WorldWideScience

Sample records for requires tender care

  1. 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

  2. Defining Abnormally Low Tenders

    DEFF Research Database (Denmark)

    Ølykke, Grith Skovgaard; Nyström, Johan

    2017-01-01

    The concept of an abnormally low tender is not defined in EU public procurement law. This article takes an interdisciplinary law and economics approach to examine a dataset consisting of Swedish and Danish judgments and verdicts concerning the concept of an abnormally low tender. The purpose...

  3. 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.

  4. 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

  5. 31 CFR 309.10 - Tenders; reservation of right to reject.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Tenders; reservation of right to... BILLS § 309.10 Tenders; reservation of right to reject. In considering the acceptance of tenders, the highest prices offered will be accepted in full down to the amount required, and if the same price appears...

  6. Drug tendering: drug supply and shortage implications for the uptake of biosimilars

    Directory of Open Access Journals (Sweden)

    Dranitsaris G

    2017-09-01

    Full Text Available George Dranitsaris,1 Ira Jacobs,2 Carol Kirchhoff,3 Robert Popovian,4 Lesley G Shane5 1Augmentium Pharma Consulting Inc., Toronto, ON, Canada; 2Global Medical Affairs, Pfizer Inc, New York, NY, 3Global Technology Services, Biotechnology and Aseptic Sciences Group, Pfizer Inc, Chesterfield, MO, 4US Government Relations, Pfizer Inc, Washington, DC, 5Outcomes and Evidence, Global Health and Value, Pfizer Inc, New York, NY, USA Abstract: Due to the continued increase in global spending on health care, payers have introduced a number of programs, policies, and agreements on pharmaceutical pricing in order to control costs. While incentives to increase generic drug use have achieved significant savings, other cost-containment measures are required. Tendering is a formal procedure to purchase medications using competitive bidding for a particular contract. Although useful for cost containment, tendering can lead to decreased competition in a given market. Consequently, drug shortages can occur, resulting in changes to treatment plans to products that may have lower efficacy and/or an increased risk of adverse effects. Therefore, care must be taken to ensure that tendering does not negatively impact patient care or the health care system. A large and expanding portion of total pharmaceutical expenditure is for biologic therapies. These agents have revolutionized the treatment of many diseases, including cancer and inflammatory conditions; however, patient access to biologic drugs can be limited due to availability, insurance coverage, and cost. As branded biologic therapies reach the end of patent- and data-protection periods, biosimilars are being approved as lower-cost alternatives. Biosimilars are products that are highly similar to the originator product with no clinically meaningful differences in terms of safety, purity, or potency. As more biosimilars receive regulatory approval and adoption increases, these therapies are expected to have an

  7. 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.

  8. 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.

  9. 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

  10. 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...

  11. 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

  12. 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)

  13. 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...

  14. Tender Notices | About IASc | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Limited tender notification for AMC for computers & peripherals. Open tender for supply of printing and photocopier paper. Tender for Transport, Housekeeping and Catering services. Tender for website redesign - Work awarded to lowest bidder Sriranga Digital Software Technologies after scrutiny of price bids; Tender for ...

  15. 49 CFR 230.107 - Tender frame and body.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Tender frame and body. 230.107 Section 230.107... Tenders Trucks, Frames and Equalizing System § 230.107 Tender frame and body. (a) Maintenance. Tender... repaired: (1) Portions of the tender frame or body (except wheels) that have less than a 21/2 inches...

  16. 12 CFR 335.501 - Tender offers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Tender offers. 335.501 Section 335.501 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY SECURITIES OF NONMEMBER INSURED BANKS § 335.501 Tender offers. The provisions of the applicable and currently...

  17. Adapting Rational Unified Process (RUP) approach in designing a secure e-Tendering model

    Science.gov (United States)

    Mohd, Haslina; Robie, Muhammad Afdhal Muhammad; Baharom, Fauziah; Darus, Norida Muhd; Saip, Mohamed Ali; Yasin, Azman

    2016-08-01

    e-Tendering is an electronic processing of the tender document via internet and allow tenderer to publish, communicate, access, receive and submit all tender related information and documentation via internet. This study aims to design the e-Tendering system using Rational Unified Process approach. RUP provides a disciplined approach on how to assign tasks and responsibilities within the software development process. RUP has four phases that can assist researchers to adjust the requirements of various projects with different scope, problem and the size of projects. RUP is characterized as a use case driven, architecture centered, iterative and incremental process model. However the scope of this study only focusing on Inception and Elaboration phases as step to develop the model and perform only three of nine workflows (business modeling, requirements, analysis and design). RUP has a strong focus on documents and the activities in the inception and elaboration phases mainly concern the creation of diagrams and writing of textual descriptions. The UML notation and the software program, Star UML are used to support the design of e-Tendering. The e-Tendering design based on the RUP approach can contribute to e-Tendering developers and researchers in e-Tendering domain. In addition, this study also shows that the RUP is one of the best system development methodology that can be used as one of the research methodology in Software Engineering domain related to secured design of any observed application. This methodology has been tested in various studies in certain domains, such as in Simulation-based Decision Support, Security Requirement Engineering, Business Modeling and Secure System Requirement, and so forth. As a conclusion, these studies showed that the RUP one of a good research methodology that can be adapted in any Software Engineering (SE) research domain that required a few artifacts to be generated such as use case modeling, misuse case modeling, activity

  18. Limited tender for disposal of old printed journals

    Indian Academy of Sciences (India)

    2016-09-20

    Sep 20, 2016 ... TENDER NO IASC 03 /DISPOSAL OF OLD PRINTED JOURNALS I 2016-17. F. No. : Tender No. ... The competent authority also reserves the right to reject any or all the tenders without assigning any reason thereof. 19.

  19. 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...

  20. 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...

  1. 49 CFR 230.103 - Tender roller bearing journal boxes.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Tender roller bearing journal boxes. 230.103... Locomotives and Tenders Running Gear § 230.103 Tender roller bearing journal boxes. Tender roller bearing journal boxes shall be maintained in a safe and suitable condition. ...

  2. 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 ...

  3. 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.

  4. Construction Tender Subcontract Selection using Case-based Reasoning

    Directory of Open Access Journals (Sweden)

    Due Luu

    2012-11-01

    Full Text Available Obtaining competitive quotations from suitably qualified subcontractors at tender tim n significantly increase the chance of w1nmng a construction project. Amidst an increasingly growing trend to subcontracting in Australia, selecting appropriate subcontractors for a construction project can be a daunting task requiring the analysis of complex and dynamic criteria such as past performance, suitable experience, track record of competitive pricing, financial stability and so on. Subcontractor selection is plagued with uncertainty and vagueness and these conditions are difficul_t o represent in generalised sets of rules. DeciSIOns pertaining to the selection of subcontr:act?s tender time are usually based on the mtu1t1onand past experience of construction estimators. Case-based reasoning (CBR may be an appropriate method of addressing the chal_lenges of selecting subcontractors because CBR 1s able to harness the experiential knowledge of practitioners. This paper reviews the practicality and suitability of a CBR approach for subcontractor tender selection through the development of a prototype CBR procurement advisory system. In this system, subcontractor selection cases are represented by a set of attributes elicited from experienced construction estimators. The results indicate that CBR can enhance the appropriateness of the selection of subcontractors for construction projects.

  5. 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.

  6. 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.

  7. 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.)

  8. 49 CFR 230.102 - Tender plain bearing journal boxes.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Tender plain bearing journal boxes. 230.102... Locomotives and Tenders Running Gear § 230.102 Tender plain bearing journal boxes. Plain bearing journal boxes... expected to damage the bearing; or have a detrimental effect on the lubrication of the journal and bearing...

  9. TRANSCUTANEOUS ELECTRIC NERVE STIMULATION IN MODULATION OF PAIN OF TENDER POINTS IN SYNDROME FIBROMYALGIA: CASE STUDY

    Directory of Open Access Journals (Sweden)

    Isabel Mara Magalhães Rori

    2008-08-01

    Full Text Available The Fibromyalgia is a syndrome of pain and chronic diffuse, characterized by the presence of at least 11 of 18 points called anatomically specific tender points, painful on palpation. As the pain diffuse the main symptom of fibromyalgia. The current treatment is focused mainly to the reduction of symptoms. Physiotherapy has animportant role in improving the control of pain. This study aimed to verify the effectiveness of the main TENS of low frequency and high intensity in modulating pain of tender points of patients with fibromyalgia. For this was a case study of patient R. S. S., 38-yearold female carrier of the syndrome of fibromyalgia attended school in the clinic of the Faculty of Integrated Ceará (FISIOFIC. The patient was treated with the TENS-pain Acupuncture points in a total of twelve care and pain assessed before starting treatment and after three attendants. There was a significant reduction in pain intensity at 77.7% of the tender points in the second evaluation and 88.8% of the points in the other assessments. It was concluded that there was a reduction in the pain of tender points of the patient showing the analgesia promoted by TENS, so it should be used as a complementary treatment programs associated with other treatments and also served as a good technique to locate the tender points.

  10. 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...

  11. 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...

  12. 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.

  13. Possibilities concerning the procurement of a tender for a new nuclear power plant

    International Nuclear Information System (INIS)

    Winkler, Thomas; Streit, Marco

    2010-01-01

    The authors describe the legal frame for the licensing of a new nuclear power plant in Switzerland. The possibilities for a company to perform the procurement of a tender are discussed with respect to the decision to assign the project to a single contractor or to a consortium. The requirements to the contractor may be grouped in the categories cost, time schedule, function, volume and quality. Another topic in the discussion covers risks with respect to the tender and the contract and the appropriate solution strategies.

  14. 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.

  15. Price Determinants of the Tendering Process for Pharmaceuticals in the Cyprus Market.

    Science.gov (United States)

    Petrou, Panagiotis; Talias, Michael A

    2015-09-01

    Tendering has been a promising approach for procuring pharmaceuticals. Significant price reductions have been well documented by several authors. To our knowledge, there are limited data detailing the impact of variables in the tendering process. In this article, our objective was to evaluate the impact of potentially exploratory variables, which included innovation status, total value and volume of sales of each product, health care setting administration (hospital/outpatient), patent status (branded/generic), tendering type, and wholesale price, on price reduction in the tendering process. Financial data of public sector sales during 2011 were analyzed. On the basis of these data, we selected 178 medicines with corresponding sales of €49 million, out of a total market value of €104 million. Medicines were selected according to volume, value, and therapeutic value across all therapeutic areas. We performed a beta regression for the assessment of impact of variables and applied the same methodology to different subgroups. The generic status of medicines is statistically significantly associated with a higher price reduction. Tendering type by alternative, high wholesale prices, and high volume are robust estimators for price reduction. Innovation status does not have any effect on price reduction. Outpatient medicines reach lower prices as compared with hospital medicines. A rather unexpected finding is the negative correlation of high sales value with price reduction. These findings will lead to better understanding of the tendering framework, enabling us to further evolve its operational capacity, aiming to generate more savings. Moreover, our study indicates areas in which a more optimized approach is needed. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. 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)

  18. 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.

  19. 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.

  20. 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.

  1. 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 ...

  2. 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 ...

  3. 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 ...

  4. 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

  5. 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...

  6. 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

  7. 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...

  8. 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.

  9. Effects of moisture enhancement, enzyme treatment, and blade tenderization on the processing characteristics and tenderness of beef semimembranosus steaks.

    Science.gov (United States)

    Pietrasik, Z; Shand, P J

    2011-05-01

    The individual and combined effects of moisture enhancement with a salt/phosphate solution (ME), blade tenderization (BT), and enzyme injection with proteinases derived from Aspergillus oryzae or Bacillus subtilis on cooking properties, Warner-Bratzler shear force (WBSF), and sensory characteristics of beef semimembranosus were investigated. ME significantly (P < 0.01) reduced WBSF and increased (P < 0.05) sensory scores for juiciness and tenderness. BT increased (P < 0.05) initial and overall tenderness scores and made connective tissue less perceptible. BT combined with ME resulted in the highest initial and overall tenderness scores, however, combining ME with either proteinase was as effective for reducing WBSF and increasing tenderness, particularly at 20 (vs. 10) ppm enzyme inclusion. Tenderness of enzyme-injected steaks was increased without compromising other palatability attributes. All treatments increased the frequency of steaks rated slightly tender or higher, with the ME+BT combination, or ME with inclusion of 20 ppm of either proteinase, being most effective. Copyright © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.

