Beef tenderness improvement by dietary vitamin D3 supplementation in the last stage of fattening of cattle

Directory of Open Access Journals (Sweden)

Półtorak Andrzej

2017-03-01

Full Text Available Tenderness is the most important characteristic of meat, determining consumer approval. There are numerous methods of its improvement, although of diverse effectiveness. addition of vitamin D3 to the feed for a short period before slaughter (7–10 days is one of the natural ways to enhance the tenderness. Vitamin D3 is responsible for Ca2+ mobilisation in serum and increase in activity of proteolytic enzymes belonging to calpains, which results in significant improvement of beef tenderness and reduction of ageing time. The use of vitamin D3 is an application tool determining tenderness improvement of beef with substantial reduction in processing costs. Moreover, shorter post mortem ageing process will exceed the retail display time, which will consequently reduce losses due to unsold meat being returned from shops to the manufacturers. Based on the results of studies conducted over the last 15 years, this paper presents the possibility and the effects of the use of vitamin D3 to improve beef tenderness.

Estimation of Sensory Pork Loin Tenderness Using Warner-Bratzler Shear Force and Texture Profile Analysis Measurements.

Science.gov (United States)

Choe, Jee-Hwan; Choi, Mi-Hee; Rhee, Min-Suk; Kim, Byoung-Chul

2016-07-01

This study investigated the degree to which instrumental measurements explain the variation in pork loin tenderness as assessed by the sensory evaluation of trained panelists. Warner-Bratzler shear force (WBS) had a significant relationship with the sensory tenderness variables, such as softness, initial tenderness, chewiness, and rate of breakdown. In a regression analysis, WBS could account variations in these sensory variables, though only to a limited proportion of variation. On the other hand, three parameters from texture profile analysis (TPA)-hardness, gumminess, and chewiness-were significantly correlated with all sensory evaluation variables. In particular, from the result of stepwise regression analysis, TPA hardness alone explained over 15% of variation in all sensory evaluation variables, with the exception of perceptible residue. Based on these results, TPA analysis was found to be better than WBS measurement, with the TPA parameter hardness likely to prove particularly useful, in terms of predicting pork loin tenderness as rated by trained panelists. However, sensory evaluation should be conducted to investigate practical pork tenderness perceived by consumer, because both instrumental measurements could explain only a small portion (less than 20%) of the variability in sensory evaluation.

41 CFR 102-118.260 - Must my agency send all quotations, tenders, or contracts with a TSP to GSA?

Science.gov (United States)

2010-07-01

... quotations, tenders, or contracts with a TSP to GSA? 102-118.260 Section 102-118.260 Public Contracts and... REGULATION TRANSPORTATION 118-TRANSPORTATION PAYMENT AND AUDIT Use of Government Billing Documents Quotations, Tenders Or Contracts § 102-118.260 Must my agency send all quotations, tenders, or contracts with a TSP to...

Call-for-tender documentation in the area of servers, personal computers and networks; Ausschreibungsunterlagen im Server-, PC- und Netzwerk-Bereich

Energy Technology Data Exchange (ETDEWEB)

Grieder, T.; Huser, A.

2003-07-01

As a result of this work, sample texts, so-called performance sheets, have been drawn up for the invitation to tender for IT devices. As a supplement to the standard technical requirements, such as computer performance, memory capacity, etc., these texts cover the aspects of energy efficiency. The performance sheets can be enclosed with the invitations to tender as an appendix, or be used directly as text modules. They are supplemented by explanatory texts, which give information regarding technical terms, labels and possible technical realizations. Performance sheets and explanatory texts are included in the appendix to this report. The goal of these activities is to exert pressure on the market, which should ultimately lead to more efficient units. In addition, however, these texts should serve to make the offices placing the invitations to tender more aware of the energy efficiency aspect. Energy saving functions are fairly common for PCs and monitors nowadays. Reference to proved technical realisations can be made in the performance sheets. The situation is more difficult for servers. Although some technical solutions have been initiated, very little is known about practical applications. Further activities are necessary here. (author)

More cost effectiveness from public tendering of energy

International Nuclear Information System (INIS)

Smith, E.

2006-01-01

From the results of an energy market analysis it appears that parties which are obliged to tender for energy contracts do not make the most of it. Timing is crucial in a liberalized market. Contracting in spring seems to deliver the best prices for energy in combination with tailor-made contracts [nl

Genome-Wide H3K4me3 Analysis in Angus Cattle with Divergent Tenderness.

Directory of Open Access Journals (Sweden)

Chunping Zhao

Full Text Available Tenderness is one of the most important properties of meat quality, which is influenced by genetic and environmental factors. As an intensively studied epigenetic marker, histone methylation, occurring on arginine and lysine residues, has pivotal regulatory functions on gene expression. To examine whether histone methylation involves in beef tenderness variation, we analyzed the transcriptome and H3K4me3 enrichment profiles of muscle strips obtained from the longissimus dorsi (LD of Angus steers previously classify to the tender or tough group. We first plotted a global bovine H3K4me3 map on chromosomes and called peak-enriched regions and genes. We found that majorities of H3K4me3 on genes were occupying the first intron and intergenic regions and its maps displayed similar patterns in tender and tough groups, with high H3K4me3 enrichment surrounding the transcription start site (TSS. We also explored the relationship of H3K4me3 and gene expression. The results showed that H3K4me3 enrichment is highly positively correlated with gene expression across the whole genome. Cluster analysis results confirmed the relationship of H3K4me3 enrichment and gene expression. By using a pathway-based approach in genes with H3K4me3 enrichment in promoter regions from the tender cluster, we revealed that those genes involved in the development of different tissues-connective tissue, skeletal and muscular system and functional tissues-; while in tough group those genes engaged in cell death, lipid metabolism and small molecule biochemistry. The results from this study provide a deep insight into understanding of the mechanisms of epigenetic regulations in meat quality and beef tenderness.

Protein degradation and post-deboning tenderization in broiler breast meat with different degrees of muscle shortening

Science.gov (United States)

Deboning broiler breast fillets prior to rigor mortis negatively influences tenderness due to sarcomere shortening. The effects of sarcomere shortening on muscle protein degradation and breast meat tenderization during post-deboning aging are not well understood. The objective of this study was to m...

INVIVO 31P MAGNETIC-RESONANCE SPECTROSCOPY (MRS) OF TENDER POINTS IN PATIENTS WITH PRIMARY FIBROMYALGIA SYNDROME

NARCIS (Netherlands)

DEBLECOURT, AC; WOLF, RF; VANRIJSWIJK, MH; KAMMAN, RL; KNIPPING, AA; MOOYAART, EL

1991-01-01

31P Magnetic Resonance-Spectroscopy was performed at the site of tender points in the trapezius muscle of patients with primary fibromyalgia syndrome. Earlier, in vitro studies have reported changes in the high energy phosphate-metabolism in biopsies taken from tender points of fibromyalgia

Association between Neck/Shoulder Pain and Trapezius Muscle Tenderness in Office Workers

DEFF Research Database (Denmark)

Brandt, Mikkel; Sundstrup, Emil; Jakobsen, Markus D.

2014-01-01

workers. Methods. 653 employees from two large office workplaces in Copenhagen, Denmark, replied to a questionnaire on health and working conditions (mean: age 43 years, body mass index 24 kg⋅m−2, computer use 90% of work time, 73% women). Respondents rated intensity of neck/shoulder pain during...... for age, gender, and chronic disease. Results.The prevalence of “no,” “some,” and “severe” tenderness of the trapeziusmuscle was 18%, 59%, and 23% in women and 51%, 42%, and 7%inmen, respectively (chi-square, P Participants with “no,” “some,” and “severe” tenderness of the trapezius muscle......, respectively, rated their neck/shoulder pain intensity to 1.5 (SD 1.6), 3.8 (SD 2.0), and 5.7 (SD 1.9) for women and 1.4 (SD 1.4), 3.1 (SD 2.2), and 5.1 (SD 1.7) for men. For every unit increase in neck/shoulder pain intensity, the OR for one unit increase in trapezius tenderness was 1.86 (95% confidence...

Criteria procedure development for tender in construction design

Directory of Open Access Journals (Sweden)

Malykha Galina Gennad’evna

order". The article describes in detail the above evaluation criteria (sub-criteria and presents a new procedure of evaluation of competitive bids, which will allow combining its new components with those existing under the law and giving the actual result of their interaction with each other in determination of a winner, i.e. a more well-deserved candidate (a tenderer. Thus the requirements given above are met, the participants in order placement will be able to declare themselves as organizations that are highly skilled, fair and able to perform the high-quality design works, know how to perform work in due time and in strict compliance with the current regulations of the Russian Federation and are able not only to show a creative approach to solving the objectives, but also to create a project characterized by both architectural and artistic aesthetics and its high technological effectiveness.

Adding ultrasound to clinical examination reduced frequency of enthesitis in primary care psoriasis patients with musculoskeletal complaints.

Science.gov (United States)

van der Ven, Myrthe; Karreman, Maren C; Weel, Angelique E A M; Tchetverikov, Ilja; Vis, Marijn; Nijsten, Tamar E C; Hazes, Johanna M W; Luime, Jolanda J

2016-01-01

Part of the psoriasis patients with musculoskeletal complaints will have inflammation of the entheses. Entheseal inflammation is difficult to assess by clinical examination only. Therefore, we aimed to determine the frequency of clinically relevant ultrasound inflammation at the most commonly assessed entheses (MASEI; Madrid Sonographic Enthesis Index) in primary care psoriasis patients with one or more tender entheses. Adult primary care psoriasis patients with musculoskeletal complaints (tender enthesis or arthritis at physical examination) had an ultrasound examination of seven entheses according to the MASEI. Clinically relevant ultrasound inflammation was defined as active inflammation on ultrasound in combination with at least one clinical feature at the same enthesis. Active ultrasound inflammation contained positive power Doppler signal or in case of the plantar aponeurosis increased thickness. Structural changes entailed calcifications, enthesophytes, increased thickness, hypoechogeneicity indicating irregular fibre structure and erosions. Clinically, an enthesis was scored positive by a tender enthesis at clinical examination, reported pain in the history or self-reported pain in the questionnaires. Of 542 primary care psoriasis patient, 111 patients had tender entheses and/or arthritis. These patients were both clinically and ultrasonographically evaluated. Active ultrasound inflammation accompanied with pain or tenderness at the enthesis was found in 36% of the patients (n=40). Most common were inflammation at the knee (n=11) and at the plantar aponeurosis (n=10). Structural changes were observed in 95% of the psoriasis patients independent of their clinical manifestation. We found concurrent presence of ultrasound inflammatory changes and clinical symptoms in 36% of the primary care psoriasis patients who had tenderness at one or more entheseal sites.

Role expectations and agency in the audit tendering process

NARCIS (Netherlands)

Taminiau, Y.T.A.; Heusinkveld, H.S.

2017-01-01

Purpose – Tenders are generally considered an important in auditing research and practice, and are associated with significant difficulties for the auditing profession, as well as for individual auditors in the context of client relationships. The paper aims to explore the way auditors respond to

Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia

DEFF Research Database (Denmark)

Henriksen, Marius; Lund, Hans; Christensen, Robin

2009-01-01

of the patients completed version 1 of the Fibromyalgia Impact Questionnaire (FIQ) and were assessed for tender points and knee muscle strength. All subjects underwent bilateral isokinetic knee muscle strength testing in flexion and extension. Normative knee muscle strength values were calculated from the healthy......OBJECTIVE: To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength. METHODS: A total of 840 FM patients and 122 healthy subjects were evaluated between 1998 and 2005. All....... There were no clinically significant differences between patients with low versus normal muscle strength. There were no clinically significant correlations between total FIQ score, tender point count, and muscle strength. Only 4.6% of the FIQ scores and 5.1% of the tender point counts were explained...

The gas turbine - a bundle of energy - requires tender care

Energy Technology Data Exchange (ETDEWEB)

Saarinen, J.; Uronen, J.; Leisio, C. [ed.

1997-11-01

The ability of a power plant to generate energy economically depends to a great extent on the functioning of the turbine. These days, an increasingly large number of these power plant `motors` are gas turbines. IVO`s expertise in the operation, maintenance and repair of gas turbines is based on long practical experience and the company`s own research. And IVO is also no stranger to the design and construction of new gas turbine plants

Usefulness of tenderness to characterise fibromyalgia severity in women.

Science.gov (United States)

Aparicio, V A; Carbonell-Baeza, A; Ortega, F B; Estevez, F; Ruiz, J R; Delgado-Fernández, M

2011-01-01

To investigate the usefulness of tenderness (tender points count (TPC) and algometer score) to characterise fibromyalgia (FM) severity and symptomatology in women. The study sample comprised 174 women aged 51±7 years. We ossesse tenderness using pressure algometry; quality of life by means of the Short-Form 36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). We used the FM impact questionnaire (FIQ) to assess FM severity and symptomatology. Patients were categorised according to three FIQ-derived categories: FIQFIQFIQ≥59 (16.9±2 vs. 15.6±4, p=0.02), whereas no differences between groups were observed according to FIQ≥70 (17.0±2 vs. 16.2±3, p=0.12) or FM type (16.8±3 for type II vs. 15.9±4 for type I, p=0.13). We observed a significant association between TPC and FIQ-job difficulty, pain, morning tiredness and stiffness dimensions (all pFIQ, FIQ-anxiety, fatigue and depression dimensions (all p>0.05). Algometer score was lower in the FIQ≥70 (45.7±12 vs. 51.1±14, p=0.05) and FIQ≥59 (46.7±13 vs. 52.7±14, p=0.05) groups, and there were no difference between FM types (48.7±13 vs. 49.5±14 for type II and I respectively, p=0.81). Algometer score was not associated with total score of FIQ or FIQ dimensions (all p≥0.1). Widespread pain and pain hypersensitivity, as measured by TPC and algometer score, do not seem to be useful to characterise FM severity and symptomatology (measured by FIQ) in women.

48 CFR 47.104-1 - Government rate tender procedures.

Science.gov (United States)

2010-10-01

... and 13712 rates are published in Government rate tenders and apply to shipments moving for the account of the Government on— (1) Commercial bills of lading endorsed to show that total transportation charges are assignable to, and will be reimbursed by, the Government (see the clause at 52.247-1...

Invitations to tenders from Hydro-Quebec: many projects, little MW?

International Nuclear Information System (INIS)

Turmel, A.

2004-01-01

Topics discussed include the regulatory and jurisdictional framework governing the tendering process, and the difficulties involved in filing applications. The roles of Hydro-Quebec, the Quebec government, and the Quebec government's economic regulation agency, Regie de l'energie were covered

The Role of Quality in the Adjudication of Public Tenders | Quinot ...

African Journals Online (AJOL)

Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad ... The quality of the goods or services that government procures is obviously a ... tender adjudication as prescribed by public procurement regulation since the ...

Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders.

Science.gov (United States)

Silveira, A; Gadotti, I C; Armijo-Olivo, S; Biasotto-Gonzalez, D A; Magee, D

2015-01-01

Tender points in the neck are common in patients with temporomandibular disorders (TMD). However, the correlation among neck disability, jaw dysfunction, and muscle tenderness in subjects with TMD still needs further investigation. This study investigated the correlation among neck disability, jaw dysfunction, and muscle tenderness in subjects with and without chronic TMD. Participants. Forty females between 19 and 49 years old were included in this study. There were 20 healthy controls and 20 subjects who had chronic TMD and neck disability. Subjects completed the neck disability index and the limitations of daily functions in TMD questionnaires. Tenderness of the masticatory and cervical muscles was measured using an algometer. The correlation between jaw disability and neck disability was significantly high (r = 0.915, P cervical muscles with jaw dysfunction and neck disability showed fair to moderate correlations (r = 0.32-0.65). High levels of muscle tenderness in upper trapezius and temporalis muscles correlated with high levels of jaw and neck dysfunction. Moreover, high levels of neck disability correlated with high levels of jaw disability. These findings emphasize the importance of considering the neck and its structures when evaluating and treating patients with TMD.

Managing meat tenderness.

Science.gov (United States)

Thompson, John

2002-11-01

This paper discusses the management of meat tenderness using a carcass grading scheme which utilizes the concept of total quality management of those factors which impact on beef palatability. The scheme called Meat Standards Australia (MSA) has identified the Critical Control Points (CCPs) from the production, pre-slaughter, processing and value adding sectors of the beef supply chain and quantified their relative importance using large-scale consumer testing. These CCPs have been used to manage beef palatability in two ways. Firstly, CCPs from the pre-slaughter and processing sectors have been used as mandatory criteria for carcasses to be graded. Secondly, other CCPs from the production and processing sectors have been incorporated into a model to predict palatability for individual muscles. The evidence for the importance of CCPs from the production (breed, growth path and HGP implants), pre-slaughter and processing (pH/temperature window, alternative carcass suspension, marbling and ageing) sectors are reviewed and the accuracy of the model to predict palatability for specific muscle×cooking techniques is presented.

Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia

DEFF Research Database (Denmark)

Henriksen, Marius; Lund, Hans Peter; Christensen, Robin

2009-01-01

To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength.......To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength....

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.

Proposal to negotiate, without competitive tendering, a blanket contract for an instant-reading dosimeter system

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the supply, installation and maintenance of an instant-reading dosimeter system. Following a market survey (MS-3118/TIS) carried out among 28 firms in eleven Member States, a request for a quotation was sent to one firm on 3 October 2003. The Finance Committee is invited to agree to the negotiation of a blanket contract, without competitive tendering, with RADOS TECHNOLOGY (FI) for the supply, installation and maintenance of an instant-reading dosimeter system for a total amount not exceeding 2 100 000 euros (3 252 284 Swiss francs), subject to revision for inflation after 1 January 2007. The rate of exchange used is that stipulated in the tender. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FI - 58%; CH - 38%; GB - 4%.

Effects of natural plant tenderizers on proteolysis and texture of dry ...

African Journals Online (AJOL)

, and overall acceptability. From these results, it is shown that those enzymes as a raw plant juices could be used as tenderizers in dry sausage production. Keywords: Dry sausages, wild boar meat, plant enzymes, proteolysis, texture, sensory ...

Do sarcomere length, collagen content, pH, intramuscular fat and desmin degradation explain variation in the tenderness of three ovine muscles?

Science.gov (United States)

Starkey, Colin P; Geesink, Geert H; Collins, Damian; Hutton Oddy, V; Hopkins, David L

2016-03-01

The longissimus (n=118) (LL), semimembranosus (n=104) (SM) and biceps femoris (n=134) (BF) muscles were collected from lamb and sheep carcases and aged for 5days (LL and SM) and 14days (BF) to study the impact of muscle characteristics on tenderness as assessed by shear force (SF) and sensory evaluation. The impact of gender, animal age, collagen content, sarcomere length (SL), desmin degradation, ultimate pH and intramuscular fat (IMF) on tenderness was examined. The main factors which influenced SF of the LL were IMF, SL and desmin degradation, but for sensory tenderness, IMF, ultimate pH and gender were the main factors. The SF and sensory tenderness of the SM was best predicted by the degree of desmin degradation. For the BF soluble collagen and animal age both influenced SF. Different factors affect tenderness across muscles and not one prediction model applied across all muscles equally well. Copyright © 2015 Elsevier Ltd. All rights reserved.

The transformation of the tender evaluation process in public procurement in Poland

Science.gov (United States)

Plebankiewicz, E.; Kozik, R.

2017-10-01

Procedures regarding the evaluation of tenders have been changed since the public procurement law was enacted (it came into force in January 1, 1995). The contracting authority could apply both the criteria related to the qualities of the contractor and those related to the to the subject - matter of public contract. Two extensive amendments in 2001 and a government project introduced vital regulations and excluded the possibility of applying criteria related to the qualities of the contractor. Act of 29 January 2004 Public Procurement Law allowed to use price as the sole contract award criterion. The changes in the Law in 2014 restricted that possibility to the situation in which the subject matter of a contract is commonly available and has established quality standards. The Act of 22 June 2016 amending the Public Procurement Law Act and some other laws introduced the new criteria list and limited the importance of the price criterion in the certain situations. Instead of price, the cost can also be a criterion for tender evaluation. The cost criterion can be determined using life cycle costing. In the paper, based on contract notices of open tendering published in the Public Procurement Bulletin, the criteria of construction contract selection will be analysed. In particular the effectiveness of changes in the Procurement Law will be researched.

McMurray's Test and Joint Line Tenderness for Medial Meniscus ...

African Journals Online (AJOL)

The wide variations reported have an impact on clinical decision concerning whether to go for other diagnostic tests before going for diagnostic arthroscopy, which is considered as the gold standard.The purpose of this study was to determine the diagnostic value of Joint line tenderness and McMurray's test, as clinical signs ...

Electrical stimulation affects metabolic enzyme phosphorylation, protease activation and meat tenderization in beef

DEFF Research Database (Denmark)

Li, C.B.; Li, J.; Zhou, G.H.

2012-01-01

The objective of this study was to investigate the response of sarcoplasmic proteins in bovine longissimus muscle to low-voltage electrical stimulation (ES, 80 V, 35 s) after dressing and its contribution to meat tenderization at early postmortem time. Proteome analysis showed that ES resulted...... muscles up to 24 h. Immunohistochemistry and transmission electron microscopy further indicated that lysosomal enzymes were released at early postmortem time. ES also induced ultrastructural disruption of sarcomeres. In addition, ES accelerated (P ..., as well as pH decline and more preferred pH/temperature decline mode. Finally, ES accelerated meat tenderization with lower (P time. A possible relationship was suggested between change in phosphorylation level of energy metabolic enzymes and postmortem...

Tendering by municipalities of wind turbines; Aanbesteding door gemeenten van windmolens

Energy Technology Data Exchange (ETDEWEB)

NONE

2013-04-15

This manual provides municipalities answers to the questions of how the municipality must do the tendering for wind turbines and what choices they have [Dutch] Deze handleiding biedt gemeenten antwoorden op de vragen hoe de gemeente moet aanbesteden en welke keuzes zij daarin heeft.

Tenderness and taste qualification of red brangus beef in Mexico / Suavidad y aceptabilidad de la carne de bovinos brangus rojo en México

Directory of Open Access Journals (Sweden)

Gaspar Manuel Parra-Bracamonte

2014-01-01

Full Text Available Beef tenderness is an important trait in consumer satisfaction and has been considered as the main trait for palatability, for which reason it is important to evaluate its variability in different cattle breeds. An experiment was designed to evaluate the Warner Bratzler Shear Force (WBSF of Red Brangus cattle rib eye steaks and consumer acceptance. The tenderness of beef rib eye steaks was evaluated by the WBSF. A consumer preference evaluation test was carried out to quantitatively estimate tenderness, juiciness, flavor, doneness and general acceptance of the evaluated steaks. Mean WBSF was 5.03 kg ± 0.93 kg, theoretically indicating a tough beef. The distribution of the samples showed 21 % and 11 % of moderately tender and tender beef cuts, respectively. Cattle condition (bulls and steers was not significant for the WBSF (p > 0.5. All the traits evaluated in the hedonic evaluation had approximately 6 points of a total of 8 (8 was best. Tenderness, juiciness and flavor presented a high and significant correlation (p < 0.5. None of the subjective traits was correlated with total acceptance. Under theoretical criteria, tender Red Brangus beef cuts are infrequent; however the beef has a good acceptance. Characterization studies may be necessary and useful to create marketing niches specific for this and other cattle breeds.

Tenderization effect of soy sauce on beef M. biceps femoris.

Science.gov (United States)

Kim, Hyun-Wook; Choi, Yun-Sang; Choi, Ji-Hun; Kim, Hack-Youn; Lee, Mi-Ai; Hwang, Ko-Eun; Song, Dong-Heon; Lim, Yun-Bin; Kim, Cheon-Jei

2013-08-15

This study was conducted to evaluate the tenderization effect of soy sauce on beef M. biceps femoris (BF). Five marinades were prepared with 4% (w/v) sodium chloride and 25% (w/v) soy sauce solutions (4% salt concentration) and mixed with the ratios of 100:0 (S0, pH 6.52), 75:25 (S25, 5.40) 50:50 (S50, 5.24), 25:75 (S75, 5.05), and 0:100 (S100, 4.85), respectively. The BF samples which were obtained from Hanwoo cows at 48 h postmortem (n=24) were marinated with five marinades for 72 h at 4°C (1:4 w/w), and the effects of soy sauce on tenderness were evaluated. Soy sauce marination resulted in a decrease in the pH value of the BF sample. However, there were no significant differences in the water holding capacity (Psauce may attribute various mechanisms such as increased collagen solubility or proteolysis which depend on soy sauce level in marinade. Copyright © 2013 Elsevier Ltd. All rights reserved.

Supply Chain Planning for a Timber Harvesting Plus Sale Tender

Directory of Open Access Journals (Sweden)

Josef Holoubek

2015-01-01

Full Text Available Since 2010, the Czech State Forest Enterprise has been inviting timber-harvesting tenders while insisting on the forestry company purchasing the timber from the felled trees as well. To win, a tender must offer the greatest difference between the price of the timber purchased and the cost of the operations. Thus, the forest companies are now facing new problem: apart from minimizing the logging costs they are searching for a cross-cutting and mill-distribution strategy that maximizes the selling price of the harvested timber. The optimization model devised by the present paper provides support for finding an optimal timber selling strategy and, as an important contribution, include a detailed plan for cross-cutting the logs and assign them to the particular customers. We keep the support accessible via common office software and the cross-cutting and customer-assigning problem is formulated as a linear programming model for EXCEL, a particular real-world problem is solved and, using expert comparison, the model appears to provide very good results.

The influence of low temperature, type of muscle and electrical stimulation on the course of rigor mortis, ageing and tenderness of beef muscles.

Science.gov (United States)

Olsson, U; Hertzman, C; Tornberg, E

1994-01-01

The course of rigor mortis, ageing and tenderness have been evaluated for two beef muscles, M. semimembranosus (SM) and M. longissimus dorsi (LD), when entering rigor at constant temperatures in the cold-shortening region (1, 4, 7 and 10°C). The influence of electrical stimulation (ES) was also examined. Post-mortem changes were registered by shortening and isometric tension and by following the decline of pH, ATP and creatine phosphate. The effect of ageing on tenderness was recorded by measuring shear-force (2, 8 and 15 days post mortem) and the sensory properties were assessed 15 days post mortem. It was found that shortening increased with decreasing temperature, resulting in decreased tenderness. Tenderness for LD, but not for SM, was improved by ES at 1 and 4°C, whereas ES did not give rise to any decrease in the degree of shortening during rigor mortis development. This suggests that ES influences tenderization more than it prevents cold-shortening. The samples with a pre-rigor mortis temperature of 1°C could not be tenderized, when stored up to 15 days, whereas this was the case for the muscles entering rigor mortis at the other higher temperatures. The results show that under the conditions used in this study, the course of rigor mortis is more important for the ultimate tenderness than the course of ageing. Copyright © 1994. Published by Elsevier Ltd.

Effect of packaging and storage time on survival of Listeria monocytogenes on kippered beef steak and turkey tenders.

Science.gov (United States)

Uppal, Kamaldeep K; Getty, Kelly J K; Boyle, Elizabeth A E; Harper, Nigel M; Lobaton-Sulabo, April Shayne S; Barry, Bruce

2012-01-01

The objective of our study was to determine effect of packaging method and storage time on reducing Listeria monocytogenes in shelf-stable meat snacks. Commercially available kippered beef steak strips and turkey tenders were dipped into a 5-strain L. monocytogenes cocktail, and dried at 23 °C until a water activity of 0.80 was achieved. Inoculated samples were packaged with 4 treatments: (1) vacuum, (2) nitrogen flushed with oxygen scavenger, (3) heat sealed with oxygen scavenger, and (4) heat sealed without oxygen scavenger. Samples were stored at 23 °C and evaluated for L. monocytogenes levels at 0, 24, 48, and 72 h. Initial levels (time 0) of L. monocytogenes were approximately 5.7 log CFU/cm² for steak and tenders. After 24 h of storage time, a 1 log CFU/cm² reduction of L. monocytogenes was observed for turkey tenders for all packaging treatments. After 48 h, turkey tenders showed >1 log CFU/cm² reduction of L. monocytogenes for all packaging treatments except for vacuum, where only 0.9 log CFU/cm² reduction was observed. After 72 h, reductions for all packaging treatments for turkey tenders ranged from 1.5 to 2.4 log CFU/cm². For kippered beef steak, there was no interaction between the packaging treatments and all storage times (P > 0.05) whereas, time was different (P packaging treatments and a 2.1 log CFU/ cm² L. monocytogenes reduction at 72 h of storage time. Processors of kippered beef steak and turkey tenders could use a combination of vacuum or nitrogen-flushing or heat sealed with an oxygen scavenger packaging methods and a holding time of 24 h prior to shipping to reduce potential L. monocytogenes numbers by ≥1 log. However, processors should be encouraged to hold packaged product a minimum of 72 h to enhance the margin of safety for L. monocytogenes control. © 2011 Institute of Food Technologists®

Deciding about Design Quality : Value judgements and decision making in the selection of architects by public clients under European tendering regulations

NARCIS (Netherlands)

Volker, L.

2010-01-01

In the past few years the image of tender procedures in which Dutch public clients selected an architect has been dominated by distressing newspaper headlines. Architects fear that the current tender culture will harm the quality of our built environment due to a potential lack of diversity,

Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study.

Science.gov (United States)

Kasch, Helge; Qerama, Erisela; Kongsted, Alice; Bach, Flemming W; Bendix, Tom; Jensen, Troels S

2008-11-15

Local sensitization to noxious stimuli has been previously described in acute whiplash injury and has been suggested to be a risk factor for chronic sequelae following acute whiplash injury. In this study, we prospectively examined the development of tender points and mechano-sensitivity in 157 acute whiplash injured patients, who fulfilled criteria for WAD grade 2 (n=153) or grade 3 (n=4) seen about 5 days after injury (4.8+/-2.3) and who subsequently had or had not recovered 1 year after a cervical sprain. Tender point scores and stimulus-response function for mechanical pressure were determined in injured and non-injured body regions at specific time-points after injury. Thirty-six of 157 WAD grade 2 patients (22.9%) had not recovered, defined as reduced work capacity after 1 year. Non-recovered patients had higher total tender point scores after 12 (pwhiplash injury and the development of further sensitization in patients with long-term disability.

Audit market competition: auditor changes and the impact of tendering

OpenAIRE

Beattie, V.; Fearnley, S.

1998-01-01

Increased competition within the external audit market and the recent phenomenon of audit tendering has renewed interest in the factors influencing auditor changes. In this paper, a questionnaire instrument is used to elicit perceptions of the factors which influence auditor-client realignments in this new environment and to indicate the relative influence of economic and behavioural factors. Positive, statistically significant associations were found between unsolicited approaches and the co...

Joint involvement in patients affected by systemic lupus erythematosus: application of the swollen to tender joint count ratio

Directory of Open Access Journals (Sweden)

E. Cipriano

2015-09-01

Full Text Available Joint involvement is a common manifestation in systemic lupus erythematosus (SLE. According to the SLE disease activity index 2000 (SLEDAI-2K, joint involvement is present in case of ≥2 joints with pain and signs of inflammation. However this definition could fail to catch all the various features of joint involvement. Alternatively the Swollen to Tender joint Ratio (STR could be used. This new index, which was originally proposed for rheumatoid arthritis (RA patients, is based on the count of 28 swollen and tender joints. Our study is, therefore, aimed to assess joint involvement in a SLE cohort using the STR. SLE patients with joint symptoms (≥1 tender joint were enrolled over a period of one month. Disease activity was assessed by SLEDAI-2K. We performed the swollen and tender joint count (0-28 and calculated the STR. Depending on the STR, SLE patients were grouped into three categories of disease activity: low (STR1.0. We also calculated the disease activity score based on a 28-joint count and the erythrocyte sedimentation rate (DAS28-ESR. We enrolled 100 SLE patients [F/M 95/5, mean±standard deviation (SD age 46.3±10.6 years, mean±SD disease duration 147.1±103.8 months]. The median of tender and swollen joints was 4 (IQR 7 and 1 (IQR 2.5, respectively. The median STR value was 0.03 (IQR 0.6. According to the STR, disease activity was low in 70 patients, moderate in 23 and high in 7. A significant correlation was identified between STR values and DAS28 (r=0.33, p=0.001. The present study suggests a correlation between STR and DAS28, allowing an easier and faster assessment of joint involvement with the former index.

Automatizovani sistem podrške odlučivanju u procesima javne nabavke / Automatic automatic decision support in a tender process

Directory of Open Access Journals (Sweden)

Siniša Borović

2004-01-01

Full Text Available U poslednjoj fazi procesa javne nabavke komisija se susreće sa problemom izbora naboljeg ponuđača, odnosno onog čija ponuda u najvećoj meri ispunjava zahteve i uslove koji su navedeni u konkursnoj dokumentaciji. Mora se doneti odluka uz uvažavanje više različitih, a često i protivrečnih kriterijuma. Za rešavanje ovakvih i sličnih problema razvijen je čitav niz metoda koje pripadaju oblasti višekriterijumske analize i rangiranja. Uzimajući u obzir karakteristike problema izbora ponuđača u procesu javne nabavke, iz skupa navedenih metoda izdvojena je metoda analitičkih hijerarhijskih procesa (AHP, kao osnovna metoda za rangiranje ponuđača. Za eventualnu kontrolu izvršenog rangiranja predlaže se familija metoda PROMETHEE I-II. / In the last phase of a tender process, the Commission has a problem with choosing the best bidder, i.e. the one whose offer meets the highest requirements in the Tender documentation. A decision has to be made taking into account many different, and very often contradictory, criteria. For solving this one as well as similar problems, numerous methods, belonging to the multicriteria analysis and ranking, are developed. Taking in to account the characteristics of a problem imposed by choosing the bidder in a Tender process, one of the mentioned methods, the method of analytical hierarchy process (AHP has been chosen as a basic method for ranking bidders. For the performed ranking control, the PROMETHEE I-II, method family is proposed.

What impact has tendering had on trainees? Results of a national survey by British Association for Sexual Health and HIV Trainees' Collaborative for audit, research and quality improvement projects.

Science.gov (United States)

Wiggins, Helen; Hartley, Anna; Clarke, Emily; Foley, Elizabeth; Nandwani, Rak; Carlin, Elizabeth; Waters, Laura; Ahmed, Nadia

2018-01-01

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees' Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.

Pain sensitivity and pericranial tenderness in children with tension-type headache: a controlled study

Directory of Open Access Journals (Sweden)

Soee ABL

2013-06-01

Full Text Available Ann-Britt L Soee,1 Liselotte Skov,1 Svend Kreiner,4 Birte Tornoe,1,2 Lise L Thomsen3 1Department of Paediatrics, Children's Headache Clinic, Copenhagen University Hospital Herlev, Copenhagen, Denmark; 2Department of Physiotherapy, Medical Department O, Copenhagen University Hospital Herlev, Copenhagen, Denmark; 3Department of Neuropediatrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark; 4Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark Purpose: To compare tenderness and pain sensitivity in children (aged 7–17 years with tension-type headache (TTH and healthy controls using total tenderness score (TTS, pressure pain threshold (PPT, and pain perceived at suprapressure pain threshold (supraPPT. Patients and methods: Twenty-three children with frequent episodic TTH, 36 with chronic TTH, and 57 healthy controls were included. TTS was measured bilaterally at seven pericranial myofascial structures. PPT and supraPPT were assessed in the finger, m. temporalis, and m. trapezius by a Somedic® algometer. SupraPPT was defined as the pain perceived at a stimulus calculated as the individual site-specific PPT + 50%. Statistics: The effect of group, sex, age, headache frequency, intensity, and years on TTS, PPT, and supraPPT was analyzed by general linear models. Confirmatory factor analysis was analyzed for mutual relations between measurements. Results and conclusion: Tenderness increased uniformly in both frequent episodic TTH (median 14; interquartile range [IQR] 10–18; P < 0.001 and chronic TTH (median 13; IQR 9–20; P < 0.001 compared to controls (median 5, IQR 3–11. However, the children with frequent episodic TTH and chronic TTH did not show significantly increased sensitivity when measured by PPT or supraPPT. Factor analysis confirmed that the site-specific measurements depended on general latent variables. Consequently, the PPT and supraPPT tests can be assumed to measure

Meat tenderness genetic polymorphisms occurrence and distribution in five Zebu breeds in Mexico

Directory of Open Access Journals (Sweden)

Gaspar Manuel Parra-Bracamonte

2015-09-01

Conclusions: Although the relatively low occurrence of favorable alleles in assessed loci may limit their use in selection programs, genotyping availability might be a practical and comprehensive tool for introgression programs by marker assisted selection and management as to improve meat tenderness of Zebu breeds.

Technical note: use of belt grill cookery and slice shear force for assessment of pork longissimus tenderness.

Science.gov (United States)

Shackelford, S D; Wheeler, T L; Koohmaraie, M

2004-01-01

The present experiments were conducted to determine whether improved beef longissimus shear force methodology could be used to assess pork longissimus tenderness. Specifically, three experiments were conducted to: 1) determine the effect of belt grill (BG) cookery on repeatability of pork longissimus Warner-Bratzler shear force (WBSF), 2) compare the correlation of WBSF and slice shear force (SSF) with trained sensory panel tenderness ratings, and 3) estimate the repeatability of pork longissimus SSF for chops cooked with a BG. In Exp. 1 and 2, the longissimus was removed from the left side of each carcass (Exp. 1, n = 25; Exp. 2, n = 23) at 1 d postmortem and immediately frozen to maximize variation in tenderness. In Exp. 1, chops were cooked with either open-hearth electric broilers (OH) or BG, and WBSF was measured. Percentage of cooking loss was lower (P cooked with a BG (23.2%; SD = 1.7%) vs. OH (27.6%; SD = 3.0%). Estimates of the repeatability of WBSF were similar for chops cooked with OH (0.61) and BG (0.59). Although significant (P cooking methods accounted for less than 5% of the total variation in WBSF. In Exp. 2, the correlation of SSF (r = -0.72; P cooked with BG, and SSF was determined. The repeatability of SSF was 0.90, which is comparable to repeatability estimates for beef and lamb. Use of BG cookery and SSF could facilitate the collection of accurate pork longissimus tenderness data. Time and labor savings associated with BG cookery and the SSF technique should help to decrease research costs.

Requirements Engineering for a Pervasive Health Care System

DEFF Research Database (Denmark)

Jørgensen, Jens Bæk; Bossen, Claus

2003-01-01

We describe requirements engineering for a new pervasive health care system for hospitals in Denmark. The chosen requirements engineering approach composes iterative prototyping and explicit environment description in terms of workflow modelling. New work processes and their proposed computer...

Decision making in goverment tenders: A formalized qualitative model

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Štěpán Veselý

2012-01-01

Full Text Available The paper presents a simple formalized qualitative model of government tenders (GTs. Qualitative models use just three values: Positive/Increasing, Zero/Constant and Negative/Decreasing. Such quantifiers of trends are the least information intensive. Qualitative models can be useful, since GT evaluation often includes such goals as e.g. efficiency of public purchasing, and variables as e.g. availability of relevant information or subjectivity of judgment, that are difficult to quantify. Hence, a significant fraction of available information about GTs is not of numerical nature, e.g. if availability of relevant information is decreasing then efficiency of public purchasing is decreasing as well. Such equationless relations are studied in this paper. A qualitative model of the function F(Goals, Variables is developed. The model has four goal functions, eight variables, and 39 equationless relations. The model is solved and seven solutions, i.e. scenarios are obtained. All qualitative states, including first and second qualitative derivatives with respect to time, of all variables are specified for each scenario. Any unsteady state behavior of the GT model is described by its transitional oriented graph. There are eight possible transitions among seven scenarios. No a priori knowledge of qualitative modeling is required on the reader’s part.