  10. LEGAL AND TAX TREATMENT OF THE ASSOCIATIONS FOR THE PARTICIPATION IN TENDERS

    Directory of Open Access Journals (Sweden)

    Alina Bilan

    2017-12-01

    Full Text Available The participation of groups of economic operators with joint tender to public procurement procedures requires the conclusion of association agreements published together with the procurement documents by the contracting authorities. The contracting authorities often require these temporary associations specific legal forms, similar to joint ventures, or certain conditions concerning their organisation and functioning. This present study analyses the associations for participation to public tenders in light of public procurement and fiscal legislation, trying to asses if these contracts are joint venture agreements, to what extent the clauses comprised in the drafts imposed in the procuremnt documents are compatible with the public procurement and fiscal laws and if they may be challenged by the economic operators.

  11. 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

  12. Survey of billing and coding for counterstrain tender points.

    Science.gov (United States)

    Snider, Karen T; Johnson, Jane C

    2012-06-01

    The names of certain counterstrain tender points are incongruent with their physical locations because of an assumption that these points are reflective of dysfunction in neighboring body areas. Because the body area that is physically examined does not always match the body region in which somatic dysfunction is diagnosed for these tender points, it is not always clear which evaluation and management service codes should be used for billing physician services. To assess the attitudes of osteopathic physicians toward the billing and coding of incongruent counterstrain tender points. Physician members of the American Academy of Osteopathy who use counterstrain in clinical practice were surveyed regarding the body area that they would physically examine when assessing for incongruent tender points and, if tender points were present, the body regions to which they would assign somatic dysfunction for billing and coding purposes. Physician responses were categorized as indicating a structural approach (ie, reflective of anatomic location) or a functional approach (ie, reflective of dysfunction in neighboring body areas) to tender point examination and treatment. Associations between sex, specialty, and years in practice with the approach chosen were also examined. Of 175 physicians who responded to the survey, 156 met the study criteria. Respondents were primarily board-certified in neuromusculoskeletal medicine/osteopathic manipulative medicine (98 [63%]), special proficiency in osteopathic manipulative medicine (30 [19%]), or family practice/family practice and osteopathic manipulative treatment (94 [60%]). Ninety percent of physicians predominantly chose responses indicating a structural approach to the physical examination of tender points and 21% predominantly chose responses indicating a functional approach to somatic dysfunction diagnosis. There were inconsistencies among individual respondents regarding the type of approach chosen for a single tender point. For

  13. 17 CFR 240.14e-1 - Unlawful tender offer practices.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Unlawful tender offer... Securities Exchange Act of 1934 Regulation 14e § 240.14e-1 Unlawful tender offer practices. As a means... section 14(e) of the Act, no person who makes a tender offer shall: (a) Hold such tender offer open for...

  14. 49 CFR 230.90 - Draw gear between steam locomotive and tender.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Draw gear between steam locomotive and tender. 230... Steam Locomotives and Tenders Draw Gear and Draft Systems § 230.90 Draw gear between steam locomotive and tender. (a) Maintenance and testing. The draw gear between the steam locomotive and tender...

  15. 49 CFR 230.100 - Defects in tender truck axles and journals.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Defects in tender truck axles and journals. 230... Steam Locomotives and Tenders Running Gear § 230.100 Defects in tender truck axles and journals. (a... wheel seats that is more than 1/8 of an inch in depth. (b) Tender truck journal condemning defects...

  16. 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...

  17. 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.

  18. 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...

  19. Decision making in goverment tenders: A formalized qualitative model

    Directory of Open Access Journals (Sweden)

    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.

  20. 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

  1. 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.

  2. The unique requirements of primary health care in Southern Africa

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. 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."

  5. 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...

  6. 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....

  7. 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.

  8. 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.

  9. 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."

  10. 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...

  11. 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

  12. 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.

  13. 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...

  14. 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

  15. 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

  16. 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.

  17. Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care.

    Science.gov (United States)

    Cortina, Gerard; McRae, Rosemary; Chiletti, Roberto; Butt, Warwick

    2018-02-01

    To characterize the clinical indications, procedural safety, and outcome of critically ill children requiring therapeutic plasma exchange. Retrospective observational study based on a prospective registry. Tertiary and quaternary referral 30-bed PICU. Forty-eight critically ill children who received therapeutic plasma exchange during an 8-year period (2007-2014) were included in the study. Therapeutic plasma exchange. A total of 48 patients underwent 244 therapeutic plasma exchange sessions. Of those, therapeutic plasma exchange was performed as sole procedure in 193 (79%), in combination with continuous renal replacement therapy in 40 (16.4%) and additional extracorporeal membrane oxygenation in 11 (4.6%) sessions. The most common admission diagnoses were hematologic disorders (30%), solid organ transplantation (20%), neurologic disorders (20%), and rheumatologic disorders (15%). Complications associated with the procedure occurred in 50 (21.2%) therapeutic plasma exchange sessions. Overall, patient survival from ICU was 82%. Although patients requiring therapeutic plasma exchange alone (n = 31; 64%) had a survival rate of 97%, those with additional continuous renal replacement therapy (n = 13; 27%) and extracorporeal membrane oxygenation (n = 4; 8%) had survival rates of 69% and 50%, respectively. Factors associated with increased mortality were lower Pediatric Index of Mortality 2 score, need for mechanical ventilation, higher number of failed organs, and longer ICU stay. Our results indicate that, in specialized centers, therapeutic plasma exchange can be performed relatively safely in critically ill children, alone or in combination with continuous renal replacement therapy and extracorporeal membrane oxygenation. Outcome in children requiring therapeutic plasma exchange alone is excellent. However, survival decreases with the number of failed organs and the need for continuous renal replacement therapy and extracorporeal membrane oxygenation.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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)....

  3. 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

  4. 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...

  5. 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...

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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…

  11. 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.

  12. 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...

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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...

  18. 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.

  19. 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

  20. 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....

  1. 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...

  2. 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.

  3. 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.

  4. 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...

  5. 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.

  6. 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.

  7. 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.

  8. [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.

  9. 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

  10. 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.

  11. 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.

  12. 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...

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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...

  1. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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...

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. Fermentation of tender coconut water by probiotic bacteria Bacillus coagulans

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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.

  1. 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 ...

  2. 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 ...

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Cement: Administrative tender specifications and standards in Spain

    Directory of Open Access Journals (Sweden)

    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.

  8. 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...

  9. 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

  10. 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.

  11. 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

  12. 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

  13. 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...

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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...

  4. 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)

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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...

  10. 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%.

  11. Intravenous dextrose administration reduces postoperative antiemetic rescue treatment requirements and postanesthesia care unit length of stay.

    Science.gov (United States)

    Dabu-Bondoc, Susan; Vadivelu, Nalini; Shimono, Chantelle; English, Annette; Kosarussavadi, Boonsri; Dai, Feng; Shelley, Kirk; Feinleib, Jessica

    2013-09-01

    , postanesthesia IV dextrose administration resulted in improved PONV management as defined by reductions in antiemetic rescue medication requirements and PACU length of stay that are worthy of further study. In light of its ease, low risk, and benefit to patient care and satisfaction, this therapeutic modality could be considered.

  12. 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.

  13. 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.

  14. The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care.

    Science.gov (United States)

    Grönholm, L; Lemberg, K K; Tjäderhane, L; Lauhio, A; Lindqvist, C; Rautemaa-Richardson, R

    2013-01-01

    The aim of this study was to evaluate clinical and radiological findings and the role of periapical infection and antecedent dental treatment of infected focus teeth in odontogenic maxillofacial abscesses requiring hospital care. In this retrospective cohort study, we evaluated medical records and panoramic radiographs during the hospital stay of patients (n = 60) admitted due to odontogenic maxillofacial infection originating from periapical periodontitis. Twenty-three (38 %) patients had received endodontic treatment and ten (17 %) other acute dental treatment. Twenty-seven (45 %) had not visited the dentist in the near past. Median age of the patients was 45 (range 20-88) years and 60 % were males. Unfinished root canal treatment (RCT) was the major risk factor for hospitalisation in 16 (27 %) of the 60 cases (p = .0065). Completed RCT was the source only in 7 (12 %) of the 60 cases. Two of these RCTs were adequate and five inadequate. The initiation of inadequate or incomplete primary RCT of acute periapical periodontitis appears to open a risk window for locally invasive spread of infection with local abscess formation and systemic symptoms. Thereafter, the quality of the completed RCT appears to have minor impact. However, a considerable proportion of the patients had not received any dental treatment confirming the importance of good dental health. Thus, thorough canal debridement during the first session is essential for minimising the risk for spread of infection in addition to incision and drainage of the abscess. If this cannot be achieved, tooth extraction should be considered. Incomplete or inadequate canal debridement and drainage of the abscess may increase the risk for spread of endodontic infection.

  15. Financial and Temporal Advantages of Virtual Consultation in Veterans Requiring Specialty Care.

    Science.gov (United States)

    Abbott, Daniel E; Macke, Ryan A; Kurtz, Jodi; Safdar, Nasia; Greenberg, Caprice C; Weber, Sharon M; Voils, Corrine I; Fisher, Deborah A; Maloney, James D

    2018-01-01

    Access to specialty health care in the Veterans Affairs (VA) system continues to be problematic. Given the potential temporal and fiscal benefits of telehealth, the Madison VA developed a virtual consultation (VC) mechanism to expedite diagnostic and therapeutic interventions for Veterans with incidentally discovered pulmonary nodules. Materials and. VC, a remote encounter between referring provider and thoracic surgeon for incidentally discovered pulmonary nodules, was implemented at the Madison VA between 2009 and 2011. Time from request to completion of consultation, hospital cost, and travel costs were determined for 157 veterans. These endpoints were then compared with in-person consultations over a concurrent 6-mo period. For the entire study cohort, the mean time to completion of VC was 3.2 d (SD ± 4.4 d). For the 6-mo period of first VC availability, the mean time to VC completion versus in-person consultation was 2.8 d (SD ± 2.8 d) and 20.5 d (SD ± 15.6 d), respectively (p < 0.05). Following initial VC, 84 (53%) veterans were scheduled for virtual follow-up alone; no veteran required an additional office visit before further diagnostic or therapeutic intervention. VA hospital cost was $228 per in-person consultation versus $120 per episode for VC - a 47.4% decrease. The average distance form veteran home to center was 86 miles, with an average travel reimbursement of $112 per in-person consultation, versus no travel cost associated with VC. VC for incidentally discovered pulmonary nodules significantly decreases time to consultation completion, hospital cost, and veteran travel cost. These data suggest that a significant opportunity exists for expansion of telehealth into additional practice settings within the VA system. © Association of Military Surgeons of the United States 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  16. 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.

  17. 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...

  18. 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...

  19. 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.

  20. 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

  1. 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....

  2. 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

  3. 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...

  4. 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.

  5. 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...

  6. 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

  7. 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.

  8. 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.

  9. 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)...

  10. 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 ...

  11. 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

  12. Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature.

    Science.gov (United States)

    Aij, Kjeld Harald; Rapsaniotis, Sofia

    2017-01-01

    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.

  13. Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

    OpenAIRE

    Aij,Kjeld Harald; Rapsaniotis,Sofia

    2017-01-01

    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 inform...

  14. 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

  15. 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.

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

    Science.gov (United States)

    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.

  17. Bronchial thermoplasty: a novel treatment for severe asthma requiring monitored anesthesia care.

    Science.gov (United States)

    Lee, Jamille A; Rowen, David W; Rose, David D

    2011-12-01

    Dexmedetomidine used in monitored anesthesia care produces a safe and effective technique well documented in research. We report the successful use of dexmedetomidine for sedation during bronchial thermoplasty, a new treatment for patients with severe persistent asthma refractory to inhaled corticosteroids and long-term beta-2 agonists.

  18. Barriers and requirements for achieving interoperable eHealth technology in primary care

    NARCIS (Netherlands)

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

    2015-01-01

    Despite its great promises, eHealth is not yet structurally embedded within the IT infrastructure of primary care. This is mainly due to the fact that healthcare technologies have been developed without coordination and a centralized approach [1], which in turn has led to a lack of shared standards

  19. 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.

  20. Rancangan Aplikasi Manajemen Dokumen Tender Berbasis Web Pada PT. Emi

    Directory of Open Access Journals (Sweden)

    Sablin Yusuf

    2010-12-01

    Full Text Available The objective of this researh is to design a software application for bidding document management as required by PT Energy Management Indonesia (EMI in order to increase the company performance. The methodology used is fact-finding through direct observation, followed by literature study, and web application development method using waterfall model and rapid prototyping for software development. The result is a software application, web based, which can increase the company performance due to the required bidding document preparation and the responding data are well stored and managed hence can be accessed easily when needed. In summary the application which is well supported by the related database will assist the company quikly and easily in bidding preparation process 

  1. 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.)

  2. 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.

  3. 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.

  4. 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.

  5. What kind of information will be required if we are to reform health care?

    Science.gov (United States)

    Kaplan, J G

    1994-10-01

    The only logical way to avoid unnecessary future costs and improve quality is to analyze the past, providing input for the present. The informational management strategies are ready. There is continuous quality improvement, profiling with case-mix adjustment, and other techniques that will help us manage care and caring. But these strategies all rely on the customer being empowered to make truly informed decisions (the ethical principle of autonomy) and for us to advocate for patients (beneficence). Translating relevant data into information is the concentration of medical informatics. Virtually everyone in medical management can attest to the fact that, competitive forces notwithstanding, it is time for us to recognize not only that we are in the information business, but also that this information belongs to a larger community. Clearly, it is time to collaborate!

  6. Quality Assurance in Breast Health Care and Requirement for Accreditation in Specialized Units.

    Science.gov (United States)

    Güler, Sertaç Ata; Güllüoğlu, Bahadır M

    2014-07-01

    Breast health is a subject of increasing importance. The statistical increase in the frequency of breast cancer and the consequent increase in death rate increase the importance of quality of services to be provided for breast health. For these reasons, the minimum standards and optimum quality metrics of breast care provided to the community are determined. The quality parameters for breast care service include the results, the structure and the operation of services. Within this group, the results of breast health services are determined according to clinical results, patient satisfaction and financial condition. The structure of quality services should include interdisciplinary meetings, written standards for specific procedures and the existence of standardized reporting systems. Establishing breast centers that adopt integrated multidisciplinary working principles and their cost-effective maintenance are important in terms of operation of breast health services. The importance of using a "reviewing/auditing" procedure that checks if all of these functions existing in the health system are carried out at the desired level and an "accreditation" system indicating that the working breast units/centers provide minimum quality adequacy in all aspects, is undeniable. Currently, the accreditation system for breast centers is being used in the European Union and the United States for the last 5-10 years. This system is thought to provide standardization in breast care services, and is accepted as one of the important factors that resulted in reduction in mortality associated with breast cancer.

  7. A Joint Force Medical Command is Required to Fix Combat Casualty Care

    Science.gov (United States)

    2017-10-05

    DISTRIBUTION STATEMENT: A Approved for Public Release Distribution is Unlimited The views expressed herein are those of the author(s) and do not...MHS) is required to provide medical operational forces for military and contingency operations while also providing services that maintain a healthy...provide timely support of joint forcible entry or other contingencies requiring rapid response. Further, the complexity and cost of the beneficiary

  8. 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.

  9. 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...

  10. 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...

  11. 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...

  12. 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)

  13. 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...

  14. 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)

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. 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.

  20. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. [Neonatal ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care].

    Science.gov (United States)

    Senterre, T; Minon, J-M; Rigo, J

    2011-03-01

    ABO allo-immunization is the most frequent hemolytic disease of the newborn and ABO incompatibility is present in 15-25 % of pregnancies. True ABO alloimmunization occurs in approximately one out of 150 births. Intensity is generally lower than in RhD allo-immunization. We report on three cases showing that ABO allo-immunization can lead to severe hemolytic disease of the newborn with potentially threatening hyperbilirubinemia and complications. Early diagnosis and adequate care are necessary to prevent complications in ABO incompatibility. A direct antiglobulin test is the cornerstone of diagnosis and should be performed at birth on cord blood sampling in all group infants born to O mothers, especially if of African origin. Risk factor analysis and attentive clinical monitoring during the first days of life are essential. Vigilance is even more important for infants discharged before the age of 72 h. Every newborn should be assessed for the risk of developing severe hyperbilirubinemia and should be examined by a qualified healthcare professional in the first days of life. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 h of life in cases of hemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinemia encephalopathy. Intravenous immunoglobulins are used to reduce exchange transfusion. Treatments of severe hemolytic disease of the newborn should be provided and performed by trained personnel in neonatal intensive care units. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  3. Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

    Science.gov (United States)

    van Diepen, Sean; Lin, Meng; Bakal, Jeffrey A; McAlister, Finlay A; Kaul, Padma; Katz, Jason N; Fordyce, Christopher B; Southern, Danielle A; Graham, Michelle M; Wilton, Stephen B; Newby, L Kristin; Granger, Christopher B; Ezekowitz, Justin A

    2016-05-01

    Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described. We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, PST-segment myocardial infarction or unstable angina. There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 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

  5. 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...

  6. 77 FR 28790 - Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act

    Science.gov (United States)

    2012-05-16

    ... Internet Web site of the Department of Health and Human Services.'' In addition, section 1103(b) of the... other things, ``require the inclusion of information on the percentage of total premium revenue expended..., pursuant to this final rule, for the 2011 MLR reporting year. \\5\\ Source: Agency for Healthcare Research...

  7. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2013-06-27

    .... The LTC facility regulations clearly specify what services the facility is required to provide to... professional caregivers and are often paid by third-party payers, such as Medicaid. These facilities are... benefit. In regulations at 42 CFR 418.112(c), we specify what must be included in a written agreement...

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

    Science.gov (United States)

    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.

  9. 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

  10. Sex Differences in Health Care Requirements Aboard U.S. Navy Ships

    Science.gov (United States)

    1990-03-20

    asymptomatic in females, and yet may lead to serious complications, requires more sensitive laboratory and test capabilities than currently exist aboard...DISEASES OF THE DIGESTIVE SYSTEM (520-579) 18.0 28.1 14.7 1.92 522 Diseases of pulp or periapical tissues .08 .00 .11 -- 523 Gingival or periodontal ...ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATiON Naval Health Research Center (if apicable ) Chief 40 Bureau of Medicine and Surgery 6c ADDRESS

  11. The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care.

    Science.gov (United States)

    Koegelenberg, C F N; Nortje, A; Lalla, U; Enslin, A; Irusen, E M; Rosenkranz, B; Seifart, H I; Bolliger, C T

    2013-04-05

    There is a paucity of data on the pharmacokinetics of fixed-dose combination enteral antituberculosis treatment in critically ill patients. To establish the pharmacokinetic profile of a fixed-dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol given according to weight via a nasogastric tube to patients admitted to an intensive care unit (ICU). We conducted a prospective, observational study on 10 patients (mean age 32 years, 6 male) admitted to an ICU and treated for tuberculosis (TB). Serum concentrations of the drugs were determined at eight predetermined intervals over 24 hours by means of high-performance liquid chromatography. The therapeutic maximum plasma concentration (Cmax) for rifampicin at time to peak concentration was achieved in only 4 patients, whereas 2 did not achieve therapeutic Cmax for isoniazid. No patient reached sub-therapeutic Cmax for pyrazinamide (6 were within and 4 above therapeutic range). Three patients reached sub-therapeutic Cmax for ethambutol, and 6 patients were within and 1 above the therapeutic range. Patients with a sub-therapeutic rifampicin level had a higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p=0.03) and a lower estimated glomerular filtration rate (GFR) (p=0.03). A fixed-dose combination tablet, crushed and mixed with water, given according to weight via a nasogastric tube to patients with TB admitted to an ICU resulted in sub-therapeutic rifampicin plasma concentrations in the majority of patients, whereas the other drugs had a more favourable pharmacokinetic profile. Patients with a sub-therapeutic rifampicin concentration had a higher APACHE II score and a lower estimated GFR, which may contribute to suboptimal outcomes in critically ill patients. Studies in other settings have reported similar proportions of patients with 'sub-therapeutic' rifampicin concentrations.

  12. Genomic selection needs to be carefully assessed to meet specific requirements in livestock breeding programs.

    Science.gov (United States)

    Jonas, Elisabeth; de Koning, Dirk-Jan

    2015-01-01

    Genomic selection is a promising development in agriculture, aiming improved production by exploiting molecular genetic markers to design novel breeding programs and to develop new markers-based models for genetic evaluation. It opens opportunities for research, as novel algorithms and lab methodologies are developed. Genomic selection can be applied in many breeds and species. Further research on the implementation of genomic selection (GS) in breeding programs is highly desirable not only for the common good, but also the private sector (breeding companies). It has been projected that this approach will improve selection routines, especially in species with long reproduction cycles, late or sex-limited or expensive trait recording and for complex traits. The task of integrating GS into existing breeding programs is, however, not straightforward. Despite successful integration into breeding programs for dairy cattle, it has yet to be shown how much emphasis can be given to the genomic information and how much additional phenotypic information is needed from new selection candidates. Genomic selection is already part of future planning in many breeding companies of pigs and beef cattle among others, but further research is needed to fully estimate how effective the use of genomic information will be for the prediction of the performance of future breeding stock. Genomic prediction of production in crossbreeding and across-breed schemes, costs and choice of individuals for genotyping are reasons for a reluctance to fully rely on genomic information for selection decisions. Breeding objectives are highly dependent on the industry and the additional gain when using genomic information has to be considered carefully. This review synthesizes some of the suggested approaches in selected livestock species including cattle, pig, chicken, and fish. It outlines tasks to help understanding possible consequences when applying genomic information in breeding scenarios.

  13. Genomic selection needs to be carefully assessed to meet specific requirements in livestock breeding programs

    Directory of Open Access Journals (Sweden)

    Elisabeth eJonas

    2015-02-01

    Full Text Available Genomic selection is a promising development in agriculture, aiming improved production by exploiting molecular genetic markers to design novel breeding programs and to develop new markers-based models for genetic evaluation. It opens opportunities for research, as novel algorithms and lab methodologies are developed. Genomic selection can be applied in many breeds and species. Further research on the implementation of genomic selection in breeding programs is highly desirable not only for the common good, but also the private sector (breeding companies. It has been projected that this approach will improve selection routines, especially in species with long reproduction cycles, late or sex-limited or expensive trait recording and for complex traits. The task of integrating genomic selection into existing breeding programs is, however, not straightforward. Despite successful integration into breeding programs for dairy cattle, it has yet to be shown how much emphasis can be given to the genomic information and how much additional phenotypic information is needed from new selection candidates. Genomic selection is already part of future planning in many breeding companies of pigs and beef cattle among others, but further research is needed to fully estimate how effective the use of genomic information will be for the prediction of the performance of future breeding stock. Genomic prediction of production in crossbreeding and across-breed schemes, costs and choice of individuals for genotyping are reasons for a reluctance to fully rely on genomic information for selection decisions. Breeding objectives are highly dependent on the industry and the additional gain when using genomic information has to be considered carefully. This review synthesizes some of the suggested approaches in selected livestock species including cattle, pig, chicken and fish. It outlines tasks to help understanding possible consequences when applying genomic information in

  14. 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

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

    Science.gov (United States)

    Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

    2017-01-01

    Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel ® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact

  5. 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.

  6. An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

    Science.gov (United States)

    Khan, Rasheda; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

    2012-01-01

    Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008–August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health

  7. A new approach to scoring systems to improve identification of acute medical admissions that will require critical care.

    Science.gov (United States)

    Carmichael, H A; Robertson, E; Austin, J; McCruden, D; Messow, C M; Belcher, P R

    2011-11-01

    Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92·4%) than PREAMBLE-1 (88·1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years.

  8. 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.