The effect of adenosine 5'-monophosphate (AMP) on tenderness, microstructure and chemical-physical index of duck breast meat.

Science.gov (United States)

Wang, Daoying; Deng, Shaoying; Zhang, Muhan; Geng, Zhiming; Sun, Chong; Bian, Huan; Xu, Weimin; Zhu, Yongzhi; Liu, Fang; Wu, Haihong

2016-03-30

Adenosine 5'-monophosphate (AMP) is often used in meat and poultry soups as a flavor enhancer (flavor modifier), or as food additives for specific nutritional purposes. Our previous research as well as evidence from others showed that actomyosin could be dissociated into myosin and actin by AMP in extracted muscle solution. However, there is no report available on the application of AMP to dissociate actomyosin and to improve meat tenderness. The objectives of this study were to evaluate the effect of AMP on duck meat tenderness and other quality traits and to explore the mechanism of the action of AMP on meat tenderness. Duck breast muscle was treated with 0, 10, 20, 30, 40 mmol L(-1) AMP at 5 °C for 10 h and examined for shear force, microstructure, actomyosin dissociation, myofibril fragmentation index (MFI), pH, water content, cooking loss, CIE* color (L*, a*, b*), inosine monophosphate (IMP) and free amino acid (FAA) contents. Results showed that shear force, cooking loss, L* and b* of the muscles significantly decreased after AMP treatment (P 0.05), and muscle shrinkage in transverse and longitudinal directions were restrained after AMP treatment. The results suggest that AMP could notably improve meat tenderness, and this effect was probably mainly through increasing muscle pH, promoting actomyosin dissociation and disrupting the Z-line; meanwhile, the conversion of AMP to IMP may contribute to the flavor of meat. © 2015 Society of Chemical Industry.

Plant X-tender: An extension of the AssemblX system for the assembly and expression of multigene constructs in plants

Science.gov (United States)

Machens, Fabian; Coll, Anna; Baebler, Špela; Messerschmidt, Katrin; Gruden, Kristina

2018-01-01

Cloning multiple DNA fragments for delivery of several genes of interest into the plant genome is one of the main technological challenges in plant synthetic biology. Despite several modular assembly methods developed in recent years, the plant biotechnology community has not widely adopted them yet, probably due to the lack of appropriate vectors and software tools. Here we present Plant X-tender, an extension of the highly efficient, scar-free and sequence-independent multigene assembly strategy AssemblX, based on overlap-depended cloning methods and rare-cutting restriction enzymes. Plant X-tender consists of a set of plant expression vectors and the protocols for most efficient cloning into the novel vector set needed for plant expression and thus introduces advantages of AssemblX into plant synthetic biology. The novel vector set covers different backbones and selection markers to allow full design flexibility. We have included ccdB counterselection, thereby allowing the transfer of multigene constructs into the novel vector set in a straightforward and highly efficient way. Vectors are available as empty backbones and are fully flexible regarding the orientation of expression cassettes and addition of linkers between them, if required. We optimised the assembly and subcloning protocol by testing different scar-less assembly approaches: the noncommercial SLiCE and TAR methods and the commercial Gibson assembly and NEBuilder HiFi DNA assembly kits. Plant X-tender was applicable even in combination with low efficient homemade chemically competent or electrocompetent Escherichia coli. We have further validated the developed procedure for plant protein expression by cloning two cassettes into the newly developed vectors and subsequently transferred them to Nicotiana benthamiana in a transient expression setup. Thereby we show that multigene constructs can be delivered into plant cells in a streamlined and highly efficient way. Our results will support faster

Plant X-tender: An extension of the AssemblX system for the assembly and expression of multigene constructs in plants.

Science.gov (United States)

Lukan, Tjaša; Machens, Fabian; Coll, Anna; Baebler, Špela; Messerschmidt, Katrin; Gruden, Kristina

2018-01-01

Cloning multiple DNA fragments for delivery of several genes of interest into the plant genome is one of the main technological challenges in plant synthetic biology. Despite several modular assembly methods developed in recent years, the plant biotechnology community has not widely adopted them yet, probably due to the lack of appropriate vectors and software tools. Here we present Plant X-tender, an extension of the highly efficient, scar-free and sequence-independent multigene assembly strategy AssemblX, based on overlap-depended cloning methods and rare-cutting restriction enzymes. Plant X-tender consists of a set of plant expression vectors and the protocols for most efficient cloning into the novel vector set needed for plant expression and thus introduces advantages of AssemblX into plant synthetic biology. The novel vector set covers different backbones and selection markers to allow full design flexibility. We have included ccdB counterselection, thereby allowing the transfer of multigene constructs into the novel vector set in a straightforward and highly efficient way. Vectors are available as empty backbones and are fully flexible regarding the orientation of expression cassettes and addition of linkers between them, if required. We optimised the assembly and subcloning protocol by testing different scar-less assembly approaches: the noncommercial SLiCE and TAR methods and the commercial Gibson assembly and NEBuilder HiFi DNA assembly kits. Plant X-tender was applicable even in combination with low efficient homemade chemically competent or electrocompetent Escherichia coli. We have further validated the developed procedure for plant protein expression by cloning two cassettes into the newly developed vectors and subsequently transferred them to Nicotiana benthamiana in a transient expression setup. Thereby we show that multigene constructs can be delivered into plant cells in a streamlined and highly efficient way. Our results will support faster

Proposal for the award of a blanket purchase agreement, without competitive tendering, for the supply of Burndy connectors

CERN Document Server

2004-01-01

This document concerns the award of a blanket purchase agreement, without competitive tendering, for the supply of Burndy connectors. The Finance Committee is invited to agree to the negotiation of a blanket purchase agreement, without competitive tendering, with SOURIAU (CH), for the supply of Burndy connectors over a period of three years, for a total amount not exceeding 600 000 euros (932 000 Swiss francs), subject to revision for inflation from 1st January 2006. The amount in Swiss francs has been calculated using the present rate of exchange.

Pulsed electric field processing of functional drink based on tender coconut water (Cococus nucifera L. - nannari (Hemidesmus indicus blended beverage

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R. Kumar

2014-01-01

Full Text Available Tender coconut water (Cocos nucifera L. Nannari extract (Hemidesmus indicus L. ready-to serve (RTS blended beverage were optimised. Response Surface Methodology (RSM was employed to optimize the levels of independent variables (levels of tender coconut water, nannari extract and sugar. The responses of pH, ºBrix, CIE colour (L*, a* and b* value and OAA were studied. The data obtained were analysed by multiple regression technique to generate suitable mathematical models. The developed blended beverage was processed using pulsed electric field (PEF with electric field 31.2 kV/cm, 20 pulse widths at 100 Hz frequency to minimise nutritional and sensory attributes losses and compared with conventional thermal pasteurization (96 ºC for 360 s with p-value of 8.03. Thermal pasteurization showed a significant (p<0.05 decrease in colour value, radical scavenging activity and overall acceptability after treatment and also during storage, when compared to PEF treated tender coconut water-nannari blended beverage. PEF treatment also achieved a 3.01 ± 0.69 log inactivation, similar to thermal pasteurization of native micro flora. PEF treated tender coconut water-nannari blended beverage was stable up to 120 days under ambient storage condition (27-30 °C.

Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability.

Science.gov (United States)

Silveira, Anelise; Armijo-Olivo, Susan; Gadotti, Inae C; Magee, David

2014-01-01

To compare the masticatory and cervical muscle tenderness and pain sensitivity in the hand (remote region) between patients with temporomandibular disorders (TMD) and healthy controls. Twenty female subjects were diagnosed with chronic TMD, and 20 were considered healthy. Subjects completed the Neck Disability Index and Limitations of Daily Functions in a TMD questionnaire. Tenderness of the masticatory and cervical muscles and pain sensitivity in the hand were measured using an algometer. Three-way mixed analysis of variance (ANOVA) evaluated differences in muscle tenderness between groups. One-way ANOVA compared pain sensitivity in the hand between groups. Effect sizes were assessed using Cohen guidelines. Significantly increased masticatory and cervical muscle tenderness and pain sensitivity in the hand were found in subjects with TMD when compared with healthy subjects. Moderate to high effect sizes showed the clinical relevance of the findings. The results of this study have highlighted the importance of assessing TMD patients not only in the craniofacial region but also in the neck and other parts of the body. Future studies should focus on testing the effectiveness of treatments addressing the neck and the pain sensitivity in the hand in patients with TMD.

Forecasting Construction Tender Price Index in Ghana using Autoregressive Integrated Moving Average with Exogenous Variables Model

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Ernest Kissi

2018-03-01

Full Text Available Prices of construction resources keep on fluctuating due to unstable economic situations that have been experienced over the years. Clients knowledge of their financial commitments toward their intended project remains the basis for their final decision. The use of construction tender price index provides a realistic estimate at the early stage of the project. Tender price index (TPI is influenced by various economic factors, hence there are several statistical techniques that have been employed in forecasting. Some of these include regression, time series, vector error correction among others. However, in recent times the integrated modelling approach is gaining popularity due to its ability to give powerful predictive accuracy. Thus, in line with this assumption, the aim of this study is to apply autoregressive integrated moving average with exogenous variables (ARIMAX in modelling TPI. The results showed that ARIMAX model has a better predictive ability than the use of the single approach. The study further confirms the earlier position of previous research of the need to use the integrated model technique in forecasting TPI. This model will assist practitioners to forecast the future values of tender price index. Although the study focuses on the Ghanaian economy, the findings can be broadly applicable to other developing countries which share similar economic characteristics.

Tender in power-plants back to starting point

International Nuclear Information System (INIS)

TREND

2003-01-01

Even though there was no progress in privatisation of a 40-percent stake in Slovenske elektrarne (SE), a.s., Bratislava a government decree on re-opening of the tender issued in July will allow more prospects to participate. New prospects that are expected to submit their offers are Czech CEZ and American AES. At the same time the original eight prospects that submitted their offers earlier will have the opportunity to withdraw from the tender or review their offers. The new prospects can show their interest in requesting a information memorandum that will be published shortly and then PricewaterhouseCoopers (PwC) will state a date when the offers have to be submitted. After the original offers are updated and the new ones submitted, the offers will be evaluated. Representative of PwC, Peter Mitka refused to discuss the evaluation deadlines and the consecutive due diligence in SE to be conducted by selected investors. The company to have restarted the whole process was the Czech CEZ that had announces its intention to privatise not only the conventional part of SE but the nuclear part as well. The remaining prospects only show interest in hydraulic power plants or conventional power plants but none of them is interested in nuclear power plants. Even though the process is still open and theoretically other prospects could show their interest in the future, Minister of Economy, Robert Nemcsics does not expect that this step would be repeated. And so the number of prospects is ten. In the past the Minister expressed his view that the most suitable solution would be so sell the SE as a whole and during the first press conference given together with privatisation advisor the Minister explained that there was no time-pressure in regards to the privatisation process as an internal restructuring of the company had to be completed first

Tenderness, pH and Water Activity (Aw of Spices Dried Meat on Various Concentrate of Ginger Extract (Zingiber Officinale Roscoe and Different Soaking Time

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Akhadiyah Afrila

2012-09-01

Full Text Available The objectives of current research were to find out the concentrate of Ginger extract (Zingiber officinale Roscoe and different soaking time of to tenderness, pH, and water activity (Aw, microbial count and sensory evaluation of spices dried meat. The result showed that higher the ginger extract (Zingiber officinale Roscoe concentrate and longer the soaking time, it would give more tenderness, pH, and water activity (Aw to spices dried meat with 15% ginger extract (Zingiber officinale Roscoe extract and 20 minutes length of soaking time. Key Words : Dendeng, ginger, soaking time, tenderness, pH and Aw

Proposal for the award of a contract without competitive tendering for the supply of coaxial high-voltage cable for the LHC beam dumping system

CERN Document Server

2002-01-01

This document concerns the award of a contract without competitive tendering for the supply of two types of coaxial high-voltage cable for the LHC beam dumping system. Following a market survey carried out among 14 firms in four Member States, a call for tenders (IT-2969/SL/LHC) was sent on 10 July 2001 to one firm. By the closing date, CERN had received one tender. The Finance Committee is invited to agree to the negotiation of a contract with DRAKA MULTIMEDIA CABLE (DE), the only bidder, for the supply of 14 km of coaxial high-voltage cable for the LHC beam dumping system for a total amount of 530 488 euros (779 900 Swiss francs), not subject to revision. The rate of exchange which has been used is that stipulated in the tender. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: DE - 100%.

Public-Private partnership procurement: Game-theoretic studies of the tender process.

OpenAIRE

De Clerck, Dennis

2015-01-01

A Public-private partnership (PPP) is a settlement between a public party and a contractor or private sector consortium to engage in a long-term contractual agreement for designing, building, operating and/or maintaining capital intensive projects, while trying to attain value for money. PPPs are globally gaining importance in the construction industry. The risk transfer from the contracting government towards the private entity has important repercussions on the tender. Contractors need to c...

25 CFR 20.507 - What requirements must foster care providers meet?

Science.gov (United States)

2010-04-01

... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must foster care providers meet? If a child needs foster care, the social services worker must select care that... contain an approved current home study. (c) An off-reservation foster home, or residential care facility...

Physical, psychosocial, and individual risk factors for neck/shoulder pain with pressure tenderness in the muscles among workers performing monotonous, repetitive work

DEFF Research Database (Denmark)

Andersen, JH; Kaergaard, A.; Frost, P.

2002-01-01

factors versus individual factors in the etiology of pain in the neck and/or shoulders. METHODS: Study participants were 3123 workers from 19 plants. Physical risk factors were evaluated via video observations, and psychosocial risk factors were assessed with the job content questionnaire. Other...... procedures included symptom survey, clinical examination, and assessment of health-related quality of life (SF-36). The main outcome variable, neck/shoulder pain with pressure tenderness, was defined on the basis of subjective pain score and pressure tenderness in muscles of the neck/shoulder region. RESULTS......STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate the effect of individual characteristics and physical and psychosocial workplace factors on neck/shoulder pain with pressure tenderness in the muscles. SUMMARY OF BACKGROUND DATA: Controversy prevails about the importance of workplace...

Regulatory polymorphisms in the bovine Ankyrin 1 gene promoter are associated with tenderness and intramuscular fat content

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Sweeney Torres

2010-12-01

Full Text Available Abstract Background Recent QTL and gene expression studies have highlighted ankyrins as positional and functional candidate genes for meat quality. Our objective was to characterise the promoter region of the bovine ankyrin 1 gene and to test polymorphisms for association with sensory and technological meat quality measures. Results Seven novel promoter SNPs were identified in a 1.11 kb region of the ankyrin 1 promoter in Angus, Charolais and Limousin bulls (n = 15 per breed as well as 141 crossbred beef animals for which meat quality data was available. Eighteen haplotypes were inferred with significant breed variation in haplotype frequencies. The five most frequent SNPs and the four most frequent haplotypes were subsequently tested for association with sensory and technological measures of meat quality in the crossbred population. SNP1, SNP3 and SNP4 (which were subsequently designated regulatory SNPs and SNP5 were associated with traits that contribute to sensorial and technological measurements of tenderness and texture; Haplotype 1 and haplotype 4 were oppositely correlated with traits contributing to tenderness (P Conclusion The conclusion from this study is that alleles defining haplotypes 2 and 4 could usefully contribute to marker SNP panels used to select individuals with improved IMF/juiciness or tenderness in a genome-assisted selection framework.

The 6-minute walk test in female fibromyalgia patients: relationship with tenderness, symptomatology, quality of life, and coping strategies.

Science.gov (United States)

Carbonell-Baeza, Ana; Ruiz, Jonatan R; Aparicio, Virginia A; Ortega, Francisco B; Delgado-Fernández, Manuel

2013-12-01

The purpose of this study was to examine the relationship between the 6-minute walk test (6-MWT) and tenderness, symptomatology, quality of life, and coping strategies in women with fibromyalgia. One hundred eighteen women with fibromyalgia aged 51.9 ± 7.3 years participated in the study. The examination included the 6-MWT, tender points, and the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Short-Form Health Survey 36 (SF-36), and Vanderbilt Pain Management Inventory. Fair correlations between the 6-MWT and the subscales of physical impairment (FIQ) and physical function (SF-36) were observed (ρ -0.365 and 0.347, respectively, both p fibromyalgia shows significant relationships, ranging from weak to fair, between the 6-MWT and tenderness, symptomatology, quality of life, and coping strategies. These findings indicate that functional capacity, as assessed by the distance walked in 6 minutes, might be important when planning the assessment, treatment, and monitoring of patients with fibromyalgia. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The effects of degree of dark cutting on tenderness and sensory attributes of beef

Science.gov (United States)

The objective of this study was to determine the effect of degree of dark cutting (DC) on the tenderness, juiciness, and flavor attributes of beef. During carcass grading at a large U.S. commercial beef harvesting facility, DC carcasses (n = 160) and matching normal control (NC) carcasses (n = 160)...

Exploring Factors of Successful Tendering Practices using Qualitative Comparative Analysis (QCA): The Study of Organizational Repetitions

DEFF Research Database (Denmark)

Bekdik, Baris; Thuesen, Christian

2015-01-01

combinations of factors leading to particular results of tendering practices. Empirical material collected through data mining in previously completed project records (quantitative data) is supported by data obtained from project managers of a general contractor company (qualitative data) in order...... to holistically describe the combination of conditions resulting in particular tender results. As a result of the analysis, a solution set is found explaining the path leading to project contract winning; previous work experience between client and general contractor together with either previous work experience...... between architect and general contractor for design-bid-build projects or senior project responsible involvement from the contractors side in design-build projects. The analysis illustrates how QCA is a powerful strategy for exploring the complexity of project practices being able to bridge the divide...

Proposal for the award of a contract, without competitive tendering, for the maintenance of low-voltage switchgear

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the maintenance of low-voltage switchgear. The Finance Committee is invited to agree to the negotiation of a contract, without competitive tendering, for the maintenance of low-voltage switchgear with HAZEMEYER (FR) for a total amount of 385 000 euros (610 000 Swiss francs), covering an initial period of five years, subject to revision for inflation after 1 January 2007. The contract will include options for two one-year extensions beyond the initial five-year period. The amount in Swiss francs has been calculated using the present rate of exchange. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FR - 100%.

Relationships between widespread pain and thresholds pain tolerance on tender points in Portuguese women with fibromyalgia: impact on daily life.

Directory of Open Access Journals (Sweden)

Pablo Tomas-Carus

2015-07-01

Full Text Available Objectives: to establish a relationship between widespread pain subjectively perceived and threshold pain tolerance on tender points, and to determine whether there are differences in threshold pain tolerance on tender points between the upper and lower body, as well as between the dominant and non-dominant side, and whether these differences have an impact on the daily life of Portuguese women with fibromyalgia (FM. Material e Methods: thirty-one women with FM aged between 34 and 67 years volunteered for the study. Threshold pain tolerance was assessed at critical points using a digital algometer pressure; the widespread pain index (WPI was constructed by the addition of 19 painful body regions; and the impact on the daily life assessed by the Portuguese version of the Fibromyalgia Impact Questionnaire (FIQ, with individual interviews. Results: significant differences between the percentage of threshold pain tolerance of the whole body and the scales of widespread pain subjectively perceived were observed, showing that the widespread pain subjectively perceived by patients was between +25.9% and +27.5%. Also, significant differences between threshold pain tolerance of tender points located on the upper and lower body (1.9 ± 0.5 kg/cm2 vs. 2.6 ± 0.7 kg/cm2; respectively were observed. However, no significant differences were found between threshold pain tolerance of tender points located on dominant and non-dominant sides (2.1 ± 0.5 kg/cm2 e 2.1 ± 0.6 kg/cm2; respectively. Additionally, the analysis showed significant correlations between pain and patient`s daily life in: FIQ total score, physical function, feel good, job ability and fatigue. Conclusions: the women with FM show higher widespread pain subjectively perceived than threshold pain tolerance on tender points. Furthermore, the pain suffered by the patients with FM, especially that located on the upper body, either on the dominant or on the non-dominant side, has a negative

Variation at the Calpain 3 gene is associated with meat tenderness in zebu and composite breeds of cattle

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Bunch Rowan J

2008-07-01

Full Text Available Abstract Background Quantitative Trait Loci (QTL affecting meat tenderness have been reported on Bovine chromosome 10. Here we examine variation at the Calpain 3 (CAPN3 gene in cattle, a gene located within the confidence interval of the QTL, and which is a positional candidate gene based on the biochemical activity of the protein. Results We identified single nucleotide polymorphisms (SNP in the genomic sequence of the CAPN3 gene and tested three of these in a sample of 2189 cattle. Of the three SNP genotyped, the CAPN3:c.1538+225G>T had the largest significant additive effect, with an allele substitution effect in the Brahman of α = -0.144 kg, SE = 0.060, P = 0.016, and the polymorphism explained 1.7% of the residual phenotypic variance in that sample of the breed. Significant haplotype substitution effects were found for all three breeds, the Brahman, the Belmont Red, and the Santa Gertrudis. For the common haplotype, the haplotype substitution effect in the Brahman was α = 0.169 kg, SE = 0.056, P = 0.003. The effect of this gene was compared to Calpastatin in the same sample. The SNP show negligible frequencies in taurine breeds and low to moderate minor allele frequencies in zebu or composite animals. Conclusion These associations confirm the location of a QTL for meat tenderness in this region of bovine chromosome 10. SNP in or near this gene may be responsible for part of the overall difference between taurine and zebu breeds in meat tenderness, and the greater variability in meat tenderness found in zebu and composite breeds. The evidence provided so far suggests that none of these tested SNP are causative mutations.

Potentiation of antioxidant effect of dietary tender cluster beans (Cyamopsis tetragonoloba) by garlic (Allium sativum) in high-cholesterol-fed rats.

Science.gov (United States)

Pande, Shubhra; Srinivasan, Krishnapura

2013-10-01

The antioxidant role of tender cluster beans (Cyamopsis tetragonoloba, CB), a rich source of soluble fibre, was investigated in a hypercholesterolemia-induced oxidative stress situation in rats. In the context of dietary garlic (Allium sativa) potentiating the hypocholesterolemic influence of CB, we also examined if dietary garlic enhances the antioxidant potential of CB. Groups of Wistar rats were rendered hypercholesterolemic by feeding them a 0.5% cholesterol diet for 8 weeks. Dietary interventions were made by inclusion of 15% tender CB powder or 1% garlic powder or their combination in a high-cholesterol diet. Concentrations of antioxidant molecules and activities of antioxidant enzymes in blood and liver were examined. Dietary CB displayed an antioxidant influence in terms of elevating ascorbic acid and glutathione concentrations and stimulating the activities of antioxidant enzymes both in blood and liver. The antioxidant effect of dietary CB was generally potentiated by co-administration of garlic. Thus, consumption of tender CB and garlic together could form a strategy for improving the body's antioxidant status.

A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients.

Science.gov (United States)

Neumann, Lily; Lerner, Ella; Glazer, Yael; Bolotin, Arkady; Shefer, Alexander; Buskila, Dan

2008-12-01

We examined the relationship between body mass index (BMI) and measures of tenderness, quality of life, and physical functioning in female fibromyalgia (FMS) patients. A random sample of 100 female FMS patients from a database of 550 FMS individuals was interviewed and assessed according to a structured questionnaire that included FMS-related symptoms, measures of tenderness (point count and dolorimetry), quality of life (SF-36), physical functioning, and BMI. Weight was defined as normal, overweight, and obesity according to BMI. Twenty-seven percent of the FMS patients had normal BMI, 28% were overweight, and 45% were obese. BMI was negatively correlated with quality of life (r = -0.205, P = 0.044) and tenderness threshold (r = -0.238, P = 0.021) and positively correlated with physical dysfunctioning (r = 0.202, P = 0.047) and point count (r = 0.261, P = 0.011). Obese FMS patients display higher pain sensitivity and lower levels of quality of life. In designing studies that explore factors affecting tenderness, BMI should be included in addition to sex, age, etc.

Access to care for patients with insulin-requiring diabetes in developing countries

DEFF Research Database (Denmark)

Beran, David; Yudkin, John S; de Courten, Maximilian

2005-01-01

The objective of this study was to assess the barriers to care for patients with insulin-requiring diabetes in Mozambique and Zambia.......The objective of this study was to assess the barriers to care for patients with insulin-requiring diabetes in Mozambique and Zambia....

Mediating Informal Care Online: Findings from an Extensive Requirements Analysis

Directory of Open Access Journals (Sweden)

Christiane Moser

2015-05-01

Full Text Available Organizing and satisfying the increasing demand for social and informal care for older adults is an important topic. We aim at building a peer-to-peer exchange platform that empowers older adults to benefit from receiving support for daily activities and reciprocally offering support to others. In situated interviews and within a survey we investigated the requirements and needs of 246 older adults with mild impairments. Additionally, we conducted an interpretative role analysis of older adults’ collaborative care processes (i.e., support exchange practices in order to identify social roles and understand the inherent expectations towards the execution of support. We will describe our target group in the form of personas and different social roles, as well as user requirements for establishing a successful peer-to-peer collaboration. We also consider our finding from the perspective of social capital theory that allows us to describe in our requirements how relationships provide valuable social resources (i.e., social capital for informal and social care.

Korea nuclear exports: Why did the Koreans win the UAE tender? Will Korea achieve its goal of exporting 80 nuclear reactors by 2030?

International Nuclear Information System (INIS)

Berthelemy, Michel; Leveque, Francois

2011-01-01

The success of Korea in winning, in December 2009, a USD 18.6 billion nuclear tender in the United Arab Emirates (UAE) has led to a growing interest in the organization and strengths of the Korean nuclear industry. In this paper, we present the main economic and political factors that explain the success of the Korean consortium. In particular, thanks to an active national program of Nuclear Power Plant (NPP) construction, Korea has developed distinct competitive advantages in terms of low cost, high credibility and high performance. At the same time, due to the important barriers to enter into the nuclear export market in the UAE, Korea has had to sacrifice its profit margin and has benefited from a strong political support from its government through export financing. More importantly, Korea's success is also due to its alliance with Westinghouse and the support of the US diplomacy. Subsequently, we show that while Korea has recently experienced setbacks in nuclear tenders, it will most certainly try to win in the short run a second nuclear tender with another aggressive price. In the longer run, Korea could take a growing share of the international market for NPPs. However, the extent to which Korea can achieve its long term export target will depend upon its capacity to finance nuclear export through export credits and upon the development of its alliance with Westinghouse. It is important to note that this paper was written before the Fukushima nuclear disaster. The scale of the human and environmental consequences of this accident are still unknown, and will undoubtedly have short and long term consequences on nuclear safety requirements and public attitude toward nuclear energy, which will most certainly impact the outlooks for nuclear new-builds. (authors)

Health care economy II

International Nuclear Information System (INIS)

Beer, G.; Slovak, K.

2008-01-01

In Slovakia a strange approach to the purchase of health care equipment has not been limited to ophthalmology. Suspicious procurements are symptomatic. This applies also to specialisation where the correct spending of money can make the difference between life and death and can greatly effect the quality of life. More than a year ago, the Ministry of Health started the procurement of linear accelerators for oncology units in three hospitals. This plan placed on the market a potential order worth more than 11 million EUR without VAT. Three companies produce this complex equipment. The US company, Varian, the German company, Siemens, and the Swedish company, Elekta. Three suppliers, three hospitals. What a coincidence that each hospital - in Presov, Banska Bystrica and Bratislava - received only one envelope with an offer. Each from a different supplier. If anyone wanted to prove that the suppliers did not agree on a common approach, he would soon get into trouble. Each tender was organized by Pro-Tender, Kosice. The tender for the purchase of linear accelerators observed all the legal regulations. For each hospital there was only one offer and so it won. No-one complained, because each company got an order. Amedis Piestany will deliver a Varian product to Bystrica. In Narodny onkologicky ustav in Bratislava the winner was Transkontakt with Elekta products. And in Presov it was Ad Rem from Dunajska Streda that succeeded. The small company owned by a local vet joined up with Siemens and is now opening the doors of state-owned and regional hospitals to the company. (authors)

Italian mission. Found a consortium with Italgas and win a Greek tender

International Nuclear Information System (INIS)

Matejovic, R.; Kinces, P.

1999-01-01

In this interview two projects of the company Slovak Gas Industry (SPP) are discussed. The first project is SPP's joint participation in the international tender on introduction of gas in Greece. The second project regards the construction of a steam-gas power plant nearby the town of Lucenec. This project has already entered a certain stage of solution and a third partner that has been approached - Russian gas company Gazprom - is to become involved in it. (authors)

Proposal for the award of a contract, without competitive tendering, for the maintenance of uninterruptable power supply systems

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the maintenance of uninterruptable power supply systems. The Finance Committee is invited to agree to the negotiation of a contract, without competitive tendering, for the maintenance of uninterruptable power supply systems with MGE (FR) for a total amount of 575 000 euros (911 000 Swiss francs), covering an initial period of five years, subject to revision for inflation after 1 January 2007. The contract will include options for two one-year extensions beyond the initial five-year period. The amount in Swiss francs has been calculated using the present rate of exchange. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FR - 100%.

Preliminary findings of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia.

Science.gov (United States)

Carbonell-Baeza, Ana; Romero, Alejandro; Aparicio, Virginia A; Ortega, Francisco B; Tercedor, Pablo; Delgado-Fernández, Manuel; Ruiz, Jonatan R

2011-09-01

The study aimed to determine the effects of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. The effect of a 3-month detraining period was also analyzed. Six men with fibromyalgia (age 52.3 ± 9.3 years) followed a 4-month Tai Chi intervention. The outcome variables were tenderness, functional capacity (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk tests), and self-administered questionnaires. A significant improvement (p = .028) after the intervention period for the chair sit and reach test was found, such improvement was maintained after the detraining phase. Tenderness, symptomatology, and quality of life did not significantly change after the intervention period or the detraining phase. In summary, a 4-month Tai Chi intervention improved lower body flexibility in men with fibromyalgia. This improvement persisted after the detraining period.

Repeated tender point injections of granisetron alleviate chronic myofascial pain--a randomized, controlled, double-blinded trial.

Science.gov (United States)

Christidis, Nikolaos; Omrani, Shahin; Fredriksson, Lars; Gjelset, Mattias; Louca, Sofia; Hedenberg-Magnusson, Britt; Ernberg, Malin

2015-01-01

Serotonin (5-HT) mediates pain by peripheral 5-HT3-receptors. Results from a few studies indicate that intramuscular injections of 5-HT3-antagonists may reduce musculoskeletal pain. The aim of this study was to investigate if repeated intramuscular tender-point injections of the 5-HT3-antagonist granisetron alleviate pain in patients with myofascial temporomandibular disorders (M-TMD). This prospective, randomized, controlled, double blind, parallel-arm trial (RCT) was carried out during at two centers in Stockholm, Sweden. The randomization was performed by a researcher who did not participate in data collection with an internet-based application ( www.randomization.com ). 40 patients with a diagnose of M-TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were randomized to receive repeated injections, one week apart, with either granisetron (GRA; 3 mg) or isotonic saline as control (CTR). The median weekly pain intensities decreased significantly at all follow-ups (1-, 2-, 6-months) in the GRA-group (Friedman test; P  0.075). The numbers needed to treat (NNT) were 4 at the 1- and 6-month follow-ups, and 3.3 at the 2-month follow-up in favor of granisetron. Repeated intramuscular tender-point injections with granisetron provide a new pharmacological treatment possibility for myofascial pain patients with repeated intramuscular tender-point injections with the serotonin type 3 antagonist granisetron. It showed a clinically relevant pain reducing effect in the temporomandibular region, both in a short- and long-term aspect. European Clinical Trials Database 2005-006042-41 as well as at Clinical Trials NCT02230371 .

Application and optimization of the tenderization of pig Longissimus dorsi muscle by adenosine 5'-monophosphate (AMP) using the response surface methodology.

Science.gov (United States)

Deng, Shaoying; Wang, Daoying; Zhang, Muhan; Geng, Zhiming; Sun, Chong; Bian, Huan; Xu, Weimin; Zhu, Yongzhi; Liu, Fang; Wu, Haihong

2016-03-01

Based on single factor experiments, NaCl concentration, adenosine 5'-monophosphate (AMP) concentration and temperature were selected as independent variables for a three-level Box-Behnken experimental design, and the shear force and cooking loss were response values for regression analysis. According to the statistical models, it showed that all independent variables had significant effects on shear force and cooking loss, and optimal values were at the NaCl concentration of 4.15%, AMP concentration of 22.27 mmol/L and temperature of 16.70°C, which was determined with three-dimensional response surface diagrams and contour plots. Under this condition, the observed shear force and cooking loss were 0.625 kg and 8.07%, respectively, exhibiting a good agreement with their predicted values, showing the good applicability and feasibility of response surface methodology (RSM) for improving pork tenderness. Compared with control pig muscles, AMP combined with NaCl treatment demonstrated significant effects on improvement of meat tenderness and reduction of cooking loss. Therefore, AMP could be regarded as an effective tenderization agent for pork. © 2015 Japanese Society of Animal Science.

Acute sports injuries requiring hospital care.

OpenAIRE

Sandelin, J

1986-01-01

The present investigation reports 138 consecutive patients injured in sports, who needed treatment as in-patients in a one year period. More injuries were sustained in soccer than in other sports. The lower extremity was the site of most injuries, fractures and dislocations being the most common type of injury. At follow-up 50% of the patients complained of discomfort. The average stay in hospital after a sports injury requiring hospital care was 6 days. In 52% of the patients the duration of...

Requiring influenza vaccination for health care workers: seven truths we must accept.

Science.gov (United States)

Poland, Gregory A; Tosh, Pritish; Jacobson, Robert M

2005-03-18

In this paper we outline the seven primary truths supporting the call for requiring influenza immunization of all health care workers. We view this as a serious patient safety issue, given the clear and compelling data regarding the frequency and severity of influenza infection. In addition, clear-cut safety, efficacy, economic, legal, and ethical platforms support the use of influenza vaccine. Unfortunately health care workers have demonstrated, over almost 25 years that they are unwilling to comply with voluntary influenza immunization programs utilizing a variety of education and incentive programs, at rates sufficient to protect the patients in their care. We suggest that an annual influenza immunization should be required for every health care worker with direct patient contact, unless a medical contraindication or religious objection exists, or an informed declination is signed by the health care worker. High rates of health care worker immunization will benefit patients, health care workers, their families and employers, and the communities within which they work and live.

Cooking loss, tenderness, and sensory evaluation of chicken meat roasted after wrapping with edible films.

Science.gov (United States)

Küçüközet, Ahmet Oktay; Uslu, Mustafa Kemal

2018-01-01

In this study, edible films were produced from sodium caseinate and a sodium caseinate-starch mixture and with or without oleoresins (cumin and oregano oleoresin mixture). Chicken meat was wrapped in the respective films, stored at 4 ℃ for four days, and roasted at 200 ℃ for 30 min. The cooking loss, color changes, instrumental tenderness (shear force and energy) were measured. In addition, sensory evaluation was performed. All films effectively reduced cooking loss from chicken meat. The sodium caseinate-starch-based films were the most successful in preventing cooking loss. The average shear force and shear energy values of the wrapped samples were about 40% and 30% less than those of control samples, respectively. In sensory evaluation, chicken meat roasted after wrapping with the films was considered more tender and delicious than the control. Particularly, chicken meat wrapped with the films containing oleoresin mixture was assessed as the most delicious among the samples. It was shown that the cooking quality of the chicken meat could be significantly improved by pre-wrapping the meat with edible films.

[Development of weight-estimation formulae for the bedridden elderly requiring care].

Science.gov (United States)

Oonishi, Reiko; Fujii, Kouji; Tsuda, Hiroko; Imai, Katsumi

2012-01-01

Bedridden elderly persons requiring care need special body-weight measurement implements, and body-weighting assumes more difficult if they live at their own homes. Therefore, we tried to design a new weight-estimation formulae using various anthropometric variables. The subjects were 33 male and 132 female elderly inpatients certified to be at care level 4 or 5. The body composition included height, body weight, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, calf circumference, and waist circumference. We studied the correlation between the body weight and each anthropometric variable and age. In men, the highest correlation with body weight was shown by waist circumference (r=0.891, pbedridden elderly patients requiring care.

77 FR 16023 - New York City Department of Environmental Protection; Notice of Application Tendered for Filing...

Science.gov (United States)

2012-03-19

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 13287-004] New York City Department of Environmental Protection; Notice of Application Tendered for Filing With the Commission and Soliciting Additional Study Requests Take notice that the following hydroelectric application has been filed with the Commission and is available...

78 FR 41390 - Pershing County Water Conservation District; Notice of Application Tendered for Filing with the...

Science.gov (United States)

2013-07-10

... Water Conservation District; Notice of Application Tendered for Filing with the Commission and... License. b. Project No.: 14327-000. c. Date filed: June 26, 2013. d. Applicant: Pershing County Water Conservation District. e. Name of Project: Humboldt River Hydro Power Project. f. Location: At the existing U.S...

Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care

NARCIS (Netherlands)

Cranendonk, Duncan R.; van Vught, Lonneke A.; Wiewel, Maryse A.; Cremer, Olaf L.; Horn, Janneke; Bonten, Marc J.; Schultz, Marcus J.; van der Poll, Tom; Wiersinga, W. Joost

2017-01-01

Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing fasciitis

Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care

NARCIS (Netherlands)

Cranendonk, Duncan R; van Vught, Lonneke A; Wiewel, Maryse A; Cremer, Olaf L; Horn, Janneke; Bonten, Marc J; Schultz, Marcus J; van der Poll, Tom; Wiersinga, W Joost

Importance: Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing

ANALISIS NILAI WAJAR SAHAM PUBLIK DALAM TENDER OFFER (Studi Kasus PT Bentoel Internasional Investama Tbk

Directory of Open Access Journals (Sweden)

Herlitah

2014-08-01

Full Text Available The purpose of this research is to analyze Fair Value of the stock price of PT Bentoel Internasional Investama Tbk. for tender offer after the acquisition from British American Tobacco. The Discounted Cash Flow/DCF Method of the Income Approach used for calculation within the Free Cash Flow to The Equity/FCFE Model.

Effect of Wagyu- versus Angus-sired calves on feedlot performance, carcass characteristics, and tenderness.

Science.gov (United States)

Radunz, A E; Loerch, S C; Lowe, G D; Fluharty, F L; Zerby, H N

2009-09-01

Wagyu-sired (n = 20) and Angus-sired (n = 19) steers and heifers were used to compare the effects of sire breed on feedlot performance, carcass characteristics, and meat tenderness. Calves were weaned at 138 +/- 5 d of age and individually fed a finishing diet consisting of 65% whole corn, 20% protein/vitamin/mineral supplement, and 15% corn silage on a DM basis. Heifers and steers were slaughtered at 535 and 560 kg of BW, respectively. Carcasses were ribbed between the 12th and 13th (USDA grading system) and the 6th and 7th ribs (Japanese grading system) to measure fat thickness, LM area (LMA), and intramuscular fat (IMF). Two steaks were removed from the 12th rib location and aged for 72 h and 14 d to determine Warner-Bratzler shear force and cooking loss. Sire breed x sex interactions were not significant (P > 0.05). Angus-sired calves had greater (P Angus. Sire breed did not affect (P > 0.20) HCW, 12th-rib fat, or USDA yield grade. Carcasses of Wagyu had greater (P = 0.0001) marbling scores at the 12th rib than those of Angus (770.9 vs. 597.3 +/- 41.01, respectively). Carcasses of Wagyu also had greater (P Angus, resulting in a greater proportion of carcasses grading Prime (65.0 vs. 21.1%; P = 0.006). Carcasses from Wagyu tended (P = 0.08) to have greater LMA at the 12th rib, whereas Angus carcasses had greater (P Angus and Wagyu had similar (P > 0.50) tenderness at aging times of 72 h and 14 d. Cooking loss was greater (P Angus than Wagyu steaks at 72 h and 14 d. Using Wagyu sires vs. Angus sires on British-based commercial cows combined with early weaning management strategies has the potential to produce a product with greater marbling, but is unlikely to significantly enhance tenderness.

Using reflectance spectroscopy to predict beef tenderness.

Science.gov (United States)

Bowling, M B; Vote, D J; Belk, K E; Scanga, J A; Tatum, J D; Smith, G C

2009-05-01

A study was conducted to determine if reflectance measurements made in the near-infrared region of the spectrum were additive to reflectance measurements made in the visible region of the spectrum for predicting Warner-Bratzler shear force (WBSF) values. Eighty seven strip loins were collected following fabrication over 3d at a commercial beef processing facility from heifer carcasses with Slight or Traces marbling scores. Spectroscopic measurements were made at approximately 50h postmortem using a Hunter-Lab UltraScan. Subsequently, all strip loins were aged for 14d, cooked to an internal temperature of 70°C, and sheared to obtain WBSF values. Reflectance measurements obtained in the near-infrared region of the spectrum were correlated with WBSF values, however, these measurements were not additive to the predictive ability of reflectance measurements (R(2) values did not differ) made in the visible portion of the spectrum when the use of broad-band wavelength filters were simulated. It was therefore determined, that both the visible and near-infrared spectra measure reflectance and that both methods are acceptable methods of tenderness prediction.

Women's opinions of legal requirements for drug testing in prenatal care.

Science.gov (United States)

Tucker Edmonds, Brownsyne; Mckenzie, Fatima; Austgen, MacKenzie B; Carroll, Aaron E; Meslin, Eric M

2017-07-01

To explore women's attitudes and perceptions regarding legal requirements for prenatal drug testing. Web-based survey of 500 US women (age 18-45) recruited from a market research survey panel. A 24-item questionnaire assessed their opinion of laws requiring doctors to routinely verbal screen and urine drug test patients during pregnancy; recommendations for consequences for positive drug tests during pregnancy; and opinion of laws requiring routine drug testing of newborns. Additional questions asked participants about the influence of such laws on their own care-seeking behaviors. Data were analyzed for associations between participant characteristics and survey responses using Pearson's chi-squared test. The majority of respondents (86%) stated they would support a law requiring verbal screening of all pregnant patients and 73% would support a law requiring universal urine drug testing in pregnancy. Fewer respondents were willing to support laws that required verbal screening or urine drug testing (68% and 61%, respectively) targeting only Medicaid recipients. Twenty-one percent of respondents indicated they would be offended if their doctors asked them about drug use and 14% indicated that mandatory drug testing would discourage prenatal care attendance. Women would be more supportive of policies requiring universal rather than targeted screening and testing for prenatal drug use. However, a noteworthy proportion of women would be discouraged from attending prenatal care - a reminder that drug testing policies may have detrimental effects on maternal child health.

Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley's, McMurray's and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis.

Science.gov (United States)

Blyth, Mark; Anthony, Iain; Francq, Bernard; Brooksbank, Katriona; Downie, Paul; Powell, Andrew; Jones, Bryn; MacLean, Angus; McConnachie, Alex; Norrie, John

2015-08-01

Reliable non-invasive diagnosis of meniscal tears is difficult. Magnetic resonance imaging (MRI) is often used but is expensive and incidental findings are problematic. There are a number of physical examination tests for the diagnosis of meniscal tears that are simple, cheap and non-invasive. To determine the diagnostic accuracy of the Thessaly test and to determine if the Thessaly test (alone or in combination with other physical tests) can obviate the need for further investigation by MRI or arthroscopy for patients with a suspected meniscal tear. Single-centre prospective diagnostic accuracy study. Although the study was performed in a secondary care setting, it was designed to replicate the results that would have been achieved in a primary care setting. Two cohorts of patients were recruited: patients with knee pathology (n = 292) and a control cohort with no knee pathology (n = 75). Sensitivity, specificity and diagnostic accuracy of the Thessaly test in determining the presence of meniscal tears. Participants were assessed by both a primary care clinician and a musculoskeletal clinician. Both clinicians performed the Thessaly test, McMurray's test, Apley's test, joint line tenderness test and took a standardised clinical history from the patient. The Thessaly test had a sensitivity of 0.66, a specificity of 0.39 and a diagnostic accuracy of 54% when utilised by primary care clinicians. This compared with a sensitivity of 0.62, a specificity of 0.55 and diagnostic accuracy of 59% when used by musculoskeletal clinicians. The diagnostics accuracy of the other tests when used by primary care clinicians was 54% for McMurray's test, 53% for Apley's test, 54% for the joint line tenderness test and 55% for clinical history. For primary care clinicians, age and past history of osteoarthritis were both significant predictors of MRI diagnosis of meniscal tears. For musculoskeletal clinicians age and a positive diagnosis of meniscal tears on clinical history

Studies on tender wheatgrass: estimation of elemental content, bioaccessibility of essential elements and antioxidant activity

International Nuclear Information System (INIS)

Reddy, A.V.R.; Acharya, R.; Nair, A.G.C.; Kulkarni, S.D.; Rajurkar, N.S.

2008-08-01

Tender wheatgrass is being consumed by human beings in juice form or as it is due to its antioxidant potential and medicinal value. Systematic studies were carried out to (i) estimate elemental profiles as a function of growth period and conditions, bioaccessibility of different elements and the antioxidant potential of the tender wheatgrass, (ii) determine the optimum growth period for obtaining maximum benefit and (iii) examine the possible correlation between antioxidant potential and mineral content. Wheatgrass was grown in four different conditions namely (i) tap water, (ii) tap water with nutrients, (iii) soil and tap water and (iv) soil with nutrient solution. The studies were carried out on the wheatgrass of 5-20 days old. For comparison with laboratory grown wheatgrass, a set of commercially available wheatgrass tablets and wheat seeds were also studied. Instrumental neutron activation analysis (INAA) was used for concentration determination of elements in the wheatgrass, wheat seeds and wheatgrass tablets. A total of 15 elements like Na, K, Ca, Mg, Mn, Br, Fe and Zn were determined in the samples of shoots and roots of tender wheatgrass. A comparison with the recommended dietary allowance (RDA) of different essential elements with that in tender wheatgrass revealed that wheatgrass is a good source of minerals for health benefits rather than a food supplement. Bioaccessible fractions of various elements were estimated by a chemical NAA method by subjecting the samples to in vitro gastric and gastro-intestinal digestion followed by NAA. The bioaccessibility concentrations by both the measurements were in the range of 9-60%. It was found that bioaccessibility of the elements studied was the highest from fresh wheatgrass and the lowest from wheat seeds. Accuracy of the NAA method was evaluated by analyzing two biological reference materials, SRM 1573a (Tomato leaves) from NIST, USA and ICHTJ CTA-vtl-2 (Tobacco leaves) from INCT, Poland. The antioxidant

42 CFR 409.43 - Plan of care requirements.

Science.gov (United States)

2010-10-01

...) Changes to the plan of care signature requirements. Any changes in the plan must be signed and dated by a...) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same... skilled nursing, physical therapy, speech-language pathology services, or occupational therapy visit in a...

Evaluation of sampling, cookery, and shear force protocols for objective evaluation of lamb longissimus tenderness.

Science.gov (United States)

Shackelford, S D; Wheeler, T L; Koohmaraie, M

2004-03-01

Experiments were conducted to compare the effects of two cookery methods, two shear force procedures, and sampling location within non-callipyge and callipyge lamb LM on the magnitude, variance, and repeatability of LM shear force data. In Exp. 1, 15 non-callipyge and 15 callipyge carcasses were sampled, and Warner-Bratzler shear force (WBSF) was determined for both sides of each carcass at three locations along the length (anterior to posterior) of the LM, whereas slice shear force (SSF) was determined for both sides of each carcass at only one location. For approximately half the carcasses within each genotype, LM chops were cooked for a constant amount of time using a belt grill, and chops of the remaining carcasses were cooked to a constant endpoint temperature using open-hearth electric broilers. Regardless of cooking method and sampling location, repeatability estimates were at least 0.8 for LM WBSF and SSF. For WBSF, repeatability estimates were slightly higher at the anterior location (0.93 to 0.98) than the posterior location (0.88 to 0.90). The difference in repeatability between locations was probably a function of a greater level of variation in shear force at the anterior location. For callipyge LM, WBSF was higher (P lamb LM chops cooked with the belt grill using a larger number of animals (n = 87). In Exp. 2, LM chops were obtained from matching locations of both sides of 44 non-callipyge and 43 callipyge carcasses. Chops were cooked with a belt grill and SSF was measured, and repeatability was estimated to be 0.95. Repeatable estimates of lamb LM tenderness can be achieved either by cooking to a constant endpoint temperature with electric broilers or cooking for a constant amount of time with a belt grill. Likewise, repeatable estimates of lamb LM tenderness can be achieved with WBSF or SSF. However, use of belt grill cookery and the SSF technique could decrease time requirements which would decrease research costs.

LHCb Online Networking Requirements

CERN Document Server

Jost, B

2003-01-01

This document describes the networking requirements of the LHCb online installation. It lists both quantitative aspects such as the number of required switch ports, as well as some qualitative features of the equipment, such as minimum buffer sizes in switches. The document comprises both the data acquisition network and the controls/general-purpose network. While the numbers represent our best current knowledge and are intended to give (in particular) network equipment manufacturers an overview of our needs, this document should not be confused with a market survey questionnaire or a formal tendering document. However the information contained in this document will be the input of any such document. A preliminary schedule for procurement and installation is also given.

Report on Evaluation of Tender for the Valentine Iron Ore Project in Uruguay

International Nuclear Information System (INIS)

1981-01-01

This report prepared by Dastur Engineering International GmbH (DEI)Consulting Engineers, Dusseldorf at the instance of United Nations Industrial Development Organization (UNIDO) seeks to present an evaluation of the feasibility study presented by Republica Oriental del Uruguay, Ministerio de Industria y- Energia (Project Authority) by the Brazilian Consortium (comprising Tenenga, Coferraz, Cimetal and Interbras) along with a project BID including financing possibilities. In accordance with the contract requirements, this Draft Final Report is being submitted. Based on the comments to be received on the findings incorporated in this Draft Final Report from UNIDO and Project Authorities in Uruguay, the Final Report will be prepared and submitted to UNIDO in accordance with the time schedule stipulated in the contract between UNIDO and DEI. The aims of the Project are:a) The development objective is the utilisation of the country's natural resources by exploiting the iron ore deposits of Valentines, for iron and steel production. b)The immediate objective is to evaluate the tenders for the execution of a project to undertake the industrial exploitation of the iron or deposits in close co-operation and co-ordination with the Uruguayan authorities.

76 FR 13173 - Jersey Central Power & Light Company and PSEG Fossil, LLC; Notice of Application Tendered for...

Science.gov (United States)

2011-03-10

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 2309-019] Jersey Central Power & Light Company and PSEG Fossil, LLC; Notice of Application Tendered for Filing With the.... Date Filed: February 18, 2011. d. Applicant: Jersey Central Power & Light Company and PSEG Fossil, LLC...

Regulatory polymorphisms in the bovine Ankyrin 1 gene promoter are associated with tenderness and intra-muscular fat content

LENUS (Irish Health Repository)

Aslan, Ozlem

2010-12-15

Abstract Background Recent QTL and gene expression studies have highlighted ankyrins as positional and functional candidate genes for meat quality. Our objective was to characterise the promoter region of the bovine ankyrin 1 gene and to test polymorphisms for association with sensory and technological meat quality measures. Results Seven novel promoter SNPs were identified in a 1.11 kb region of the ankyrin 1 promoter in Angus, Charolais and Limousin bulls (n = 15 per breed) as well as 141 crossbred beef animals for which meat quality data was available. Eighteen haplotypes were inferred with significant breed variation in haplotype frequencies. The five most frequent SNPs and the four most frequent haplotypes were subsequently tested for association with sensory and technological measures of meat quality in the crossbred population. SNP1, SNP3 and SNP4 (which were subsequently designated regulatory SNPs) and SNP5 were associated with traits that contribute to sensorial and technological measurements of tenderness and texture; Haplotype 1 and haplotype 4 were oppositely correlated with traits contributing to tenderness (P < 0.05). While no single SNP was associated with intramuscular fat (IMF), a clear association with increased IMF and juiciness was observed for haplotype 2. Conclusion The conclusion from this study is that alleles defining haplotypes 2 and 4 could usefully contribute to marker SNP panels used to select individuals with improved IMF\\/juiciness or tenderness in a genome-assisted selection framework.

Actual problems of the antimonopoly requirements` observance in the bidding for the sale of land in the Russian Federation

Directory of Open Access Journals (Sweden)

Alexey Pavlovich ANISIMOV

2013-06-01

Full Text Available A comprehensive view of the topic of Antimonopoly regulation in the sphere of land auctions for the Russian legal science and legal science other Eastern European countries is highly relevant. The importance of such research is that foreign companies having business in Russia are not always aware of specificity in land tendering legal regulation and antimonopoly requirements in this sphere. Moreover, the practice of violation of antimonopoly legislation in the sphere of land tendering and probable means of legislation improvement may hereby present more interest for them. The authors cite and analyze various typical violations in the sphere of land tendering, including publication of land auctions notices in an improper printing agency; lack of applications registration and putting forward extra requirements towards the participants; display for land parcels auctions for which no technical specifications of networking have been determined and no payment for such networking has been established; attempts of local administration to provide land parcels without prior approval of the objects’ places of location and without auctions (though such a procedure is of an extremely local character and is only performed in cases expressly specified by the Federal Law; collection of extra and illegal fees from physical and legal entities for participation in auctions; tendering in cases when they are not to be carried out under the Law (gardening, haymaking; underpricing of a land parcel, etc. Eventually a conclusion is drawn on the effectiveness of auctions which shall be secured by establishing a legal procedure which details and definitely determines tendering regulations, requirements towards the participants and order of agreement’s conclusion. Control on the part of antimonopoly bodies, undoubtedly, allows forming barriers for dishonest participants of the auctions. The authors assume that it is rather difficult to achieve absence of mal-usage by

The Importance of Submarine Tenders to a Modern Naval War: Naval Combat Logistics and Seabasing

Science.gov (United States)

2017-04-28

concern of political risk or consequences of sovereignty . 15. SUBJECT TERMS TENDER, SEABASING, SUBMARINE MAINTENANCE, NAVAL COMBAT LOGISTICS...anywhere in the world’s oceans, with minimal concern of political risk or consequences of sovereignty . 1 INTRODUCTION...logistics beyond the basic peacetime considerations of food and fuel. If a maritime conflict occurs in a distant theatre, the Navy will find that it

76 FR 14651 - BOST4 Hydroelectric Company, LLC; Notice of Application Tendered for Filing With the Commission...

Science.gov (United States)

2011-03-17

... Hydroelectric Company, LLC; Notice of Application Tendered for Filing With the Commission and Soliciting Additional Study Requests Take notice that the following hydroelectric application has been filed with the... No.: P-12757-003. c. Date filed: February 24, 2011. d. Applicant: BOST4 Hydroelectric Company, LLC...

76 FR 21885 - BOST5 Hydroelectric Company, LLC; Notice of Application Tendered for Filing With the Commission...

Science.gov (United States)

2011-04-19

... Hydroelectric Company, LLC; Notice of Application Tendered for Filing With the Commission and Soliciting Additional Study Requests Take notice that the following hydroelectric application has been filed with the... No.: P-12758-003. c. Date filed: March 28, 2011. d. Applicant: BOST5 Hydroelectric Company, LLC...

Study on the effect of reactive oxygen species-mediated oxidative stress on the activation of mitochondrial apoptosis and the tenderness of yak meat.

Science.gov (United States)

Wang, Lin-Lin; Yu, Qun-Li; Han, Ling; Ma, Xiu-Li; Song, Ren-De; Zhao, Suo-Nan; Zhang, Wen-Hua

2018-04-01

This study investigated the effect of reactive oxygen species-mediated oxidative stress on activation of mitochondrial apoptosis and tenderness of yak meat during postmortem ageing. Oxidative stress degree, Ca 2+ levels, membrane permeability transition pore opening, mitochondrial membrane potential, apoptotic factors and the shear force were examined. Results showed that the ROS generated by H 2 O 2 significantly increased mitochondrial oxidative stress by decreasing the activities of superoxide dismutase, catalase and glutathione peroxidase, and increasing lipid peroxidation. Furthermore, oxidative stress enhanced Ca 2+ production and cytochrome c release, changed the levels of Bcl-2 family proteins and activated caspase-9 and -3 activities. Ultimately, oxidative stress increased the apoptosis rate and tenderness of yak meat. These observations confirmed that ROS-mediated oxidative stress participates in the activation of the apoptotic cascade reaction involving Ca 2+ and Bcl-2 family proteins. The results further suggested that ROS-mediated oxidative stress plays a significant role in meat tenderization through the mitochondrial apoptotic pathway. Copyright © 2017. Published by Elsevier Ltd.

77 FR 99 - Barren River Lake Hydro LLC; Notice of Application Tendered for Filing With the Commission...

Science.gov (United States)

2012-01-03

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 13022-003] Barren River Lake Hydro LLC; Notice of Application Tendered for Filing With the Commission, Soliciting Additional Study Requests, and Establishing Procedural Schedule for Licensing and a Deadline for Submission of Final Amendments Take notice that the following...

Analysis of Disposal of Public Property without Tender Procedure on the Example of the Municipality of Krakow

Directory of Open Access Journals (Sweden)

Trembecka Anna

2016-06-01

Full Text Available The aim of this study is to analyze the procedure for the disposal of public property without tender on the example of the Municipality of Krakow, with respect to the scope, purpose, conditions of disposal and generated income, in the period of 2012–2014.

75 FR 45106 - Great River Hydropower, LLC; Notice of Application Tendered for Filing With the Commission and...

Science.gov (United States)

2010-08-02

... Hydropower, LLC; Notice of Application Tendered for Filing With the Commission and Soliciting Additional... License. b. Project No.: P-13637-001. c. Date filed: July 12, 2010. d. Applicant: Great River Hydropower.... 21, and would consist of the following facilities: (1) A new hydropower structure, located about 100...

Production and processing studies on calpain-system gene markers for tenderness in Brahman cattle: 2. Objective meat quality.

Science.gov (United States)

Cafe, L M; McIntyre, B L; Robinson, D L; Geesink, G H; Barendse, W; Pethick, D W; Thompson, J M; Greenwood, P L

2010-09-01

Effects and interactions of calpain-system tenderness gene markers on objective meat quality traits of Brahman (Bos indicus) cattle were quantified within 2 concurrent experiments at different locations. Cattle were selected for study from commercial and research herds at weaning based on their genotype for calpastatin (CAST) and calpain 3 (CAPN3) gene markers for beef tenderness. Gene marker status for mu-calpain (CAPN1-4751 and CAPN1-316) was also determined for inclusion in statistical analyses. Eighty-two heifer and 82 castrated male cattle with 0 or 2 favorable alleles for CAST and CAPN3 were studied in New South Wales (NSW), and 143 castrated male cattle with 0, 1, or 2 favorable alleles for CAST and CAPN3 were studied in Western Australia (WA). The cattle were backgrounded for 6 to 8 mo and grain-fed for 117 d (NSW) or 80 d (WA) before slaughter. One-half the cattle in each experiment were implanted with a hormonal growth promotant during feedlotting. One side of each carcass was suspended from the Achilles tendon (AT) and the other from the pelvis (tenderstretch). The M. longissimus lumborum from both sides and the M. semitendinosus from the AT side were collected; then samples of each were aged at 1 degrees C for 1 or 7 d. Favorable alleles for one or more markers reduced shear force, with little effect on other meat quality traits. The size of effects of individual markers varied with site, muscle, method of carcass suspension, and aging period. Individual marker effects were additive as evident in cattle with 4 favorable alleles for CAST and CAPN3 markers, which had shear force reductions of 12.2 N (P 0.05) of interactions between the gene markers, or between the hormonal growth promotant and gene markers for any meat quality traits. This study provides further evidence that selection based on the CAST or CAPN3 gene markers improves meat tenderness in Brahman cattle, with little if any detrimental effects on other meat quality traits. The CAPN1-4751 gene

Understanding the health care utilization of children who require medical technology: A descriptive study of children who require tracheostomies.

Science.gov (United States)

Spratling, Regena

2017-04-01

Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology. A retrospective electronic health record (EHR) review was completed on the EHR records on 171 children who require medical technology, specifically tracheostomies, at an outpatient technology dependent pulmonary clinic over a three year period (January 2010-December 2012). Descriptive statistics were used to analyze sociodemographic and clinical characteristics, including medical diagnoses, and emergency department (ED) visits and hospitalizations. Of the 171 children requiring medical technology studied, there were numerous medical diagnoses (n=791), 99% had chronic illnesses affecting two or more body systems, and 88% required two or more technologies, including a tracheostomy and a feeding tube. In addition, 91% of the children had at least one ED visit or hospitalization and were treated in the ED approximately three times over the three year period. The findings from this study noted an increased utilization of health care by these children, and identified common symptoms and medical technologies for which caregivers may need interventions, focusing on education in managing symptoms and medical technology prior to presentation to the ED or hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

Changes in protein abundance between tender and tough meat from bovine Longissimus thoracis muscle assessed by isobaric Tag for Relative and Absolute Quantitation (iTRAQ) and 2-dimensional gel electrophoresis analysis

DEFF Research Database (Denmark)

Bjarnadóttir, S G; Hollung, K; Høy, M

2012-01-01

The aim of this study was to find potential biomarkers for meat tenderness in bovine Longissimus thoracis muscle and to compare results from isobaric Tag for Relative and Absolute Quantitation (iTRAQ) and 2-dimensional gel electrophoresis (2-DE) analysis. The experiment included 4 tender and 4...

Proposal for the award of a contract, without competitive tendering, for the maintenance of high-voltage switchgear and protection equipment

CERN Document Server

2003-01-01

This document concerns the award of a contract, without competitive tendering, for the maintenance of high-voltage switchgear and protection equipment. The Finance Committee is invited to agree to the negotiation of a contract, without competitive tendering, for the maintenance of high-voltage switchgear and protection equipment with SCHNEIDER (FR) for a total amount of 1 100 000 euros (1 742 000 Swiss francs), covering an initial period of five years, subject to revision for inflation after 1 January 2007. The contract will include options for two one-year extensions beyond the initial five-year period. The amount in Swiss francs has been calculated using the present rate of exchange. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FR - 100%.

Health information needs of professional nurses required at the point of care

Directory of Open Access Journals (Sweden)

Esmeralda Ricks

2015-06-01

Conclusion: This study has enabled the researcher to identify the information needs required by professional nurses at the point of care to enhance the delivery of patient care. The research results were used to develop a mobile library that could be accessed by professional nurses.

Nutrition in Cancer Care (PDQ)

Science.gov (United States)

... are easy to chew, such as milkshakes, scrambled eggs, and custards. Cook foods until soft and tender. Cut food into ... to chew and swallow, such as milkshakes, scrambled eggs, oatmeal, or other cooked ... alcohol. Cook foods until soft and tender. Cut food into ...

Radiation doses to neonates requiring intensive care

International Nuclear Information System (INIS)

Robinson, A.; Dellagrammaticas, H.D.

1983-01-01

Radiological investigations have become accepted as an important part of the range of facilities required to support severely ill newborn babies. Since the infants are so small, many of the examinations are virtually ''whole-body'' irradiations and it was thought that the total doses received might be appreciable. A group of such babies admitted to the Neonatal Intensive Care Unit in Sheffield over a six-month period have been studied. X-ray exposure factors used for each examination have been noted and total skin, gonad and bone marrow doses calculated, supplemented by measurements on phantoms. It is concluded that in most cases doses received are of the same order as those received over the same period from natural background radiation and probably less than those received from prenatal obstetric radiography, so that the additional risks from the diagnostic exposure are small. The highest doses are received in CT scans and barium examinations and it is recommended that the need for these should be carefully considered. (author)

Proposal to negotiate, without competitive tendering, a blanket order for high-voltage thyratrons for the CERN accelerators

CERN Document Server

1999-01-01

This document concerns the supply of thyratrons to be used as high-voltage and high-current switches for the fast-pulsed magnet systems of the CERN accelerators and for the protection of the klystrons of RF systems. In June 1981 the Finance Committee approved the placing, without competitive tendering, of a blanket order with EEV Ltd (UK) for a total value of up to 2 000 000 Swiss francs to cover the supply of thyratrons for the years 1982, 1983 and 1984. New blanket orders were subsequently negotiated for three-year periods with the approval of the Finance Committee in 1984, 1987, 1990 and 1993. After a new market survey in 1995-1996 had confirmed that EEV Ltd is the sole manufacturer of such thyratrons in the CERN Member States, a new blanket order was negotiated in 1996 with the approval of the Finance Committee. The Finance Committee is invited to agree to the negotiation, without competitive tendering, of a new blanket order with EEV Ltd (UK) for up to 800 000 pounds sterling to cover the supply of thyra...

Weed and Onion Response to multiple Applications of Goal Tender beginning at the 1-Leaf Stage of Onion

Science.gov (United States)

Broadleaf weed control in onion is difficult in part due to a lack of postemergence herbicide options at an early growth stage of onions. Onion tolerance to sequential applications of oxyfluorfen (Goal-Tender) alone and with bromoxynil (Buctril) beginning at the 1-lf stage of onions was evaluated n...

Assessing decision quality in patient-centred care requires a preference-sensitive measure

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Cunich, Michelle; Salkeld, Glenn

2014-01-01

A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value...... aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all...

Health care professionals' perspectives on the requirements facilitating the roll-out of kangaroo mother care in South Africa

Directory of Open Access Journals (Sweden)

Wilma ten Ham

2016-10-01

Purpose of the research: To explore and describe the perspectives of health professionals on the requirements for the rolling-out process of KMC as a best practice in South Africa. Methodology: Twelve semi-structured individual interviews were conducted in 2012 with health professionals from various South African healthcare levels, involved in the implementation and the rolling-out process of kangaroo mother care. Content analysis were guided in terms of the four requirements for roll-out of best practices, identified in Edwards and Grinspun's Evidence Informed Model of Care. Results: The requirements for the successful rollout of best practices mentioned by the participants in this study concur with the requirements of Edwards and Grinspun: personal alignment and protocol/policy alignment with the best practice; a roll-out plan; leadership; and supporting and reinforcing structures such as: resources, communicating, education and development regarding the best practice, and the organisational structure. The requirements were identified at four different levels: individual level (e.g. the nurse and medical specialists, management level (of the hospital, provincial level and national level.

Patient-centered care requires a patient-oriented workflow model.

Science.gov (United States)

Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N

2013-06-01

Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.

A gap between need and reality: neonatal nursing staff requirements on a German intensive care unit

Directory of Open Access Journals (Sweden)

Christian Patry

2014-03-01

Full Text Available Recently, new staffing rules for neonatal nurses in intensive care units (ICU were issued in Germany, using categories of care of the British Association of Perinatal Medicine as blueprint. Neonates on intensive care require a nurse-to-patient ratio of 1:1, on intensive surveillance (high dependency care of 1:2. No requirements exist for special care, transitional care, and pediatric ICU patients. Using these rules, nursing staff requirement was calculated over a period of 31 consecutive days once a day in a combined pediatric and neonatal ICU of a metropolitan academic medical center in south-west Germany. Each day, 18.9±0.98 patients (mean±standard deviation were assessed (14.26±1.21 neonatal, 4.65±0.98 pediatric. Among neonates, 9.94±2.56 received intensive therapy, 3.77±1.85 intensive surveillance, and 0.65±0.71 special care. Average nursing staff requirement was 12.10±1.81 full time equivalents (FTE per shift. Considering additional pediatric patients in the ICU and actual nursing staff availability (8.97±0.87 FTE per shift, this ICU seems understaffed.

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

Science.gov (United States)

Chou, Deng-Wei; Wu, Shu-Ling; Chung, Kuo-Mou; Han, Shu-Chen; Cheung, Bruno Man-Hon

2016-01-01

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential. PMID:27759843

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

Directory of Open Access Journals (Sweden)

Deng-Wei Chou

Full Text Available OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%. The most common computed tomographic findings included a feeding vessel sign (90%, peripheral nodules without cavities (80% or with cavities (65%, and peripheral wedge-shaped opacities (75%. The most common primary source of infection was liver abscess (40%, followed by pneumonia (25%. The two most frequent causative pathogens were Klebsiella pneumoniae (50% and Staphylococcus aureus (35%. Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

Case study on the quality of tenders submitted by Occupational Health and Safety Professionals in the South African built environment

CSIR Research Space (South Africa)

Mphahlele, C

2017-08-01

Full Text Available Purpose of this paper: The purpose of the paper is to provide an overview of the current state of tenders submitted by Occupational Health and Safety (OHS) professionals in terms of functionality criteria. Design/methodology/approach: The research...

Conditions of call for tenders on the offshore wind power plants; Conditions de l'appel d'offres portant sur des centrales eolienne en mer

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-07-01

In the framework of the renewable energies sources development, the french government decided to launch a call for tenders for the realization of offshore wind power plants in 2007. The call for tenders conditions concern: the energetic and technical characteristics of the installations as the primary energy, the production technic, the power; the industrial implementing delay; the exploitation and the operating time; the implementing sites; the weighting and the classification principles. The main conditions concerning the utilization of the maritime public land property outside of the harbors. (A.L.B.)

Health care professionals' perspectives on the requirements facilitating the roll-out of kangaroo mother care in South Africa

Directory of Open Access Journals (Sweden)

Wilma ten Ham

2016-12-01

Conclusion: Although certain requirements, such as personal alignment and reinforcing structures can be used in the roll-out of best practices, further research is desirable to promote fuller understanding of how to devise and apply the requirements in the wider adoption of best practices in South African health care settings.

Renewable energies: the choice of invitation to tender candidates for the electric power plants supplied by biomass or biogas

International Nuclear Information System (INIS)

2005-01-01

To contribute to the french objectives of renewable energies development, the Ministry of Industry proposed an invitation to tender for the realization at the first of january 2007 of electric power plants (more than 12 MW) from biomass and biogas. This document presents the selected projects. (A.L.B.)

45 CFR 1356.30 - Safety requirements for foster care and adoptive home providers.

Science.gov (United States)

2010-10-01

... licensing file for that foster or adoptive family must contain documentation which verifies that safety... 45 Public Welfare 4 2010-10-01 2010-10-01 false Safety requirements for foster care and adoptive... ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND...

Requirements for and barriers towards interoperable ehealth technology in primary care

NARCIS (Netherlands)

Oude Nijeweme-d'Hollosy, Wendeline; van Velsen, Lex Stefan; Huygens, Martine; Hermens, Hermanus J.

Despite eHealth technology's rapid growth, eHealth applications are rarely embedded within primary care, mostly because systems lack interoperability. This article identifies requirements for, and barriers towards, interoperable eHealth technology from healthcare professionals' perspective -- the

CNA Training Requirements and Resident Care Outcomes in Nursing Homes.

Science.gov (United States)

Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy B; Yang, Bo Kyum; Han, Kihye

2017-06-01

To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes. Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status. A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes. Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care. © The Author 2016. 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.

The tibial nerve compression test for the diagnosis of lumbar spinal canal stenosis-A simple and reliable physical examination for use by primary care physicians.

Science.gov (United States)

Adachi, Shu; Nakano, Atsushi; Kin, Akihiro; Baba, Ichiro; Kurokawa, Yoshitaka; Neo, Masashi

2018-01-01

In the present study, we aimed to evaluate the diagnostic accuracy and suitability of the 'Tibial Nerve Compression Test (TNCT)' as a screening tool for lumbar spinal canal stenosis (LSS). A total of 108 consecutive patients admitted to our hospital for surgical treatment or diagnosis of LSS were included in this study. Fifty healthy volunteers were examined as a control group. The severity of tenderness was scored (tenderness score) and measured on a visual analogue scale (P-VAS score). These scores were compared between the LSS and control groups. Moreover, they were compared before and after the operation among operated patients. The positive tenderness rate was significantly higher (92.6% [100/108]) in the LSS group than in the control group (30% [15/50]). The sensitivity and specificity of TNCT (95% confidence interval) were 0.93 (0.88-0.96) and 0.70 (0.61-0.77), respectively. Positive tenderness rates and P-VAS scores were significantly higher in the LSS group (p Test is a useful screening tool for LSS diagnosis in a primary care setting. Level II, diagnostic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.

Science.gov (United States)

Cohen, Steven P; Peterlin, B Lee; Fulton, Larry; Neely, Edward T; Kurihara, Connie; Gupta, Anita; Mali, Jimmy; Fu, Diana C; Jacobs, Michael B; Plunkett, Anthony R; Verdun, Aubrey J; Stojanovic, Milan P; Hanling, Steven; Constantinescu, Octav; White, Ronald L; McLean, Brian C; Pasquina, Paul F; Zhao, Zirong

2015-12-01

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

Idade e sexo na maciez da carne de ovinos da raça Corriedale Meat lamb tenderness influenced by age and sex in Corriedale lineage

Directory of Open Access Journals (Sweden)

Márcia Arocha Gularte

2000-06-01

Full Text Available A maciez da carne geralmente é o atributo mais importante para o consumidor. Vários são os fatores que influem sobre esSe aspecto no animal, como por exemplo: genótipo, idade, sexo, entre outros. Neste estudo, verificou-se a influência da idade e do sexo na maciez do músculo Longissimus dorsi de ovinos da raça Corriedale, através de métodos sensoriais e instrumentais. Após o abate, realizou-se a avaliação visual da textura do músculo pela granulação da superfície do mesmo. As amostras foram congeladas por 5 meses. Após a cocção, foi analisada a maciez da carne pelo equipamento Warner-Bratzler shear medindo a força de cisalhamento, e por avaliação sensorial realizada por uma equipe treinada de julgadores. Resultados obtidos pela avaliação sensorial e instrumental indicaram que o músculo Longissimus dorsi de fêmeas e de animais de menor idade foram mais macios.The meat tenderness is the most important atribute to the consumer. Several factors have influence in this aspect, for exemple: genotype, age, sex and others. The objective of this work was to study the influence of age and sex on Longissimus dorsi muscle tenderness of Corriedale lineage lamb, through sensory and instrumental methods. After slaughter Longissimus dorsi, texture was evaluated by granite’s surface method. The samples were frozen for five months. After thawing and cooking, meat tenderness was evaluated by Warner-Bratzler shear and sensory evaluation by a group of trained judges. The results indicated that female and younger animals produced more tender meat.

Proposal for the award of a contract, without competitive tendering, for the supply of eight glass-coated beryllium mirrors for the LHCb RICH1 detector

CERN Document Server

2004-01-01

This document concerns the award of a contract, without competitive tendering, for the supply of eight glass-coated beryllium mirrors for the LHCb RICH1 detector. The Finance Committee is invited to agree to the negotiation of a contract, without competitive tendering, with the ISTC Moscow (RU) for the supply of eight glass-coated beryllium mirrors for a total amount of 282 000 US dollars, not subject to revision. At the present rate of exchange this is equivalent to approximately 370 000 Swiss francs. The contract will be financed by PPARC (GB) and CERN. PPARC will contribute 65 000 US dollars (approximately 85 000 Swiss francs) and CERN will contribute 217 000 US dollars (approximately 285 000 Swiss francs).

Incidence and preventability of adverse events requiring intensive care admission: a systematic review.

Science.gov (United States)

Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Neree

2012-04-01

Adverse events are unintended patient injuries or complications that arise from health care management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the health care system, but also their global impact on patients and society is probably underestimated. The objectives of this systematic review were to synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission, to determine the type and consequences [mortality, length of intensive care unit (ICU) stay and costs] of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions on ICUs. Several other sources were searched for additional studies. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. For the purposes of this systematic review, ICUs were defined as specialized hospital facilities which provide continuous monitoring and intensive care for acutely ill patients. Studies that were published in the English, Dutch, German, French or Spanish language were eligible for inclusion. Two reviewers independently extracted data and assessed the methodological quality of the included studies. A total of 27 studies were reviewed. Meta-analysis of the data was not appropriate because of methodological and statistical heterogeneity between studies; therefore, results are presented in a descriptive way. The percentage of surgical and medical adverse events that required ICU admission ranged from 1.1% to 37.2%. ICU readmissions varied from 0% to 18.3%. Preventability of the adverse events varied from 17% to 76.5%. Preventable adverse events are further synthesized by type of event. Consequences of the adverse events included a

Fate of Escherichia coli O157:H7 in mechanically tenderized beef prime rib following searing, cooking, and holding under commercial conditions.

Science.gov (United States)

Porto-Fett, Anna C S; Shoyer, Bradley A; Thippareddi, Harshavardhan; Luchansky, John B

2013-03-01

We evaluated the effect of commercial times and temperatures for searing, cooking, and holding on the destruction of Escherichia coli O157:H7 (ECOH) within mechanically tenderized prime rib. Boneless beef ribeye was inoculated on the fat side with ca. 5.7 log CFU/g of a five-strain cocktail of ECOH and then passed once through a mechanical tenderizer with the fat side facing upward. The inoculated and tenderized prime rib was seared by broiling at 260°C for 15 min in a conventional oven and then cooked in a commercial convection oven at 121.1°C to internal temperatures of 37.8, 48.9, 60.0, and 71.1°C before being placed in a commercial holding oven maintained at 60.0°C for up to 8 h. After searing, ECOH levels decreased by ca. 1.0 log CFU/g. Following cooking to internal temperatures of 37.8 to 71.1°C, pathogen levels decreased by an additional ca. 2.7 to 4.0 log CFU/g. After cooking to 37.8, 48.9, or 60.0°C and then warm holding at 60.0°C for 2 h, pathogen levels increased by ca. 0.2 to 0.7 log CFU/g. However, for prime rib cooked to 37.8°C, pathogen levels remained relatively unchanged over the next 6 h of warm holding, whereas for those cooked to 48.9 or 60.0°C pathogen levels decreased by ca. 0.3 to 0.7 log CFU/g over the next 6 h of warm holding. In contrast, after cooking prime rib to 71.1°C and holding for up to 8 h at 60.0°C, ECOH levels decreased by an additional ca. 0.5 log CFU/g. Our results demonstrated that to achieve a 5.0-log reduction of ECOH in blade tenderized prime rib, it would be necessary to sear at 260°C for 15 min, cook prime rib to internal temperatures of 48.9, 60.0, or 71.1°C, and then hold at 60.0°C for at least 8 h.

Chiropractic care of a patient with vertebral subluxation and Bell's palsy.