  9. Psychometric study of the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG).

    Science.gov (United States)

    Lascorz, David; López, Victoria; Pinedo, Carmen; Trujols, Joan; Vegué, Joan; Pérez, Víctor

    2016-03-08

    People with severe mental disorder have significant difficulties in everyday life that involve the need for continued support. These needs are not easily measurable with the currently available tools. Therefore, a multidimensional scale that assesses the different levels of need for care is proposed, including a study of its psychometric properties. One-hundred and thirty-nine patients (58% men) with a severe mental disorder were assessed using the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG), the Camberwell Assessment of Need scale, and the Health of the Nation Outcome Scales. ENAR-TMG's psychometric features were examined by: a) evaluating 2 sources of validity evidence (evidence based on internal structure and evidence based on relations to other variables), and b) estimating the internal consistency, temporal stability, inter-rater reliability, and sensitivity to change of scores of the ENAR-TMG's subscales. Exploratory factor analyses revealed a one-factor structure for each of the theoretical dimensions of the scale, in which all but one showed a significant and positive correlation with the Camberwell Assessment of Need (range of r: 0.143-0.557) and Health of the Nation Outcome Scales (range of r: 0.241-0.474) scales. ENAR-TMG subscale scores showed acceptable internal consistency (range of ordinal α coefficients: 0.682-0.804), excellent test-retest (range of intraclass correlation coefficients: 0.889-0.999) and inter-rater reliabilities (range of intraclass correlation coefficients: 0.926-0.972), and satisfactory sensitivity to treatment-related changes (range of η 2 : 0.003-0.103). The satisfactory psychometric behaviour of the ENAR-TMG makes the scale a promising tool to assess global functioning in people with a severe mental disorder. Copyright © 2016 SEP y SEPB. Published by Elsevier España. All rights reserved.

  10. 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.

  11. 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,

  12. 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...

  13. 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.

  14. 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.

  15. [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.

  16. 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.

  17. 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.

  18. 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...

  19. 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...

  20. 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.

  1. 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...

  2. 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.)

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. The impact of architectural design upon the environmental sound and light exposure of neonates who require intensive care: an evaluation of the Boekelheide Neonatal Intensive Care Nursery.

    Science.gov (United States)

    Stevens, D C; Akram Khan, M; Munson, D P; Reid, E J; Helseth, C C; Buggy, J

    2007-12-01

    To evaluate the differences in environmental sound, illumination and physiological parameters in the Boekelheide Neonatal Intensive Care Unit (BNICU), which was designed to comply with current recommendations and standards, as compared with a conventional neonatal intensive care unit (CNICU). Prospectively designed observational study. Median sound levels in the unoccupied BNICU (37.6 dBA) were lower than the CNICU (42.1 dBA, P<0.001). Median levels of minimum (6.4 vs 48.4 lux, P<0.05) and maximum illumination (357 vs 402 lux, P<0.05) were lower in the BNICU. A group of six neonates delivered at 32 weeks gestation showed significantly less periodic breathing (14 vs 21%) and awake time (17.6 vs 29.3%) in the BNICU as compared to the CNICU. Light and sound were both significantly reduced in the BNICU. Care in the BNICU was associated with improved physiological parameters.

  13. 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.

  14. 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.

  15. 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 ...

  16. 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®

  17. 78 FR 16795 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

    Science.gov (United States)

    2013-03-19

    ... can be defined by race/ethnicity, socioeconomic status, geography, gender, age, disability status... received on this very important issue. CMS is committed to addressing health care inequalities for racial...

  18. The Air Force Critical Care Air Transport Team (CCATT): Using the Estimating Supplies Program (ESP) to Validate Clinical Requirements

    Science.gov (United States)

    2005-04-05

    Disease, Severe. 0249 Peptic Ulcer , Gastric or Duodenal, Penetrating and/or Perforating . 0250 Peptic Ulcer , Gastric or Duodenal, Uncomplicated. 0251...in US Air Force (USAF) Allowance Standard (AS) development and management . The Critical Care Air Transport Team (CCATT) Unit Type Code (UTC) AS was...tasks enabling the management of the critically ill or injured en route to the appropriate level of care (LOC) or medical treatment facility (MTF

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

    Directory of Open Access Journals (Sweden)

    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

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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...

  7. 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%.

  8. 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%.

  9. An aging population and growing disease burden will require a large and specialized health care workforce by 2025.

    Science.gov (United States)

    Dall, Timothy M; Gallo, Paul D; Chakrabarti, Ritasree; West, Terry; Semilla, April P; Storm, Michael V

    2013-11-01

    As the US population ages, the increasing prevalence of chronic disease and complex medical conditions will have profound implications for the future health care system. We projected future prevalence of selected diseases and health risk factors to model future demand for health care services for each person in a representative sample of the current and projected future population. Based on changing demographic characteristics and expanded medical coverage under the Affordable Care Act, we project that the demand for adult primary care services will grow by approximately 14 percent between 2013 and 2025. Vascular surgery has the highest projected demand growth (31 percent), followed by cardiology (20 percent) and neurological surgery, radiology, and general surgery (each 18 percent). Market indicators such as long wait times to obtain appointments suggest that the current supply of many specialists throughout the United States is inadequate to meet the current demand. Failure to train sufficient numbers and the correct mix of specialists could exacerbate already long wait times for appointments, reduce access to care for some of the nation's most vulnerable patients, and reduce patients' quality of life.

  10. Understanding patient requirements for technology systems that support pain management in palliative care services: A qualitative study.

    Science.gov (United States)

    Allsop, Matthew J; Taylor, Sally; Bennett, Michael I; Bewick, Bridgette M

    2017-11-01

    Approaches to pain management using electronic systems are being developed for use in palliative care. This article explores palliative care patients' perspectives on managing and talking about pain, the role of technology in their lives and how technology could support pain management. Face-to-face interviews were used to understand patient needs and concerns to inform how electronic systems are developed. A total of 13 interviews took place with a convenience sample of community-based patients with advanced cancer receiving palliative care through a hospice. Data were analysed using framework analysis. Four meta-themes emerged: Technology could be part of my care; I'm trying to understand what is going on; My pain is ever-changing and difficult to control; and I'm selective about who to tell about pain. Patients described technology as peripheral to existing processes of care. To be relevant, systems may need to take account of the complexity of a patient's pain experience alongside existing relationships with health professionals.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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%.

  1. Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

    Science.gov (United States)

    Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

    2013-06-10

    The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes

  2. 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...

  3. 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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  6. 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.

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

    Science.gov (United States)

    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.

  8. 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.

  9. Planning intensive care unit design using computer simulation modeling: optimizing integration of clinical, operational, and architectural requirements.

    Science.gov (United States)

    OʼHara, Susan

    2014-01-01

    Nurses have increasingly been regarded as critical members of the planning team as architects recognize their knowledge and value. But the nurses' role as knowledge experts can be expanded to leading efforts to integrate the clinical, operational, and architectural expertise through simulation modeling. Simulation modeling allows for the optimal merge of multifactorial data to understand the current state of the intensive care unit and predict future states. Nurses can champion the simulation modeling process and reap the benefits of a cost-effective way to test new designs, processes, staffing models, and future programming trends prior to implementation. Simulation modeling is an evidence-based planning approach, a standard, for integrating the sciences with real client data, to offer solutions for improving patient care.

  10. An Interdisciplinary Approach Between Medical Informatics and Social Sciences to Transdisciplinary Requirements Engineering for an Integrated Care Setting.

    Science.gov (United States)

    Vielhauer, Jan; Böckmann, Britta

    2017-01-01

    Requirements engineering of software products for elderly people faces some special challenges to ensure a maximum of user acceptance. Within the scope of a research project, a web-based platform and a mobile app are approached to enable people to live in their own home as long as possible. This paper is about a developed method of interdisciplinary requirements engineering by a team of social scientists in cooperation with computer scientists.

  11. 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

  12. 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.

  13. 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 .

  14. 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.

  15. 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

  16. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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)

  19. Medical Device Connectivity Challenges Outline the Technical Requirements and Standards For Promoting Big Data Research and Personalized Medicine in Neurocritical Care.

    Science.gov (United States)

    Rodriguez, Anna; Smielewski, Peter; Rosenthal, Eric; Moberg, Dick

    2018-03-01

    Brain injuries are complicated medical problems and their management requires data from disparate sources to extract actionable information. In neurocritical care, interoperability is lacking despite the perceived benefits. Several efforts have been underway, but none have been widely adopted, underscoring the difficulty of achieving this goal. We have identified the current pain points of data collection and integration based on the experience with two large multi-site clinical studies: Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) in the United States and Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) in Europe. The variability of measurements across sites remains a barrier to uniform data collection. We found a need for annotation standards and for a standardized archive format for high-resolution data. Overall, the hidden cost for successful data collection was initially underestimated.Although the use of bedside data integration solutions, such as the Moberg's Component Neuromonitoring System (Moberg Research, Inc., Ambler, PA, USA) or ICM+ software (Cambridge Enterprise, Cambridge, UK), facilitated the homogenous collection of synchronized data, there remain issues that need to be addressed by the neurocritical care community. To this end, we have organized a Working Group on Neurocritical Care Informatics, whose next step is to create an overarching informatics framework that takes advantage of the collected information to answer scientific questions and to accelerate the translation of trial results to actions benefitting military medicine.

  20. Enhanced self-monitoring blood glucose in non-insulin requiring Type 2 diabetes: A qualitative study in primary care.

    Science.gov (United States)

    Brackney, Dana Elisabeth

    2018-03-31

    To contribute to both theoretical and practical understanding of the role of self-monitoring blood glucose for self-management by describing the experience of people with non-insulin requiring Type 2 diabetes in an enhanced structured self-monitoring blood glucose intervention. The complex context of self-monitoring blood glucose in Type 2 diabetes requires a deeper understanding of the clients' illness experience with structured self-monitoring of blood glucose. Clients' numeracy skills contribute to their response to blood glucose readings. Nurses' use of motivational interviewing to increase clients' regulatory self-efficacy is important to the theoretical perspective of the study. A qualitative descriptive study. A purposive sample of eleven adults recently (diabetes who had experienced a structured self-monitoring blood glucose intervention participated in this study. Audio recordings of semi-structured interviews and photos of logbooks were analyzed for themes using constant comparison and member checking. The illness experience states of Type 2 diabetes include 'Diagnosis', 'Behavior change', and 'Routine checking'. People check blood glucose to confirm their Type 2 diabetes diagnosis, to console their diabetes related fears, to create personal explanations of health behavior's impact on blood glucose, to activate behavior change and to congratulate their diabetes self-management efforts. These findings support the Transtheoretical model's stages of change and change processes. Blood glucose checking strengthens the relationships between theoretical concepts found in Diabetes Self-management Education-Support including: engagement, information sharing, and behavioral support. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. 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.

  2. 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.

  3. 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...

  4. Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care

    Directory of Open Access Journals (Sweden)

    Zhihong Feng

    2017-01-01

    Full Text Available We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients and those who did not (survival group; 336 patients. Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age (P<0.05 for all. With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II (P=1.519. Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

  5. 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.

  6. 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...

  7. 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...

  8. 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.)

  9. Guidelines, minimal requirements and standard of cancer care around the Mediterranean Area: report from the Collaborative AROME (Association of Radiotherapy and Oncology of the Mediterranean Area) working parties.

    Science.gov (United States)

    2011-04-01

    Guidelines are produced in oncology to facilitate clinical decision making and improve clinical practice. However, existing guidelines are mainly developed for countries with a certain availability of means and cultural aspects are rarely taken into account. Around the Mediterranean Area, countries share common cultural backgrounds but also great disparities with respect to availability of means; current guidelines by most societies are not applicable to all of those countries. Association of Radiotherapy and Oncology of the Mediterranean Area (AROME) is a scientific organization for the promotion and overcoming of inequalities in oncology clinical practice around the Mediterranean Area. In an effort to accomplish this goal, members of the AROME society have developed clinical recommendations for most common cancer sites in countries around the Mediterranean Area. The structure of these recommendations lies in the concept of minimal requirements vs. standard of care; they are being presented and discussed in the main text. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  10. 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...

  11. Effects of aspiration pneumonia on the intensive care requirements and in-hospital mortality of hospitalised patients with acute cerebrovascular disease.