Science.gov (United States)

Alcantara, Joel; Plaugher, Gregory; Van Wyngarden, Darwin L

2003-05-01

To describe the chiropractic care of a patient medically diagnosed with Bell's palsy and discuss issues clinically relevant to this disorder, such as its epidemiology, etiology, diagnosis, care, and prognosis. A 49-year-old woman with a medical diagnosis of Bell's palsy sought chiropractic care. Her symptoms included right facial paralysis, extreme phonophobia, pain in the right temporomandibular joint (TMJ), and neck pain. Signs of cervical vertebral and TMJ subluxations included edema, tenderness, asymmetry of motion and posture, and malalignment detected from plain film radiographs. The patient was cared for with full spine contact-specific, high-velocity, low-amplitude adjustments (Gonstead Technique) to sites of vertebral and occipital subluxations. The patient's left TMJ was also adjusted. The initial symptomatic response to care was positive, and the patient made continued improvements during the 6 months of care. There are indications that patients suffering from Bell's palsy may benefit from a holistic chiropractic approach that not only includes a focus of examination and care of the primary regional areas of complaint (eg, face, TMJ) but also potentially from significant vertebral subluxation concomitants.

Tender rules and trust influence on cooperation in the building industry

DEFF Research Database (Denmark)

Ussing, Lene Faber; Wandahl, Søren

2012-01-01

The building industry has for many years been criticized for not having as efficient and effective co-operation as other industries. Some parties in the building sector try to use a new form of collaboration as i.a. partnering. In a big part of those partnering projects a good working relationship...... exists, the building owner is satisfied, the involved companies earn money and the project finish in time. A lot of projects do not use partnering or other new forms of collaboration. In these projects the general impression is that the parties in the building sector are fighting instead of co......-operating. A questionnaire survey including building owners, contractors, suppliers, architects, engineers and client design advisor has been accomplished. The survey shows that the problem with co-operation among others is the way the tendering rules normally are used, where the normal assignment criterion is the lowest...

Public vs. Private Provision of Charity Care? Evidence from the Expiration of Hill-Burton Requirements in Florida

OpenAIRE

Douglas Almond; Janet Currie; Emilia Simeonova

2010-01-01

This paper explores the consequences of the expiration of charity care requirements imposed on private hospitals by the Hill-Burton Act. We examine delivery care and the health of newborns using the universe of Florida births from 1989-2003 combined with hospital data from the American Hospital Association. We find that charity care requirements were binding on hospitals, but that private hospitals under obligation "cream skimmed" the least risky maternity patients. Conditional on patient cha...

Requirements for a minimum standard of care for phenylketonuria: the patients’ perspective

Science.gov (United States)

2013-01-01

Phenylketonuria (PKU, ORPHA716) is an inherited disorder that affects about one in every 10,000 children born in Europe. Early and continuous application of a modified diet is largely successful in preventing the devastating brain damage associated with untreated PKU. The management of PKU is inconsistent: there are few national guidelines, and these tend to be incomplete and implemented sporadically. In this article, the first-ever pan- European patient/carer perspective on optimal PKU care, the European Society for Phenylketonuria and Allied Disorders (E.S.PKU) proposes recommendations for a minimum standard of care for PKU, to underpin the development of new pan-European guideline for the management of PKU. New standards of best practice should guarantee equal access to screening, treatment and monitoring throughout Europe. Screening protocols and interpretation of screening results should be standardised. Experienced Centres of Expertise are required, in line with current European Union policy, to guarantee a defined standard of multidisciplinary treatment and care for all medical and social aspects of PKU. Women of childbearing age require especially intensive management, due to the risk of severe risks to the foetus conferred by uncontrolled PKU. All aspects of treatment should be reimbursed to ensure uniform access across Europe to guideline-driven, evidence-based care. The E.S.PKU urges PKU healthcare professionals caring for people with PKU to take the lead in developing evidence based guidelines on PKU, while continuing to play an active role in serving as the voice of patients and their families, whose lives are affected by the condition. PMID:24341788

Health information needs of professional nurses required at the point of care.

Science.gov (United States)

Ricks, Esmeralda; ten Ham, Wilma

2015-06-11

Professional nurses work in dynamic environments and need to keep up to date with relevant information for practice in nursing to render quality patient care. Keeping up to date with current information is often challenging because of heavy workload, diverse information needs and the accessibility of the required information at the point of care. The aim of the study was to explore and describe the information needs of professional nurses at the point of care in order to make recommendations to stakeholders to develop a mobile library accessible by means of smart phones when needed. The researcher utilised a quantitative, descriptive survey design to conduct this study. The target population comprised 757 professional nurses employed at a state hospital. Simple random sampling was used to select a sample of the wards, units and departments for inclusion in the study. A convenience sample of 250 participants was selected. Two hundred and fifty structured self-administered questionnaires were distributed amongst the participants. Descriptive statistics were used to analyse the data. A total of 136 completed questionnaires were returned. The findings highlighted the types and accessible sources of information. Information needs of professional nurses were identified such as: extremely drug-resistant tuberculosis, multi-drug-resistant tuberculosis, HIV, antiretrovirals and all chronic lifestyle diseases. This study has enabled the researcher to identify the information needs required by professional nurses at the point of care to enhance the delivery of patient care. The research results were used to develop a mobile library that could be accessed by professional nurses.

31 CFR 309.7 - Tenders; submission through Federal Reserve Banks and branches and to the Bureau of the Public Debt.

Science.gov (United States)

2010-07-01

... Reserve Banks and branches and to the Bureau of the Public Debt. 309.7 Section 309.7 Money and Finance... Reserve Banks and branches and to the Bureau of the Public Debt. Tenders in response to any such public notice will be received at the Federal Reserve Banks, or Branches thereof and at the Bureau of the Public...

We are not alone: international learning for professionals caring for children requiring palliative care.

Science.gov (United States)

Price, Jayne; Quinn, Karen; McNeilly, Patricia; Heywood, Melissa

2015-06-01

Educational opportunities for professionals working with children requiring palliative care are central to future development within the specialty across countries. International educational initiatives involving a range of professionals are important for learning with and from others working within the field. To explore the experiences and value to students from participating in an international online discussion forum. This article examines one such initiative; the use of an international asynchronous discussion forum with students in Melbourne, Australia and Belfast, UK who work with children and families. The innovation is examined and student perspectives of the forum's value are presented. Students endorsed the value of the forum, identifying three main areas of learning: differences across locations within countries, respecting different views and being open, and need for continued learning within children's palliative care. The overarching theme 'we are not alone' supported the idea that participation in the international discussion forum enabled students to see a broader perspective. Ideas for future developments of similar forums are also explored.

Low-level waste management in the South. Task 4.2 - long-term care requirements

International Nuclear Information System (INIS)

1983-01-01

This paper provides an analysis of the long-term care requirements of low-level radioactive waste disposal facilities. Among the topics considered are the technical requirements for long-term care, the experiences of the three inactive and three active commercial disposal facilities concerning perpetual care and maintenance, and the financial management of a perpetual care fund. In addition, certain recommendations for the establishment of a perpetual care fund are provided. The predominant method of disposing of low-level radioactive wastes is shallow land burial. After studying alternative methods of disposal, the U.S Nuclear Regulatory Commission (NRC) concluded that there are no compelling reasons for abandoning this disposal method. Of the 22 shallow land burial facilities in the U.S., the federal government maintains 14 active and two inactive disposal sites. There are three active (Barnwell, South Carolina; Hanford, Washington; and Beatty, Nevada) and three inactive commercial disposal facilities (Maxey Flats, Kentucky; Sheffield, Illinois; and West Valley, New York). The life of a typical facility can be broken into five phases: preoperational, operational, closure, postclosure observation and maintenance, and institutional control. Long-term care of a shallow land burial facility will begin with the disposal site closure phase and continue through the postclosure observation and maintenance and institutional control phases. Since the postclosure observation and maintenance phase will last about five years and the institutional control phase 100 years, the importance of a well planned long-term care program is apparent. 26 references, 1 table

Successful chronic disease care for Aboriginal Australians requires cultural competence.

Science.gov (United States)

Liaw, Siaw Teng; Lau, Phyllis; Pyett, Priscilla; Furler, John; Burchill, Marlene; Rowley, Kevin; Kelaher, Margaret

2011-06-01

To review the literature to determine the attributes of culturally appropriate healthcare to inform the design of chronic disease management (CDM) models for Aboriginal patients in urban general practice. A comprehensive conceptual framework, drawing on the Access to Care, Pathway to Care, Chronic Care, Level of Connectedness, and Cultural Security, Cultural Competency and Cultural Respect models, was developed to define the search strategy, inclusion criteria and appraisal methods for the literature review. Selected papers were reviewed in detail if they examined a chronic disease intervention for an Aboriginal population and reported on its evaluation, impacts or outcomes. In the 173 papers examined, only 11 programs met the inclusion criteria. All were programs conducted in rural and remote Aboriginal community-controlled health services. Successful chronic disease care and interventions require adequate Aboriginal community engagement, utilising local knowledge, strong leadership, shared responsibilities, sustainable resources and integrated data and systems. These success factors fitted within the conceptual framework developed. Research and development of culturally appropriate CDM models concurrently in both urban and rural settings will enable more rigorous evaluation, leading to stronger evidence for best practice. A partnership of mainstream and Aboriginal-controlled health services is essential to successfully 'close the gap'. Findings will inform and guide the development, implementation and evaluation of culturally appropriate CDM in mainstream general practice and primary care. © 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.

Reduced neck-shoulder muscle strength and aerobic power together with increased pericranial tenderness are associated with tension-type headache in girls

DEFF Research Database (Denmark)

Tornoe, Birte; Andersen, Lars L; Skotte, Jørgen H

2013-01-01

BACKGROUND: Tension-type headaches (TTH) are common among children worldwide and mean a potential risk of disability and medication overuse headache. The associated mechanisms, however, remain unsolved. Our study investigated muscle strength in the neck-shoulder region, aerobic power and pericran......BACKGROUND: Tension-type headaches (TTH) are common among children worldwide and mean a potential risk of disability and medication overuse headache. The associated mechanisms, however, remain unsolved. Our study investigated muscle strength in the neck-shoulder region, aerobic power...... and pericranial tenderness in girls with TTH compared with healthy controls. METHODS: A blinded case-control study comprising 41 girls with TTH and 41 age-matched healthy controls. Standardised testing of isometric maximal voluntary contraction (MVC) and force steadiness of neck flexion and extension, as well.......3 (95% CI 1.0-1.6) and 5.2 (95% CI: 1.4-19.6) for each unit of decrease in VO2 max. CONCLUSIONS: Reduced neck-shoulder strength and aerobic power together with increased pericranial tenderness are associated with TTH in girls. Future interventions should be directed towards health promoting patient...

Thermal inactivation of Escherichia coli 0157:H7 (ECOH) and non-0157 Shiga toxin-producing E.coli (STEC)in mechanically tenderized veal

Science.gov (United States)

We quantified thermal destruction of Shiga toxin-producing Escherichia coli O157:H7 (ECOH) and Shiga toxin-producing non-O157 E. coli (STEC) cells within mechanically tenderized veal cutlets following cooking on an electric skillet. For each of five trials, flattened veal cutlets (ca. 71.6 g; ca. 1/...

Health care administration in the year 2000: practitioners' views of future issues and job requirements.

Science.gov (United States)

Hudak, R P; Brooke, P P; Finstuen, K; Riley, P

1993-01-01

This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.

Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements.

Science.gov (United States)

Saadat, Lily V; Dahlke, Allison R; Rajaram, Ravi; Kreutzer, Lindsey; Love, Remi; Odell, David D; Bilimoria, Karl Y; Yang, Anthony D

2016-06-01

The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial was a national, cluster-randomized, pragmatic, noninferiority trial of 117 general surgery programs, comparing standard ACGME resident duty hour requirements ("Standard Policy") to flexible, less-restrictive policies ("Flexible Policy"). Participating program directors (PDs) were surveyed to assess their perceptions of patient care, resident education, and resident well-being during the study period. A survey was sent to all PDs of the general surgery residency programs participating in the FIRST trial (N = 117 [100% response rate]) in June and July 2015. The survey compared PDs' perceptions of the duty hour requirements in their arm of the FIRST trial during the study period from July 1, 2014 to June 30, 2015. One hundred percent of PDs in the Flexible Policy arm indicated that residents used their additional flexibility in duty hours to complete operations they started or to stabilize a critically ill patient. Compared with the Standard Policy arm, PDs in the Flexible Policy arm perceived a more positive effect of duty hours on the safety of patient care (68.9% vs 0%; p care (98.3% vs 0%; p care (71.8%), continuity of care (94.0%), quality of resident education (83.8%), and resident well-being (55.6%) would be improved with a hypothetical permanent adoption of more flexible duty hours. Program directors involved in the FIRST trial perceived improvements in patient safety, continuity of care, and multiple aspects of resident education and well-being with flexible duty hours. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Call for tender - Areva-Alstom: watershed in wind energy - Technological duel on the open sea

International Nuclear Information System (INIS)

Dupin, L.

2012-01-01

The author comments the answers to a call for tender made by the French government and concerning five offshore wind farm sites (Le Treport, Fecamp, Courseulles sur Mer, Saint-Brieuc and Saint-Nazaire). As they are present within the three consortiums, Areva and Alstom should provide the wind turbines. This would result in the construction by Alstom of two blade and mast factories and two turbine and pad factories. For both companies, this market of 500 to 600 turbines is an opportunity. Many jobs are at stake. They push themselves forward for their experience or their innovation capacity. But their wind turbines will be based on foreign (Spanish or German) technology

Physical Examination Tools Used to Identify Swollen and Tender Lower Limb Joints in Juvenile Idiopathic Arthritis: A Scoping Review.

Science.gov (United States)

Fellas, Antoni; Singh-Grewal, Davinder; Santos, Derek; Coda, Andrea

2018-01-01

Juvenile idiopathic arthritis (JIA) is the most common form of rheumatic disease in childhood and adolescents, affecting between 16 and 150 per 100,000 young persons below the age of 16. The lower limb is commonly affected in JIA, with joint swelling and tenderness often observed as a result of active synovitis. The objective of this scoping review is to identify the existence of physical examination (PE) tools to identify and record swollen and tender lower limb joints in children with JIA. Two reviewers individually screened the eligibility of titles and abstracts retrieved from the following online databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. Studies that proposed and validated a comprehensive lower limb PE tool were included in this scoping review. After removal of duplicates, 1232 citations were retrieved, in which twelve were identified as potentially eligible. No studies met the set criteria for inclusion. Further research is needed in developing and validating specific PE tools for clinicians such as podiatrists and other allied health professionals involved in the management of pathological lower limb joints in children diagnosed with JIA. These lower limb PE tools may be useful in conjunction with existing disease activity scores to optimise screening of the lower extremity and monitoring the efficacy of targeted interventions.

The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study

DEFF Research Database (Denmark)

Amris, Kirstine; Wæhrens, Eva Ejlersen; Jespersen, Anders

2014-01-01

The clinical utility of tender point (TP) examination in patients reporting chronic widespread pain (CWP) is the subject of contemporary debate. The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity...

Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation.

Science.gov (United States)

Wiskar, Katie J; Celi, Leo Anthony; McDermid, Robert C; Walley, Keith R; Russell, James A; Boyd, John H; Rush, Barret

2018-04-01

Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P care ( P care. The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.

Fate of Escherichia coli O157:H7 (ECOH) in blade tenderized beef prime rib following searing, cooking and holding under commercial conditions

Science.gov (United States)

Undercooked non-intact beef has caused a number of illnesses due to contamination with serotype O157:H7 strains of Escherichia coli (ECOH). Few studies have quantified translocation and/or thermal inactivation of ECOH directly in blade tenderized beef. There have been no such studies for prime rib,...

Ensuring sustained user quality in buildings. Success contracting with functional tendering of the building services equipment guarantees quality for 15 years; Nutzerqualitaet in Gebaeuden dauerhaft sicherstellen. Erfolgscontracting mit funktionaler Ausschreibung ermoeglicht eine 15-jaehrige Garantie auf die Gebaeudetechnik

Energy Technology Data Exchange (ETDEWEB)

Milles, Uwe

2012-07-01

Until now, buildings regularly require more energy and provide less user quality in practice than was to be expected from the installed technology during the planning. That has structural reasons. The naerco research project has investigated this aspect and developed the success contracting concept: pre-defined energy and quality parameters are contracted out as part of a function-based tender. A contractor guarantees their realisation for 15 years. The contractual process also includes continual control of the agreed values and a bonus-malus system.

A SUSTAINABLE HEALTH CARE SYSTEM REQUIRES MANAGEMENT TRANSFORMATION

Directory of Open Access Journals (Sweden)

Kanellopoulos Dimitros

2011-12-01

Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes

Relationship between commercially available DNA analysis and phenotypic observations on beef quality and tenderness.

Science.gov (United States)

Magolski, J D; Buchanan, D S; Maddock-Carlin, K R; Anderson, V L; Newman, D J; Berg, E P

2013-11-01

Warner-Bratzler shear force values from 560 mixed breed heifers and steers were used to determine estimates of genetic selection. Cattle were marketed from 2008 to 2011, and included five feedlot based research projects at the North Dakota State University-Carrington Research Extension Center. Samples were collected for IGENITY® analysis providing information that included selection indices and estimated breeding values for carcass traits. DNA-based test results were compared with actual carcass measurements. Marbling accounted for over 10% of the variation in WBSF while hot carcass weight was the second most influential carcass trait accounting for 4% (Pfeeding a diet that meets or exceeds recommended nutrients for growth are the most important factors influencing beef tenderness and acceptability. Copyright © 2013 Elsevier Ltd. All rights reserved.

Surgical Care Required for Populations Affected by Climate-related Natural Disasters: A Global Estimation.

Science.gov (United States)

Lee, Eugenia E; Stewart, Barclay; Zha, Yuanting A; Groen, Thomas A; Burkle, Frederick M; Kushner, Adam L

2016-08-10

Climate extremes will increase the frequency and severity of natural disasters worldwide.  Climate-related natural disasters were anticipated to affect 375 million people in 2015, more than 50% greater than the yearly average in the previous decade. To inform surgical assistance preparedness, we estimated the number of surgical procedures needed.   The numbers of people affected by climate-related disasters from 2004 to 2014 were obtained from the Centre for Research of the Epidemiology of Disasters database. Using 5,000 procedures per 100,000 persons as the minimum, baseline estimates were calculated. A linear regression of the number of surgical procedures performed annually and the estimated number of surgical procedures required for climate-related natural disasters was performed. Approximately 140 million people were affected by climate-related natural disasters annually requiring 7.0 million surgical procedures. The greatest need for surgical care was in the People's Republic of China, India, and the Philippines. Linear regression demonstrated a poor relationship between national surgical capacity and estimated need for surgical care resulting from natural disaster, but countries with the least surgical capacity will have the greatest need for surgical care for persons affected by climate-related natural disasters. As climate extremes increase the frequency and severity of natural disasters, millions will need surgical care beyond baseline needs. Countries with insufficient surgical capacity will have the most need for surgical care for persons affected by climate-related natural disasters. Estimates of surgical are particularly important for countries least equipped to meet surgical care demands given critical human and physical resource deficiencies.

Test-retest repeatability of strength capacity, aerobic power and pericranial tenderness of neck and shoulder muscles in children - relevant for tension-type headache

Directory of Open Access Journals (Sweden)

Tornøe B

2013-08-01

Full Text Available Birte Tornøe,1,2,5,6 Lars L Andersen,3 Jørgen H Skotte,3 Rigmor Jensen,4 Gunvor Gard,1 Liselotte Skov,2 Inger Hallström1 1Department of Health Sciences, Lund University, Scania, Sweden; 2Children's Headache Clinic, Department of Pediatrics, University of Copenhagen, Herlev Hospital, Herlev, Denmark; 3National Research Centre for the Working Environment, Copenhagen, Denmark; 4Danish Headache Center, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark; 5Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark; 6Department of Physiotherapy, Medical Department, University of Copenhagen, Herlev Hospital, Herlev, Denmark Background: Frequent or chronic tension-type headache in children is a prevalent and debilitating condition for the child, often leading to medication overuse. To explore the relationship between physical factors and tension-type headache in children, the quality of repeated measures was examined. The aim of the present study was to determine the test-retest repeatability of parameters determining isometric neck and shoulder strength and stability, aerobic power, and pericranial tenderness in children. Methods: Twenty-five healthy children, 9 to 18 years of age, participated in test-retest procedures within a 1-week interval. A computerized padded force transducer was used for testing. The tests included the isometric maximal voluntary contraction and force steadiness of neck flexion and extension, and the isometric maximal voluntary contraction and rate of force of the dominant shoulder. Pericranial tenderness was recorded by means of standardized manual palpation, and a submaximal cycle ergometer test predicted maximal oxygen uptake (VO2 max. The measurements were evaluated in steps, using the intraclass correlation coefficient (ICC; changes in the mean between the two test occasions; the levels of agreement, visualized in Bland

Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

Science.gov (United States)

Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

2016-11-01

Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload

Survival of Escherichia coli O157:H7 in needle-tenderized dry cured Westphalian ham.

Science.gov (United States)

Graumann, Gary H; Holley, Richard A

2007-09-15

Westphalian ham is a dry cured, ready-to-eat product that is manufactured without a lethal heat treatment. Hams are preserved by a process that involves curing, fermenting, smoking and drying, which may take 3 months or more to complete. The process can be accelerated by tenderizing the meat with solid needles, to increase the rate of cure-salt diffusion throughout muscle tissues. In this study, intact hams were immersed in a solution containing a five strain cocktail of Escherichia coli O157:H7 at 8 log cfu/mL, to determine whether needle treatment before cure application would internalize organisms from the surface. In two trials, the survival of E. coli O157:H7 on external surfaces and within deep tissues after needle treatment was followed during the ripening of hams. The injured E. coli O157:H7 cells were recovered by plating samples on pre-poured Tryptic Soy Agar plates which were incubated for 3 to 4 h at 35 degrees C, overlaid with Sorbitol MacConkey Agar containing cefixime and tellurite and re-incubated at 35 degrees C for 48 to 72 h. Inoculated-injected hams initially carried E. coli O157:H7 at numbers of 7.3 and 4.6 log cfu/g E. coli O157:H7 on the surface and inside, respectively. After 112 d of ripening, which included 79 d of drying, no E. coli O157:H7 were detected at the surface of hams following enrichment, whereas in deep tissue the organism was recovered at numbers of 3.1 log cfu/g. The Westphalian ham ripening procedure evidently was not adequate to eliminate E. coli O157:H7 internalized by needle tenderization.

Recommendations on basic requirements for intensive care units: structural and organizational aspects.

Science.gov (United States)

Valentin, Andreas; Ferdinande, Patrick

2011-10-01

To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESICM.

Alternative pre-rigor foreshank positioning can improve beef shoulder muscle tenderness.

Science.gov (United States)

Grayson, A L; Lawrence, T E

2013-09-01

Thirty beef carcasses were harvested and the foreshank of each side was independently positioned (cranial, natural, parallel, or caudal) 1h post-mortem to determine the effect of foreshank angle at rigor mortis on the sarcomere length and tenderness of six beef shoulder muscles. The infraspinatus (IS), pectoralis profundus (PP), serratus ventralis (SV), supraspinatus (SS), teres major (TM) and triceps brachii (TB) were excised 48 h post-mortem for Warner-Bratzler shear force (WBSF) and sarcomere length evaluations. All muscles except the SS had altered (P<0.05) sarcomere lengths between positions; the cranial position resulted in the longest sarcomeres for the SV and TB muscles whilst the natural position had longer sarcomeres for the PP and TM muscles. The SV from the cranial position had lower (P<0.05) shear than the caudal position and TB from the natural position had lower (P<0.05) shear than the parallel or caudal positions. Sarcomere length was moderately correlated (r=-0.63; P<0.01) to shear force. Copyright © 2013 Elsevier Ltd. All rights reserved.

Proposal to negotiate a contract, without competitive tendering, for the supply and installation of pipework for the new hostel

CERN Document Server

2005-01-01

This document concerns the proposal to negotiate a contract for the supply and installation of new piping as preparatory work for the construction of a third on-site hostel. For the reasons explained in this document, the Finance Committee is invited to approve a contract with the SERVICES INDUSTRIELS DE GENEVE (SIG) (CH), without competitive tendering, for the supply and installation of new piping for an amount not exceeding 700 000 Swiss francs, not subject to revision.

32 CFR 732.17 - Nonemergency care requirements.

Science.gov (United States)

2010-07-01

... her leave address or travel to the most accessible USMTF or USTF with capability for maternity care... approval of nonemergency care (medical, dental, or maternity) from non-Federal sources to the adjudication... information addressee on each letter of authorization. (c) Maternity care. (1) Pregnant active duty members...

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

Science.gov (United States)

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

2015-07-01

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

Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Council on Graduate Medical Education, Eighth Report.

Science.gov (United States)

Council on Graduate Medical Education.

This report reassesses recommendations made by the Council on Graduate Medical Education in earlier reports which had, beginning in 1992, addressed the problems of physician oversupply. In this report physician supply and requirements are examined in the context of a health care system increasingly dominated by managed care. Patterns of physician…

Proposal for the Award of Three Contracts without competitive tendering or Design Calculations and Drawings for the Reinforced Concrete Work in LEP Surface Buildings and Supervision of their Implementation

CERN Document Server

1987-01-01

Proposal for the Award of Three Contracts without competitive tendering or Design Calculations and Drawings for the Reinforced Concrete Work in LEP Surface Buildings and Supervision of their Implementation

User Interface Requirements for Web-Based Integrated Care Pathways: Evidence from the Evaluation of an Online Care Pathway Investigation Tool.

Science.gov (United States)

Balatsoukas, Panos; Williams, Richard; Davies, Colin; Ainsworth, John; Buchan, Iain

2015-11-01

Integrated care pathways (ICPs) define a chronological sequence of steps, most commonly diagnostic or treatment, to be followed in providing care for patients. Care pathways help to ensure quality standards are met and to reduce variation in practice. Although research on the computerisation of ICP progresses, there is still little knowledge on what are the requirements for designing user-friendly and usable electronic care pathways, or how users (normally health care professionals) interact with interfaces that support design, analysis and visualisation of ICPs. The purpose of the study reported in this paper was to address this gap by evaluating the usability of a novel web-based tool called COCPIT (Collaborative Online Care Pathway Investigation Tool). COCPIT supports the design, analysis and visualisation of ICPs at the population level. In order to address the aim of this study, an evaluation methodology was designed based on heuristic evaluations and a mixed method usability test. The results showed that modular visualisation and direct manipulation of information related to the design and analysis of ICPs is useful for engaging and stimulating users. However, designers should pay attention to issues related to the visibility of the system status and the match between the system and the real world, especially in relation to the display of statistical information about care pathways and the editing of clinical information within a care pathway. The paper concludes with recommendations for interface design.

Requirements for a text that integrates the oncological pharmacy into the Cuban national health care system

International Nuclear Information System (INIS)

Arbesú Michelena, Ma Antonieta; Sedeño Argilagos, C. Caridad; Fernández Argüelles, Rogelio Alberto

2015-01-01

Introduction: oncological patients are cared for at all health care system levels. The pharmaceutical professional requires unifying instructions for his/her work in order to be part of the health team. Currently, there is no domestic literature for the pharmaceutical services, mainly that one devoted to oncological area, which comprises in just one text all the functional requirements and directs his/her professional daily work. Objective: to verify the requirement for national integral literature for the development of the oncological pharmaceutical service work. Methods: one two-question questionnaire was designed to assess the knowledge of experts and another with eight questions to learn about the requirement for literature on oncological pharmaceutical service adapted to the conditions of the Cuban health system. The questionnaires were e-mailed to 15 pharmacists who had an outstanding experience in several activities of the oncological pharmacy. Results: ten university experts, with 14.5 years of work experience as average in assistance activities from three provinces, responded. Two were excluded because their low level of information on oncological activity; poor incorporation of the pharmacist involved in services to activities inherent to his/her formation. All the experts believed that it was necessary to have a comprehensive text on the tasks, functions and activities linked to the oncological patient care, and to use the formal learning pathways for updating. A positive association with the favorable answers (1.40) was noticed. Conclusions: there exists a need for a text as a guide of the oncological pharmaceutical services according to the demands of the Cuban health care system. (author) 1

Proposal for the award of a contract, without competitive tendering, for the supply of two cabling machines for the manufacture of superconducting cable for the LHC main magnets

CERN Document Server

2001-01-01

This document concerns the award of a contract, without competitive tendering, for the supply of two cabling machines for the production of superconducting cable for the LHC main magnets. These cables are of two different types, hereafter referred as Cable 1 and Cable 2. For the reasons set out in this document, the Finance Committee is invited to agree to the negotiation of a contract with SETIC (FR) for the supply of two cabling machines, for a total amount not exceeding 3 200 000 euros (4 948 800 Swiss francs), not subject to revision. The rate of exchange which has been used is that stipulated in the tender. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: FR - 100%.

The Impact of the Choice of Evaluation Criteria and the Type of Tender on the Awarding Public Contracts (in the Case of Construction Contracts at the Local Level in the Czech Republic

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František Ochrana

2015-01-01

Full Text Available Public procurement may be examined from different perspectives. Using the Czech Republic as an example, this study is devoted to examining the impact of decisions made by the contracting authority regarding a public tender on the tender process itself and on the outcomes of the tender. The contracting authority addresses a number of decision-making issues regarding public procurements. For example, it needs to decide between two types of criteria (choosing between a single-criterion evaluation or rather opting for several evaluation criteria. At the same time, the authority is free to choose among different types of award procedures while adhering to certain restrictions imposed by the Act on Public Contracts. Using a sample of 1,027 construction work contracts awarded in the Czech Republic, the study examines, in more detail, the impacts of individual choices made by the contracting authority (namely the type of evaluation criteria chosen and the type of procedure for awarding contracts on the estimated and final price of public contracts. Recommendations on how to streamline the process of public procurement can be drawn from conclusions from the empirical analysis.

Qualification Requirements for Foreign Suppliers in Public Procurement – Evidence from the Czech Republic

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Vyklický Martin

2016-03-01

Full Text Available Qualification requirements for foreign suppliers in Public Procurement (PP are quite different in each European Union (EU member state. The most complex requirements for foreign suppliers in the context of public purchases are included in the Czech PP law. The aim of this paper is to make an overview of the problem of qualification requirements for foreign suppliers in the PP law of the CR. Its sub-objectives are the identification and explanation of solutions to the problem in the PP legislation of neighboring countries of the CR that are also members of the EU. The methodological part of the contribution is based mainly on the analysis and critical evaluation of the current state of legal issues relating to the proof of qualification of foreign suppliers in PP orders of the CR; with examples of fairly extensive decision-making practices of the Office for the Protection of Competition and law courts, including the jurisprudence of the European Court of Justice. The paper highlights the unnecessary complexity of qualification requirements that, on purely formal grounds, inhibits submissions of tenders from potential foreign suppliers that would otherwise be able to submit a bid for a public contract without any problems whatsoever. The authors are using and applying a comparative-legal method in the context of the comparison of the PP legislation of neighboring countries of the CR that are also members of the EU. The case study of foreign suppliers bidding for above-threshold public tenders in the CR at the minimum legal requirements of the contracting authority (CA for proof of qualification, the comparation study with selected EU countries or analysis of the development of the proportion of public contracts awarded to foreign suppliers in 2010–2014 shows that there is legislation uncertainty in EU PP law that should be reduced and simplified on an EC basis.

Potentiation of anti-cholelithogenic influence of dietary tender cluster beans (Cyamopsis tetragonoloba) by garlic (Allium sativum) in experimental mice.

Science.gov (United States)

Raghavendra, Chikkanna K; Srinivasan, Krishnapura

2015-10-01

Dietary fibre-rich tender cluster beans (Cyamopsis tetragonoloba; CB) are known to exert beneficial cholesterol lowering influence. We examined the influence of a combination of dietary tender CB and garlic (Allium sativum) in reducing the cholesterol gallstone formation in mice. Cholesterol gallstones were induced in Swiss mice by feeding a high-cholesterol diet (HCD) for 10 wk. Dietary interventions were made with 10 per cent CB and 1 per cent garlic included individually or together along with HCD. A total of 100 mice were divided into five groups of 20 mice each. Dietary CB, garlic and CB+garlic reduced the formation of cholesterol gallstones by 44, 25 and 56 per cent, respectively, lowered cholesterol by 23-48, 16-24, and 24-58 in bile, serum, and liver, respectively. Cholesterol saturation index in bile and cholesterol: phospholipid ratio in circulation and hepatic tissue were significantly lowered by these dietary interventions, with highest beneficial effect from CB+garlic. Activities of hepatic cholesterol metabolizing enzymes were modulated by CB, garlic and CB+garlic. Elevation in lipid peroxides caused by HCD was also countered by these dietary interventions, the combination producing the highest effect. The results showed that the prevention of experimentally induced formation of cholesterol gallstones by dietary CB and garlic was due to decreased biliary cholesterol secretion and increased cholesterol saturation index. In addition of anti-lithogenic effect, dietary CB and garlic in combination had a beneficial antioxidant effect.

[Geographic distribution of supportive care for disabled young people].

Science.gov (United States)

Bourgarel, Sophie; Piteau-Delord, Monique

2013-01-01

To analyse the logic for the distribution of home care services for disabled children (SESSAD) in a context of under-equipment. Questionnaire-based survey of 75 units (82% of the region's SESSAD units) concerning patient transport. Equipment and transport mapping. Support units for disabled children are often set up in the housing facilities that contributed to their creation. These sites are sometimes situated a long way from densely populated regions, thereby generating unnecessary travel times and expenses. Chronic under-equipment makes these sites viable, as the various units are always full, despite their distance from the children for whom they provide support. Mapping illustrates the extensive recruitment zones overlapping several units managing similar patients. The major revision of accreditation of these units, planned for 2017, could lead to redefinition of geographical zones of accreditations. New unit opening procedures based on ARS calls for tenders may help to improve the geographical distribution of this supportive care.

SUNSTORE 3. Phase 1. Project design and tender. Final report; SUNSTORE 3. Fase 1. Projektering og udbud. Slutrapport

Energy Technology Data Exchange (ETDEWEB)

Soerensen, P.A. (PlanEnergi, Skoerping (Denmark)); Moeller Nielsen, C. (Dronninglund Fjernvarme, Dronninglund (Denmark)); Baunwall, M. (NIRAS Aalborg (Denmark)); Munkholt, H. (GG-Construction, Aalborg (Denmark)); Paaske, B. (Teknologisk Institut, AArhus (Denmark)); Schmidt, T. (SOLITES, Stuttgart (Germany))

2011-03-15

The objective of the project has been to carry out detailed design and tendering for a heat production plant consisting of: - 35.000 m{sub 2} solar thermal collectors, - 60.000 m{sub 3} pit heat storage, - 3 MW{sub heat} heat pump, covering app. 50% of the heat production at Dronninglund district heating plant (Denmark). The final report for the project includes detailed design of the pit heat storage (a further development of a 10.000 m{sub 3} storage implemented in Marstal) and simulation of the total production system in the simulation software TRNSYS. (ln)

20 CFR 404.450 - Required reports of work outside the United States or failure to have care of a child.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Required reports of work outside the United States or failure to have care of a child. 404.450 Section 404.450 Employees' Benefits SOCIAL SECURITY... Nonpayments of Benefits § 404.450 Required reports of work outside the United States or failure to have care...

5 CFR 792.220 - What are the requirements that child care providers must meet in order to participate in this...

Science.gov (United States)

2010-01-01

..., where applicable, by local authorities where the child care service is delivered. Outside of the United States, agencies may adopt or create criteria to ensure a child care center or family child care home is... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the requirements that child care...

Fermentation of tender coconut water by probiotic bacteria Bacillus coagulans

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Aishwarya Singh Gangwar

2018-04-01

Full Text Available Coconut water is currently being considered as an elixir for patients suffering from diseases like dengue and malaria as well as chikungunia to provide hydration properties to the body. It has become a popular beverage for many people owing to its palatability and high mineral content. In this study, the growth, survival and fermentation performance of the probiotic bacterium Bacillus coagulans in coconut water was assessed in order to produce a novel non-dairy, probiotic beverage. The species was characterized on the basis of morphology, physiology and biochemical parameters and its probiotic attributes were assessed. Batch fermentations were carried out for 2 days at a constant 37°C, thereafter the samples were subjected to microbiological and chemical analysis. The results suggested that the specie produced lactic acid and was acid and bile tolerant. The pH and titratable acidity of probiotic fermented coconut water were found to be 4.4 and 0.53 % lactic acid, respectively. The viscosity of fermented coconut water increased significantly from an initial 5.13 mPa.s to 5.35 mPa.s because of the increase in soluble solids content due to exopolysaccharide production by B. coagulans during fermentation. Also, the overall acceptability score of probiotic coconut water was higher than tender coconut water, suggesting its feasibility for use as a probiotic beverage.

Proposal for the Purchase, Without a New Call for Tenders, of Four Additional Superconducting Quadrupole Magnets for the Duplication of the Low-Beta Insertion of the CERN Intersecting Storage Rings (ISR)

CERN Document Server

1978-01-01

Proposal for the Purchase, Without a New Call for Tenders, of Four Additional Superconducting Quadrupole Magnets for the Duplication of the Low-Beta Insertion of the CERN Intersecting Storage Rings (ISR)

Cement: Administrative tender specifications and standards in Spain

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Soria Santamaría, Francisco

1991-03-01

Full Text Available The paper describes, in chronological order, the different competent Authorities in Spain and the documents issued by them regarding Cement Regulations and Standards. The origin of the early cement quality Rules is referred to, the issuing of Regulations by the Public Bodies and finally the adoption of National Standards on the one hand, as well as the first initiatives to establish International Standards, especially motivated by the export boom after the Second World War, on the other. The second part of the paper offers a brief synthesis of the terms and conditions for cement in Administrative Tender Specifications from 1919 to date regarding definitions, classifications and specifications. Finally the present state of the art is outlined in a series of Tables describing the cement standards in force in Spain.

Se empieza exponiendo, en orden cronológico, los organismos españoles y documentos elaborados por los mismos relativos a Reglamentos y Normas sobre cementos. Se justifica el origen de las primeras reglas para establecer la calidad de los cementos, la aparición de reglamentos por parte de las Administraciones públicas y la elaboración de normas a nivel nacional, en primer término, y los inicios de normas internacionales con motivo del auge de las exportaciones acabada la 2ª Guerra Mundial, en segundo lugar. A continuación se hace un breve resumen de la evolución de los Pliegos de Cemento en España desde 1919 hasta nuestros días, en lo que se refiere a Definiciones, Clasificación, Nomenclatura y Especificaciones. Finalmente, se incluye en forma tabulada la situación actual de las normas sobre cementos en España.

Microbiological Safety of Commercial Prime Rib Preparation Methods: Thermal Inactivation of Salmonella in Mechanically Tenderized Rib Eye.

Science.gov (United States)

Calle, Alexandra; Porto-Fett, Anna C S; Shoyer, Bradley A; Luchansky, John B; Thippareddi, Harshavardhan

2015-12-01

Boneless beef rib eye roasts were surface inoculated on the fat side with ca. 5.7 log CFU/g of a five-strain cocktail of Salmonella for subsequent searing, cooking, and warm holding using preparation methods practiced by restaurants surveyed in a medium-size Midwestern city. A portion of the inoculated roasts was then passed once through a mechanical blade tenderizer. For both intact and nonintact roasts, searing for 15 min at 260°C resulted in reductions in Salmonella populations of ca. 0.3 to 1.3 log CFU/g. For intact (nontenderized) rib eye roasts, cooking to internal temperatures of 37.8 or 48.9°C resulted in additional reductions of ca. 3.4 log CFU/g. For tenderized (nonintact) rib eye roasts, cooking to internal temperatures of 37.8 or 48.9°C resulted in additional reductions of ca. 3.1 or 3.4 log CFU/g, respectively. Pathogen populations remained relatively unchanged for intact roasts cooked to 37.8 or 48.9°C and for nonintact roasts cooked to 48.9°C when held at 60.0°C for up to 8 h. In contrast, pathogen populations increased ca. 2.0 log CFU/g in nonintact rib eye cooked to 37.8°C when held at 60.0°C for 8 h. Thus, cooking at low temperatures and extended holding at relatively low temperatures as evaluated herein may pose a food safety risk to consumers in terms of inadequate lethality and/or subsequent outgrowth of Salmonella, especially if nonintact rib eye is used in the preparation of prime rib, if on occasion appreciable populations of Salmonella are present in or on the meat, and/or if the meat is not cooked adequately throughout.

A Requirement Engineering Framework for Electronic Data Sharing of Health Care Data Between Organizations

Science.gov (United States)

Liu, Xia; Peyton, Liam; Kuziemsky, Craig

Health care is increasingly provided to citizens by a network of collaboration that includes multiple providers and locations. Typically, that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to use the new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating health organizations, we introduce a framework based on requirements engineering. Key concerns and objectives are identified and modeled (privacy, security, quality of care, and timeliness of service). And, then, proposed business processes which use new technologies are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated.

The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualised homeopathy, in children requiring secondary care for asthma.

Science.gov (United States)

Thompson, E A; Shaw, A; Nichol, J; Hollinghurst, S; Henderson, A J; Thompson, T; Sharp, D

2011-07-01

To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Requirements for light water reactors

International Nuclear Information System (INIS)

Hedin, F.

2009-01-01

The EUR (European Utilities Requirements) is an organization founded in 1991 whose aim was to write down the European specifications and requirements for the future reactors of third generation. EUR gathers most of the nuclear power producers of Europe. The EUR document has been built on the large and varied experience of EUR members and can be used to elaborate invitations to tender for nuclear projects. 4000 requirements only for the nuclear part of the plant are listed, among which we have: -) the probability of core meltdown for a reactor must be less than 10 -6 per year, -) the service life of every component that is not replaceable must be 60 years, -) the capacity of the spent fuel pool must be sufficient to store 10-15 years of production without clearing out. The EUR document is both open and complete: every topic has been considered, it does not favor any type of reactor but can ban any technology that is too risky or has an unfavourable feedback experience. The assessment of the conformity with the EUR document of 7 reactor projects (BWR 90/, EPR, EP1000, SWR1000, ABWR, AP1000 and VVER-AES-92) has already be made. (A.C.)

Brazilian consumers' perception of tenderness of beef steaks classified by shear force and taste Percepção pelos consumidores brasileiros da maciez da carne classificada pela força de cisalhamento e sabor

Directory of Open Access Journals (Sweden)

Eduardo Francisquine Delgado

2006-06-01

Full Text Available The knowledge of consumer perception of meat tenderness and taste is essential to forecast a Brazilian quality value-based beef market. This study aimed to verify perception of tender (WBSF 4.8 kg strip loin steak or uncharacteristic (calcium-treated/Ca-IM and normal (non-calcium/NO-Ca meat taste by consumers according to gender, age, education and income levels. Steaks were previously classified by shear force measurements as tender or tough. Each consumer was served a paired sample of one tender and of one tough steak, which were either Ca-IM or NO-Ca treated before tenderness classification. Three hundred and eight consumers answered a nine-point intensity (tenderness and hedonic (taste scales evaluation questionnaire. Among consumers, 82.2% indicated beef as first choice meat products, 75.3% had beef at least four times a week; 39.3% considered taste as the most important meat attribute and 30.2% considered tenderness; 75.8% were males; 73.6% were 21 to 55 years old; 56.7% had college education; 76.6% had monthly income higher than US $ 435,00. Tender steaks were scored highest (P O conhecimento da percepção de maciez e sabor da carne bovina pelo consumidor é essencial para vislumbrar um mercado brasileiro que pague por qualidade. Este estudo avaliou a percepção diferenciada de contra-filé macio (WBSF 4.8 kg, ou ainda com sabor não característico (imersão em Ca/ Ca-IM ou normal (sem cálcio/ NO-Ca de acordo com sexo, faixa etária, e nível de escolaridade formal e renda dos consumidores. Os bifes foram pareados em amostras macia/dura e Ca-IM/NO-Ca, e servidos a 308 consumidores que responderam a um questionário apresentando escalas de intensidade (maciez e hedônica (sabor de nove pontos. O perfil dos consumidores mostrava que: 82,2% indicaram carne bovina como sua primeira escolha entre as carnes; 75,3% consumiam carne bovina pelo menos quatro vezes por semana; 39,3% consideravam sabor como o atributo mais importante durante o

Effectiveness of high-frequency transcutaneous electrical nerve stimulation at tender points as adjuvant therapy for patients with fibromyalgia.

Science.gov (United States)

Carbonario, F; Matsutani, L A; Yuan, S L K; Marques, A P

2013-04-01

Fibromyalgia is a chronic pain syndrome associated with sleep disorders, fatigue and psychological symptoms. Combinations therapies, such as electrotherapy and therapeutic exercises have been used in the clinical practice. To assess the efficacy of high-frequency transcutaneous electrical nerve stimulation (TENS) as an adjuvant therapy to aerobic and stretching exercises, for the treatment of fibromyalgia. Controlled clinical trial. Unit of rehabilitation of a public hospital. Twenty-eight women aged 52.4±7.5 years, with fibromyalgia. A visual analogue scale measured pain intensity; tender points pain threshold, by dolorimetry; and quality of life, by the Fibromyalgia Impact Questionnaire. All subjects participated in an eight-week program consisting of aerobic exercises, followed by static stretching of muscle chains. In TENS group, high-frequency (150 Hz) was applied on bilateral tender points of trapezium and supraspinatus. TENS group had a greater pain reduction (mean change score=-2.0±2.9 cm) compared to Without TENS group (-0.7±3.7 cm). There was a difference between mean change scores of each group for pain threshold (right trapezium: 0.2±1 kg/cm² in TENS group and -0.2±1.2 kg/cm² in Without TENS group). In the evaluation of clinically important changes, patients receiving TENS had relevant improvement of pain, work performance, fatigue, stiffness, anxiety and depression compared to those not receiving TENS. It has suggested that high-frequency TENS as an adjuvant therapy is effective in relieving pain, anxiety, fatigue, stiffness, and in improving ability to work of patients with fibromyalgia. High-frequency TENS may be used as a short-term complementary treatment of fibromyalgia.

La diaspora americana in Europa: il caso degli espatriati in Tender is the Night di F. Scott Fitzgerald

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Elisa A. Pantaleo

2015-11-01

Full Text Available From 1921 to 1930, F. Scott Fitzgerald travelled to Europe four times, and he spent almost four years in France and one year in Switzerland. While living abroad in the multicultural environment of Paris and of the French Riviera, his attitude towards Europe underwent a major change. Tender is the Night marks a significant transition from the narrow nationalism of Fitzgerald’s first travel correspondence to an increased sensitivity towards European otherness. The cultural encounter with Europe – that in the novel is rendered through an hybridization of the language and the characters –helped the author to reinterpret his identity in a cosmopolitan perspective.

Human resources requirements for diabetic patients healthcare in primary care clinics of the Mexican Institute of Social Security

Directory of Open Access Journals (Sweden)

Svetlana V Doubova

2013-11-01

Full Text Available Objective. To estimate the requirements of human resources (HR of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS. Materials and methods. An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using the evidence-based adjusted service target approach for health workforce planning; then, comparisons between existing and estimated HRs were made. Results. To provide healthcare in accordance with the patients’ metabolic control, the conventional model required increasing the number of family doctors (1.2 times nutritionists (4.2 times and social workers (4.1 times. The DiabetIMSS model requires greater increase than the conventional model. Conclusions. Increasing HR is required to provide evidence-based healthcare to diabetes patients.

Decision concerning Hydro-Quebec's request to rescind the need to go to tender to fulfill the electricity needs of bi-energy rate commercial, institutional and industrial (BT rate) consumers, article 74.1 of la Loi sur la Regie de l'energie

International Nuclear Information System (INIS)

Patoine, M.A.

2002-01-01

In 1983 Hydro-Quebec initiated a special rate for commercial, institutional and industrial power consumers that made use of dual energy systems to heat and power their facilities. In October 2001, Hydro-Quebec made a request to the Regie to rescind the preferential bi-energy rate for commercial, institutional and industrial consumers. The report presents Hydro-Quebec's justification for this request with particular reference to the problems related with going to tender. The contents of the agreement between distributors and power producers were also revealed with respect to short term contracts. The report also presents the position and comments of the interveners with particular reference to the consequences of rescinding the need to go to tender. The opinion of the Regie de l'energie went in favour of the interveners. The Regie denied the request to rescind the need for tender to satisfy the electricity needs of subscribers of the preferential bi-energy rate for commercial, institutional and industrial consumers. refs., tabs

Invitation to tender for performing studies in the field of 'development and performance of radiation protection measures, and development of instruments and methods for radiotherapy'

International Nuclear Information System (INIS)

1992-01-01

Tenders are invited for the following work: Measurment of radiation exposure in aircraft. Further development of electron dosemeters. Statistical analysis of the area distribution of precipitations in the various geographical regions of Germany. Description and evaluation of acute radiation syndrome. Diagnostic evaluation of the thyroid as a possible indicator of exposure to radioactive iodine as a result of accidents. (orig./HP) [de

The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

Science.gov (United States)

Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

2017-06-01

Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Test-retest repeatability of strength capacity, aerobic power and pericranial tenderness of neck and shoulder muscles in children - relevant for tension-type headache

DEFF Research Database (Denmark)

Tornøe, Birte; Andersen, Lars L; Skotte, J H

2013-01-01

Frequent or chronic tension-type headache in children is a prevalent and debilitating condition for the child, often leading to medication overuse. To explore the relationship between physical factors and tension-type headache in children, the quality of repeated measures was examined. The aim of...... of the present study was to determine the test-retest repeatability of parameters determining isometric neck and shoulder strength and stability, aerobic power, and pericranial tenderness in children....

Presentations and Outcome of Thyroiditis from a Tertiary Care Hospital of Karachi.

Science.gov (United States)

Mahar, Saeed Ahmed; Shahid, Muhammad; Sarfaraz, Aqiba; Shaikh, Zuhaib-u-Ddin; Shaikh, Shiraz; Shahid, Nadia

2015-10-01

To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan. Case series. Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015. Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study. A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 ± 11.12 years. There were 18 (69.2%) females. Clinical presentations were fever (65.4%), tender neck (23.1%), goiter (19.2%), localized tenderness in neck and palpable lymph nodes (26.9%). Major symptoms reported were: sore throat (69.2%), weight loss (38.5%), upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate (ESR). Low Thyroid Stimulating Hormone (TSH) 1.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism. Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism.

Religious care required for Japanese terminally ill patients with cancer from the perspective of bereaved family members.

Science.gov (United States)

Okamoto, Takuya; Ando, Michiyo; Morita, Tatsuya; Hirai, Kei; Kawamura, Ryo; Mitsunori, Miyashita; Sato, Kazuki; Shima, Yasuo

2010-02-01

The aim of this study was to explore the most suitable religious care for Japanese terminally ill patients with cancer based on the opinions of bereaved family members. A multicenter questionnaire survey on palliative care service was sent to 592 bereaved family members of patients with cancer who were admitted to palliative care units in Japan, and 430 responded by mail. In the section of the questionnaire about religious care, 382 responses were used for quantitative analysis, and 71 responses about religious care for qualitative analysis. In the current study, the 71 responses were grouped into families with and without a religion and were analyzed qualitatively. Families with a religion (N = 28) chose answers such as ''Instrumental care'' such as music or a religious event, ''Freedom of choice of kinds for religious care,'' ''Staff involvement of religious care,'' ''Meeting with a pastoral care workers,'' and ''Burden of offering a different kind of personal religion.'' In contrast, families without a religion (N = 44) chose answers such as ''Instrumental care,'' ''Freedom of choice whether patients receive religious care or not,'' ''Spiritual care,'' ''Not being able to accept religious care,'' and ''Burden of thinking about a religion and nuisance.'' These findings suggest that Japanese bereaved families with a religion generally regard religious care positively and prefer care through their own religion, whereas some families without a religion require religious care but some do not prefer it.

Comprehensive primary health care under neo-liberalism in Australia.

Science.gov (United States)

Baum, Fran; Freeman, Toby; Sanders, David; Labonté, Ronald; Lawless, Angela; Javanparast, Sara

2016-11-01

This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Guideline for the tendering of the Europe-wide procurement of the electricity supply. 2. rev. ed.; Arbeitshilfe zur Durchfuehrung einer europaweiten Ausschreibung der Stromlieferung

Energy Technology Data Exchange (ETDEWEB)

Buchmueller, Christian [Schnutenhaus und Kollegen, Berlin (Germany)

2013-05-02

In order to describe the practical fundamentals for the procurement of electricity, the authors of this contribution present a guideline for the implementation of a Europe-wide tendering of the electricity supply. The main aspects of this contribution are the procedure and time schedule of the procurement procedure, preparation of the procurement procedure, design of the procurement procedure concerning to the contents as well as the implementation of the procurement procedure.

48 CFR 801.602-73 - Review requirements for scarce medical specialist contracts and contracts for health-care resources.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Review requirements for scarce medical specialist contracts and contracts for health-care resources. 801.602-73 Section 801.602... Responsibilities 801.602-73 Review requirements for scarce medical specialist contracts and contracts for health...

Uk-Didcot: aluminium products [Tenders

CERN Multimedia

2002-01-01

"The CMS-ECAL-EE detector project for CERN require a firm to produce a number of small-machined components in Al Alloy. Mainly milling and drilling operations are required and would be most suited to a firm capable of small batch production. The general machining tolerance required is +/- 0,2mm, and the surface texture is 1,6 micrometers. All of the components are to be manufactured from Al Alloy."

Liberalisation of municipal waste handling

DEFF Research Database (Denmark)

Busck, Ole Gunni

2006-01-01

for improved performance of municipal waste management. The study stresses the need for training and guidance of municipal administrators. Highlighting ‘best practice’ examples the study shows, however, that it is perfectly possible to end up with quality service on contract. It takes a mixture of careful...... of price reductions in stead of quality demands in both environmental and working environmental terms. A recent study showed major deficits in the capacities of the municipalities to administer qualitative requirements in the tender process and to manage the contracts as an integral part of a scheme...... forces and low quality performance. By assuming responsibility, setting and following up on high quality standards the tender instrument presents an additional instrument to legislation and market based means to institutionalize more sustainable practices in waste management...

Proposal for the conclusion of a partnership agreement, without competitive tendering, for the management of medical emergencies on the CERN site and the training of CERN's medical staff and firefighters in emergency situations

CERN Document Server

2014-01-01

Proposal for the conclusion of a partnership agreement, without competitive tendering, for the management of medical emergencies on the CERN site and the training of CERN's medical staff and firefighters in emergency situations

Characteristics and trends in required home care by GPs in Austria: diseases and functional status of patients

Directory of Open Access Journals (Sweden)

Pichler Ingrid

2006-10-01

Full Text Available Abstract Background Almost all societies carry responsibility towards patients who require continuous medical care at home. In many health systems the general practitioner cooperates with community based services of home care and coordinates all medical and non medical activities. In Austria the general practitioner together and in cooperation with relatives of the patient and professional organisations usually takes on this task by visiting his patients. This study was carried out to identify diseases that need home care and to describe the functional profile of home care patients in eastern Austria. Methods Cross sectional observational study with 17 GP practices participating during 2 study periods in 1997 and in 2004 in eastern Austria. Each GP identified patients requiring home care and assessed their underlying diseases and functional status by filling in a questionnaire personally after an encounter. Patients in nursing homes were excluded. Statistical tests used were t-tests, contingency tables, nonparametric Wilcoxon signed rank sum test and Fisher-combination test. Results Patients with degenerative diseases of the central nervous system (65% caused by Alzheimer's disease and cerebrovascular occlusive disease and patients with degenerative diseases of the skeletal system (53% were the largest groups among the 198 (1997 and 261 (2004 home care cases of the 11 (1997 and 13 (2004 practices. Malignant diseases in a terminal state constituted only 5% of the cases. More than two thirds of all cases were female with an average age of 80 years. Slightly more than 70% of the patients were at least partially mobile. Conclusion Home care and home visits for patients with degenerative diseases of the central nervous and skeletal system are important elements of GP's work. Further research should therefore focus on effective methods of training and rehabilitation to better the mental and physical status of patients living in their private homes.

Tender Systems and Processes within the Mauritian Construction Industry: Investigating the Predominance of International Firms and the Lack of Absorptive Capacity in Local Firms

OpenAIRE

K. Appasamy; P. Paul

2016-01-01

Mauritius, a developing small-island-state, is facing a recession which is having a considerable economic impact particularly on its construction sector. Further, the presence of foreign entities, both as companies and workers, within this sector is creating a very competitive environment for local firms. This study investigates the key drivers that allow foreign firms to participate in this sector, in particular looking at the international and local tender processes, and the capacity of loc...

Associations between Depressive State and Impaired Higher-Level Functional Capacity in the Elderly with Long-Term Care Requirements.

Science.gov (United States)

Ogata, Soshiro; Hayashi, Chisato; Sugiura, Keiko; Hayakawa, Kazuo

2015-01-01

Depressive state has been reported to be significantly associated with higher-level functional capacity among community-dwelling elderly. However, few studies have investigated the associations among people with long-term care requirements. We aimed to investigate the associations between depressive state and higher-level functional capacity and obtain marginal odds ratios using propensity score analyses in people with long-term care requirements. We conducted a cross-sectional study based on participants aged ≥ 65 years (n = 545) who were community dwelling and used outpatient care services for long-term preventive care. We measured higher-level functional capacity, depressive state, and possible confounders. Then, we estimated the marginal odds ratios (i.e., the change in odds of impaired higher-level functional capacity if all versus no participants were exposed to depressive state) by logistic models using generalized linear models with the inverse probability of treatment weighting (IPTW) for propensity score and design-based standard errors. Depressive state was used as the exposure variable and higher-level functional capacity as the outcome variable. The all absolute standardized differences after the IPTW using the propensity scores were functional capacity.

A survey of system architecture requirements for health care-based wireless sensor networks.

Science.gov (United States)

Egbogah, Emeka E; Fapojuwo, Abraham O

2011-01-01

Wireless Sensor Networks (WSNs) have emerged as a viable technology for a vast number of applications, including health care applications. To best support these health care applications, WSN technology can be adopted for the design of practical Health Care WSNs (HCWSNs) that support the key system architecture requirements of reliable communication, node mobility support, multicast technology, energy efficiency, and the timely delivery of data. Work in the literature mostly focuses on the physical design of the HCWSNs (e.g., wearable sensors, in vivo embedded sensors, et cetera). However, work towards enhancing the communication layers (i.e., routing, medium access control, et cetera) to improve HCWSN performance is largely lacking. In this paper, the information gleaned from an extensive literature survey is shared in an effort to fortify the knowledge base for the communication aspect of HCWSNs. We highlight the major currently existing prototype HCWSNs and also provide the details of their routing protocol characteristics. We also explore the current state of the art in medium access control (MAC) protocols for WSNs, for the purpose of seeking an energy efficient solution that is robust to mobility and delivers data in a timely fashion. Furthermore, we review a number of reliable transport layer protocols, including a network coding based protocol from the literature, that are potentially suitable for delivering end-to-end reliability of data transmitted in HCWSNs. We identify the advantages and disadvantages of the reviewed MAC, routing, and transport layer protocols as they pertain to the design and implementation of a HCWSN. The findings from this literature survey will serve as a useful foundation for designing a reliable HCWSN and also contribute to the development and evaluation of protocols for improving the performance of future HCWSNs. Open issues that required further investigations are highlighted.

A Survey of System Architecture Requirements for Health Care-Based Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Abraham O. Fapojuwo

2011-05-01

Full Text Available Wireless Sensor Networks (WSNs have emerged as a viable technology for a vast number of applications, including health care applications. To best support these health care applications, WSN technology can be adopted for the design of practical Health Care WSNs (HCWSNs that support the key system architecture requirements of reliable communication, node mobility support, multicast technology, energy efficiency, and the timely delivery of data. Work in the literature mostly focuses on the physical design of the HCWSNs (e.g., wearable sensors, in vivo embedded sensors, et cetera. However, work towards enhancing the communication layers (i.e., routing, medium access control, et cetera to improve HCWSN performance is largely lacking. In this paper, the information gleaned from an extensive literature survey is shared in an effort to fortify the knowledge base for the communication aspect of HCWSNs. We highlight the major currently existing prototype HCWSNs and also provide the details of their routing protocol characteristics. We also explore the current state of the art in medium access control (MAC protocols for WSNs, for the purpose of seeking an energy efficient solution that is robust to mobility and delivers data in a timely fashion. Furthermore, we review a number of reliable transport layer protocols, including a network coding based protocol from the literature, that are potentially suitable for delivering end-to-end reliability of data transmitted in HCWSNs. We identify the advantages and disadvantages of the reviewed MAC, routing, and transport layer protocols as they pertain to the design and implementation of a HCWSN. The findings from this literature survey will serve as a useful foundation for designing a reliable HCWSN and also contribute to the development and evaluation of protocols for improving the performance of future HCWSNs. Open issues that required further investigations are highlighted.

Effect of Ginger Extract and Citric Acid on the Tenderness of Duck Breast Muscles

Science.gov (United States)

2015-01-01

The objective of this study was to examine the effect of ginger extract (GE) combined with citric acid on the tenderness of duck breast muscles. Total six marinades were prepared with the combination of citric acid (0 and 0.3 M citric acid) and GE (0, 15, and 30%). Each marinade was sprayed on the surface of duck breasts (15 mL/100 g), and the samples were marinated for 72 h at 4℃. The pH and proteolytic activity of marinades were determined. After 72 h of marination, Warner Bratzler shear force (WBSF), myofibrillar fragmentation index (MFI), pH, cooking loss, moisture content, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and protein solubility were evaluated. There was no significant (p>0.05) difference in moisture content or cooking loss among all samples. However, GE marination resulted in a significant (pcitric acid) and WC (with citric acid) conditions were significantly (pcitric acid may be attributed to various mechanisms such as increased MFI and myofibrillar protein solubility. PMID:26877631

Effect of pulsed electric field treatment on hot-boned muscles of different potential tenderness.

Science.gov (United States)

Suwandy, Via; Carne, Alan; van de Ven, Remy; Bekhit, Alaa El-Din A; Hopkins, David L

2015-07-01

In this study, the effect of pulsed electric field (PEF) treatment and ageing on the quality of beef M. longissimus lumborum (LL) and M. semimembranosus (SM) muscles was evaluated, including the tenderness, water loss and post-mortem proteolysis. Muscles were obtained from 12 steers (6 steers for each muscle), removed from the carcasses 4 hour postmortem and were treated with pulsed electric field within 2h. Six different pulsed electric field intensities (voltages of 5 and 10 kV × frequencies of 20, 50 and 90 Hz) plus a control were applied to each muscle to determine the optimum treatment conditions. Beef LL was found to get tougher with increasing treatment frequency whereas beef SM muscle was found to have up to 21.6% reduction in the shear force with pulsed electric field treatment. Post-mortem proteolysis showed an increase in both troponin and desmin degradation in beef LL treated with low intensity PEF treatment (20 Hz) compared to non-treated control samples. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of pain sensitivity by tender point counts and myalgic score in patients with and without obstructive sleep apnea syndrome.

Science.gov (United States)

Terzi, Rabia; Yılmaz, Zahide

2017-03-01

The purpose of this study was to assess the difference between patients with and without obstructive sleep apnea syndrome (OSAS) with respect to pain sensitivity. The study was conducted on 31 womens diagnosed with OSAS and 31 healthy women. All patients underwent polysomnographic testing. A pressure algometer (dolorimeter) was used to measure the pressure pain threshold. Fibromyalgia was diagnosed based on the 1990 American College of Rheumatology diagnosis criteria. The myalgic score was 73.95 ± 18.09 in patients with OSAS, while this value was 84.18 ± 24.31 in the control group. The difference between the groups was statistically significant (P = 0.041).The number of tender points was 8.19 ± 3.35 in the patient group with OSAS, while this number was 6.35 ± 2.23 in the control group. The difference between the two groups was statistically significant (P = 0.014). No statistically significant differences were found between age, body mass index, Beck depression scores, control point score and the presence of fibromyalgia, between the two groups (P > 0.05). A statistically significant positive correlation was found between the myalgic scores and mean saturation O 2 (%) values of the patients (r = 0.357; P = 0.049). The differences noted between OSAS patients and the control group with respect to myalgic score and the number of tender points suggest that there might be a relation between OSAS and pain sensitivity. There might be an association between low oxygen saturation and total myalgic score. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

National Beef Tenderness Survey-2010: Warner-Bratzler shear force values and sensory panel ratings for beef steaks from United States retail and food service establishments.

Science.gov (United States)

Guelker, M R; Haneklaus, A N; Brooks, J C; Carr, C C; Delmore, R J; Griffin, D B; Hale, D S; Harris, K B; Mafi, G G; Johnson, D D; Lorenzen, C L; Maddock, R J; Martin, J N; Miller, R K; Raines, C R; VanOverbeke, D L; Vedral, L L; Wasser, B E; Savell, J W

2013-02-01

The tenderness and palatability of retail and food service beef steaks from across the United States (12 cities for retail, 5 cities for food service) were evaluated using Warner-Bratzler shear (WBS) and consumer sensory panels. Subprimal postfabrication storage or aging times at retail establishments averaged 20.5 d with a range of 1 to 358 d, whereas postfabrication times at the food service level revealed an average time of 28.1 d with a range of 9 to 67 d. Approximately 64% of retail steaks were labeled with a packer/processor or store brand. For retail, top blade had among the lowest (P 0.05) in WBS values between moist-heat and dry-heat cookery methods for the top round and bottom round steaks or between enhanced (contained salt or phosphate solution) or nonenhanced steaks. Food service top loin and rib eye steaks had the lowest (P food service top loin steaks received among the greatest (P food service rib eye steaks received the greatest ratings (P food service steaks were greater (P Choice, and Low Choice groups. The WBS values and sensory ratings were comparable to the last survey, signifying that no recent or substantive changes in tenderness have occurred.

Proposal for the award of a contract, without competitive tendering, for the supply and upgrade of positioning sensors for the LHC

CERN Document Server

2004-01-01

This document concerns the award of a contract, without competitive tendering, for the supply of 60 new Hydrostatic Leveling Systems (HLS sensors) and 25 new Wire Positioning Systems (WPS sensors) and for the upgrade of 63 existing sensors. For the reasons explained in this document, the Finance Committee is invited to agree to the negotiation of a contract with FOGALE NANOTECH (FR), for the supply and upgrade of HLS and WPS sensors for a total amount of 412 913 euros (631 757 Swiss francs), not subject to revision. The amount in Swiss francs has been calculated using the present rate of exchange.

To tender, re-negotiate or partner: Strategies for contracting service companies

International Nuclear Information System (INIS)

Gouldie, T.A.

1994-01-01

The contracting of oilfield service companies by petroleum exploration and production operating companies is different than the contracting of civil engineering, construction or other project-oriented contractors. The relationship between operating companies and oilfield service companies has had a long and unique history which has evolved since the first oil wells were drilled over a century ago. The process of contracting service companies by operating companies for petroleum exploration and production work can be split into three distinct stages: (1) decide what it is that should be contracted out and what should be kept in house; (2) determine the method to use to select the contractor(s) to perform the work; and (3) agree to the contractual structure to best reflect the relationship the operating company and the service company with to initiate and maintain. As there are ongoing changes to the business structures and corporate thinking of both operating and service companies, there are also evolving changes to what are considered core businesses and the methods of selecting and contracting service companies by operating companies. Operating companies are recognizing the high costs of tendering for contractor services in terms of personnel time and administrative effort, and are relying more on negotiating and rolling-over existing contracts with their suitable, capable contractors. Partnering, in its many forms and levels, is increasingly being recognized as a useful method to get better work done at cheaper overall costs

Are stipulated requirements for the quality of maternity care complied with?

Science.gov (United States)

Johansen, Lars T; Pay, Aase Serine Devold; Broen, Lise; Roland, Brit; Øian, Pål

2017-09-19

The Directorate of Health’s national guide Et trygt fødetilbud – kvalitetskrav til fødselsomsorgen [A safe maternity service – requirements regarding the quality of maternity care] was published in December 2010 and was intended to provide a basis for an improved and more predictable maternity service. This article presents data from the maternity institutions on compliance with the quality requirements, including information on selection, fetal monitoring, organisation, staffing and competencies. The information was acquired with the aid of an electronic questionnaire in the period January–May 2015. The form was sent by e-mail to the medical officer in charge at all maternity units in Norway as at 1 January 2015 (n=47). There was a 100 % response to the questionnaire. The criteria for selecting where pregnant women should give birth were stated to be in conformity with the quality requirements. Some maternity institutions failed to describe the areas of responsibilities of doctors and midwives (38.5 % and 15.4 %, respectively). Few institutions recorded whether the midwife was present with the patient during the active phase. Half of the maternity departments (level 2 birth units) reported unfilled doctors’ posts, and a third of the university hospitals/central hospitals (level 1 birth units) reported a severe shortage of locum midwives. Half of the level 2 birth units believed that the quality requirements had resulted in improved training, but reported only a limited degree of interdisciplinary or mandatory instruction. The study reveals that there are several areas in which the health enterprises have procedures that conform to national quality requirements, but where it is still unclear whether they are observed in practice. Areas for improvement relate to routines describing areas of responsibility, availability of personnel resources and staff training.

[Expectations, requirements and limitations of future task sharing between the nursing profession and the medical profession: results from the Care-N Study M-V].

Science.gov (United States)

Dreier, Adina; Rogalski, Hagen; Homeyer, Sabine; Oppermann, Roman Frank; Hingst, Peter; Hoffmann, Wolfgang

2015-10-01

The aging population causes a sustained increase in demand of medical and nursing care services. At the same time health care professionals are aging, too. This leads to a growing number of health care gaps. Therefore, the health care system needs to be reformed. This includes a reallocation of task between some of the health care professions. This article addresses developments, potentials and limitations in the context of the future allocation of tasks between the nursing and the medical profession. Aim is to specify the future task sharing between nurses and physicians regarding expectations, requirements and limitations. We conducted questionnaire based Delphi interviews with an interdisciplinary group of experts. (type aggregation of ideas). In the future, to expert’s point of view, nurses will take over routine tasks in the medical and nursing health care supply. Task sharing by substitution is regarded with skepticism by experts. It requires a long time perspective and an early involvement of all stakeholders. Germany is at the beginning of the process of the future task sharing between nurses and physicians. The realization requires a comprehensive political support and further development of concepts including scientific implementation and evaluation.

Financial impact of nursing professionals staff required in an Intensive Care Unit.

Science.gov (United States)

Araújo, Thamiris Ricci de; Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Castilho, Valéria; Chaves, Lucieli Dias Pedreschi; Laus, Ana Maria

2016-11-21

to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution. calcular o custo do tempo médio de assistência de enfermagem despendido e requerido pelos pacientes internados em Unidade de Terapia Intensiva (UTI) e o dispêndio financeiro para adequação do quadro de profissionais de enfermagem. pesquisa descritiva, quantitativa, na modalidade de estudo de caso, desenvolvida na UTI de pacientes adultos. Utilizou-se o índice de carga de trabalho - Nursing Activities Score; o tempo médio de assistência despendido, requerido e o quantitativo de profissionais requerido foram calculados por meio de equações e, a partir desses dados, e de valores da composição salarial dos profissionais e tempo mensal contratual, calculou-se o custo da mão de obra direta de enfermagem. o custo mensal do quantitativo médio de profissionais disponível foi de US$ 35.763,12, correspondendo a 29,6 profissionais, e o requerido para 24 horas de cuidado é de 42,2 profissionais de

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Directory of Open Access Journals (Sweden)

Monique Venter

2016-11-01

Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.

Correlação entre a contagem dos pontos dolorosos na fibromialgia com a intensidade dos sintomas e seu impacto na qualidade de vida Correlation between the number of tender points in fibromyalgia, the intensity of symptoms and its impact on quality of life

Directory of Open Access Journals (Sweden)

José Eduardo Martinez

2009-02-01

Full Text Available OBJETIVO: Estabelecer se há correlação entre o número de pontos dolorosos e a intensidade da percepção de aspectos centrais da síndrome (dor, fadiga, ansiedade, depressão e do seu impacto na capacidade funcional. MATERIAL E MÉTODOS: Avaliaram-se quarenta e um prontuários de pacientes que preenchem os Critérios de Classificação para Fibromialgia do Colégio Americano de Reumatologia, considerando as seguintes variáveis: percepção da intensidade de dor, fadiga, qualidade de vida global, depressão, ansiedade e contagem de pontos dolorosos. A avaliação da capacidade funcional foi realizada através do Questionário de Avaliação de Saúde simplificado (Health Assessment Questionnaire-HAQ. RESULTADOS: Observou-se correlação entre a contagem de pontos dolorosos e a intensidade da dor e a capacidade funcional. Não houve correlação com as notas atribuídas à fadiga (p = 0,358, ansiedade (p = 0,58, depressão (p = 0,50 e qualidade de vida (p = 0,538. A correlação entre o número de pontos dolorosos e a intensidade da dor foi mais forte que com o HAQ. CONCLUSÃO: Há correlação entre contagem dos pontos dolorosos e intensidade da dor e capacidade funcional. A correlação entre os pontos dolorosos e a intensidade da dor é mais importante do que com a capacidade funcional medida pelo HAQ. Não há correlação com as demais variáveis estudadas.OBJECTIVE: to study the correlation between the number of tender points and the intensity of the perception of key aspects of the fibromyalgia syndrome (pain, fatigue, anxiety, depression, and its impact in functional capacity. MATERIAL AND METHODS: forty-one records of patients who meet the Criteria for Classification of Fibromyalgia of the American College of Rheumatology were reviewed, focusing on the following variables: perception of the intensity of pain, fatigue, quality of sleep, depression, anxiety and the tender point count. The assessment of functional capacity was done by

Proposal for the award of a contract, without competitive tendering, for the supply of electricity

CERN Document Server

2000-01-01

This document concerns the award of a contract, without competitive tendering, for the supply of electricity for the period from January 2001 until 30 June 2003. On 13 January 2000 a market survey was sent to 43 firms in sixteen Member States. Following this market survey, CERN received an unsolicited offer from EDF/EOS. With a view to verifying the competitiveness of the offer, three firms and one consortium in four Member States, qualified from the market survey, were requested to submit quotations. CERN received three quotations from two firms and the consortium which indeed confirmed that the offer from EDF/EOS was very competitive. The Finance Committee is invited to agree to the negotiation of a contract with the consortium EDF (FR)/EOS (CH), which submitted the unsolicited offer, for the supply of electricity until June 2003 for a total estimated amount, based on the present schedules of the accelerators for the associated period, of 290 000 000 French francs, not subject to revision. At the present ra...

Do assisted-reproduction twin pregnancies require additional antenatal care?

Science.gov (United States)

Jauniaux, E; Ben-Ami, I; Maymon, R

2013-02-01

Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are

Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design.

Science.gov (United States)

Staccini, P; Joubert, M; Quaranta, J F; Fieschi, D; Fieschi, M

2001-12-01

Healthcare institutions are looking at ways to increase their efficiency by reducing costs while providing care services with a high level of safety. Thus, hospital information systems have to support quality improvement objectives. The elicitation of the requirements has to meet users' needs in relation to both the quality (efficacy, safety) and the monitoring of all health care activities (traceability). Information analysts need methods to conceptualise clinical information systems that provide actors with individual benefits and guide behavioural changes. A methodology is proposed to elicit and structure users' requirements using a process-oriented analysis, and it is applied to the blood transfusion process. An object-oriented data model of a process has been defined in order to organise the data dictionary. Although some aspects of activity, such as 'where', 'what else', and 'why' are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for the processes to be interrelated, and for their characteristics to be shared, in order to avoid data redundancy and to fit the gathering of data with the provision of care.

A burn center paradigm to fulfill deferred consent public disclosure and community consultation requirements for emergency care research.

Science.gov (United States)

Blackford, Martha G; Falletta, Lynn; Andrews, David A; Reed, Michael D

2012-09-01

To fulfill Food and Drug Administration and Department of Health and Human Services emergency care research informed consent requirements, our burn center planned and executed a deferred consent strategy gaining Institutional Review Board (IRB) approval to proceed with the clinical study. These federal regulations dictate public disclosure and community consultation unique to acute care research. Our regional burn center developed and implemented a deferred consent public notification and community consultation paradigm appropriate for a burn study. Published accounts of deferred consent strategies focus on acute care resuscitation practices. We adapted those strategies to design and conduct a comprehensive public notification/community consultation plan to satisfy deferred consent requirements for burn center research. To implement a robust media campaign we engaged the hospital's public relations department, distributed media materials, recruited hospital staff for speaking engagements, enlisted community volunteers, and developed initiatives to inform "hard-to-reach" populations. The hospital's IRB determined we fulfilled our obligation to notify the defined community. Our communication strategy should provide a paradigm other burn centers may appropriate and adapt when planning and executing a deferred consent initiative. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Assessing decision quality in patient-centred care requires a preference-sensitive measure

Science.gov (United States)

Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

2014-01-01

A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient�

Assessment Of Ethical Behavior Among Professionals At Procurement And After Tendering Process With Its Impacts And Drivers In Nepalese Construction Industry

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Ram Sagar Yadav

2015-08-01

Full Text Available Objective of this study is to assess ethical behavior among professionals at procurement and after tendering process with its impacts and drivers in Nepalese Construction Industry. Different literatures were reviewed to assess ethical practices along with its cause and effect inside Nepalese Construction Industry. Pilot study was conducted for the validity of the questionnaire. One key informant from each selected organization was interviewed. The questionnaire contains shortcomings of ethical behavior at procurement and after tendering phase impact of shortcomings of ethical practices and factors leading to these ethical practices based on the objectives of the research. Five ranking Likert Scale were used. The collected data were analyzed based on relative importance index RII in three different categories as Investigating Offices 3 numbers Professional Associations 4 numbers and Government Departments 4 numbers with total of 11 organizations. All together 240 respondents were targeted out of which 170 response were collected with response rate of 70.83. The research shows that for commitment of professionals The overall level of unethical conduct in construction industry is placed at first rank with agreement level of 72.7. For Professionals shortcomings of ethical behavior at procurement phase Individuals or organizations undertaking work without adequate qualification experience training is placed at first rank with agreement level of 68.00. For Professionals shortcomings of ethical behavior after awarding the Tender Contractors professional dont dispose waste in suitable and safe ways which is friendly with the environment is placed at first rank with agreement level of 67.50. For factors lead to shortcomings of ethical behavior Personal culture or personal behavior is placed at first rank with agreement level of 78.20. From the research it is clear that shortcomings of ethical behaviors have negative impact firstly on cost as it affects

A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

Science.gov (United States)

Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

2012-01-01

BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements.