    Science.gov (United States)

    Güngen, Adil Can; Aydemir, Yusuf; Güngen, Belma Dogan; Yazar, Esra Ertan; Yağız, Orhan; Aras, Yeşim Güzey; Gümüş, Hatice; Erkorkmaz, Ünal

    2017-08-01

    In this study, we aimed to evaluate the effects of the development of aspiration pneumonia (AP) on the intensive care unit (ICU) requirements and in-hospital mortality of patients hospitalised in the neurology ward due to an acute cerebrovascular accident (CVA). Five hundred and three patients hospitalised in the neurology ward following an acute CVA were retrospectively analysed. The patients were divided into two groups: those with AP (group 1) and those without AP (group 2). Demographic characteristics and physical and radiological findings, including the localisation, lateralisation and aetiology of the infarction, in addition to ICU requirements and mortality, were evaluated. Aspiration pneumonia was detected in 80 (15.9%) patients during the in-hospital stay. Transfer to the ICU for any reason was required in 37.5% of the patients in group 1 and 4.7% of those in group 2 ( p < 0.001). In-hospital mortality occurred in 7.5% and 1.4% of the patients in group 1 and group 2, respectively ( p = 0.006). The incidence of AP was highest in patients with an infarction of the medial cerebral artery (MCA) ( p < 0.001). The AP was associated with older age ( p < 0.001), hypertension ( p = 0.007), echocardiography findings ( p = 0.032) and the modified Rankin Scale (mRS) score ( p < 0.001). Our findings suggest that the requirement rate for transfer to the ICU and the mortality rate appear to be significantly higher in patients with a diagnosis of AP. Precautions should be taken, starting from the first day of hospitalisation, to decrease the incidence of AP in patients with acute CVA, focusing especially on older patients and those with a severe mRS score.

  12. 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...

  13. 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%.

  14. 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.

  15. 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.

  16. 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.

  17. Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements.

    Science.gov (United States)

    Bernhard, Gerda; Mahler, Cornelia; Seidling, Hanna Marita; Stützle, Marion; Ose, Dominik; Baudendistel, Ines; Wensing, Michel; Szecsenyi, Joachim

    2018-03-27

    Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients' knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user' adoption is optimal. The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients' ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align

  18. [Modeling the requirements on routine data of general practitioners from the health-care researcher's point of view with the help of unified modeling langauge (UML)].

    Science.gov (United States)

    Kersting, M; Hauswaldt, J; Lingner, H

    2012-08-01

    Health-care research is, besides primary acquired study data, based on data from widely differing secondary sources. In order to link, compare and analyze data sources uniform models and methods are needed. This could be facilitated by a more structured description of requirements, models and methods of health-care research than those currently used. Suitable methods of presentation were sought in an approach to this target and the unified modeling language (UML) identified as a possible alternative. Using different tools 3 UML diagrams were created to represent some individual aspects of a scientific use file (SUF): A use case diagram as well as an activity and a class diagram. In the use case diagram we attempted to represent the general use cases of an SUF based on general practitioners routine data. Secondly a class diagram was constructed to visualize the contents and structure of a SUF. Thirdly an activity diagram was developed to graphically represent the concept of a general practitioner's episode of care. The creation of the UML diagrams was possible without any technical difficulties. Regarding the content the 3 diagrams must still be considered as prototypes. The use case diagram shows possible uses and users of an SUF, e. g. a research worker, industry but also the general practitioner who supplies the data. The class diagram reveals a general data structure that can serve information processes in practice and research. Besides aggregation, possibilities for specialization and generalization are essential elements of the class diagram that can be used meaningfully. The activity diagram for the schematic representation of a general practitioner's episode of care reveals the existence of multiple endpoints of an episode and the possibility to form relationships by means of episodes (diagnosis>therapy). The constructed diagrams are preliminary results and should be refined in future steps. Use case diagrams enable a rapid overview of the meaning and

  19. 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,...

  20. 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...

  1. 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/...

  2. 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

  3. 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.

  4. 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...

  5. 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.

  6. Problems facing the radiologist tendering for a hospital wide PACS system

    International Nuclear Information System (INIS)

    Pilling, John

    1999-01-01

    As PACS becomes a reality the practical difficulties of installing the new technology become evident. The practical issues of developing a strategy, understanding the market, writing a business case, and an outline based specification are considered. The complexities of European procurement, the evaluation of responses, the contracting process and the problems of implementation, training, assessing the benefits and foreseeing the problems are covered. Provided there is careful attention to detail a hospital can expect to implement a successful PACS system

  7. 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.

  8. 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.

  9. Care requirements for clients who present after rape and clients who presented after consensual sex as a minor at a clinic in Harare, Zimbabwe, from 2011 to 2014.

    Directory of Open Access Journals (Sweden)

    Rebecca E Harrison

    Full Text Available To describe the differences between clients presenting after rape and clients who have consented to sex as a minor to an SGBV clinic in Harare, Zimbabwe, and how these differences affect their care requirements.Adolescents and adults presenting at the specialized Sexual and Gender Based Violence clinic in Harare are offered a standardised package of free medical and psychosocial care. Zimbabwe has an HIV prevalence of 14%, so prevention of HIV infection using PEP for those that present within 72 hours is a key part of the response. STI treatment, emergency contraceptive pills, referral for termination of pregnancy, psychological, social and legal support is also provided.This is a retrospective descriptive study of routine programmatic data collected at the Edith Opperman polyclinic in Mbare SGBV clinic from 2011 to 2014. Chi-square tests and logistic regression were used to describe the different experiences and the differences in uptake of care between clients presenting for rape compared to those who consented to sex as a minor.During the study period a total of 3617 clients presented to the clinic. 2242 (62% sought care after rape, 602 (17% for having consented to sex as a minor and 395 (11% for suspected sexual abuse. 1615 (45% of people presenting were 12-15 year olds. Minors who consented to sex compared to survivors of rape were less likely to report within 72 hours- 156 (26% vs 894 (40% p<0.001; less likely to report that they delayed due to fear- 68 (17% vs 472 (40% p<0.001, less likely to have experienced accompanying violence- 9 (1% vs 176 (8% p<0.001 or physical trauma-34 (6% vs 427 (19% p<0.001; and less likely to display psychological symptoms at presentation 51 (8% vs 411 (18% p<0.001. Minors who consented to sex compared to those who were raped were less likely to start PEP if eligible-123 (80% vs 751 (93% p<0.001, less likely to take emergency contraceptives if eligible-125 (81% vs 598 (88% p<0.001, more likely to be pregnant

  10. The Survey of Iran’s New Accreditation System Challenges Based on International Society for Quality in Health Care (ISQua Requirements

    Directory of Open Access Journals (Sweden)

    Farid Gharibi

    2015-08-01

    Full Text Available Background and objectives : Nowadays, successful health systems are focused on performance indicators especially on quality and continuous improvement is taken as a sign of organization’s success and survival. Regarding the fact that accreditation is one of the main fields in health systems management and has great effects on quality improvement, this study aimed to assess the weaknesses and strengths of Iran’s new accreditation system based on the International Society for Quality in Health care (ISQua requirements.   Material and Methods : Data were collected using ISQua questionnaire. First, the questionnaire was translated and its content validity was assessed by experts’ opinions based on 5 items in the quality of questions. Then, its reliability was evaluated and finally a questionnaire with 39 questions in four aspects was approved. In the following, opinions of 20 experts were obtained and the results were reported by frequency (percent.  Data were analyzed using SPSS16 software. Results: The results showed that Iran’s new accreditation system deals with great problems in “Policy, Values and Cultures”, “Organization and Structure”, “Methodology” and “Resources” areas, meaning that the system was approved only in one third of the questions. The results indicated that this system has the most problems in “Resources” aspect and the least in “Methodology” but obtained scores were not acceptable in none of the aspects. Conclusion: This study showed that this accreditation system has critical problems and its successful application requires resolving them. No doubt that identified problems and delivered advices in this study are valuable guides to policy-makers of this program.

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

    Science.gov (United States)

    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 of clinical context while providing elements for analysis. One of the solutions for filling this gap is to consider the process model itself in the role of a hub as a centralized means of facilitating communication between team members. Starting with a robust and descriptive technique for process modeling called IDEF0/SADT, we refined the basic data model by extracting concepts from ISO 9000 process analysis and from enterprise ontology. We defined a web-based architecture to serve as a collaborative tool and implemented it using an object-oriented database. The prospects of such a tool are discussed notably regarding to its ability to generate data dictionaries and to be used as a navigation tool through the medium of hospital-wide documentation.

  12. At-risk adolescents as experts in a new requirements elicitation procedure for the development of a smart phone psychoeducational trauma-informed care application.

    Science.gov (United States)

    Sockolow, Paulina; Schug, Seran; Zhu, Jichen; Smith, T J; Senathirajah, Yalini; Bloom, Sandra

    2017-01-01

    Adolescents from urban, socioeconomically disadvantaged communities of color encounter high rates of adverse childhood experiences. To address the resulting multidimensional problems, we developed an innovative approach, Experiential Participatory and Interactive Knowledge Elicitation (EPIKE), using remote experiential needs elicitation methods to generate design and content requirements for a mobile health (mHealth) psychoeducational intervention. At a community-based organization in a northeastern city, the research team developed EPIKE by incorporating elicitation of input on the graphics and conducting remotely recorded experiential meetings and iterative reviews of the design to produce an mHealth smartphone story application (app) prototype for the participants to critique. The 22 participants were 13- to 17-year-olds, predominantly African American and female, from underresourced communities. The four goals of the design process were attained: 1) story development from participant input; 2) needs-elicitation that reflected the patient-centered care approach; 3) interactive story game creation that accommodates the participants' emotional and cognitive developmental needs; 4) development of a game that adolescents can relate to and that which matches their comfort levels of emotional intensity. The EPIKE approach can be used successfully to identify the needs of adolescents across the digital divide to inform the design and development of mHealth apps.

  13. Decreased activity of daily living produced by the combination of Alzheimer's disease and lower limb fracture in elderly requiring nursing care.

    Science.gov (United States)

    Inagawa, Toshimitsu; Hamagishi, Toshio; Takaso, Yuji; Hitomi, Yoshiaki; Kambayashi, Yasuhiro; Hibino, Yuri; Shibata, Aki; Ngoc, Nguyen T M; Okochi, Jiro; Hatta, Kotaro; Takamuku, Kiyoshi; Konoshita, Tadashi; Nakamura, Hiroyuki

    2013-01-01

    Alzheimer's disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture. We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants. We recognized that activities of cognitive function (p lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery. These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.

  14. 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.

  15. THE RESEARCH RESULTS OF TENDER PROCUREMENTS OF THE DRUGS FOR CANCER PATIENTS IN UKRAINE

    Directory of Open Access Journals (Sweden)

    G. L. Panfilova

    2014-02-01

    Full Text Available Introduction. Since 2002, the pharmaceutical care of the cancer patients in Ukraine is carried out centrally by public funds in the framework of the target program "Oncology." In a chronic shortage of funds in the national health care system, as well as taking into account the perspectives of the introduction of the social model of obligatory medical insurance (OMI, enhanced the importance of research on the development of rational mechanisms for the use of public funds, which are sent to drug purchases. Given the high mortality rate among cancer patients, especially in children in Ukraine, these works are of particular socio-economic importance. The aim of work. To study drug purchases that are made for cancer patients in Ukraine in order to identify the main problems and directions of rational scientific basis for the use of public funds in terms of lack of resources in health care, as well as from the perspectives of the introduction of the social model of OMI in Ukraine. Materials and methods. Objects of research: data from the National Cancer Registry, annual plans and registers of public drug procurement Ministry of Ukraine. The paper used data from national legislative and regulatory framework governing the organization of pharmaceutical support cancer patients, standard methods of statistical processing of the dynamics of the clinic-economic analysis. Results and discussion. During 2010-2013 marked increase in the amounts of permanent drug purchases for cancer patients, which is on the growth rate did not meet the dynamics of changes in the relevant during epidemiological indicators. The results integrated ABC/VEN-analysis found no drug purchasing products from the group N and with the status A/V, and the dominance of the number of agents with the status items C/V. The main volume of financial resources was directed to the purchase of drugs from the group E (84.8% - 92.4% and the status of A/E (78,9% -79,8%, as well as drug belonging to

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. 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.

  19. Life Brought at a Tender Age: The Lived Experiences of Filipino Teenage Pregnant Women

    Directory of Open Access Journals (Sweden)

    CRISTOPHER R. PARUNGAO

    2014-02-01

    Full Text Available Unintended teenage pregnancy is an ever-present issue in developing countries such as the Philippines. The impact of teenage pregnancy affects the physical, emotional, social, and spiritual well being of the adolescents. Teen pregnancies carry extra health risks to both the mother and the baby. Nurses play a crucial role in supporting young people as trusted practitioners in a range of settings. This study aimed to explore the lived experiences of the teenage pregnant women. Six adolescent female aged 12-19 years old who were pregnant with their first child agreed to participate. A qualitative inquiry, specifically Husserlian descriptive phenomenology was employed. Semi-structured in depth face-to-face interviews were undertaken, audiotaped, transcribed, and analyzed using Colaizzi’s method. The richness of the experiences shared by the selections provided the necessary information to understand and describe the essence of the phenomenon understudy. Cool and warm analyses captured the following emergent themes of Trends toward issues, Fortified faith, and Optimistic outlook. For the selections in this study, being pregnant at a young age did not mean that their life and future were all over. The women were optimistic about their futures. The findings of the study have vital implications in offering specific programs and services and in developing educational materials that focus on preventing teen pregnancy. While health nurse practitioners primarily provide services and education to teens and parents in various health care facilities, they also can be significant participants in prevention activities and coalitions that are based in a community. The outcomes of the study have possible contributions to the nursing practice, to policies that facilitate the promotion of the health of the teenage mothers and the prevention of teenage pregnancies, and in building future researches especially in the education of the teens about the consequences of

  20. 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).