Science.gov (United States)

Yang, Lianping; Huang, Cunrui; Liu, Chaojie

2017-11-14

Poor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at the county level in Hubei province, China. Procurement ordering and distribution data were collected from four counties that pioneered a new distribution arrangement (commencing September 2012) compared with six counties that continued the existing arrangement over the period from August 2011 to September 2013. The new arrangement allowed primary care institutions and/or suppliers to select a local distributor from a limited panel (from 3 to 5) of government nominated distributors. Difference-in-differences analyses were performed to assess the impact of the new arrangements on delivery and receipt of essential medicines. Overall, the new distribution arrangement has not improved distribution of essential medicines to primary care institutions. On the contrary, we found a 7.78-19.85 percentage point (p Procurement arrangements need to consider the special characteristics of rural facilities. In a county, there are more rural primary care institutions than urban ones. On average, rural primary care institutions demand more and are more geographically dispersed compared to their urban counterparts, which may impose increased distribution costs.

A Rare Manifestation of Tuberculosis Presenting in the United States

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Osman Bhatty

2016-01-01

Full Text Available A 64-year-old Bangladeshi female presented to her primary care physician with a tender right breast lump that had been present for 4-5 days along with subjective fevers and malaise. Initial biopsy revealed granulomas, but Ziehl-Neelsen and Gram stain were negative for TB so antibiotics were prescribed for abscess until culture came positive for tuberculosis. She was started on triple therapy for extrapulmonary tuberculosis, an exceedingly rare presentation that requires high clinical suspicion in the Western world.

Proposal to Negotiate, without Competitive Tendering, a Blanket Order for High-Voltage Thyratrons for the CERN Accelerators

CERN Document Server

2002-01-01

This document concerns the supply of thyratrons to be used as high-voltage and high-current switches for the fast-pulsed magnet systems of the CERN accelerators and for the protection of the klystrons of RF systems. Following a market survey (MS-3136/SL/LHC) carried out among 18 firms in ten Member States, CERN entered into negotiations with one firm in one Member State. The Finance Committee is invited to agree to the negotiation, without competitive tendering, of a new blanket order with E2V TECHNOLOGIES (GB) for up to 800 000 pounds sterling to cover the supply of thyratrons for the years 2003, 2004 and 2005, subject to price revision for inflation for deliveries after 31 December 2003. At the present rate of exchange, this amount is equivalent to 1 855 000 Swiss francs. The firm has indicated the following distribution by country of the order value covered by this adjudication proposal: GB - 100%.

System requirements for a computerised patient record information system at a busy primary health care clinic

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PJ Blignaut

2001-09-01

Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

Influence of supplementing vitamin C to yearling steers fed a high sulfur diet during the finishing period on meat color, tenderness and protein degradation, and fatty acid profile of the longissimus muscle.

Science.gov (United States)

Pogge, Danielle J; Lonergan, Steven M; Hansen, Stephanie L

2014-08-01

The objective was to determine the influence of vitamin C (VC) supplemented for approximately 102 d during the finishing period on color, tenderness, and fatty acid profile of longissimus thoracis (LT; n=136) from steers fed a 0.55% sulfur diet. Treatments included 4 supplemental VC concentrations: 1) 0 (CON), 2) 5 (5VC), 3) 10 (10VC), or 4) 20 (20VC) gVC·h(-1)∙d(-1) in a common diet. Increasing supplemental VC decreased (Pvitamin E and tended to increase (P≤0.07) calcium and iron content of steaks. No VC (P≥0.25) effect was noted for WBSF, calpain-1 autolysis, troponin T degradation, or most fatty acid profiles. A quadratic effect (P≤0.03) was observed for cholesterol and CLA content of LT. Under the conditions of our study, supplementing VC to steers fed a 0.55% sulfur diet late in the finishing period did not influence color or tenderness, but increased the vitamin E content. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of alternative salt use on broiler breast meat yields, tenderness, flavor, and sodium concentration.

Science.gov (United States)

Broadway, P R; Behrends, J M; Schilling, M W

2011-12-01

Fresh chicken breast fillets were marinated with gourmet-style salts: Himalayan pink salt, Sonoma gourmet salt, sel gus de Guerande, and Bolivian rose salt to evaluate their effects on marination and cook loss yields, tenderness, sensory attributes, and sodium concentration. Fresh chicken breast fillets (48-h postmortem) were vacuum tumbled (137 kPa at 20 rpm for 17 min) in a solution of water, salt, and sodium tripolyphosphate at a level of 20% of the meat weights. Instrumental analyses showed no significant difference (P > 0.05) in meat quality with respect to marination yield, cook yield, or shear-force value. There were also no significant differences (P > 0.05) in sensory descriptors between salt treatments. However, Sonoma gourmet salt showed a tendency (P = 0.0693) to score increased savory note values from panelists, whereas Bolivian rose salt received the lowest score. There were no significant differences (P > 0.05) in sodium concentrations between salt treatments, but numerically, sel gus de Guerande had the lowest sodium concentration, which could be important in producing reduced sodium products. Understanding different salts and sodium concentrations allows the poultry industry to use gourmet salts in products and maintain overall meat quality and flavor.

Comprehensive Care

Science.gov (United States)

... Comprehensive Care Share this page Facebook Twitter Email Comprehensive Care Understand the importance of comprehensive MS care ... In this article A complex disease requires a comprehensive approach Today multiple sclerosis (MS) is not a ...

Requirements for work of nurses and technicians in a centre for specialized health care of irradiated persons

International Nuclear Information System (INIS)

Blaha, M.; Pidrman, V.; Vanasek, J.; Brandova, J.

1982-01-01

Experience is presented with the training of nurses of the Centre of Specialized Health Care For Irradiated Persons of the Unit for Treatment of Hematological Diseases, which may serve as the model for the treatment of acute radiation syndrome. The concept of the training course is presented. The basic requirement is a nursing school diploma and a post-secondary training course (theoretical and practical, including the preparation of the work place, the treatment of patients, psychotherapy, microbial checks, etc.). Experience has shown that 2 to 3 years work in this field is needed to master the required theoretical knowledge and skills. (J.B.)

Requirements for work of nurses and technicians in a centre for specialized health care of irradiated persons

Energy Technology Data Exchange (ETDEWEB)

Blaha, M; Pidrman, V; Vanasek, J; Brandova, J [Vojensky Lekarsky Vyzkumny a Doskolovaci Ustav J.E. Purkyne, Hradec Kralove (Czechoslovakia)

1982-12-01

Experience is presented with the training of nurses of the Centre of Specialized Health Care For Irradiated Persons of the Unit for Treatment of Hematological Diseases, which may serve as the model for the treatment of acute radiation syndrome. The concept of the training course is presented. The basic requirement is a nursing school diploma and a post-secondary training course (theoretical and practical, including the preparation of the work place, the treatment of patients, psychotherapy, microbial checks, etc.). Experience has shown that 2 to 3 years work in this field is needed to master the required theoretical knowledge and skills.

Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills.

Science.gov (United States)

Vergo, Maxwell T; Sachs, Sharona; MacMartin, Meredith A; Kirkland, Kathryn B; Cullinan, Amelia M; Stephens, Lisa A

2017-05-01

Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. To assess skills acquisition and acceptability for IM residents not selecting an elective. A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points. IM second year residents from Dartmouth-Hitchcock were exposed to a required experiential palliative care rotation. Pre- and post-OSCE using a standardized score card for behavioral skills, including patient-centered interviewing, discussing goals of care/code status, and responding to emotion, as well as a confidential mixed qualitative and quantitative evaluation of the experience. Twelve residents were included in the educational program (two were excluded because of shortened experiences) and showed statistically significant improvements in overall communication and more specifically in discussing code status and responding to emotions. General patient-centered interviewing skills were not significantly improved, but prerotation scores reflected pre-existing competency in this domain. Residents viewed the observed simulated clinical experience (OSCE) and required rotation as positive experiences, but wished for more opportunities to practice communication skills in real clinical encounters. A required palliative care experiential rotation flanked by OSCEs at our institution improved the acquisition of primary palliative care communication skills similarly to other nonclinical educational platforms, but may better meet the needs of the resident and faculty as well as address all required ACGME milestones.

Nurse management skills required at an emergency care unit

OpenAIRE

Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth

2013-01-01

Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...

Reindeer meat – is it always tender, tasty and healthy?

Directory of Open Access Journals (Sweden)

Eva Wiklund

2007-04-01

Full Text Available Meat with high pH values, so called DFD (Dark, Firm, Dry meat, is a persistent quality defect foundmin all meat species. DFD shortens shelf life, especially for vacuum-packed meat and affects meat colour, tenderness and water-holding properties. High pH values in reindeer meat have been related to pre-slaughter handling stress and poor nutritional status of the animals. There are numerous reports that variation in muscle pH and glycogen content give rise to considerable variations in meat tenderness in species such as beef and lamb. In contrast, reindeer meat has been found to be extremely tender regardless of ultimate pH. This phenomenon has been related to the speed of post mortem protein degradation and the small muscle fibre size in reindeer. Previous research has demonstrated that the fatty acid composition of meat changes in response to diets. Generally, a higher proportion of long, unsaturated fatty acids were found in meat from grazing animals compared with animals fed a grain-based diet. Reindeer meat has been found to contain moderate amounts of polyunsaturated fatty acids (PUFA, especially so-called n-3 (or omega-3 PUFAs. The PUFAs are known to be susceptible to oxidation and may therefore be easily oxidized during processing by techniques like smoking and drying. A trained sensory panel concluded that meat from reindeer fed commercial feed scored higher for liverish and sweet flavours and lower for off-flavou (i.e. ‘grass’, ‘wild’ and ‘game’ compared with meat from grazing animals. Consumer preference tests on reindeer meat showed that 50 per cent of the consumers preferred meat from grazing reindeer and 50 per cent meat from pellet-fed animals. Recent reindeer meat research has included new feed mixtures using ingredients like linseed and fishmeal. Crushed linseed in the feed gave meat with a fat composition similar to that of natural pasture, which meant more PUFA than in meat from reindeer fed the normal grain

MEASUREMENT OF BLOOD FLOW IN ARTERIA MENINGEA MEDIA OF PATIENTS WITH FREQUENT EPISODIC TENSION-TYPE HEADACHE NOT ASSOCIATED WITH PERICRANIAL TENDERNESS

Directory of Open Access Journals (Sweden)

A.A. Skoromets

2008-06-01

Full Text Available Twenty seven patients with frequent episodic tension-type headache not associated with pericrania! tenderness (TTH aged from 18 to 69 years old were examined. Arteria meningea media (AMM and brachiocephalic arteries (BCA were examined by supersonic power Doppler scanning during the paroxysm of headache and without the paroxysm of headache. Results: Blood flow in AMM of patients with TTH was significantly different during the paroxysm of headache and without the paroxysm of headache (p<0.01. Blood flow in arteria carotid external did not change (p>0.05. The pattern of hypoperfusion in AMM was displayed in two groups during the paroxysm of headache. The increase of average blood velocity (TAmx in groups of patients with TTH in comparison with the control group.

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

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Shafazand Masoud

2012-03-01

Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points

DEFF Research Database (Denmark)

Ge, Hongyou; Wang, Ying; Danneskiold-Samsøe, Bente

2010-01-01

. PERSPECTIVE: This article underlies the importance of active MTrPs in FMS patients. Most of the TP sites in FMS are MTrPs. Active MTrPs may serve as a peripheral generator of fibromyalgia pain and inactivation of active MTrPs may thus be an alternative for the treatment of FMS.......The aim of this present study is to test the hypotheses that the 18 predetermined sites of examination for tender points (TP sites) in fibromyalgia syndrome (FMS) are myofascial trigger points (MTrPs), and that the induced pain from active MTrPs at TP sites may mimic fibromyalgia pain. Each TP site......), but not latent MTrPs (r = -.001, P = .99), was positively correlated with spontaneous pain intensity in FMS. The current study provides first evidence that pain from active MTrPs at TP sites mimics fibromyalgia pain. MTrPs may relate to generalized increased sensitivity in FMS due to central sensitization...

The influence of postmortem electrical stimulation on rigor mortis development, calpastatin activity, and tenderness in broiler and duck pectoralis.

Science.gov (United States)

Alvarado, C Z; Sams, A R

2000-09-01

This study was conducted to evaluate the effects of electrical stimulation (ES) on rigor mortis development, calpastatin activity, and tenderness in anatomically similar avian muscles composed primarily of either red or white muscle fibers. A total of 72 broilers and 72 White Pekin ducks were either treated with postmortem (PM) ES (450 mA) at the neck in a 1% NaCl solution for 2 s on and 1 s off for a total of 15 s or were used as nonstimulated controls. Both pectoralis muscles were harvested from the carcasses after 0.25, 1.25, and 24 h PM and analyzed for pH, inosine:adenosine ratio (R-value), sarcomere length, gravimetric fragmentation index, calpastatin activity, shear value, and cook loss. All data were analyzed within species for the effects of ES. Electrically stimulated ducks had a lower muscle pH at 0.25 and 1.25 h PM and higher R-values at 0.25 h PM compared with controls. Electrically stimulated broilers had a lower muscle pH at 1.25 h and higher R-values at 0.25 and 1.25 h PM compared with controls. Muscles of electrically stimulated broilers exhibited increased myofibrillar fragmentation at 0.25 and 1.25 h PM, whereas there was no such difference over PM time in the duck muscle. Electrical stimulation did not affect calpastatin activity in either broilers or ducks; however, the calpastatin activity of the broilers did decrease over the aging time period, whereas that of the ducks did not. Electrical stimulation decreased shear values in broilers at 1.25 h PM compared with controls; however, there was no difference in shear values of duck muscle due to ES at any sampling time. Cook loss was lower for electrically stimulated broilers at 0.25 and 1.25 h PM compared with the controls, but had no effect in the ducks. These results suggest that the red fibers of the duck pectoralis have less potential for rigor mortis acceleration and tenderization due to ES than do the white fibers of the broiler pectoralis.

Myasthenic crisis patients who require intensive care unit management.

Science.gov (United States)

Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

2012-09-01

The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

Modelling the Determinants of Winning in Public Tendering Procedures Based on the Activity of a Selected Company

Directory of Open Access Journals (Sweden)

Maciej Malara

2012-01-01

Full Text Available The purpose of this article is to identify the factors influencing the probability of winning in public procurement procedures and to assess the strength of their impact from the perspective of both: the bidder and procurer. The research was conducted with the use of series of quantitative methods: binary logistic regression, discriminant analysis and cluster analysis. It was based on a sample consisting of public tenders, in which the examined company performed the role of a bidder. Thus, the research process was aimed at both identifying the factors of success and estimating the probability of achieving it, where it was possible to obtain probabilities. The main idea of this research is to answer questions about the utility of various methods of quantitative analysis in the case of analyzing determinants of success. Results of the research are presented in the following sequence of sections: characteristics of the examined material, the process of modelling the probability of winning, evaluation of the quality of the results obtained. (original abstract

Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

Science.gov (United States)

Johnston, Maximilian J; King, Dominic; Arora, Sonal; Cooper, Kerri; Panda, Neha Aparajita; Gosling, Rebecca; Singh, Kaushiki; Sanders, Bradley; Cox, Benita; Darzi, Ara

2014-08-01

In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety. © 2014 John Wiley & Sons, Ltd.

High and low rigor temperature effects on sheep meat tenderness and ageing.

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Devine, Carrick E; Payne, Steven R; Peachey, Bridget M; Lowe, Timothy E; Ingram, John R; Cook, Christian J

2002-02-01

Immediately after electrical stimulation, the paired m. longissimus thoracis et lumborum (LT) of 40 sheep were boned out and wrapped tightly with a polyethylene cling film. One of the paired LT's was chilled in 15°C air to reach a rigor mortis (rigor) temperature of 18°C and the other side was placed in a water bath at 35°C and achieved rigor at this temperature. Wrapping reduced rigor shortening and mimicked meat left on the carcass. After rigor, the meat was aged at 15°C for 0, 8, 26 and 72 h and then frozen. The frozen meat was cooked to 75°C in an 85°C water bath and shear force values obtained from a 1×1 cm cross-section. The shear force values of meat for 18 and 35°C rigor were similar at zero ageing, but as ageing progressed, the 18 rigor meat aged faster and became more tender than meat that went into rigor at 35°C (Prigor at each ageing time were significantly different (Prigor were still significantly greater. Thus the toughness of 35°C meat was not a consequence of muscle shortening and appears to be due to both a faster rate of tenderisation and the meat tenderising to a greater extent at the lower temperature. The cook loss at 35°C rigor (30.5%) was greater than that at 18°C rigor (28.4%) (P<0.01) and the colour Hunter L values were higher at 35°C (P<0.01) compared with 18°C, but there were no significant differences in a or b values.

Direct and indirect effects of nutritional status, physical function and cognitive function on activities of daily living in Japanese older adults requiring long-term care.

Science.gov (United States)

Kamo, Tomohiko; Nishida, Yuusuke

2014-10-01

To identify the direct and indirect effects of nutritional status, physical function, and cognitive function on activities of daily living in Japanese older adults requiring long-term care. In total, 179 participants aged ≥ 65 years who were eligible for long-term care insurance (mean age 85.5 ± 7.8 years) were recruited for this study. Nutritional status (Mini Nutritional Assessment, Short Form) and physical function (Short Physical Performance Battery) were examined. Activities of daily living, cognitive function and frailty were assessed using the Barthel Index, Mini-Mental State Examination and Clinical Frailty Scale, respectively. Path analysis was used to determine relationships between these factors and the activities of daily living. For Japanese older adults requiring long-term care, pathways were modeled for nutritional status, physical function and the activities of daily living. The total effect of nutritional status was 0.516 (Pphysical function on the activities of daily living was 0.458 (Pphysical function in aged Japanese people requiring long-term care. These findings suggest that maintaining good nutritional status and nutritional support might delay physical function decline, and prolong the activities of daily living. © 2013 Japan Geriatrics Society.

August 2016 critical care case of the month

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Deangelis JL

2016-08-01

Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: The patient is a previously healthy, albeit anxious, 15-year-old girl seen by her primary care physician. She has had several months of general malaise and ongoing fatigue and an increased frequency in night terrors over the past few weeks. Her family attributes this to stress of school and her new job. She was noted to have lost 3 kg in the previous nine weeks. PMH, SH, and FH: Her PMH was unremarkable. She is a student and denies smoking, drinking or drug abuse. Her family history is noncontributory. Physical Examination: Vital signs: BP 100/60 mm Hg, P 90 beats/min and regular, R 16 breaths/min, T 100.8 ºF, BMI 15; Diffuse, non-tender lymphadenopathy through the submandibular and upper anterior cervical chains; Lungs: clear; Heart: regular rhythm without murmur: Abdomen: slightly rounded and firm. Which of the following are diagnostic considerations at this time? 1. Anorexia nervosa 2. ...

Tender coconut water as alternative food to increase potassium intake among prehypertension adult female?

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Farapti Farapti

2016-01-01

Full Text Available AbstrakLatar belakang: Hampir seluruh populasi di dunia mengonsumsi kalium lebih rendah dari rekomendasi yangdianjurkan. Air kelapa muda merupakan minuman khas yang tinggi kalium. Tujuan penelitian ini adalahuntuk menganalisis asupan kalium pada perempuan prahipertensi dan menentukan peningkatan asupankalium dengan pemberian air kelapa muda untuk menurunkan tekanan darah di antara subyek prahipertensi.Metode: Pada uji klinis paralel single blind dengan subyek sebanyak 32 guru perempuan dan karyawatiprahipertensi berusia 25-44 tahun di Surabaya bulan April – Juni 2013. Pemilihan subyek penelitian denganrandomisasi blok, 16 subyek tiap kelompok. Kelompok perlakuan (P mendapat air kelapa muda disertaipenyuluhan gizi, sedangkan kelompok kontrol (K mendapat air putih disertai penyuluhan gizi. Penilaianasupan kalium dengan food record 2x24 jam selama fase run in, minggu pertama, dan minggu kedua periodepenelitian. Food record dianalisis menggunakan nutrisurvey, dan kandungan kalium dalam air kelapa mudasegar dan air putih dianalisis dengan metode atomic absorption spectrophotometry (AAS.Hasil: Pada awal penelitian, rerata asupan kalium subyek 1420,28±405,54 mg/hari atau sekitar 30,22%± 8,63% dari angka kecukupan gizi (AKG. Selama perlakuan, didapatkan peningkatan asupan kaliumsebesar 2 kali lipat dan meningkat signifikan pada kelompok perlakuan, tetapi masih lebih rendah darirekomendasi AKG dan WHO.Kesimpulan: Pada perempuan prahipertensi, asupan kalium dikategorikan rendah, dan air kelapa mudasegar 300 ml dua kali sehari selama 14 hari berturut-turut dapat meningkatkan asupan kalium. (HealthScience Journal of Indonesia 2015;6:12-16Kata kunci: asupan kalium, air kelapa muda segar AbstractBackground: Most populations around the world consume less than the recommended intake of potassium.Tender coconut water (TCW is a typical drinks high in potassium. The study aimed to analyze potassiumintake in prehypertension subjects and to identify the

Caring Science and the Development of Forensic Psychiatric Caring.

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Hörberg, Ulrica

2015-10-01

This study aimed to discuss how caring science can contribute and provide a theoretical foundation for the development of caring within forensic psychiatric care. It is not only a challenge but also a great opportunity to use caring science theory within forensic psychiatric care when caring for the patients and supporting their health processes. There is a need for more knowledge about, understanding of, and willingness to care for patients within forensic psychiatric settings in a "true caring" way. In order to achieve this, a caring culture is required, one that supports carers and provides them with opportunities to further develop a caring attitude. © 2014 Wiley Periodicals, Inc.

Acute renal failure requiring renal replacement therapy in the intensive care unit: impact on prognostic assessment for shared decision making.

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Johnson, Robert F; Gustin, Jillian

2011-07-01

A 69-year-old female was receiving renal replacement therapy (RRT) for acute renal failure (ARF) in an intensive care unit (ICU). Consultation was requested from the palliative medicine service to facilitate a shared decision-making process regarding goals of care. Clinician responsibility in shared decision making includes the formulation and expression of a prognostic assessment providing the necessary perspective for a spokesperson to match patient values with treatment options. For this patient, ARF requiring RRT in the ICU was used as a focal point for preparing a prognostic assessment. A prognostic assessment should include the outcomes of most importance to a discussion of goals of care: mortality risk and survivor functional status, in this case including renal recovery. A systematic review of the literature was conducted to document published data regarding these outcomes for adult patients receiving RRT for ARF in the ICU. Forty-one studies met the inclusion criteria. The combined mean values for short-term mortality, long-term mortality, renal-function recovery of short-term survivors, and renal-function recovery of long-term survivors were 51.7%, 68.6%, 82.0%, and 88.4%, respectively. This case example illustrates a process for formulating and expressing a prognostic assessment for an ICU patient requiring RRT for ARF. Data from the literature review provide baseline information that requires adjustment to reflect specific patient circumstances. The nature of the acute primary process, comorbidities, and severity of illness are key modifiers. Finally, the prognostic assessment is expressed during a family meeting using recommended principles of communication.

An Expanded Theoretical Framework of Care Coordination Across Transitions in Care Settings.

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Radwin, Laurel E; Castonguay, Denise; Keenan, Carolyn B; Hermann, Cherice

2016-01-01

For many patients, high-quality, patient-centered, and cost-effective health care requires coordination among multiple clinicians and settings. Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centeredness and quality outcomes. This article describes an expanded theoretical framework to better understand care coordination. The framework provides clear articulation of concepts. Examples are provided of ways to measure the concepts.

PERFORATION OF A DUODENAL ULCER IN A 10 YEAR OLD BOY: A CASE REPORT

OpenAIRE

Prasenjit; Himadri Sekhar; Amalesh; Tanumoy

2014-01-01

In this modern era of medicine, perforation of duodenal or gastric ulcer in pediatric patients is very rare. Here we are presenting a 10 year boy presented in emergency department of our rural tertiary care hospital with complaints of diffuse abdominal pain, nausea, vomiting of 36 hours and mild fever of 12 hours duration. O/E he had tachycardia, raised temperature, generalized abdominal tenderness, guarding, rigidity and rebound tenderness. On chest x-ray, free gas under ...

Designing robots for care: care centered value-sensitive design.

Science.gov (United States)

van Wynsberghe, Aimee

2013-06-01

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

Requirements Identification Towards a Design of Adaptive ICTs for Supporting Bipolar Disorder Treatment in Different Healthcare Contexts

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Emanuele Torri

2015-10-01

Full Text Available This paper presents patient and caregiver perspective on ICTs supporting bipolar disorder management in multinational healthcare provisioning contexts. The envisioned mHealth solutions should adopt general requirements that could be instantiated into different clinical settings. Engagement of users in designing new technologies for mental health is crucial to ensure empowerment and patient-centeredness of services. We performed focus groups to understand user needs, attitudes and experiences towards the supportive ICTs in two target regions where the expected solutions will operate. The survey offered valuable inputs for the construction of the clinical requirements used to produce a trans-national call for tender on mobile health solutions aimed at supporting bipolar disorders treatment among public purchasers in different European countries. The study was part of the NYMHPA-MD (Next Generation Mobile Platform for Health in Mental Disorders project, co-funded by the European Commission.

Proposal for the award of a contract, without competitive tendering, for the supply of radiation-tolerant anti-fuse FPGAs for the LHC

CERN Document Server

2004-01-01

This document concerns the award of a contract, without competitive tendering, for the supply of 14 800 radiation-tolerant anti-fuse Field Programmable Gate Arrays (FPGAs) for the LHC. For the reasons explained in this document, the Finance Committee is invited to agree to the negotiation of a contract with MEMEC (CH), for the supply of 14 800 anti-fuse FPGAs for a total amount of 574 330 US dollars (654 900 Swiss francs), not subject to revision, with an option for up to 2960 additional anti-fuse FPGAs for an amount not exceeding 114 866 US dollars (130 980 Swiss francs) bringing the total amount to 689 196 US dollars (758 880 Swiss francs) not subject to revision. The amounts in Swiss francs have been calculated using the present rate of exchange.

Not the usual suspect: a case of erythema induration of Bazin in an urban primary care clinic

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Ling Xu

2015-12-01

Full Text Available Frontline clinicians in the United States, especially those working in safety net hospitals or with immigrant populations, will likely see cutaneous tuberculosis given the tremendous burden of tuberculosis infection worldwide. The tuberculid is a subtype of cutaneous tuberculosis that poses a diagnostic challenge because organisms are not found in smears or cultures taken from the lesions. Tuberculid lesions can mimic erythema nodosum, thrombophlebitis, and cellulitis. We describe the case of a 57-year-old woman immigrant from China who presented with tender, subcutaneous nodules on her ankle and thigh in the setting of prior exposure to tuberculosis. We describe the clinical, pathophysiologic, and histopathologic features of tuberculids in order to raise awareness among primary care clinicians about this difficult to diagnose but readily treatable manifestation of tuberculosis.

Impact of a Revised Curriculum Focusing on Clinical Neurology and Musculoskeletal Care on a Required Fourth-Year Medical Student Physical Medicine and Rehabilitation Clerkship

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John W. Norbury

2016-01-01

Full Text Available Background. A Required Fourth-Year Medical Student Physical Medicine and Rehabilitation (PM&R Clerkship was found to increase students’ knowledge of PM&R; however the students’ overall rotation evaluations were consistently lower than the other 8 required clerkships at the medical school. Objective. To describe the impact of a revised curriculum based upon Entrustable Professional Activities and focusing on basic pain management, musculoskeletal care, and neurology. Setting. Academic Medical Center. Participants. 73 fourth-year medical students. Methods. The curriculum changes included a shift in the required readings from rehabilitation specific topics toward more general content in the areas of clinical neurology and musculoskeletal care. Hands-on workshops on neurological and musculoskeletal physical examination techniques, small group case-based learning, an anatomy clinical correlation lecture, and a lecture on pain management were integrated into the curriculum. Main Outcome Measurements. Student evaluations of the clerkship. Results. Statistically significant improvements were found in the students’ evaluations of usefulness of lecturers, development of patient interviewing skills, and diagnostic and patient management skills (p≤0.05. Conclusions. This study suggests that students have a greater satisfaction with a required PM&R clerkship when lecturers utilize a variety of pedagogic methods to teach basic pain, neurology and musculoskeletal care skills in the rehabilitation setting rather than rehabilitation specific content.

Business Process Modelling is an Essential Part of a Requirements Analysis. Contribution of EFMI Primary Care Working Group.

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de Lusignan, S; Krause, P; Michalakidis, G; Vicente, M Tristan; Thompson, S; McGilchrist, M; Sullivan, F; van Royen, P; Agreus, L; Desombre, T; Taweel, A; Delaney, B

2012-01-01

To perform a requirements analysis of the barriers to conducting research linking of primary care, genetic and cancer data. We extended our initial data-centric approach to include socio-cultural and business requirements. We created reference models of core data requirements common to most studies using unified modelling language (UML), dataflow diagrams (DFD) and business process modelling notation (BPMN). We conducted a stakeholder analysis and constructed DFD and UML diagrams for use cases based on simulated research studies. We used research output as a sensitivity analysis. Differences between the reference model and use cases identified study specific data requirements. The stakeholder analysis identified: tensions, changes in specification, some indifference from data providers and enthusiastic informaticians urging inclusion of socio-cultural context. We identified requirements to collect information at three levels: micro- data items, which need to be semantically interoperable, meso- the medical record and data extraction, and macro- the health system and socio-cultural issues. BPMN clarified complex business requirements among data providers and vendors; and additional geographical requirements for patients to be represented in both linked datasets. High quality research output was the norm for most repositories. Reference models provide high-level schemata of the core data requirements. However, business requirements' modelling identifies stakeholder issues and identifies what needs to be addressed to enable participation.

Physician leadership: a health-care system's investment in the future of quality care.

Science.gov (United States)

Orlando, Rocco; Haytaian, Marcia

2012-08-01

The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

Effect of tender coconut water on systolic and diastolic blood pressure in prehypertensive women

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Farapti Farapti

2014-02-01

. Dietary intakes of high potassium will decrease blood pressure (BP. Tender coconut water (TCW is a typical drink high in potassium. This study aimed to investigate the effect of TCW on BP in female teachers and employees prehypertension. Methods: The research was a parallel single blind randomized clinical trial. A total of 32 female prehypertension subjects aged 25-44 years. The subjects were selected using certain criteria and randomly allocated to one of two groups using block randomized, 16 subjects each. The treatment group received TCW 300 ml twice daily for 14 days and nutritional counseling, and the control group received water 300 ml twice daily for 14 days and nutritional counseling. Assessment of BP was done on day 0, day 8, and day 15. Statistical analysis were done using t-test and Mann-Whitney test. Results: Mean dietary intakes of potassium were 1420.28±405.54 mg/day or 30.22±8.63% compared to Recommended Dietary Allowance (RDA. During treatment period, potassium intake increased significantly in the treatment group. There were decreased BP in both groups, which were greater in the treatment group, but not statistically significant different (P > 0.05. The mean decrease of systolic BP was significant in treatment group (P = 0.031, meanwhile the mean decrease of diastolic BP was not significant (P=0.134. Conclusion: Tender coconut water 300 ml twice daily for 14 consecutive days has tendency to decrease systolic BP, but not diastolic blood pressure. (Health Science Indones 2013;2: 64-8Key words: coconut water, systolic and diastolic blood pressure

[Is therapy with local infiltrations feasible in primary care consultations?].

Science.gov (United States)

Magaña Loarte, J E; Pérez Franco, J; Sánchez Sánchez, G

1999-01-01

To study the feasibility of local infiltration in primary care consultations. Before-and-after intervention study. Two clinics at an urban health centre. Patients diagnosed with pathology of tender areas and treated with corticosteroid infiltration between May 1997 and May 1998. Corticoid infiltration plus local anaesthetic. Weekly check-up. Analysis of the variables: sex, age, diagnosis, time elapsed between indication and start of treatment, subjective assessment of pain before and after treatment (VRS scale), number of infiltrations per patient, side-effects. Evaluation of overall and individual effectiveness. 41 patients were infiltrated. Average age was 58. Most common pathologies were: rotary joint tendinitis (48.7%), anserine bursitis (24.4%), plantar fasciitis (7.3%). Average number of infiltrations per pathology: 1.3. Mean waiting time: 3.5 days. Comparison of pain by means of VRS (range 0-5) before and after treatment used the Wilcoxon test, with a statistically significant difference and p < 0.001 (z = -5.5109). For 35 patients (85.4%), pain was solved very well (values 0 and 1 on the VRS). For 3 patients (7.3%), improvement was moderate; and for 3 (7.3%) there was no improvement. 1. Treatment with local infiltration of corticosteroids is effective in dealing with pain, and is an alternative to treatment with NSAIDs. 2. It is feasible in primary care, and there are many advantages if the general practitioner employs this therapeutic technique.

Investment of financial resources for the procurement of medicines for primary care in Brazilian municipalities.

Science.gov (United States)

Pontes, Marcela Amaral; Tavares, Noemia Uruth Leão; Francisco, Priscila Maria Stolses Bergamo; Naves, Janeth de Oliveira Silva

2017-08-01

This study shows a descriptive data analysis related to the procurement of medicines for primary care in Brazilian municipalities, as recorded in the National database of Pharmaceutical Service Actions and Services for the period July 2013 - June 2014, by geographic region and population size. Nine hundred and sixty municipalities were analyzed, of which 27% invested monetary value equal to or greater than the minimum statutory recommendations and 43% of these are located in the Southeast. The North region has the highest number of municipalities with less investment. Municipalities with a population over 500,000 inhabitants used, on average, lower resources to provide more items to users. The average number of items purchased was 86 and represents 25% of the National List of Essential Medicines (Rename); 64% had a decentralized resource management and the most commonly used procurement method was "tender". The most purchased drugs are in line with the most prevalent primary care diseases. Findings showed that most municipalities invests below statutory recommendations and are located mainly in the North, Northeast and Midwest. It was not possible to establish a trend between population and amount invested per capita/year.

Web survey-based selection of controls for epidemiological analyses of a multi-prefectural outbreak of enterohaemorrhagic Escherichia coli O157 in Japan associated with consumption of self-grilled beef hanging tender.

Science.gov (United States)

Yahata, Y; Ohshima, N; Odaira, F; Nakamura, N; Ichikawa, H; Matsuno, K; Shuri, J; Toyozawa, T; Terajima, J; Watanabe, H; Nakashima, K; Sunagawa, T; Taniguchi, K; Okabe, N

2018-03-01

An outbreak of enterohaemorrhagic Escherichia coli O157 occurred in multiple prefectures of Japan in November 2009. We conducted two case-control studies with trace-back and trace-forward investigations to determine the source. The case definition was met by 21 individuals; 14 (66.7%) were hospitalised, but no haemolytic uraemic syndrome, acute encephalopathy or deaths occurred. Median age was 23 (range 12-48) years and 14 cases were male (66.7%). No significant associations with food were found in a case-control study by local public health centres, but our matched case-control study using Internet surveys found that beef hanging tender (or hanger steak), derived from the diaphragm of the cattle, was significantly associated with illness (odds ratio = 15.77; 95% confidence interval, 2.00-124.11). Pulsed-field gel electrophoresis analysis of isolates from patients and the suspected food showed five different patterns: two in faecal and food samples, and another three in patient faecal samples only, although there were epidemiological links to the meat consumed at the restaurants. Trace-back investigation implicated a common food processing company from outside Japan. Examination of the logistics of the meat processing company suggested that contamination did not occur in Japan. We concluded that the source of the outbreak was imported hanging tender. This investigation revealed that Internet surveys could be useful for outbreak investigations.

Usefulness of a 50-meter round walking test for fall prediction in the elderly requiring long-term care

Science.gov (United States)

Hachiya, Mizuki; Murata, Shin; Otao, Hiroshi; Ihara, Takehiko; Mizota, Katsuhiko; Asami, Toyoko

2015-01-01

[Purpose] This study aimed to verify the usefulness of a 50-m round walking test developed as an assessment method for walking ability in the elderly. [Subjects] The subjects were 166 elderly requiring long-term care individuals (mean age, 80.5 years). [Methods] In order to evaluate the factors that had affected falls in the subjects in the previous year, we performed the 50-m round walking test, functional reach test, one-leg standing test, and 5-m walking test and measured grip strength and quadriceps strength. [Results] The 50-m round walking test was selected as a variable indicating fall risk based on the results of multiple logistic regression analysis. The cutoff value of the 50-m round walking test for determining fall risk was 0.66 m/sec. The area under the receiver operating characteristic curve was 0.64. The sensitivity of the cutoff value was 65.7%, the specificity was 63.6%, the positive predictive value was 55.0%, the negative predictive value was 73.3%, and the accuracy was 64.5%. [Conclusion] These results suggest that the 50-m round walking test is a potentially useful parameter for the determination of fall risk in the elderly requiring long-term care. PMID:26834327

Designing Robots for Care: Care Centered Value-Sensitive Design

OpenAIRE

van Wynsberghe, Aimee

2012-01-01

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship?what I refer to as care robots?require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What?s more, given the stage of their develo...

The unique requirements of primary health care in Southern Africa

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D. P. Knobel

1986-03-01

Full Text Available The critical need for primary health care in Southern Africa with special reference to the demands of the heterogenous population is measured against the background of the declaration of Alma Ata at the WHO/UNICEF conference in 1978. In particular the provision of primary health care to the Third World communities of the RSA as an essential part of the security power base of the State is underlined and it is analised in terms of how shortcomings in this service can be exploited in a subversive revolutionary onslaught.

Which pediatric blunt trauma patients do not require pelvic imaging?

Science.gov (United States)

Haasz, Maya; Simone, Laura A; Wales, Paul W; Stimec, Jennifer; Stephens, Derek; Beno, Suzanne; Schuh, Suzanne

2015-11-01

This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%. This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture. Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs. Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging. Therapeutic study, level IV.

Efficacy and Effectiveness of Exercise on Tender Points in Adults with Fibromyalgia: A Meta-Analysis of Randomized Controlled Trials

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George A. Kelley

2011-01-01

Full Text Available Fibromyalgia is a major public health problem affecting an estimated 200 to 400 million people worldwide. The purpose of this study was to use the meta-analytic approach to determine the efficacy and effectiveness of randomized controlled exercise intervention trials (aerobic, strength training, or both on tender points (TPs in adults with fibromyalgia. Using random effects models and 95% confidence intervals (CI, a statistically significant reduction in TPs was observed based on per-protocol analyses (8 studies representing 322 participants but not intention-to-treat analyses (5 studies representing 338 participants (per-protocol, , −0.68, 95% CI, −1.16, −0.20; intention-to-treat, , −0.24, 95% CI, −0.62, 0.15. Changes were equivalent to relative reductions of 10.9% and 6.9%, respectively, for per-protocol and intention-to-treat analyses. It was concluded that exercise is efficacious for reducing TPs in women with FM. However, a need exists for additional well-designed and reported studies on this topic.

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."

Is bone tenderness, as measured by manual algometry, associated with vitamin D deficiency?