  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%.

  2. 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%.

  3. 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...

  4. 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....

  5. 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.

  6. 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.

  7. 16% renewable energy in 2020. When invite for tenders?; 16% hernieuwbare energie in 2020. Wanneer aanbesteden?

    Energy Technology Data Exchange (ETDEWEB)

    Hekkenberg, M.; Lensink, S. [ECN Beleidsstudies, Petten (Netherlands)

    2013-01-15

    The Dutch government has set a target of 16% renewable energy to be realized in 2020. This goal is feasible, when a sufficiently supportive policy framework is established. This study examines the turnaround of projects and the potential growth path of different technologies that can be used to achieve the goal. The study works step by step towards an answer to the key question: What is the ultimate time of procurement by the government, or of establishing a binding legal framework, to ensure the required capacity of key renewable energy technologies in 2020, taking into account the time for completion of the project completion and any growth limitations [Dutch] Het huidige regeerakkoord stelt een doel van 16% hernieuwbare energie in 2020. Dit doel lijkt begin 2013 binnen bereik te liggen, wanneer een voldoende ondersteunend beleidskader tijdig wordt vastgesteld. Deze studie onderzoekt de doorlooptijd van projecten en het mogelijke ingroeipad van verschillende technologieën die ingezet kunnen worden om het doel te bereiken. De studie werkt stapsgewijs toe naar een antwoord op de kernvraag: Wat is het uiterste moment van aanbesteding door de overheid, of van vaststelling van een bindend wettelijk kader, om de benodigde capaciteit van de belangrijkste hernieuwbare-energietechnologieën in 2020 zeker te stellen, rekening houdend met projectdoorlooptijd en eventuele ingroeibeperkingen.

  8. Outsourcing strategy and tendering methodology for the operation and maintenance of CERN’s cryogenic facilities

    Science.gov (United States)

    Serio, L.; Bremer, J.; Claudet, S.; Delikaris, D.; Ferlin, G.; Ferrand, F.; Pezzetti, M.; Pirotte, O.

    2017-12-01

    CERN operates and maintains the world largest cryogenic infrastructure ranging from ageing but well maintained installations feeding detectors, test facilities and general services, to the state-of-the-art cryogenic system serving the flagship LHC machine complex. A study was conducted and a methodology proposed to outsource to industry the operation and maintenance of the whole cryogenic infrastructure. The cryogenic installations coupled to non LHC-detectors, test facilities and general services infrastructure have been fully outsourced for operation and maintenance on the basis of performance obligations. The contractor is responsible for the operational performance of the installations based on a yearly operation schedule provided by CERN. The maintenance of the cryogenic system serving the LHC machine and its detectors has been outsourced on the basis of tasks oriented obligations, monitored by key performance indicators. CERN operation team, with the support of the contractor operation team, remains responsible for the operational strategy and performances. We report the analysis, strategy, definition of the requirements and technical specifications as well as the achieved technical and economic performances after one year of operation.

  9. 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.

  10. 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.

  11. 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.

  12. 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)

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. Joint line tenderness and McMurray tests for the detection of meniscal lesions: what is their real diagnostic value?

    Science.gov (United States)

    Galli, Marco; Ciriello, Vincenzo; Menghi, Amerigo; Aulisa, Angelo G; Rabini, Alessia; Marzetti, Emanuele

    2013-06-01

    To assess the interobserver concordance of the joint line tenderness (JLT) and McMurray tests, and to determine their diagnostic efficiency for the detection of meniscal lesions. Prospective observational study. Orthopedics outpatient clinic, university hospital. Patients (N=60) with suspected nonacute meniscal lesions who underwent knee arthroscopy. Not applicable. Patients were examined by 3 independent observers with graded levels of experience (>10y, 3y, and 4mo of practice). The interobserver concordance was assessed by Cohen-Fleiss κ statistics. Accuracy, negative and positive predictive values for prevalence 10% to 90%, positive (LR+) and negative (LR-) likelihood ratios, and the Bayesian posttest probability with a positive or negative result were also determined. The diagnostic value of the 2 tests combined was assessed by logistic regression. Arthroscopy was used as the reference test. No interobserver concordance was determined for the JLT. The McMurray test showed higher interobserver concordance, which improved when judgments by the less experienced examiner were discarded. The whole series studied by the "best" examiner (experienced orthopedist) provided the following values: (1) JLT: sensitivity, 62.9%; specificity, 50%; LR+, 1.26; LR-, .74; (2) McMurray: sensitivity, 34.3%; specificity, 86.4%; LR+, 2.52; LR-, .76. The combination of the 2 tests did not offer advantages over the McMurray alone. The JLT alone is of little clinical usefulness. A negative McMurray test does not modify the pretest probability of a meniscal lesion, while a positive result has a fair predictive value. Hence, in a patient with a suspected meniscal lesion, a positive McMurray test indicates that arthroscopy should be performed. In case of a negative result, further examinations, including imaging, are needed. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Rheological Flow Behavior of Structural Polysaccharides from Edible Tender Cladodes of Wild, Semidomesticated and Cultivated 'Nopal' (Opuntia) of Mexican Highlands.

    Science.gov (United States)

    López-Palacios, C; Peña-Valdivia, C B; Rodríguez-Hernández, A I; Reyes-Agüero, J A

    2016-12-01

    The aim of this study was to quantify the content of polysaccharides of edible tender cladodes (nopalitos) of three species of Opuntia and to evaluate the rheological flow behavior of isolated polysaccharides. A completely randomized experimental design was used to characterize a wild (O. streptacantha), a semidomesticated (O. megacantha) and a domesticated (O. ficus-indica) species. Mucilage content was higher (4.93 to 12.43 g 100 g -1 dry matter), tightly bound hemicelluloses were lower (3.32 to 1.81 g 100 g -1 dry matter) and pectins and loosely bound hemicelluloses were not different in wild than in domesticated species. Aqueous solution/suspensions of mucilage, pectins, hemicellulose and cellulose of all species showed non-Newtonian behavior under simple shear flow. The flow behavior of the structural polysaccharides was well described by the Ostwald de-Waele model. Pectins and mucilages exhibited the highest consistency indexes (K values ranged from 0.075 to 0.177 Pas n ) with a moderated shear-thinning behavior (n values ranged from 0.53 to 0.67). Cellulose dispersions exhibited the most shear-thinning behavior (n values ranged from 0.17 to 0.41) and hemicelluloses showed a tendency to Newtonian flow (n values ranged from 0.82 to 0.97). The rheological flow properties of these polysaccharides may be useful to improve the textural and sensory qualities of some foods and pharmaceutical materials. Moreover, they can emerge as functional ingredients mainly due to the nutraceutical properties that have been attributed to nopalitos.

  19. Meat Science and Muscle Biology Symposium: manipulating meat tenderness by increasing the turnover of intramuscular connective tissue.

    Science.gov (United States)

    Purslow, P P; Archile-Contreras, A C; Cha, M C

    2012-03-01

    Controlled reduction of the connective tissue contribution to cooked meat toughness is an objective that would have considerable financial impact in terms of added product value. The amount of intramuscular connective tissue in a muscle appears connected to its in vivo function, so reduction of the overall connective tissue content is not thought to be a viable target. However, manipulation of the state of maturity of the collagenous component is a biologically viable target; by increasing connective tissue turnover, less mature structures can be produced that are functional in vivo but more easily broken down on cooking at temperatures above 60°C, thus improving cooked meat tenderness. Recent work using cell culture models of fibroblasts derived from muscle and myoblasts has identified a range of factors that alter the activity of the principal enzymes responsible for connective tissue turnover, the matrix metalloproteinases (MMP). Fibroblasts cultured from 3 different skeletal muscles from the same animal show different cell proliferation and MMP activity, which may relate to the different connective tissue content and architecture in functionally different muscles. Expression of MMP by fibroblasts is increased by vitamins that can counter the negative effects of oxidative stress on new collagen synthesis. Preliminary work using in situ zymography of myotubes in culture also indicates increased MMP activity in the presence of epinephrine and reactive oxidative species. Comparison of the relative changes in MMP expression from muscle cells vs. fibroblasts shows that myoblasts are more responsive to a range of stimuli. Muscle cells are likely to produce more of the total MMP in muscle tissue as a whole, and the expression of latent forms of the enzymes (i.e., pro-MMP) may vary between oxidative and glycolytic muscle fibers within the same muscle. The implication is that the different muscle fiber composition of different muscles eaten as meat may influence the

  20. System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

    Science.gov (United States)

    Bailie, Jodie; Laycock, Alison; Matthews, Veronica; Bailie, Ross

    2016-01-01

    There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health

  1. Five key pillars of an analytics center of excellence, which are required to manage populations and transform organizations into the next era of health care.

    Science.gov (United States)

    Reichert, Jim; Furlong, Gerry

    2014-01-01

    Acute care facilities are experiencing fiscal challenges as noted by decreasing admissions and lower reimbursement creating an unsustainable fiscal environment as we move into the next era of health care. This situation necessitates a strategy to move away from acting solely on hunches and instinct to using analytics to become a truly data-driven organization that identifies opportunities within patient populations to improve the quality and efficiency of care across the continuum. A brief overview of knowledge management philosophies will be provided and how it is used to enable organizations to leverage data, information, and knowledge for operational transformation leading to improved outcomes. This article outlines the 5 key pillars of an Analytics Center of Excellence; governance, organizational structure, people, process, and technology, that are foundational to the development of this strategy. While culture is the most important factor to achieve organizational transformation and improved care delivery, it is the 5 pillars of the ACoE that will enable the culture shift necessary to become a truly data-driven organization and thus achieve transformation into the next era of health care.

  2. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People’s Republic of China

    Science.gov (United States)

    Zhang, Zhenyu; Wang, Jianbing; Jin, Mingjuan; Li, Mei; Zhou, Litao; Jing, Fangyuan; Chen, Kun

    2014-01-01

    Background The People’s Republic of China’s population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People’s Republic of China. Objective To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People’s Republic of China. Methods We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People’s Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. Results We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. Conclusion A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services. PMID:24855346

  3. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People's Republic of China.

    Science.gov (United States)

    Zhang, Zhenyu; Wang, Jianbing; Jin, Mingjuan; Li, Mei; Zhou, Litao; Jing, Fangyuan; Chen, Kun

    2014-01-01

    The People's Republic of China's population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People's Republic of China. To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People's Republic of China. We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People's Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services.

  4. INDIKASI PERSENGKOKOLAN DALAM TENDER

    Directory of Open Access Journals (Sweden)

    Edi Krisharyanto

    2006-01-01

    Full Text Available Before doing big and highly amount projects invested by APBN or APBD, bids are often previously executed. However, along with the increase of participant and the business it self, any kinds and signs of collution is some possible things to find.

  5. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Zhang ZY

    2014-05-01

    Full Text Available Zhenyu Zhang,1 Jianbing Wang,1 Mingjuan Jin,1 Mei Li,1 Litao Zhou,2 Fangyuan Jing,1 Kun Chen1 1Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People’s Republic of China; 2Quality Control Department, Zhejiang Hospital, Zhejiang, People’s Republic of China Background: The People’s Republic of China’s population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People’s Republic of China.Objective: To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People’s Republic of China.Methods: We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People’s Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level.Results: We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration.Conclusion: A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services. Keywords: Gini coefficient, bedridden, long-term care, insurance

  6. 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

  7. True to form. The IRS' updated reporting rules for tax-exempt organizations could require full disclosure on community benefits, charity care.