Science.gov (United States)

Dresser, Jocelyn; MacIntyre, Mike; Chisholm, Brittney; Lawson, G E

2014-09-01

To explore the relationship between serum 25-hydroxycholecalciferol (25[OH]D3) and pressure-pain thresholds, as measured by algometer, in advance of a main study to determine whether PPT is a potentially cost-effective proxy measure of 25[OH]D3 status in the general population. The cross-sectional pilot study involved a convenience sample of twenty-two subjects (10 males, 12 females), aged 18 to 67 years. All subjects consented to three trials of pressure-pain threshold readings on both tibiae and the manubrium. Serum 25[OH]D3 levels were determined from blood samples drawn post-algometry. The average pressure pain thresholds were 14.92 (±6.03), 15.07(±6.07), 11.10 (±6.68) for the left and right tibia and sternum, respectively. The stability between the measurements was very high with the interclass correlation coefficient (95% CI) calculated as 0.94 (0.62-1.00), 0.9 (0.81-1.00), 0.96(0.93-1.00). The Pearson correlation coefficients were 0.03 for the left tibia, 0.17 for the right tibia and 0.20 for the sternum, J Dresser, M MacIntyre, B Chisholm, GE Lawson showing a negligible correlation for the left and right tibia, but a low positive correlation for the sternum. We did not find preliminary evidence of a strong or otherwise clinically meaningful correlation between bone tenderness and manual algometry in this pilot study. Only a weak linear relationship between PPT in the sternum and serum 25[OH]D3 concentrations was found. Replication of this study is warranted in larger and more representative study populations of interest. Discussion on a number of feasibility issues is provided to inform those future studies.

The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting.

Science.gov (United States)

Mishra, Pankaj Kumar; Thekkudan, Joyce; Sahajanandan, Raj; Gravenor, Mike; Lakshmanan, Suresh; Fayaz, Khazi Mohammed; Luckraz, Heyman

2015-01-01

OBJECTIVE platelet function assessment after cardiac surgery can predict postoperative blood loss, guide transfusion requirements and discriminate the need for surgical re-exploration. We conducted this study to assess the predictive value of point-of-care testing platelet function using the Multiplate® device. Patients undergoing isolated coronary artery bypass grafting were prospectively recruited ( n = 84). Group A ( n = 42) patients were on anti-platelet therapy until surgery; patients in Group B ( n = 42) stopped anti-platelet treatment at least 5 days preoperatively. Multiplate® and thromboelastography (TEG) tests were performed in the perioperative period. Primary end-point was excessive bleeding (>2.5 ml/kg/h) within first 3 h postoperative. Secondary end-points included transfusion requirements, re-exploration rates, intensive care unit and in-hospital stays. Patients in Group A had excessive bleeding (59% vs. 33%, P = 0.02), higher re-exploration rates (14% vs. 0%, P function testing was the most significant predictor of excessive bleeding (odds ratio [OR]: 2.3, P = 0.08), need for blood (OR: 5.5, P functional assessment with Multiplate® was the strongest predictor for bleeding and transfusion requirements in patients on anti-platelet therapy until the time of surgery.

Care-givers' reflections on an ethics education immersive simulation care experience: A series of epiphanous events.

Science.gov (United States)

Gallagher, Ann; Peacock, Matthew; Zasada, Magdalena; Coucke, Trees; Cox, Anna; Janssens, Nele

2017-07-01

There has been little previous scholarship regarding the aims, options and impact of ethics education on residential care-givers. This manuscript details findings from a pragmatic cluster trial evaluating the impact of three different approaches to ethics education. The focus of the article is on one of the interventions, an immersive simulation experience. The simulation experience required residential care-givers to assume the profile of elderly care-recipients for a 24-hr period. The care-givers were student nurses. The project was reviewed favourably by a university ethics committee, and participants provided informed consent. Data from six postsimulation experience focus groups were analysed thematically and three themes were identified: the experience of vulnerability, dignity in care and the organisation of care. Findings suggest that the immersive simulation experience had a powerful immediate impact as participants described epiphanous insights relating to their care experiences. It is suggested that reflecting on and recording epiphanous events has the potential to sustain ethical care practices. Further research is required to evaluate the impact of different ethics education interventions in different cultural contexts. Exploration is also required regarding the meaning and significance of care epiphanies, those "most delicate and evanescent of moments," for the sustainability of ethical care. © 2016 John Wiley & Sons Ltd.

49 CFR 1312.2 - Requirement to publish and file a tariff.

Science.gov (United States)

2010-10-01

..., and advertising and promotional material. (d) Effect of filing. The tender of a tariff and its receipt... tariff that is on file with the Board and in effect under this part. (b) Adherence to tariff. The carrier... laws, the Board's regulations, or any decision of the Board or a court, or have any effect on the...

A designated centre for people with disabilities operated by Praxis Care, Louth

LENUS (Irish Health Repository)

Aslan, Ozlem

2010-12-15

Abstract Background Recent QTL and gene expression studies have highlighted ankyrins as positional and functional candidate genes for meat quality. Our objective was to characterise the promoter region of the bovine ankyrin 1 gene and to test polymorphisms for association with sensory and technological meat quality measures. Results Seven novel promoter SNPs were identified in a 1.11 kb region of the ankyrin 1 promoter in Angus, Charolais and Limousin bulls (n = 15 per breed) as well as 141 crossbred beef animals for which meat quality data was available. Eighteen haplotypes were inferred with significant breed variation in haplotype frequencies. The five most frequent SNPs and the four most frequent haplotypes were subsequently tested for association with sensory and technological measures of meat quality in the crossbred population. SNP1, SNP3 and SNP4 (which were subsequently designated regulatory SNPs) and SNP5 were associated with traits that contribute to sensorial and technological measurements of tenderness and texture; Haplotype 1 and haplotype 4 were oppositely correlated with traits contributing to tenderness (P < 0.05). While no single SNP was associated with intramuscular fat (IMF), a clear association with increased IMF and juiciness was observed for haplotype 2. Conclusion The conclusion from this study is that alleles defining haplotypes 2 and 4 could usefully contribute to marker SNP panels used to select individuals with improved IMF\\/juiciness or tenderness in a genome-assisted selection framework.

Provision of protein and energy in relation to measured requirements in intensive care patients

DEFF Research Database (Denmark)

Allingstrup, Matilde Jo; Esmailzadeh, Negar; Knudsen, Anne Wilkens

2012-01-01

, also when adjusted for baseline prognostic variables (APACHE II, SOFA scores and age). Provision of energy, measured resting energy expenditure or energy and nitrogen balance was not related to mortality. The possible cause-effect relationship is discussed after a more detailed analysis of the initial......BACKGROUND & AIMS: Adequacy of nutritional support in intensive care patients is still a matter of investigation. This study aimed to relate mortality to provision, measured requirements and balances for energy and protein in ICU patients. DESIGN: Prospective observational cohort study of 113 ICU...... part of the admission. CONCLUSION: In these severely ill ICU patients, a higher provision of protein and amino acids was associated with a lower mortality. This was not the case for provision of energy or measured resting energy expenditure or energy or nitrogen balances. The hypothesis that higher...

Invasive candidiasis in pediatric intensive care units.

Science.gov (United States)

Singhi, Sunit; Deep, Akash

2009-10-01

Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

Effect of supplementation of tender coconut water on blood pressure of primary hypertensive subjects

Directory of Open Access Journals (Sweden)

Gullapalli HS, Avinash P Tekade, Namrata H Gullapalli

2013-04-01

Full Text Available Background: Hypertension is a major health problem worldwide. Increased vascular resistance, sodium retention & sympathetic over activity contributes to the blood pressure elevation. Plant foods may be beneficial in decreasing blood pressure (BP. Recently much attention has been focused on plant foods that may be beneficial in preventing Hypertension, metabolic syndrome and possibly reduce the risk of various diseases. This clinical study was conducted to test the effectiveness of a structured intervention on BP of primary hypertensive subjects. Aim: To study the effect of Tender Coconut Water (TCW on BP of Primary hypertensive subjects. Methods and Material: 70 subjects were selected randomly sample for 6 weeks of the intervention program. Among them 40 subjects were selected as the experimental group and 30 300ml/day for 6 weeks whereas the control group was instructed to follow the same routine without modifications. One initial, two mid intervention (after every 15 days and one final (post intervention BP recorded for both the groups. The obtained data was statistically analyzed. Results: The mean systolic BP of experimental group and control group were decreased from 145.8 mm Hg and 141mm of Hg to 135.3 mm of Hg and 140 mm of Hg respectively. The mean diastolic BP of experimental group and control group were decreased from 93.7 mm H g and 90.9 mmHg to 86.9 mm of Hg and 89.7 mm of Hg respectively. Conclusion: Irrespective of cause of hypertension TCW has beneficial effect on BP. TCW contains high amount of potassium which causes vasodilatation and also improve the endothelial function.

Cancer Survivorship Care: Person Centered Care in a Multidisciplinary Shared Care Model

Directory of Open Access Journals (Sweden)

Jacqueline Loonen

2018-01-01

Full Text Available Survivors of childhood and adult-onset cancer are at lifelong risk for the development of late effects of treatment that can lead to serious morbidity and premature mortality. Regular long-term follow-up aiming for prevention, early detection and intervention of late effects can preserve or improve health. The heterogeneous and often serious character of late effects emphasizes the need for specialized cancer survivorship care clinics. Multidisciplinary cancer survivorship care requires a coordinated and well integrated health care environment for risk based screening and intervention. In addition survivors engagement and adherence to the recommendations are also important elements. We developed an innovative model for integrated care for cancer survivors, the “Personalized Cancer Survivorship Care Model”, that is being used in our clinic. This model comprises 1. Personalized follow-up care according to the principles of Person Centered Care, aiming to empower survivors and to support self management, and 2. Organization according to a multidisciplinary and risk based approach. The concept of person centered care is based on three components: initiating, integrating and safeguarding the partnership with the patient. This model has been developed as a universal model of care that will work for all cancer survivors in different health care systems. It could be used for studies to improve self efficacy and the cost-effectiveness of cancer survivorship care.

Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.

Science.gov (United States)

de Montmollin, Etienne; Demeret, Sophie; Brulé, Noëlle; Conrad, Marie; Dailler, Frédéric; Lerolle, Nicolas; Navellou, Jean-Christophe; Schwebel, Carole; Alves, Mikaël; Cour, Martin; Engrand, Nicolas; Tonnelier, Jean-Marie; Maury, Eric; Ruckly, Stéphane; Picard, Géraldine; Rogemond, Véronique; Magalhaes, Éric; Sharshar, Tarek; Timsit, Jean-François; Honnorat, Jérôme; Sonneville, Romain

2017-02-15

Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients. To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis. This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2. Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for 50 cells/mm 3 ; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome. The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.

Point-of-Care Ultrasound: A Trend in Health Care.

Science.gov (United States)

Buerger, Anita M; Clark, Kevin R

2017-11-01

To discuss the current and growing use of point-of-care (POC) ultrasound in the management and care of patients. Several electronic research databases were searched to find articles that emphasized the use of POC ultrasound by health care providers who manage and treat critically ill or injured patients. Thirty-five relevant peer-reviewed journal articles were selected for this literature review. Common themes identified in the literature included the use of POC ultrasound in emergency medicine, military medicine, and remote care; comparison of POC ultrasound to other medical imaging modalities; investigation of the education and training required for nonimaging health care professionals who perform POC ultrasound in their practices; and discussion of the financial implications and limitations of POC ultrasound. POC ultrasound provides clinicians with real-time information to better manage and treat critically ill or injured patients in emergency medicine, military medicine, and remote care. In addition to providing immediate bedside diagnostic information, use of POC ultrasound has increased because of concerns regarding radiation protection. Finally, the expansion of POC ultrasound to other specialty areas requires nonimaging health care professionals to perform bedside ultrasound examinations and interpret the resulting images. Because POC ultrasound is user-dependent, adequate training is essential for all who perform and interpret the examinations. Research involving POC ultrasound will continue as innovations and confidence in ultrasound applications advance. Future research should continue to examine the broad use of POC ultrasound in patient care and management. ©2017 American Society of Radiologic Technologists.

Relationship-centered health care as a Lean intervention.

Science.gov (United States)

Dunsford, Jennifer; Reimer, Laura E

2017-12-01

Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Nursing care: an ethical act].

Science.gov (United States)

Gruat, Florence

2015-12-01

Care means taking care, paying extreme attention to others in vulnerable situations, "helping and not hurting". Admitting that ethical care exists would require recognizing that there are also treatments which are not ethical. However, care can only be ethical. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Criteria required for an acceptable point-of-care test for UTI detection: Obtaining consensus using the Delphi technique.

Science.gov (United States)

Weir, Nichola-Jane M; Pattison, Sally H; Kearney, Paddy; Stafford, Bob; Gormley, Gerard J; Crockard, Martin A; Gilpin, Deirdre F; Tunney, Michael M; Hughes, Carmel M

2018-01-01

Urinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care. Criteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores. The first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections. This study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test.

Palliative Care: A Partnership Across the Continuum of Care.

Science.gov (United States)

Spaulding, Aaron; Harrison, Debra A; Harrison, Jeffrey P

2016-01-01

Palliative care services are becoming more prevalent in the United States as greater portions of the population are requiring end-of-life services. Furthermore, recent policy changes and service foci have promoted more continuity and encompassing care. This study evaluates characteristics that distinguish hospitals with a palliative care program from hospitals without such a program in order to better define the markets and environments that promote the creation and usage of these programs. This study demonstrates that palliative care programs are more likely in communities with favorable economic factors and higher Medicare populations. Large hospitals with high occupancy rates and a high case mix index use palliative care programs to better meet patient needs and improve hospital efficiency. Managerial, nursing, and policy implications are discussed relating to further usage and implementation of palliative care programs.

Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems.

Science.gov (United States)

2014-05-01

Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care. Copyright © 2014 by the American Academy of Pediatrics.

Essential competencies for the education of nursing assistants and care helpers in elderly care

NARCIS (Netherlands)

Oeseburg, Barth; Hilberts, Rudi; Roodbol, Petrie F

2015-01-01

BACKGROUND: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains

Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation.

Science.gov (United States)

Iglesias, Cynthia P; Drummond, Michael F; Rovira, Joan

2005-01-01

The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA. A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward. There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest. To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate "evidence-based" approaches such as EE.

Towards a fully-fledged integration of spiritual care and medical care

NARCIS (Netherlands)

Kruizinga, R.; Scherer-Rath, M.; Schilderman, J. B. A. M.; Puchalski, C. M.; van Laarhoven, H. W. M.

2017-01-01

In this article we aim to set out current problems that hinder a fully-fledged integration of spiritual and medical care that address these obstacles. We discuss the following five statements: 1. Spiritual care requires a clear and inclusive definition of spirituality; 2. Empirical evidence for

Towards a fully-fledged integration of spiritual care and medical care

NARCIS (Netherlands)

Kruizinga, R.; Scherer-Rath, M.; Schilderman, J.B.A.M.; Puchalski, C.; Laarhoven, H.W.M. van

2018-01-01

In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for

Managing Cancer Care - Finding Health Care Services

Science.gov (United States)

... my condition? Has it been rated by state, consumer, or other groups for its quality of care? ... be both rewarding and demanding. It can change relationships and require families to cope with all aspects ...

Embedding effective depression care: using theory for primary care organisational and systems change.

Science.gov (United States)

Gunn, Jane M; Palmer, Victoria J; Dowrick, Christopher F; Herrman, Helen E; Griffiths, Frances E; Kokanovic, Renata; Blashki, Grant A; Hegarty, Kelsey L; Johnson, Caroline L; Potiriadis, Maria; May, Carl R

2010-08-06

Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development. Five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how

Health care professionals' perspectives on the requirements ...

African Journals Online (AJOL)

... a roll-out plan; leadership; and supporting and reinforcing structures such as: resources, communicating, education and development regarding the best practice, and the organisational structure. The requirements were identified at four different levels: individual level (e.g. the nurse and medical specialists), management ...

Transforming Gastroenterology Care With Telemedicine.

Science.gov (United States)

Siegel, Corey A

2017-04-01

Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Formalized description of assessment procedures of tender offers (of the construction organizer and contracting companies in case of engineering control scheme

Directory of Open Access Journals (Sweden)

Sborshchikov Sergey Borisovich

2016-10-01

Full Text Available The procedure of evaluating and selecting tender offers is not only an important element of the control system of investment and construction activity but is also an effective tool to increase its efficiency due to optimization of construction works price, reduction of their duration, stimulating innovations in the production, increasing the quality and engineering safety of construction production. At the recent time when new organizational forms and control schemes of investment and construction activity are appearing the system of competitive bidding gains more importance and new functions, because the choice of construction organizer and contracting companies directly influences the results of the construction. The authors consider the task of selecting the bidders’ offers which is a multicriterion task. The offers are evaluated according to the set of parameters reflecting the effectiveness of investment and construction projects. The criteria selection is based on the fact that the proposals of the organizer of construction and the contractors are related to the cost of works and to the deadlines which directly affects the implementation parameters of investment and construction projects.

24 CFR 232.605 - Contract requirements.

Science.gov (United States)

2010-04-01

... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Form of Contract § 232.605 Contract requirements. (a) The contract between the...

Reforming the health care system: implications for health care marketers.

Science.gov (United States)

Petrochuk, M A; Javalgi, R G

1996-01-01

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

Care for patients with an increased risk for cardiovascular diseases.

OpenAIRE

Boheemen, C. van; Geffen, K. van; Philbert, D.; Bos, M.; Dis, I. van; Strijbis, A.; Bouvy, M.; Dijk, L. van

2010-01-01

Background: In 2009, a national standard of care for vascular risk management (VRM) was developed. This standard, which was sent to all general practitioners (GPs), contains requirements for optimal care. One requirement is the formulation of a written individual-care plan which contains an extended description of the patient’s cardiovascular risk factors and a plan to reduce the risk. The aim of our study is to describe to what extent current care meets the requirement posed in the care stan...

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

Science.gov (United States)

2012-08-31

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

Do accountable care organizations (ACOs) help or hinder primary care physicians' ability to deliver high-quality care?

Science.gov (United States)

Berenson, Robert A; Burton, Rachel A; McGrath, Megan

2016-09-01

Many view advanced primary care models such as the patient-centered medical home as foundational for accountable care organizations (ACOs), but it remains unclear how these two delivery reforms are complementary and how they may produce conflict. The objective of this study was to identify how joining an ACO could help or hinder a primary care practice's efforts to deliver high-quality care. This qualitative study involved interviews with a purposive sample of 32 early adopters of advanced primary care and/or ACO models, drawn from across the U.S. and conducted in mid-2014. Interview notes were coded using qualitative data analysis software, permitting topic-specific queries which were then summarized. Respondents perceived many potential benefits of joining an ACO, including care coordination staff, data analytics, and improved communication with other providers. However, respondents were also concerned about added "bureaucratic" requirements, referral restrictions, and a potential inability to recoup investments in practice improvements. Interviewees generally thought joining an ACO could complement a practice's efforts to deliver high-quality care, yet noted some concerns that could undermine these synergies. Both the advantages and disadvantages of joining an ACO seemed exacerbated for small practices, since they are most likely to benefit from additional resources yet are most likely to chafe under added bureaucratic requirements. Our identification of the potential pros and cons of joining an ACO may help providers identify areas to examine when weighing whether to enter into such an arrangement, and may help ACOs identify potential areas for improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

Robots in Elderly Care

OpenAIRE

Alessandro Vercelli; Innocenzo Rainero; Ludovico Ciferri; Marina Boido; Fabrizio Pirri

2018-01-01

Low birth rate and the long life expectancy represent an explosive mixture, resulting in the rapid aging of population. The costs of healthcare in the grey society are increasing dramatically, and soon there will be not enough resources and people for care. This context requires conceptually new elderly care solutions progressively reducing the percentages of the human-based care. Research on robot-based solutions for elderly care and active ageing aims to answer these needs. From a general p...

Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals

Directory of Open Access Journals (Sweden)

Vlayen Annemie

2012-08-01

Full Text Available Abstract Background Adverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically. Findings A multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides the incidence and the level of causation and preventability, also the type of adverse events and their consequences (patient harm, mortality and length of stay will be assessed. Moreover, the adequacy of the patient records and quality/usefulness of the method of medical record review will be evaluated. Discussion This paper describes the rationale for a retrospective review study of adverse events that necessitate a higher level of care. More specifically, we are particularly interested in increasing our understanding in the preventability and root causes of these events in order to implement improvement strategies. Attention is paid to the strengths and limitations of the study design.

Defense Health Care. Reimbursement of Hospitals Not Meeting CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Copayment Requirements.

Science.gov (United States)

1988-06-01

8217JntedState* General AccouýLg Office __ Rteport to Congmesoa Commitee A,""FILE COPYAD-A197 876 DF7-EANSE HEF.ALTHl L’W Reimbur emen--t Of I...Secretary of Defense grant a waiver from CHAMPUS copayment requirements and be approved, tuader certain criteria, to be reimbursed for care to...that a provider waives patient copayments, it denies the provider’s claim for reimbursement . . In fiscal year 1987, cHAmpus payments to civilian

The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring.

Science.gov (United States)

Jones, Barbara L; Contro, Nancy; Koch, Kendra D

2014-02-01

Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.

Early discharge and home care after unplanned cesarean birth: nursing care time.

Science.gov (United States)

Brooten, D; Knapp, H; Borucki, L; Jacobsen, B; Finkler, S; Arnold, L; Mennuti, M

1996-09-01

This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. An urban tertiary-care hospital. The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborn was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group.

Characteristics of fibromyalgia in Muslim Bedouin women in a primary care clinic.

Science.gov (United States)

Peleg, Roni; Ablin, Jacob N; Peleg, Aya; Neumann, Lily; Rabia, Rasmia Abu; Buskila, Dan

2008-06-01

Fibromyalgia (FM) has been described and studied in various sociocultural settings in both developed and developing countries. To study the clinical manifestations of FM and to describe its effect on quality of life in the unique setting of Muslim Bedouin women in the southern Israel Negev desert area. One hundred two Bedouin women were recruited from a primary health care clinic in the Negev area. All patients fulfilled American College of Rheumatology criteria for the diagnosis of FM. Tenderness was assessed by manual dolorimetry and the fibromyalgia impact questionnaire was utilized to estimate the severity of FM symptoms. Anxiety and depression were assessed by the Arthritis Impact Measurement Scales subscales and quality of life was evaluated by the SF-36 questionnaire. The study population was characterized by a low educational level, a high rate of consanguinity, a high number of children per mother, and a high rate of polygamy. There was a high frequency of classic FM symptoms such as pain and fatigue, as well as anxiety and depression. The overall impact of FM on quality of life was exceedingly high (8.9 on a scale of 0 to 10). FM is relatively common in the unique setting of Muslim Bedouin women and has a very significant impact on their quality of life as well as on their dependents. Physicians involved in the primary care of this population should be attentive to the manifestations of FM and related disorders.

Health care of youth aging out of foster care.

Science.gov (United States)

2012-12-01

Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.

Radiation recommendation series: administratively required dental radiographs

International Nuclear Information System (INIS)

1981-09-01

Administrative requirements for radiographs are found in many segments of the United States health care system. This document presents an FDA radiation recommendation on administratively required dental x-ray examinations. In general, such examinations are not requested to further the patient's dental health, but rather as a means of monitoring claims. However, the administrative use of radiographs that have been taken in the normal course of patient care is usually appropriate, as long as the patient's right to privacy is respected

Health care policy and community pharmacy: implications for the New Zealand primary health care sector.

Science.gov (United States)

Scahill, Shane; Harrison, Jeff; Carswell, Peter; Shaw, John

2010-06-25

The aim of our paper is to expose the challenges primary health care reform is exerting on community pharmacy and other groups. Our paper is underpinned by the notion that a broad understanding of the issues facing pharmacy will help facilitate engagement by pharmacy and stakeholders in primary care. New models of remuneration are required to deliver policy expectations. Equally important is redefining the place of community pharmacy, outlining the roles that are mooted and contributions that can be made by community pharmacy. Consistent with international policy shifts, New Zealand primary health care policy outlines broad directives which community pharmacy must respond to. Policymakers are calling for greater integration and collaboration, a shift from product to patient-centred care; a greater population health focus and the provision of enhanced cognitive services. To successfully implement policy, community pharmacists must change the way they think and act. Community pharmacy must improve relationships with other primary care providers, District Health Boards (DHBs) and Primary Health Organisations (PHOs). There is a requirement for DHBs to realign funding models which increase integration and remove the requirement to sell products in pharmacy in order to deliver services. There needs to be a willingness for pharmacy to adopt a user pays policy. General practitioners (GPs) and practice nurses (PNs) need to be aware of the training and skills that pharmacists have, and to understand what pharmacists can offer that benefits their patients and ultimately general practice. There is also a need for GPs and PNs to realise the fiscal and professional challenges community pharmacy is facing in its attempt to improve pharmacy services and in working more collaboratively within primary care. Meanwhile, community pharmacists need to embrace new approaches to practice and drive a clearly defined agenda of renewal in order to meet the needs of health funders, patients

Long-term outcome of elderly patients requiring intensive care admission for abdominal pathologies: survival and quality of life.

Science.gov (United States)

Merlani, P; Chenaud, C; Mariotti, N; Ricou, B

2007-05-01

Medical developments have allowed the management of patients aged over 70 years with severe abdominal pathologies requiring intensive care unit (ICU) admission. These patients require enhanced life support and present a high ICU mortality. We investigated the outcome and quality of life (QOL) of elderly patients 2 years after their ICU stay for abdominal pathologies. Patients aged 70 years or over with abdominal pathologies, admitted to our ICU over a period of 2 years, were included. Two years following their ICU stay, a letter informed the patients about the present study. Consent to participate was obtained by telephone. QOL was assessed by the Euro-QOL and Short Form-36 questionnaires. Other patient-centered outcomes were evaluated. Overall, 2780 patients were admitted to the ICU during the study period; 141 (5%) patients were eligible; 112 of the 141 (79%) survived their ICU stay, 95 (67%) survived their hospital stay and 52 (37%) were alive 2 years after their ICU stay; 36 of the 52 survivors (69%) answered the questionnaire. Their QOL 2 years after their ICU stay was decreased in comparison with an age-matched population. Eighty-one per cent of patients lived at home and 57% were totally independent. They perceived their ICU stay as positive and 75% stated that they would agree to go through intensive care again. Factors associated with 2-year survival were the absence of co-morbidity, absence of malignancy and a lower Simplified Acute Physiology II score on ICU admission. A high mortality rate and a decrease in QOL were observed in elderly patients with severe abdominal pathologies. Nonetheless, these patients were able to adapt well to their physical disabilities.

Towards elicitation of users requirements for hospital information system: from a care process modelling technique to a web based collaborative tool.

OpenAIRE

Staccini, Pascal M.; Joubert, Michel; Quaranta, Jean-Francois; Fieschi, Marius

2002-01-01

Growing attention is being given to the use of process modeling methodology for user requirements elicitation. In the analysis phase of hospital information systems, the usefulness of care-process models has been investigated to evaluate the conceptual applicability and practical understandability by clinical staff and members of users teams. Nevertheless, there still remains a gap between users and analysts in their mutual ability to share conceptual views and vocabulary, keeping the meaning...

The Elusive Standard of Care.

Science.gov (United States)

Cooke, Brian K; Worsham, Elizabeth; Reisfield, Gary M

2017-09-01

In medical negligence cases, the forensic expert must explain to a trier of fact what a defendant physician should have done, or not done, in a specific set of circumstances and whether the physician's conduct constitutes a breach of duty. The parameters of the duty are delineated by the standard of care. Many facets of the standard of care have been well explored in the literature, but gaps remain in a complete understanding of this concept. We examine the standard of care, its origins, and who determines the prevailing standard, beginning with an overview of the historical roots of the standard of care and, using case law, tracing its evolution from the 19th century through the early 21st century. We then analyze the locality rule and consider local, state, and national standards of care. The locality rule requires a defendant physician to provide the same degree of skill and care that is required of a physician practicing in the same or similar community. This rule remains alive in some jurisdictions in the United States. Last, we address the relationship between the standard of care and clinical practice guidelines. © 2017 American Academy of Psychiatry and the Law.

Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel.

Science.gov (United States)

Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L

2014-04-01

Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

32 CFR 732.13 - Sources of care.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Sources of care. 732.13 Section 732.13 National... CARE Medical and Dental Care From Nonnaval Sources § 732.13 Sources of care. (a) Initial application. If a member requires maternity, medical, or dental care and naval facilities are unavailable, make...

42 CFR 409.31 - Level of care requirement.

Science.gov (United States)

2010-10-01

... services means services that: (1) Are ordered by a physician; (2) Require the skills of technical or professional personnel such as registered nurses, licensed practical (vocational) nurses, physical therapists...

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR)

Science.gov (United States)

2017-08-14

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

Moving Parkinson care to the home

NARCIS (Netherlands)

Dorsey, E.R.; Vlaanderen, F.P.; Engelen, L.J.; Kieburtz, K.; Zhu, W.; Biglan, K.M.; Faber, M.J.; Bloem, B.R.

2016-01-01

In many ways, the care of individuals with Parkinson disease does not meet their needs. Despite the documented benefits of receiving care from clinicians with Parkinson disease expertise, many patients (if not most) do not. Moreover, current care models frequently require older individuals with

Palliative care in home care: perceptions of occupational therapists

Directory of Open Access Journals (Sweden)

Séfora Gomez Portela

2015-03-01

Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

Pandemic influenza-implications for critical care resources in Australia and New Zealand.

Science.gov (United States)

Anderson, Therese A; Hart, Graeme K; Kainer, Marion A

2003-09-01

To quantify resource requirements (additional beds and ventilator capacity), for critical care services in the event of pandemic influenza. Cross-sectional survey about existing and potential critical care resources. Participants comprised 156 of the 176 Australasian (Australia and New Zealand) critical care units on the database of the Australian and New Zealand Intensive Care Society (ANZICS) Research Centre for Critical Care Resources. The Meltzer, Cox and Fukuda model was adapted to map a range of influenza attack rate estimates for hospitalisation and episodes likely to require intensive care and to predict critical care admission rates and bed day requirements. Estimations of ventilation rates were based on those for community-acquired pneumonia. The estimated extra number of persons requiring hospitalisation ranged from 8,455 (10% attack rate) to 150,087 (45% attack rate). The estimated number of additional admissions to critical care units ranged from 423 (5% admission rate, 10% attack rate) to 37,522 (25% admission rate, 45% attack rate). The potential number of required intensive care bed days ranged from 846 bed days (2 day length of stay, 10% attack rate) to 375,220 bed days (10 day length of stay, 45% attack rate). The number of persons likely to require mechanical ventilation ranged from 106 (25% of projected critical care admissions, 10% attack rate) to 28,142 (75% of projected critical care admissions, 45% attack rate). An additional 1,195 emergency ventilator beds were identified in public sector and 248 in private sector hospitals. Cancellation of elective surgery could release a potential 76,402 intensive care bed days (per annum), but in the event of pandemic influenza, 31,150 bed days could be required over an 8- to 12-week period. Australasian critical care services would be overwhelmed in the event of pandemic influenza. More work is required in relation to modelling, contingency plans, and resource allocation.

2-Furaldehyde diethyl acetal from tender coconut water (Cocos nucifera) attenuates biofilm formation and quorum sensing-mediated virulence of Chromobacterium violaceum and Pseudomonas aeruginosa.

Science.gov (United States)

Sethupathy, Sivasamy; Nithya, Chari; Pandian, Shunmugiah Karutha

2015-01-01

The aim of this study was to evaluate the anti-biofilm and quorum sensing inhibitory (QSI) potential of tender coconut water (TCW) against Chromobacterium violaceum and Pseudomonas aeruginosa. TCW significantly inhibited the QS regulated violacein, virulence factors and biofilm production without affecting their growth. qRT-PCR analysis revealed the down-regulation of autoinducer synthase, transcriptional regulator and virulence genes. Mass-spectrometric analysis of a petroleum ether extract of the TCW hydrolyte revealed that 2-furaldehyde diethyl acetal (2FDA) and palmitic acid (PA) are the major compounds. In vitro bioassays confirmed the ability of 2FDA to inhibit the biofilm formation and virulence factors. In addition, the combination of PA with 2FDA resulted in potent inhibition of biofilm formation and virulence factors. The results obtained strongly suggest that TCW can be exploited as a base for designing a novel antipathogenic drug formulation to treat biofilm mediated infections caused by P. aeruginosa.

[Costs of maternal-infant care in an institutionalized health care system].

Science.gov (United States)

Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

1998-01-01

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

Circular of the 13 october 2003 relative to the execution of the call for tenders for the implementation of offshore wind turbines; Circulaire du 13 octobre 2003 relative au lancement de l'appel d'offres pour l'implantation des eoliennes en mer

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-10-01

In the framework of the renewable energies sources development and following the National Debate on the energies results, the government decided to launch a call for tenders concerning the implementation of offshore wind turbines of 500 MW at year 2007 event horizon. This document gives orientations and applicable procedures to the reports, for the littoral departments Prefects. (A.L.B.)

75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

Science.gov (United States)

2010-10-22

.... Palliative care in an LTC facility involves addressing physical, intellectual, emotional, social, and... Disability, Aging and Long-Term Care Policy and the Urban Institute; ``Synthesis and Analysis of Medicare..., mental, social, or emotional status; clinical complications that suggested a need to alter the care plan...

Structural analysis of polymer thin films using GISAXS in the tender X-ray region: Concept and design of GISAXS experiments using the tender X-ray energy at BL-15A2 at the Photon Factory

Energy Technology Data Exchange (ETDEWEB)

Takagi, H., E-mail: takagih@post.kek.jp; Igarashi, N.; Mori, T.; Saijo, S.; Nagatani, Y.; Shimizu, N. [Photon Factory, Institute of Materials Structure Science, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki 305-0801 (Japan); Ohta, H. [Mitsubishi Electric System & Service Co., Ltd, Accelerator Engineering Center, 2-8- 8 Umezono, Tsukuba, Ibaraki 305-0045 (Japan); Yamamoto, K. [Graduate School of Engineering, Department of Materials Science & Technology, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555 (Japan)

2016-10-14

If small angle X-ray scattering (SAXS) utilizing the soft X-ray region is available, advanced and unique experiments, which differ from traditional SAXS methods, can be realized. For example, grazing-incidence small angle X-ray scattering (GISAXS) using hard X-ray is a powerful tool for understanding the nanostructure in both vertical and lateral directions of thin films, while GISAXS utilizing the tender X-ray region (SX-GISAXS) enables depth-resolved analysis as well as a standard GISAXS analysis in thin films. Thus, at BL-15A2 at the Photon Factory, a dedicated diffractometer for SX-GISAXS (above 2.1 keV) was constructed. This diffractometer is composed of four vacuum chambers and can be converted into the vacuum state from the sample chamber in front of the detector surface. Diffractions are clearly observed until 12th peak when measuring collagen by SAXS with an X-ray energy of 2.40 keV and a camera length of 825 mm. Additionally, we conducted the model experiment using SX-GISAXS with an X-ray energy of 2.40 keV to confirm that a poly(methyl methacrylate)-poly(n-butyl acrylate) block copolymer thin film has a microphase-separated structure in the thin film, which is composed of lamellae aligned both parallel and perpendicular to the substrate surface. Similarly, in a polystyrene-poly(methyl methacrylate) block copolymer thin film, SX-GISAXS with 3.60 keV and 5.73 keV revealed that hexagonally packed cylinders are aligned parallel to the substrate surface. The incident angle dependence of the first order peak position of the q{sub z} direction obtained from experiments at various incident X-ray energies agrees very well with the theoretical one calculated from the distorted wave Born approximation.

Structural analysis of polymer thin films using GISAXS in the tender X-ray region: Concept and design of GISAXS experiments using the tender X-ray energy at BL-15A2 at the Photon Factory

International Nuclear Information System (INIS)

Takagi, H.; Igarashi, N.; Mori, T.; Saijo, S.; Nagatani, Y.; Shimizu, N.; Ohta, H.; Yamamoto, K.

2016-01-01

If small angle X-ray scattering (SAXS) utilizing the soft X-ray region is available, advanced and unique experiments, which differ from traditional SAXS methods, can be realized. For example, grazing-incidence small angle X-ray scattering (GISAXS) using hard X-ray is a powerful tool for understanding the nanostructure in both vertical and lateral directions of thin films, while GISAXS utilizing the tender X-ray region (SX-GISAXS) enables depth-resolved analysis as well as a standard GISAXS analysis in thin films. Thus, at BL-15A2 at the Photon Factory, a dedicated diffractometer for SX-GISAXS (above 2.1 keV) was constructed. This diffractometer is composed of four vacuum chambers and can be converted into the vacuum state from the sample chamber in front of the detector surface. Diffractions are clearly observed until 12th peak when measuring collagen by SAXS with an X-ray energy of 2.40 keV and a camera length of 825 mm. Additionally, we conducted the model experiment using SX-GISAXS with an X-ray energy of 2.40 keV to confirm that a poly(methyl methacrylate)-poly(n-butyl acrylate) block copolymer thin film has a microphase-separated structure in the thin film, which is composed of lamellae aligned both parallel and perpendicular to the substrate surface. Similarly, in a polystyrene-poly(methyl methacrylate) block copolymer thin film, SX-GISAXS with 3.60 keV and 5.73 keV revealed that hexagonally packed cylinders are aligned parallel to the substrate surface. The incident angle dependence of the first order peak position of the q_z direction obtained from experiments at various incident X-ray energies agrees very well with the theoretical one calculated from the distorted wave Born approximation.

The Epital Care Model

DEFF Research Database (Denmark)

Phanareth, Klaus; Vingtoft, Søren; Christensen, Anders Skovbo

2017-01-01

BACKGROUND: There is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors...... and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports...... the intentions of the World Health Organization (WHO) to have integrated people-centered care. OBJECTIVE: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care...

A smartphone-based pain management app for adolescents with cancer: establishing system requirements and a pain care algorithm based on literature review, interviews, and consensus.

Science.gov (United States)

Jibb, Lindsay A; Stevens, Bonnie J; Nathan, Paul C; Seto, Emily; Cafazzo, Joseph A; Stinson, Jennifer N

2014-03-19

Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app

Care for patients with an increased risk for cardiovascular diseases.

NARCIS (Netherlands)

Boheemen, C. van; Geffen, K. van; Philbert, D.; Bos, M.; Dis, I. van; Strijbis, A.; Bouvy, M.; Dijk, L. van

2010-01-01

Background: In 2009, a national standard of care for vascular risk management (VRM) was developed. This standard, which was sent to all general practitioners (GPs), contains requirements for optimal care. One requirement is the formulation of a written individual-care plan which contains an extended

42 CFR 409.44 - Skilled services requirements.

Science.gov (United States)

2010-10-01

... services requirements. (a) General. The intermediary's decision on whether care is reasonable and necessary... is based upon objective clinical evidence regarding the beneficiary's individual need for care. (b... performed by a registered nurse, or practical (vocational) nurse, as defined in § 484.4 of this chapter...

Caring about caring: developing a model to implement compassionate relationship centred care in an older people care setting.

Science.gov (United States)

Dewar, Belinda; Nolan, Mike

2013-09-01

This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments. Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover. The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts. The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'. The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and

Quality management in Irish health care.

Science.gov (United States)

Ennis, K; Harrington, D

1999-01-01

This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

Dental Care Every Day: A Caregiver's Guide. Practical Oral Care for People with Developmental Disabilities

Science.gov (United States)

National Institute of Dental and Craniofacial Research (NIDCR), 2009

2009-01-01

Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with dental care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Dental care isn't always easy, but you can…

Efeito do colágeno na maciez da carne de bovinos de distintos grupos genéticos = Collagen effects in meat tenderness of bovines of different genetic groups

Directory of Open Access Journals (Sweden)

Daniela Cristina Morales

2006-01-01

Full Text Available O objetivo do trabalho foi avaliar a influência do colágeno na maciez da carne de animais de diferentes grupos genéticos produzidos no sistema de produção do novilho superprecoce. Foram utilizados bezerros machos inteiros da raça Nelore, mestiços ½ Nelore x ½ Aberdeen Angus e mestiços ½ Nelore x ½ Simental. Após abate e resfriamento por 24 horas, foram retiradas amostras do músculo Longissimus dorsi, na região entre a 11a e a 13a costela, sendo que uma amostra foi congelada e as demais maturadas por 7 e 14 dias. Nãohouve diferença significativa (P>0,01 entre os grupos genéticos para a quantidade e a solubilidade de colágeno e a força de cisalhamento. A quantidade e a solubilidade do colágeno não comprometeram a maciez da carne, indiferentemente do grupo genético utilizado e do tempo postmortem, tornando vantajosa a opção de se abaterem animais jovens.The aim of work was to analyze the collagen effect in meat tenderness of animals of different genetic groups produced by very young bullock production system. Male calves Nellore purebred, ½ Nellore x ½ Aberdeen Angus and ½ Nellore x ½ Simmental crossbred were used.After slaughter and cooling for 24 hours Longissimus dorsi samples were removed, between 11th and 13th ribs, one sample was frozen and the others ageing for 7 and 14 days. There was no difference (P>0,01 between genetic groups for amount and heat soluble collagen andshear force values. The amount and solubility collagen don’t compromised the meat tenderness, indifferent of the genetic group used and postmortem period, becoming the early slaughter an advantageous option for meat production with desirable characteristics.

Fixing the broken image of care homes, could a 'care home innovation centre' be the answer?

OpenAIRE

Hockley, Jo; Harrison, Jennifer Kirsty; Watson, Julie; Randall, Marion; Murray, Scott

2016-01-01

The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of 'good' from regulators, still significant numbers are identified as requiring 'improvement' or are 'inadequate'. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the ca...

Analysis of the Impact of Transparency, Corruption, Openness in Competition and Tender Procedures on Public Procurement in the Czech Republic

Directory of Open Access Journals (Sweden)

František Ochrana

2014-01-01

Full Text Available This study analyses the impact of transparency and openness to competition in public procurement in the Czech Republic. The problems of the Czech procurement market have been demonstrated on the analysis of a sample of contracts awarded by local government entities. From among a set of factors influencing the efficiency of public procurement, we closely analyse transparency, resilience against corruption, openness, effective administrative award procedure, and formulation of appropriate evaluation criteria for selecting the most suitable bid. Some assumptions were confirmed, including a positive effect of open procedures on the level of competition on the supply side as well as the dominant use of price criteria only. The latter case is probably often caused by low skills of workers at the contracting entities, as well as the lack of resources in public budgets. However, we have to reject the persistent legend of “undershooting” tender prices and subsequently increasing the final prices of public contracts. Increases of final prices are very limited. Based on the results of the analyses presented, we argue that the main problem of the Czech public procurement market lies in a rather low competence of administrators who are not able to use non-price criteria more often.

Building the eye care team

Directory of Open Access Journals (Sweden)

Thulasiraj Ravilla

2014-07-01

Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

Can home care services achieve cost savings in long-term care for older people?

Science.gov (United States)

Greene, V L; Ondrich, J; Laditka, S

1998-07-01

To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

Proposal to negotiate, without competitive tendering, a contract for the manufacture, testing and delivery of 320 cryogenic helium mass flowmeters for the LHC

CERN Document Server

2001-01-01

This document concerns the manufacture, testing and delivery of 320 cryogenic helium mass flowmeters for the LHC. Following a market survey (MS-2602/LHC/LHC) carried out amoung 37 firms in twelve Member States and six firms in two non-Member States, a price enquiry for qualifying prototypes was sent on 20 November 1998 to nine selected firms and the received prototypes were evaluated. As a result of this process a request for quotation was sent to one firm The Finance Committee is invited to agree to the negotiation of a contract with the firm EMERSON PROCESS MANAGEMENT/FISHER-ROSEMOUNT (CH), without competitive tendering, for the manufacture, testing and delivery of 320 cryogenic helium mass flowmeters for an amount of 1 804 840 Swiss francs, not subject to revision, with options for up to 10 additional cryogenic helium mass flowmeters and an extension of the guarantee period to five years for all units for an amount of 219 090 Swiss francs, not subject to revision, bringing the total amount to 2 023 930 Swi...

Home or foster home care versus institutional long-term care for functionally dependent older people

NARCIS (Netherlands)

Young, Camilla; Hall, Amanda M.; Goncalves-Bradley, Daniela C.; Quinn, Terry J.; Hooft, Lotty; van Munster, Barbara C.; Stott, David J.

2017-01-01

Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce

Home or foster home care versus institutional long-term care for functionally dependent older people

NARCIS (Netherlands)

Young, Camilla; Hall, Amanda M.; Gonçalves-Bradley, Daniela C.; Quinn, Terry J.; Hooft, Lotty; van Munster, Barbara C.; Stott, David J.

2017-01-01

Background: Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this

45 CFR 98.41 - Health and safety requirements.

Science.gov (United States)

2010-10-01

... establishment of any new or additional requirements if existing requirements comply with the requirements of the... as grandparents, great grandparents, siblings (if living in a separate residence), aunts, and uncles... care providers” does not include grandparents, great grandparents, siblings (if such providers live in...

The association between culture, climate and quality of care in primary health care teams.

Science.gov (United States)

Hann, Mark; Bower, Peter; Campbell, Stephen; Marshall, Martin; Reeves, David

2007-09-01

Culture and climate represent shared beliefs and values that may influence quality of care in health care teams, and which could be manipulated for quality improvement. However, there is a lack of agreement on the theoretical and empirical relationships between climate and culture, and their relative power as predictors of quality of care. This study sought to examine the association between self-report measures of climate and culture in primary care teams and comprehensive measures of quality of care. The data were derived from a cross-sectional survey of 492 professionals in 42 general practices in England. Self-report measures of culture (the Competing Values Framework) and climate (the Team Climate Inventory) were used, together with validated measures of quality of care from medical records and self-report. The majority of practices could be characterized as 'clan' culture type. Practices with a dominant clan culture scored higher on climate for participation and teamwork. There were no associations between culture and quality of care, and only limited evidence of associations between climate and quality. The current analysis would not support the hypothesis that culture and climate are important predictors of quality of care in primary care. Although larger studies are required to provide a definitive test, the results may suggest the need for a more complex model of the associations between culture, climate and outcomes, and further research may be required into the interaction between culture and climate with other determinants of behaviour such as internal and external incentives.

42 CFR 460.106 - Plan of care.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Plan of care. 460.106 Section 460.106 Public Health... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.106 Plan of care. (a) Basic requirement. The interdisciplinary team must promptly develop a...

Affordable Care Act and Women

Science.gov (United States)

... quality care for older women, and ends the gender discrimination that requires women to pay more for the same insurance coverage ... the Affordable Care Act and 13 million more women will gain coverage by 2016. Maternity Coverage Preventive ... Expanded Insurance Coverage Endnotes Download "rb. ...

Opioid use in palliative care

African Journals Online (AJOL)

Repro

care. The confident and safe use of opioids in palliative care is an essential skill required by all. d o c t o r s . ... patient for ongoing clinical review. Start the elderly and frail .... (24 hour subcutaneous infusion ... (nursing or medical), pain special-.

Professional management for eye care

Directory of Open Access Journals (Sweden)

AK Sivakumar

2006-09-01

Full Text Available IntroductionThe global initiative VISION 2020: The Right to Sight, estimates that only 25 per cent of existing infrastructure is used for eye care, while the target utilisation is set at 90 per cent. This requires a complete reorganisation. Many providers have the potential to significantly enhance their service by adopting professional management practice and new technologies in clinical services. This article addresses this opportunity from a professional management perspective.The responsibilities of a hospital administrator could be broadly classified as managing patient care, functional areas, support services, and developmental work. Eye care providers need to focus on four key areas. Strategic management to enhance the efficiency of their organisations requires: human resources management; quality management; marketing; and financial sustainability.

Improving perinatal outcome: towards individualized care

OpenAIRE

Kazemier, B.M.

2015-01-01

Unfortunately not all pregnancies and deliveries take place without complications. Complications during pregnancy or delivery can lead to maternal morbidity and poor perinatal outcomes such as perinatal mortality or (severe) neonatal morbidity. First assessment in antenatal care is to distinguish women who require standard care from those requiring special attention. At the moment, we can make some global risk assessments, but are not able to give a women a risk assessment that is adapted for...

45 CFR 150.203 - Circumstances requiring CMS enforcement.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Circumstances requiring CMS enforcement. 150.203... CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement Processes for... requiring CMS enforcement. CMS enforces HIPAA requirements to the extent warranted (as determined by CMS) in...

The home care teaching and learning process in undergraduate health care degree courses.

Science.gov (United States)

Hermann, Ana Paula; Lacerda, Maria Ribeiro; Maftum, Mariluci Alves; Bernardino, Elizabeth; Mello, Ana Lúcia Schaefer Ferreira de

2017-07-01

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

Effect of nursing care hours on the outcomes of Intensive Care assistance.

Directory of Open Access Journals (Sweden)

Tatiana do Altíssimo Nogueira

Full Text Available To correlate the average number of nursing care hours dedicated to Intensive Care Unit (ICU patients with nursing care indicators.Transverse, descriptive study conducted between 2011 and 2013. Data were obtained from the electronic records system and from the nursing staff daily schedule. Generalized Linear Models were used for analysis.A total of 1,717 patients were included in the study. The average NAS (Nursing Activities Score value was 54.87. The average ratio between the number of nursing care hours provided to the patient and the number of nursing care hours required by the patient (hours ratio was 0.87. Analysis of the correlation between nursing care indicators and the hours ratio showed that the indicators phlebitis and ventilator-associated pneumonia significantly correlated with hours ratio; that is, the higher the hours ratio, the lower the incidence of phlebitis and ventilator-associated pneumonia.The number of nursing care hours directly impacts patient outcomes, which makes adjustment of nurse staffing levels essential.

Spirituality in cancer care at the end of life.

Science.gov (United States)

Ferrell, Betty; Otis-Green, Shirley; Economou, Denice

2013-01-01

There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress.

The Womanly World of Long Term Care: The Plight of the Long Term Care Worker. Gray Paper.

Science.gov (United States)

Older Women's League, Washington, DC.

Long-term care workers (those who are paid to provide custodial care for long-term patients in nursing homes or at home) must care for a growing number of increasingly disabled or dependent persons. They are working for agencies and institutions under growing pressure to increase productivity. They face new training and competency requirements,…

Call for tender - Areva-Alstom: watershed in wind energy - Technological duel on the open sea; Appel d'offres - Areva-Alstom: partage des eaux dans l'eolien - Duel technologique au grand large

Energy Technology Data Exchange (ETDEWEB)

Dupin, L.

2012-02-16

The author comments the answers to a call for tender made by the French government and concerning five offshore wind farm sites (Le Treport, Fecamp, Courseulles sur Mer, Saint-Brieuc and Saint-Nazaire). As they are present within the three consortiums, Areva and Alstom should provide the wind turbines. This would result in the construction by Alstom of two blade and mast factories and two turbine and pad factories. For both companies, this market of 500 to 600 turbines is an opportunity. Many jobs are at stake. They push themselves forward for their experience or their innovation capacity. But their wind turbines will be based on foreign (Spanish or German) technology

[Continuity of care from the acute care hospital: Results].

Science.gov (United States)

Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia

2015-01-01

To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities.

Science.gov (United States)

McLaughlin, Dorry; Barr, Owen; McIlfatrick, Sonja; McConkey, Roy

2015-12-01

Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. Although professionals' perceptions of their training needs in this area have been studied, the perceptions of people with learning disabilities and family carers are not known. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training. A qualitative, exploratory design was used. A total of 17 people with learning disabilities were recruited to two focus groups which took place within an advocacy network. Additionally, three family carers of someone with a learning disability, requiring palliative care, and two family carers who had been bereaved recently were also interviewed. Combined data identified the perceived learning needs for healthcare professionals. Three subthemes emerged: 'information and preparation', 'provision of care' and 'family-centred care'. This study shows that people with learning disabilities can have conversations about death and dying, and their preferred end-of-life care, but require information that they can understand. They also need to have people around familiar to them and with them. Healthcare professionals require skills and knowledge to effectively provide palliative care for people with learning disabilities and should also work in partnership with their family carers who have expertise from their long-term caring role. These findings have implications for educators and clinicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Factitious panniculitis induced by cupping therapy.

Science.gov (United States)

Moon, Suk-Ho; Han, Hyun-Ho; Rhie, Jong-Won

2011-11-01

Cupping therapy is an alternative medical procedure that has been widely performed in Asian countries to relieve pain. It is known that there is no complication to this therapy, so many non-health care professionals have performed this procedure. However, there have been few reports on complications, such as iron deficiency anemia, hemorrhagic bullae, kelloids, vasovagal syncope, and foreign body reactions. Masses associated with panniculitis induced by cupping are extremely rare, and they require a unique approach.A 56-year-old woman presented with a 10-month history of multiple masses in the posterior neck and right shoulder areas. The patient repeatedly attempted cupping therapy by herself, and multiple palpable masses developed in the posterior neck and right shoulder area where cupping therapy had been performed. The masses were enlarged by repeated cupping, and they decreased in size when cupping was stopped. Among all lesions, the 2 masses with tenderness were surgically excised. The remaining masses resolved after cupping therapy was ceased. When a patient with subcutaneous mass has a history of cupping or trace of cupping marks, panniculitis induced by cupping should be suspected. The lesion seems to spontaneously resolve unless they are repeatedly stimulated. However, surgical resection is considered in patients with infections or severe tenderness as a complication.

Assessment of selected quality fields of nursing care in neurosurgical wards: a prospective study of 530 people – multicenter studies

Directory of Open Access Journals (Sweden)

Ślusarz R

2014-08-01

Full Text Available Robert Ślusarz,1 Monika Biercewicz,2 Ewa Barczykowska,3 Beata Haor,4 Mariola Głowacka5 1Neurological and Neurosurgical Nursing Department, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 2Clinic of Geriatrics, 3Nursing Department, Collegium Medicum, Nicolaus Copernicus University, Torun, 4Faculty of Health Science, University of Humanities and Economics in Wloclawek, Wloclawek, 5Institute of Health Sciences, State School of Higher Professional Education in Plock, Plock, Poland Background: One of the elements influencing the assessment of nursing care quality is the assessment of the nurse’s functions that determine the nurse’s particular tasks. The aim of this work was to assess selected tasks involved in the nurse’s caring function, which influence nursing care quality on neurosurgical wards, on the basis of patients’ and nursing staff’s opinions.Materials and methods: The research was carried out on neurosurgical wards in Poland on a group of 455 patients and 75 nurses. In order to assess nursing care quality, an author’s original questionnaire (Questionnaire – Patient Satisfaction was used.Results: Statistically significant differences concerned particular groups (both patients and nurses in the assessment of selected issues: providing information about performed activities and operations (P=0.000 and P=0.040, respecting personal dignity and assuring discretion during the operations (P=0.000 and P=0.001, speed of response to patient’s requests (P=0.000 and P=0.000, time availability of nurses for the patient (P=0.000 and P=0.000, providing information about further self-care at home (P=0.032, P=0.008, and nurses’ attitude (kindness, courtesy, tenderness, care to patients (patient’s assessment only P=0.000.Conclusion: Selected tasks in the field of the caring function of nurses were assessed differently by particular groups. There were no statistically significant differences in the assessment of particular

40 CFR 258.61 - Post-closure care requirements.

Science.gov (United States)

2010-07-01

... the final cover; (2) Maintaining and operating the leachate collection system in accordance with the...) Maintaining and operating the gas monitoring system in accordance with the requirements of § 258.23. (b) The... stop managing leachate if the owner or operator demonstrates that leachate no longer poses a threat to...

Floors: Care and Maintenance.

Science.gov (United States)

Post Office Dept., Washington, DC.

Guidelines, methods and policies regarding the care and maintenance of post office building floors are overviewed in this handbook. Procedures outlined are concerned with maintaining a required level of appearance without wasting manpower. Flooring types and characteristics and the particular cleaning requirements of each type are given along with…

Care and its dis/placing moves: Becoming with Care Moves

DEFF Research Database (Denmark)

Lutz, Peter

2012-01-01

This paper is based on an ethnographic study of senior home care practices in the Unites States and Sweden. It suggests that senior home care offers a privileged site for the study of social-technical relations and their movements because it centers analytical attention on the challenges of harne......This paper is based on an ethnographic study of senior home care practices in the Unites States and Sweden. It suggests that senior home care offers a privileged site for the study of social-technical relations and their movements because it centers analytical attention on the challenges...... of harnessing technology for care. For instance, while many studies of humans and their technologies assume competent or skilled users, older people often meet with awkward infrastructural arrangements that rub against frail bodies and fading memories. Senior home care thus renders such relations more explicit....... These relations are explored as challenges or frictions, which require constant adjustments and tinkering. Here movement is employed as a key analytical frame for this exploration. Care moves may assume violent forms or they may flow with grace. They entangle affects and effects, emotions and motions, spaces...

Institutional Care for Long-Term Mechanical Ventilation in Canada: A National Survey

Directory of Open Access Journals (Sweden)

Louise Rose

2014-01-01

Full Text Available INTRODUCTION: No national Canadian data define resource requirements and care delivery for ventilator-assisted individuals (VAIs requiring long-term institutional care. Such data will assist in planning health care services to this population.

Liquefied natural gas tender crashworthiness in train-to-train collisions

Science.gov (United States)

2016-04-12

This paper focuses on technical information to help support : development of alternative static requirements for the train-to-train : collision scenario. The goal of the static requirements is to : provide the same level of crashworthiness as the dyn...

Associations of family-centered care with health care outcomes for children with special health care needs.

Science.gov (United States)

Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick

2011-08-01

The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.

'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians.

NARCIS (Netherlands)

Bekkema, N.; Veer, A.J.E. de; Hertogh, C.M.P.M.; Francke, A.L.

2015-01-01

Background: Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people

'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians

NARCIS (Netherlands)

Bekkema, N.; de Veer, A.J.E.; Hertogh, C.M.P.M.; Francke, A.L.

2015-01-01

Background: Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people

Teaching Care Ethics: Conceptual Understandings and Stories for Learning

Science.gov (United States)

Rabin, Colette; Smith, Grinell

2013-01-01

An ethic of care acknowledges the centrality of the role of caring relationships in moral education. Care ethics requires a conception of "care" that differs from the quotidian use of the word. In order to teach care ethics more effectively, this article discusses four interrelated ways that teachers' understandings of care differ…

Early goal-directed nutrition versus standard of care in adult intensive care patients

DEFF Research Database (Denmark)

Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen

2017-01-01

Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we...... estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7......, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline...

[The Hospital, patients, health and territories Act and the recentralisation of the social and long term care sector].

Science.gov (United States)

Jourdain, Alain; Muñoz, Jorge; Hudebine, Hervé

2017-07-10

Hypothesis: The 2009 Hospital, Patients, Health and Territories Act crystallises a central government attempt to regain control over the social and long term care sector, which involves the utilisation of policy instruments borrowed from the hospital sector: capped budgets, agreements on targets and resources, competitive tendering or quasi-market mechanisms involving hospitals and services, etc. This paper is therefore based on the hypothesis of a recentralisation and healthicization of the social and long term care sector, with a key role for the regional health authorities. Method and data: 27 semi-structured interviews were conducted with actors operating within and outside the regional health agencies and thereafter analysed using Alceste. The aim was to describe and to analyse the positioning of the RHAs in relation to key actors of the social and long-term care sector in 2 regions in 2011. Results: Key issues for public organisations include the style of planning and knowhow transfer, while the professionals were chiefly concerned with the intensity of the ambulatory turn and needs analysis methodology. The compromises forged were related to types of democratic legitimacy, namely representative or participatory democracy. Conclusion: There is little evidence to support the initial hypothesis, namely the existence of a link between the creation of RHAs and a recentralisation of health policy between 2009 and 2013. One may rather suggest that a reconfiguration of the activities and resources of the actors operating at the centre (RHAs and conseils départementaux) and at the periphery (territorial units of the RHAs and third sector umbrella organisations) has occurred.

Resilient health care

DEFF Research Database (Denmark)

Hollnagel, E.; Braithwaite, J.; Wears, R. L.

Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...

Selective Nonoperative Management of Penetrating Torso Injury From Combat Fragmentation Wounds

Science.gov (United States)

2008-02-01

outlines the paradigm of care: “Penetrating inju- ries below the nipples , above the symphysis pubis, and between the posterior axillary lines must be...abdo- men and were hemodynamically stable and without abdom- inal pain or tenderness. CT scan of some of these casualties revealed fragments in the lumen

Future requirements for and supply of ophthalmologists for an aging population in Singapore.

Science.gov (United States)

Ansah, John P; De Korne, Dirk; Bayer, Steffen; Pan, Chong; Jayabaskar, Thiyagarajan; Matchar, David B; Lew, Nicola; Phua, Andrew; Koh, Victoria; Lamoureux, Ecosse; Quek, Desmond

2015-11-17

Singapore's population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios. The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements. Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040. Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040. Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8-22 residents per year is required, 17-21 under the current policy scenario, 14-18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18-23 residents per year is required. The results show that under all scenarios considered, Singapore's aging and growing population will result in an almost doubling of the number of

Drivers of maternity care in high-income countries: can health systems support woman-centred care?

Science.gov (United States)

Shaw, Dorothy; Guise, Jeanne-Marie; Shah, Neel; Gemzell-Danielsson, Kristina; Joseph, K S; Levy, Barbara; Wong, Fontayne; Woodd, Susannah; Main, Elliott K

2016-11-05

In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities. Not all care is evidenced-based, and some care provision may be harmful. Fear prevails among subsets of women and providers. In some settings, medical liability costs are enormous, human resource shortages are common, and costs of providing care can be very high. New challenges linked to alteration of epidemiology, such as obesity and older age during pregnancy, are also present. Data are often not readily available to inform policy and practice in a timely way and surveillance requires greater attention and investment. Outcomes are not equitable, and disadvantaged segments of the population face access issues and substantially elevated risks. At the same time, examples of excellence and progress exist, from clinical interventions to models of care and practice. Labourists (who provide care for all the facility's women for labour and delivery) are discussed as a potential solution. Quality and safety factors are informed by women's experiences, as well as medical evidence. Progress requires the ability to normalise birth for most women, with integrated services available if complications develop. We also discuss mechanisms to improve quality of care and highlight areas where research can address knowledge gaps with potential for impact. Evaluation of models that provide woman-centred care and the best

Customer care in the NHS.

Science.gov (United States)

Ruddick, Fred

2015-01-20

Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

Family Care Map: Sustaining family-centered care in Polytrauma Rehabilitation Centers

Science.gov (United States)

Ford, James H.; Wise, Meg; Krahn, Dean; Oliver, Karen Anderson; Hall, Carmen; Sayer, Nina

2015-01-01

The study assessed sustainability of the Family Care Map, a family-centered approach to providing care for Veterans with polytrauma-related injuries, in four Department of Veterans Affairs Polytrauma Rehabilitation Centers. We applied a mixed-methods approach. Staff surveys used standardized measures of sustainability, commitment to change, information, and participation during implementation. Qualitative inquiry assessed Family Care Map implementation and facilitators and barriers to sustainability. Staff sustainability perceptions had a significant positive correlation with affective commitment to change, participation, and information received about the change process. Family Care Map integration into standard practices and use of its concepts with patients and families related to staff perceptions about sustainability. The degree of use and integration of the Family Care Map in traumatic brain injury/polytrauma care varied among the Polytrauma Rehabilitation Centers. Some successful sustainability strategies included integration into daily workflow and organizational culture. Examples of sustainability barriers included staff awareness and use and outdated information. Some practices, such as measuring and documenting the use of the Family Care Map in treatment plans, may not routinely occur. The focus on family-centered care will require further evaluation of organization-, staff-, and innovation-level attributes that influence sustainability of changes designed to improve family-centered care. PMID:25671632

Planning an Effective Child Care Center.

Science.gov (United States)

Wright, Rodney; Wright, Sydney

This conference presentation offers general guidelines for planning a new child care facility. Particular attention is given to site selection, space requirements, functional requirements, materials, climate, and choosing an architect. (RH)

European beef consumers' interest in a beef eating-quality guarantee

DEFF Research Database (Denmark)

Verbeke, Wim; Van Wezemael, Lyn; de Barcellos, Marcia Dutra

2010-01-01

and Germany to assess their opinions about beef muscle profiling and their interest in a beef eating-quality guarantee. Findings indicate that both concepts are well accepted by European beef consumers, although not unconditional. Besides acknowledging the opportunity to purchase beef with guaranteed...... tenderness, consumers express some reserve related to the possible upgrading of lower value cuts, too much standardisation, and the fact that tenderness is to some extent subjective. They further require the system to be simple, sufficiently documented and independent-party controlled. The insights obtained...

The life cycle cost of a building from the point of view of environmental criteria of selecting the most beneficial offer in the area of competitive tendering

Directory of Open Access Journals (Sweden)

Grzyl Beata

2017-01-01

Full Text Available The article analyses environmental and ecological criteria of selecting the most beneficial offer in the aspect of LCC. Construction works contracts and the potential method of defining the above criteria, among others, is pondered on (for example by the recommendation of a material, which is supposed to be used, a ban on substances that are harmful for human health as well for the environment. In the relation to the above, it is necessary to define technical parameters that have an impact on the environment, for example the level of pollution and noise emission, electricity and water consumption, or stating the minimal involvement of a processed ingredient. In addition the article presents also an account of the life cycle cost of a building from the point of view of environmental criteria constituting an element of selecting the most beneficial offer in the area of competitive tendering.

Child Care: A Business Investment That Works.

Science.gov (United States)

Children's Action Alliance, Phoenix, AZ.

This publication explains to Arizona employers the effect of child care difficulties on the work force and profitablity and describes ways to help employees meet their child care needs. Discussion concerns the benefits of employee child care assistance programs, program options available to employees, and the steps required to implement the…

Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care.

Science.gov (United States)

Gilster, Susan D; Boltz, Marie; Dalessandro, Jennifer L

2018-01-18

This article is one in a series of articles in this supplement addressing best practice for quality dementia care. The Alzheimer's Association, in revising their Dementia Care Practice Recommendations for 2017 has identified staff across the long-term care spectrum as a distinct and important determinant of quality dementia care. The purpose of this article is to highlight areas for developing and supporting a dementia-capable workforce. The Alzheimer's Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provide a framework to examine interventions to support the dementia care workforce in long-term care settings. Evidence-based approaches that represent these principles are discussed: (a) staffing, (b) staff training, (c) compensation, (d) supportive work environments, (e) career growth and retention, and (f) engagement with family. Although not all settings currently require attention to the principles described, this article proposes these principles as best practice recommendations. Recommendations and future research considerations to further improve the lives of those who live and work in nursing homes, assisted living, hospice, and home care, are proposed. Additional areas to improve the quality of a dementia care workforce person-centered care information, communication and interdepartmental teamwork, and ongoing evaluation are discussed. © The Author(s) 2018. 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.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

Science.gov (United States)

2013-08-19

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

[Community coordination of dental care needs in a home medical care support ward and at home].

Science.gov (United States)

Sumi, Yasunori; Ozawa, Nobuyoshi; Miura, Hiroko; Miura, Hisayuki; Toba, Kenji

2011-01-01

The purpose of this study was to ascertain the current statuses and problems of dental home care patients by surveying the oral care status and needs of patients in the home medical care support ward at the National Center for Geriatrics and Gerontology. Patients that required continuous oral management even after discharge from the hospital were referred to local dental clinics to receive home dental care. We investigated the suitability and problems associated with such care, and identified the dental care needs of home patients and the status of local care coordination, including those in hospitals. The subjects were 82 patients. We ascertained their general condition and oral status, and also investigated the problems associated with patients judged to need specialized oral care by a dentist during oral treatment. Patients who required continuous specialized oral care after discharge from hospital were referred to dental clinics that could provide regular care, and the problems at the time of referral were identified. Dry mouth was reported by many patients. A large number of patients also needed specialized dental treatment such as the removal of dental calculus or tooth extraction. Problems were seen in oral function, with 38 of the patients (46%) unable to gargle and 23 (28%) unable to hold their mouths open. About half of the patients also had dementia, and communication with these patients was difficult. Of the 43 patients who were judged to need continuing oral care after discharge from hospital, their referral to a dental clinic for regular care was successful for 22 (51%) patients and unsuccessful for 21 (49%) patients. The reasons for unsuccessful referrals included the fact that the family, patient, nurse, or caregiver did not understand the need for specialized oral care. The present results suggest the need for specialized oral treatment in home medical care. These findings also suggest that coordinating seamless dental care among primary physicians

Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

Science.gov (United States)

Cheraghi, Mohammad Ali; Esmaeili, Maryam; Salsali, Mahvash

Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

A PDA based Point of Care E-Health Solution for Ambulatory Care

Directory of Open Access Journals (Sweden)

Daniel Walsh

2005-11-01

Full Text Available The adoption of PDAs and mobile communication is expected to provide a solution to the use of computer technology by healthcare workers at the point-of-care. The Australian National Health Information Strategy, Health Online, is providing national leadership for approaches to address the quality and availability of information to assist in the planning and delivery of care. One area for potential growth is the availability and capture of information at the point of care by healthcare providers. A key factor in the lack of adoption of systems, is that traditionally health care information systems have been designed for desktop computing whereas many healthcare workers are highly mobile. This paper discusses phase one of a larger, four-phase project which aims to develop information access applications at point-of-care for Ambulatory Care Services. The initial phase of the research (phase one involves workflow analysis, requirements specification and the development and testing of a system prototype to assess the feasibility of achieving increased efficiencies in workflow at the Ambulatory Care Service.

Interprofessional Care and Role of Team Leaders.

Science.gov (United States)

Kaini, B K

2015-01-01

Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

Science.gov (United States)

Dodd, Virginia J; Logan, Henrietta; Brown, Cameron D; Calderon, Angela; Catalanotto, Frank

2014-12-01

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. © 2014, American School Health Association.

Quality assessment of palliative home care in Italy.

Science.gov (United States)

Scaccabarozzi, Gianlorenzo; Lovaglio, Pietro Giorgio; Limonta, Fabrizio; Floriani, Maddalena; Pellegrini, Giacomo

2017-08-01

The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted. Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature. The evaluation strategy is based on Rasch analysis, allowing to objectively measuring both performances of facilities and quality indicators' difficulty on the same metric, using 14 quality indicators identified by the observatory's steering committee. Globally, 195 home care teams were registered in the observatory reporting globally 40 955 cured patients in 2013 representing 66% of the population of home palliative care units active in Italy in 2013. Rasch analysis identifies 5 indicators ("interview" with caregivers, continuous training provided to medical and nursing staff, provision of specialized multidisciplinary interventions, psychological support to the patient and family, and drug supply at home) easy to endorse by health care providers and 3 problematic indicators (presence of a formally established Local Network of Palliative care in the area of reference, provision of the care for most problematic patient requiring high intensity of the care, and the percentage of cancer patient dying at Home). The lack of Local Network of Palliative care, required by law 38/2010, is, at the present, the main barrier to its application. However, the adopted methodology suggests that a clear roadmap for health facilities

Leadership in primary health care: an international perspective.

Science.gov (United States)

McMurray, Anne

2007-08-01

A primary health care approach is essential to contemporary nursing roles such as practice nursing. This paper examines the evolution of primary health care as a global strategy for responding to the social determinants of health. Primary health care roles require knowledge of, and a focus on social determinants of health, particularly the societal factors that allow and perpetuate inequities and disadvantage. They also require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context, and visionary in balancing both workforce and client needs. The key to succeeding in working with communities and groups under a primary health care umbrella is to balance the big picture of comprehensive primary health care with operational strategies for selective primary health care. The other essential element involves using leadership skills to promote inclusiveness, empowerment and health literacy, and ultimately, better health.

Redesigning ambulatory care business processes supporting clinical care delivery.

Science.gov (United States)

Patterson, C; Sinkewich, M; Short, J; Callas, E

1997-04-01

The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

Directory of Open Access Journals (Sweden)

Aij KH

2017-01-01

Full Text Available Kjeld Harald Aij, Sofia Rapsaniotis VU University Medical Center, Division Acute Care and Surgery, Amsterdam, The Netherlands Abstract: As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone’s leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations. Keywords: management, leadership attributes, efficiency, patient-centered, high-value care

Minimum standard guidelines of care on requirements for setting up a laser room

Directory of Open Access Journals (Sweden)

Dhepe Niteen

2009-08-01

Full Text Available Introduction, definition, rationale and scope: Lasers are now becoming an integral part of dermatological practice in India, with more and more dermatologists starting laser dermatology practice. Lasers, when are used with care, by properly trained operators, in carefully designed environment, can deliver a range of useful aesthetic and dermatologic treatments. Facility: Laser treatment is an office procedure, hence it does not require hospital set-up. The laser room facility requires careful planning keeping in mind safety of both patient and operator, convenience of operating, and optimum handling of costly equipments. The facility should be designed to handle procedures under local anesthesia and sedation. Facilities, staff and equipment to handle any emergencies should be available. Location: A room in existing dermatology clinic can be adequately converted to a laser room. Dimensions of laser room, its door and patient′s table should be such that it should facilitate easy movement of patient, machine trolley, operator and assistant in case of routine procedures and in emergency. Physician Qualification: Any dermatologist with MD or diploma in dermatology can do laser procedures, provided he/ she has acquired necessary skills by virtue of training, observing a competent dermatologist. Such training may be obtained during post graduation or later in specified workshops or courses under a competent dermatologist or at centre which routinely performs such procedures. Electricity and uninterrupted power supply: Laser equipments should be connected to stabilizer or UPS circuits only. Preferably an on line UPS as recommended by the laser company should be installed. Earthing of the equipment is essential to avoid damage to the equipment and electrical shocks to the operator. Sufficient power back up to complete the procedure if power is off midway, is essential. Air-conditioning: Laser machines should be operated in low ambient temperature, with

Technical Quality of Delivered Care for Patients with Inflammatory Bowel Disease in Tabriz Care Centers

Directory of Open Access Journals (Sweden)

Mohammad Hosein Somi

2015-08-01

Full Text Available ​Background and objectives : Inflammatory Bowel Disease (IBD is a chronic disease and requires complex treatment. Due to the various treatment options and gradual understanding of specialists about the risks and benefits of different treatments of IBD, delivering care according to the treatment protocols and guidelines is essential. This study was conducted to assess delivered care from the perspective of patients with inflammatory bowel disease. Material and Methods : This cross-sectional study was conducted with 94 participants with IBD selected randomly in Emam Reza hospital and Golgasht clinic in Tabriz. Data were collected by an approved researcher-made questionnaire via interviewing patients. Chi-Squared Test was used to evaluate the relationship between demographic variables and accordance of delivered care with standards. SPSS17 was used for data analysis. Results : The results indicated that "visit by specialist" and "providing dietary recommendation by nutritionist" aspects had highest and lowest degree of accordance with standards, respectively. Furthermore, the aspects of “delivered care in exacerbation status of disease” and “delivered care by other specialists” had only 20 percent compliance with standards. Also, there was a significant relationship between age, job, education status, smoking and compliance with related standards in some care aspects (p Conclusion : The study results indicated that there is a deep gap between delivered cares for patients with inflammatory bowel disease and related standards. These deficiencies showed the parts that need improvement and require healthcare managers and policy makers’ attention.

[A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

Science.gov (United States)

Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu

2015-12-01

Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

Intergrated dental care in nursing homes

NARCIS (Netherlands)

Gerritsen, P.F.M.

2015-01-01

The thesis deals with integrated dental care in nursing homes. First, the dental treatment needs were ascertained of 432 residents in three Dutch nursing homes that offer integrated dental care. Dentist researchers intra-orally examined the residents and found that 72% required dental treatment.

Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients.

Science.gov (United States)

Gajewski, James L; McClellan, Mark B; Majhail, Navneet S; Hari, Parameswaran N; Bredeson, Christopher N; Maziarz, Richard T; LeMaistre, Charles F; Lill, Michael C; Farnia, Stephanie H; Komanduri, Krishna V; Boo, Michael J

2018-01-01

Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for

Care Aides' Relational Practices and Caring Contributions.

Science.gov (United States)

Andersen, Elizabeth A; Spiers, Jude

2016-11-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Care Aides' Relational Practices and Caring Contributions" found on pages 24-30, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Define the application of Swanson's Middle Range Theory of Caring in care aides' relational care practices for nursing home

Organising care for people with diabetes and renal disease.

Science.gov (United States)

Dean, John

2012-02-01

Diabetes and chronic kidney disease (CKD) are two of the commonest long-term conditions. One-fifth of patients with diabetes will have CKD, and diabetes is the commonest cause of advanced kidney disease. For most patients these comorbidities will be managed in primary care with the focus on cardiovascular prevention. Many patients with more advanced disease and complications require joint care from multidisciplinary specialist teams in diabetes and renal disease to ensure that care is consistent and coordinated. Models of joint speciality care, include joint registry management, parallel clinics, shared consulting and case discussion, but require more evaluation than has currently been performed. These underpin more informal interactions between the specialist teams. A local model of care for diabetes and renal disease that incorporates the roles of primary care, members of multidisciplinary teams and speciality care should be agreed, resourced appropriately and its effectiveness monitored. © 2012 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Designing Robots for Care: Care Centered Value-Sensitive Design

NARCIS (Netherlands)

van Wynsberghe, Amy Louise

2013-01-01

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a

Nurse education and willingness to provide spiritual care.

Science.gov (United States)

Wu, Li-Fen; Tseng, Hui-Chen; Liao, Yu-Chen

2016-03-01

Spiritual care is a critical part of holistic care, and nurses require adequate preparation to address the spiritual needs of patients. However, nurses' willingness to provide such care has rarely been reported. Hence, nurses' education, and knowledge of spiritual care, as well as their willingness to provide it require further study. A convenience sample of 200 nurses participated in the study. Quantitative data were collected using a 21-item Spiritual Care Needs Inventory (content validity index=.87; Cronbach's alpha=.96). The majority of participants were female (96.5%, n=193) between 21 and 59years old (mean=35.1years). Moreover, the majority of participants had a Bachelor's degree (74.0%, n=148) and 1-36years of clinical experience (mean=12.13years). Regarding religious beliefs, 63 (31.5%) had no religious belief, and 93 (46.5%) did not engage in any religious activity. Overall, the nurses were willing to provide spiritual care, although only 25 (12.5%) felt that they had received adequate education. The findings of this study indicate the need for further educational preparation in spiritual care for nurses. Specifically, additional teaching materials are required that are more directly related to spiritual care. Greater emphasis should be placed on different subject areas in school-based education, continuing education, and self-learning education according to the needs of nurses. Since spiritual care education needs policy support, in-depth discussions should take place regarding the approach and cultural environment for providing spiritual care in future nursing courses. Moreover, further studies should investigate barriers in providing spiritual nursing care to patients and whether they are the results of a lack of relevant knowledge or other factors. Copyright © 2016 Elsevier Ltd. All rights reserved.