    Science.gov (United States)

    Evans, Melanie

    2007-06-04

    By mid-month, the IRS expects to unveil extensive changes to its Form 990 reporting rules for not-for-profits, which could further affect current disclosure or nondisclosure of tax-exempt hospitals' community benefits and charity care. Most hospitals welcome the revisions, but the legislative process to implement those reforms could be lengthy, says healthcare attorney Bernadette Broccolo, left.

  8. The Relationship Between the Educational Background and Managerial Experience of Senior Navy Medical Service Corps Executives (Health Care Administrators) and their Perceived Current and Required Management Capabilities.

    Science.gov (United States)

    1994-03-01

    practitioner-based assessment of baccalaureate-level skills and knowledge needs ranked interpersonal skills, knowledge of the health care sector , and...OdM ctr and predicted onviroamsma nasional and world imawrelated military, economico political. scientific, and social factors. Designed for 0.5S016

  9. 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.

  10. Effect of the Army Oral Health Maintenance Program (AOHMP) on the Dental Health Status of Army Personnel. AOHMP Evaluation Study. Part 3. Dental Care Requirements of Active Duty Army Personnel, 1978

    Science.gov (United States)

    1979-06-01

    endodontics , crown and bridge, full and partial dentures, and periodontal therapy , account for about one- third of the time requirements for the...Examiners indicated the numbers of restorations, extractions, teeth needing endodontic therapy , units of crown and bridge, complete den- tures...might be that lieutenants and captains are in a younger age range where the removal of third molars is usually recommended. (3) In the care need areas

  11. 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.

  12. 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

  13. 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.

  14. 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.)

  15. U.S. Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Operational Requirements of the EMEDS Specialty Care Augmentation Team

    Science.gov (United States)

    2011-06-28

    0.20 $10.74 0.26 0.20 $10.74 A 6515013146694 STETHOSCOPE LITTMAN CLASSIC II 28IN EA 2 2 1.72 0.50 $98.82 1.72 0.50 $98.82 A 6520012650108 STOOL DENTAL ...NEC 1 533.9 PEPTIC ULCER NOS 2 5 STAPH FOOD POISONING 4 592.9 URINARY CALCULUS NOS 3 PATIENT TOTAL 320 EMEDS Specialty Care

  16. 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.

  17. Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

    Science.gov (United States)

    Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

    2018-03-23

    To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

  18. 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...

  19. 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.

  20. Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    Full Text Available BACKGROUND: Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF and coronary heart disease (CHD, by age group. METHODS: This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. RESULTS: The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds, adults (45-64, and oldest old (+85 than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y, adults (45-64 y, the very old (75-84 y and the oldest old (+85 y patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. CONCLUSION: Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.

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

    Science.gov (United States)

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

    2015-01-01

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

  2. Transfusion requirements and clinical outcome in intensive care patients receiving continuous renal replacement therapy: comparison of prostacyclin vs. heparin prefilter administration

    DEFF Research Database (Denmark)

    Windeløv, Nis Agerlin; Ostrowski, Sisse R; Perner, Anders

    2010-01-01

    Prostacyclin (PGI(2)) analogous are potent antithrombotics recommended as prefilter infusion during renal replacement therapy (RRT) when heparin is contraindicated. It is debated whether PGI(2) administration during RRT affects transfusion requirements and outcome. Retrospective cohort study of all......: before, during and after CRRT. For each time period, laboratory values were analysed as changes/day and blood transfusion requirements as absolute values. Organ failures during the ICU stay and 1 year all-cause mortality were registered. During CRRT the PGI(2) group had a higher incidence of disseminated...

  3. A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics.

    Science.gov (United States)

    Blaya, Joaquin A; Shin, Sonya S; Yagui, Martin J A; Yale, Gloria; Suarez, Carmen Z; Asencios, Luis L; Cegielski, J Peter; Fraser, Hamish S F

    2007-10-28

    Multi-drug resistant tuberculosis patients in resource-poor settings experience large delays in starting appropriate treatment and may not be monitored appropriately due to an overburdened laboratory system, delays in communication of results, and missing or error-prone laboratory data. The objective of this paper is to describe an electronic laboratory information system implemented to alleviate these problems and its expanding use by the Peruvian public sector, as well as examine the broader issues of implementing such systems in resource-poor settings. A web-based laboratory information system "e-Chasqui" has been designed and implemented in Peru to improve the timeliness and quality of laboratory data. It was deployed in the national TB laboratory, two regional laboratories and twelve pilot health centres. Using needs assessment and workflow analysis tools, e-Chasqui was designed to provide for improved patient care, increased quality control, and more efficient laboratory monitoring and reporting. Since its full implementation in March 2006, 29,944 smear microscopy, 31,797 culture and 7,675 drug susceptibility test results have been entered. Over 99% of these results have been viewed online by the health centres. High user satisfaction and heavy use have led to the expansion of e-Chasqui to additional institutions. In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people. The cost to maintain this system is approximately US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget. Electronic laboratory information systems have a large potential to improve patient care and public health monitoring in resource-poor settings. Some of the challenges faced in these settings, such as lack of trained personnel, limited transportation, and large coverage areas, are obstacles that a well-designed system can overcome. e-Chasqui has the potential to provide a national TB laboratory network in Peru

  4. Sterilization of health care products - Radiation. Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

    International Nuclear Information System (INIS)

    2006-01-01

    A sterile medical device is one that is free of viable microorganisms. International Standards, which specify requirements for validation and routine control of sterilization processes, require, when it is necessary to supply a sterile medical device, that adventitious microbiological contamination of a medical device prior to sterilization be minimized. Even so, medical devices produced under standard manufacturing conditions in accordance with the requirements for quality management systems (see, for example, ISO 13485) may, prior to sterilization, have microorganisms on them, albeit in low numbers. Such medical devices are non-sterile. The purpose of sterilization is to inactivate the microbiological contaminants and thereby transform the nonsterile medical devices into sterile ones. The kinetics of inactivation of a pure culture of microorganisms by physical and/or chemical agents used to sterilize medical devices can generally best be described by an exponential relationship between the numbers of microorganisms surviving and the extent of treatment with the sterilizing agent; inevitably this means that there is always a finite probability that a microorganism may survive regardless of the extent of treatment applied. For a given treatment, the probability of survival is determined by the number and resistance of microorganisms and by the environment in which the organisms exist during treatment. It follows that the sterility of any one medical device in a population subjected to sterilization processing cannot be guaranteed and the sterility of a processed population is defined in terms of the probability of there being a viable microorganism present on a medical device. This part of ISO 11137 describes requirements that, if met, will provide a radiation sterilization process intended to sterilize medical devices, that has appropriate microbicidal activity. Furthermore, compliance with the requirements ensures that this activity is both reliable and

  5. Sterilization of health care products - Ethylene oxide - Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

    International Nuclear Information System (INIS)

    2007-01-01

    This part of ISO 11135 describes requirements that, if met, will provide an ethylene oxide sterilization process intended to sterilize medical devices, which has appropriate microbicidal activity. Furthermore, compliance with the requirements ensures that this activity is both reliable and reproducible so that it can be predicted, with reasonable confidence, that there is a low level of probability of there being a viable microorganism present on product after sterilization. Specification of this probability is a matter for regulatory authorities and may vary from country to country. The paper provides information on scope, normative references, terms and definitions, quality management systems, sterilizing agent characterization, process and equipment characterization, product definition, process definition, validation, routine monitoring and control, product release from sterilization and maintaining process effectiveness followed by Annex A (Determination of lethal rate of the sterilization process - Biological indicator/bioburden approach), Annex B (Conservative determination of lethal rate of the sterilization process - Overkill approach, annex C (General guidance) and a bibliography.

  6. Guidelines, "minimal requirements" and standard of care in glioblastoma around the Mediterranean Area: A report from the AROME (Association of Radiotherapy and Oncology of the Mediterranean arEa) Neuro-Oncology working party.

    Science.gov (United States)

    2016-02-01

    Glioblastoma is the most common and the most lethal primary brain tumor in adults. Although studies are ongoing, the epidemiology of glioblastoma in North Africa (i.e. Morocco, Algeria and Tunisia) remains imperfectly settled and needs to be specified for a better optimization of the neuro-oncology healthcare across the Mediterranean area and in North Africa countries. Over the last years significant therapeutic advances have been accomplished improving survival and quality of life of glioblastoma patients. Indeed, concurrent temozolomide-radiotherapy (temoradiation) and adjuvant temozolomide has been established as the standard of care associated with a survival benefit and a better outcome. Therefore, considering this validated strategy and regarding the means and some other North Africa countries specificities, we decided, under the auspices of AROME (association of radiotherapy and oncology of the Mediterranean area; www.aromecancer.org), a non-profit organization, to organize a dedicated meeting to discuss the standards and elaborate a consensus on the "minimal requirements" adapted to the local resources. Thus, panels of physicians involved in daily multidisciplinary brain tumors management in the two borders of the Mediterranean area have been invited to the AROME neuro-oncology working party. We report here the consensus, established for minimal human and material resources for glioblastoma diagnosis and treatment faced to the standard of care, which should be reached. If the minimal requirements are not reached, the patients should be referred to the closest specialized medical center where at least minimal requirements, or, ideally, the standard of care should be guaranteed to the patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  8. Medical student surgery elective in rural Haiti: a novel approach to satisfying clerkship requirements while providing surgical care to an underserved population.

    Science.gov (United States)

    Chin-Quee, Anthony; White, Laura; Leeds, Ira; MacLeod, Jana; Master, Viraj A

    2011-04-01

    The addition of global health programs to medical school training results in graduates with enhanced clinical skills and increased sensitivity to cost issues. Funding from U.S. medical schools has been unable to meet student demand, and therefore it is often a critical limiting factor to the lack of development of these programs. We describe an alternative approach for global health surgical training for medical students. Emory University medical students and faculty, in collaboration with Project Medishare for Haiti, planned, raised funds, and executed a successful short-term surgical camp to supplement available surgical services in rural Haiti. Learning objectives that satisfied Emory University School of Medicine surgery clerkship requirements were crafted, and third-year students received medical school credit for the trip. In the absence of house staff and placed in an under-resourced, foreign clinical environment, the surgical elective described here succeeded in meeting learning objectives for a typical third-year surgical clerkship. Objectives were met through a determined effort to ensure that home institution requirements were aligned properly with learning activities while students were abroad and through a close collaboration between medical students, faculty members, and the administration. Emory University's international surgery elective for medical students demonstrates that opportunities for supervised, independent student-learning and global health service can be integrated into a traditional surgical clerkship. These opportunities can be organized to meet the requirements and expectations for third-year surgery clerkships at other medical colleges. This work also identifies how such trips can be planned and executed in a manner that does not burden strained academic budgets with further demands on resources.

  9. Use of a combined oxygen/nitrous oxide/morphine chlorydrate protocol for analgesia in burned children requiring painful local care.

    Science.gov (United States)

    Ozil, Camille; Vialle, Raphaël; Thevenin-Lemoine, Camille; Conti, Elvira; Annequin, Daniel

    2010-03-01

    We present the results of the use of a protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids on a prospective cohort of 33 children undergoing local care for acute but limited burned skin lesions. All the children were orally administered 0.4 mg/kg morphine chlorydrate, and nitrous oxide was administered as an equimolar mixture (50% N2O, 50% O2) via a face mask during the procedure. Pain and comfort of the patient were evaluated by the use of a validated behavioural score. After the end of the procedure, child and parent satisfactions were noted. Mean age was 3 years 6 months (10 months-11 years). A successful detersion procedure was performed in all the cases. Behavioural score was 6 in 15 cases out of 33, comprising between 7 and 9 in 15 patients and 10 in three patients. Subjective satisfaction of pain management was noted in 16 out of 20 patients after the procedure. Subjective satisfaction of the parents was noted in all the cases. Our study demonstrates that the use of a simple protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids could be safe and effective. This association was well tolerated without any adverse effect.

  10. Home care robot for socially supporting the elderly: focus group studies in three European countries to screen user attitudes and requirements.

    Science.gov (United States)

    Zsiga, Katalin; Edelmayer, Georg; Rumeau, Pierre; Péter, Orsolya; Tóth, András; Fazekas, Gábor

    2013-12-01

    The growing number of elderly individuals presents new challenges for society. Many elderly individuals have physical or cognitive impairments and require support from caregivers. An attempt to overcome the limitations caused by the lack of human caregivers is the inclusion of assistive technology such as socially active robots. The Domeo-project of the Ambient Assisted Living Joint Programme of the European Union aims to develop a new companion robotic system that would allow assistance to the elderly. The requirements and attitude of the potential users and caregivers have been assessed in Austria, France and Hungary. The robot functions were demonstrated to the participants. Three focus groups were formed: potential end users, older caregivers and younger caregivers. The discussions were recorded and processed according to six aspects: (i) acceptability and privacy, (ii) pertinence of services, (iii) possible obstacles, (iv) motivation level to use the proposed services, (v) organizational issues and (vi) recommendations. Minor differences were observed between the countries, but there were considerable differences regarding the age of the participants. The younger caregivers want to be assured of the safety of their client and to receive immediate notification in case of an emergency. As for the elderly, the most important aspect is to gain a companion and a physical helper. Many of the recommendations can be taken into consideration during robot development, but some of them are not realistic at present.

  11. Preconception Care and Prenatal Care

    Science.gov (United States)

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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

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

  17. 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

  18. Evaluation of cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health: a large-scale, multi-institutional observational study.

    Science.gov (United States)

    Kawaguchi, Hideaki; Taguchi, Masamoto; Sukigara, Masune; Sakuragi, Shoji; Sugiyama, Naoya; Chiba, Hisomu; Kawasaki, Tatsuhito

    2017-06-15

    We comprehensively evaluated cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health. We surveyed 1967 patients receiving long-term inpatient psychiatric care. Patients were further categorized into an old long-stay group (n = 892, >5 years in hospitals) and a new long-stay group (n = 1075, 1-5 years in hospitals). We obtained responses for all the International Classification of Functioning, Disability, and Health items in domain b (Body Functions) and domain d (Activities and Participation). We estimated weighted means for each item using the propensity score to adjust for confounding factors. Responses were received from 307 hospitals (response rate of hospitals: 25.5%). Cognitive and social functioning in the old long-stay group was more severely impaired than in the new long-stay group. No statistically significant differences were observed regarding the International Classification of Functioning, Disability, and Health items associated with basic activities of daily living between the two groups. Combined therapy consisting of cognitive remediation and rehabilitation on social functioning for this patient population should be started from the early stage of hospitalization. Non-restrictive, independent environments may also be optimal for this patient population. Implications for rehabilitation Rehabilitation of cognitive and social functioning for patients requiring long-term inpatient psychiatric care should be started in the early stages of hospitalization. In psychiatric fields, the International Classification of Functioning, Disability, and Health checklist could facilitate individualized rehabilitation planning by allowing healthcare professionals to visually assess the comprehensive functioning of each patient using graphics such as radar charts.

  19. Caring Science and the Development of Forensic Psychiatric Caring.

    Science.gov (United States)

    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.

  20. 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 ...

  1. 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.

  2. 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...

  3. 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

  4. 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 ...

  5. Health care professionals' perspectives on the requirements ...

    African Journals Online (AJOL)

    Wilma ten Ham

    Purpose: of the research: To explore and describe the perspectives of health .... promoting skin-to-skin contact, and exclusive breastfeeding .... ducted telephonically except for one face-to-face interview. ... tape recorded and field notes were kept of each interview. ... Data were analysed using qualitative content analysis.

  6. Post mortem rigor development in the Egyptian goose (Alopochen aegyptiacus) breast muscle (pectoralis): factors which may affect the tenderness.

    Science.gov (United States)

    Geldenhuys, Greta; Muller, Nina; Frylinck, Lorinda; Hoffman, Louwrens C

    2016-01-15

    Baseline research on the toughness of Egyptian goose meat is required. This study therefore investigates the post mortem pH and temperature decline (15 min-4 h 15 min post mortem) in the pectoralis muscle (breast portion) of this gamebird species. It also explores the enzyme activity of the Ca(2+)-dependent protease (calpain system) and the lysosomal cathepsins during the rigor mortis period. No differences were found for any of the variables between genders. The pH decline in the pectoralis muscle occurs quite rapidly (c = -0.806; ultimate pH ∼ 5.86) compared with other species and it is speculated that the high rigor temperature (>20 °C) may contribute to the increased toughness. No calpain I was found in Egyptian goose meat and the µ/m-calpain activity remained constant during the rigor period, while a decrease in calpastatin activity was observed. The cathepsin B, B & L and H activity increased over the rigor period. Further research into the connective tissue content and myofibrillar breakdown during aging is required in order to know if the proteolytic enzymes do in actual fact contribute to tenderisation. © 2015 Society of Chemical Industry.

  7. 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...

  8. 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.

  9. [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.

  10. Software requirements

    CERN Document Server

    Wiegers, Karl E

    2003-01-01

    Without formal, verifiable software requirements-and an effective system for managing them-the programs that developers think they've agreed to build often will not be the same products their customers are expecting. In SOFTWARE REQUIREMENTS, Second Edition, requirements engineering authority Karl Wiegers amplifies the best practices presented in his original award-winning text?now a mainstay for anyone participating in the software development process. In this book, you'll discover effective techniques for managing the requirements engineering process all the way through the development cy

  11. A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless.

    Science.gov (United States)

    Hanlon, Peter; Yeoman, Lynsey; Gibson, Lauren; Esiovwa, Regina; Williamson, Andrea E; Mair, Frances S; Lowrie, Richard

    2018-04-07

    Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. Community. Adults (≥18 years) fulfilling European Typology of Homelessness criteria. Delivered by healthcare professionals managing NCD and LT-CDs. Primary outcome: unscheduled healthcare utilisation. mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease

  12. 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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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...

  14. Care needs and workload required by institutionalised psychiatric patients Necesidades de cuidados y carga de trabajo de pacientes psiquiátricos institucionalizados Necessidades de cuidados e carga de trabalho de enfermagem a pacientes psiquiátricos institucionalizados

    Directory of Open Access Journals (Sweden)

    Helena Ayako Mukai

    2013-02-01

    Full Text Available OBJECTIVES: This descriptive study used a quantitative approach to assess the nursing care needs of patients with mental disorders, the mean number of care hours these patients were provided and the workload these patients require nursing team. METHODS: The research was conducted in a public neuropsychiatric hospital located in south eastern Brazil in 2010 and included 105 patients as subjects. A patient classification tool was applied to characterise care profiles. Statistical analysis was performed using principal component analysis and analysis of variance. RESULTS: Patients were predominantly in the low care category (73.3%. The mean care hours ranged from 0.57 to 0.88 for nurses and 1.97 to 3.16 for nursing assistants, and the workload ranged from 119.6 to 183 hours . CONCLUSIONS: The present study showed that the care needs of most patients were at a low level of dependency and that most patients did not need to be institutionalised. Furthermore, it was found that the care hours provided by the nursing staff were not sufficient to meet the care needs of the patients.OBJETIVOS: El propósito de este estudio descriptivo con abordaje cuantitativo fue investigar las necesidades de cuidados de enfermería de pacientes con trastornos mentales, el promedio de horas de asistencia prestadas y la carga de trabajo del equipo de enfermería. MÉTODO: El estudio fue realizado en 2010 en un hospital neuropsiquiátrico público situado en la región sudeste de Brasil e incluyó 105 pacientes. Un instrumento de clasificación de pacientes fue aplicado para caracterizar el perfil asistencial. El tratamiento estadístico fue realizado mediante Análisis de Componentes Principales y Análisis de Varianza. RESULTADOS: Predominaron los pacientes de la categoría discreta de cuidados (73,3%. El promedio de horas de asistencia varió entre 0,57 y 0,88 (enfermeros y entre 1,97 y 3,16 (auxiliares de enfermería y la carga de trabajo entre 119,6 y 183 horas

  15. Tracheostomy care

    Science.gov (United States)

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

  16. 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

  17. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness.

    Science.gov (United States)

    FitzGerald, M P; Payne, C K; Lukacz, E S; Yang, C C; Peters, K M; Chai, T C; Nickel, J C; Hanno, P M; Kreder, K J; Burks, D A; Mayer, R; Kotarinos, R; Fortman, C; Allen, T M; Fraser, L; Mason-Cover, M; Furey, C; Odabachian, L; Sanfield, A; Chu, J; Huestis, K; Tata, G E; Dugan, N; Sheth, H; Bewyer, K; Anaeme, A; Newton, K; Featherstone, W; Halle-Podell, R; Cen, L; Landis, J R; Propert, K J; Foster, H E; Kusek, J W; Nyberg, L M

    2012-06-01

    We determined the efficacy and safety of pelvic floor myofascial physical therapy compared to global therapeutic massage in women with newly symptomatic interstitial cystitis/painful bladder syndrome. A randomized controlled trial of 10 scheduled treatments of myofascial physical therapy vs global therapeutic massage was performed at 11 clinical centers in North America. We recruited women with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years' symptom duration. The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale. Secondary outcomes included ratings for pain, urgency and frequency, the O'Leary-Sant IC Symptom and Problem Index, and reports of adverse events. We compared response rates between treatment arms using the exact conditional version of the Mantel-Haenszel test to control for clustering by clinical center. For secondary efficacy outcomes cross-sectional descriptive statistics and changes from baseline were calculated. A total of 81 women randomized to the 2 treatment groups had similar symptoms at baseline. The global response assessment response rate was 26% in the global therapeutic massage group and 59% in the myofascial physical therapy group (p=0.0012). Pain, urgency and frequency ratings, and O'Leary-Sant IC Symptom and Problem Index decreased in both groups during followup, and were not significantly different between the groups. Pain was the most common adverse event, occurring at similar rates in both groups. No serious adverse events were reported. A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage. Myofascial physical therapy may be a beneficial therapy in women with this

  18. Comparing complementary alternative treatment for chronic shoulder pain of myofascial origin: Collateral meridian therapy versus local tender area-related meridians therapy.

    Science.gov (United States)

    Pan, Ru-Yu; Hsu, Yung-Chi; Wong, Chih-Shung; Lin, Shinn-Long; Li, Tsung-Ying; Cherng, Chen-Hwan; Ko, Shan-Chi; Yeh, Chun-Chang

    2016-08-01

    The aim of this study was to compare the short-term outcomes between 2 different treatments for unilateral chronic shoulder pain of myofascial origin, that is, local tender area related meridians (LTARMs) treatment and collateral meridian therapy (CMT), which were performed 6 times over a period of 4 weeks.Seventy patients with unilateral shoulder pain of chronic myofascial origin were enrolled. The patients were randomly assigned to 2 different treatment groups: 1 group received CMT (n = 35) and the other received LTARM (n = 35). Before and after the 2 treatment processes, all patients rated their overall pain intensity on a visual analogue scale (VAS) and a validated 13-question shoulder pain and disability index (SPADI) questionnaire was used to measure shoulder pain and functional impairment after therapy for 4 weeks.After CMT, the pain intensity was reduced after CMT. VAS score is reduced from 5.90 ± 2.07 (a mean of 5.90 and standard deviation of 2.07) to 3.39 ± 1.2. This was verified by the SPADI pain subscale scores (from 0.58 ± 0.193 to 0.33 ± 0.14). The pain-relief effect of CMT was significantly better than that of LTARM (VAS score from 5.78 ± 1.64 to 4.58 ± 1.40; P pain subscale score from 0.58 ± 0.16 to 0.45 ± 0.14, P pain, whereas the VAS scores for moderate pain were even higher in the LTARM group in 75% of patients (P chronic shoulder pain of myofascial origin than the LTARM treatment, where treatment with the former resulted in better functional recovery after 4 weeks than the latter.

  19. Influence of dietary tender cluster beans (Cyamopsis tetragonoloba) on biliary proteins, bile acid synthesis and cholesterol crystal growth in rat bile.

    Science.gov (United States)

    Raghavendra, Chikkanna K; Srinivasan, Krishnapura

    2015-02-01

    Tender cluster beans (CBs; Cyamopsis tetragonoloba) are observed to possess anti-lithogenic potential in experimental mice. Formation of cholesterol gallstones in gallbladder is controlled by procrystallizing and anticrystallizing factors present in bile in addition to supersaturation of cholesterol. This study aimed at evaluating the influence of CB on biliary glycoproteins, low molecular weight (LMW) and high molecular weight (HMW) proteins, cholesterol nucleation time, and cholesterol crystal growth in rat hepatic bile. Groups of rats were fed for 10 weeks with 0.5% cholesterol to render the bile lithogenic. Experimental dietary interventions were: 10% freeze-dried CB, 1% garlic powder or their combination. Incorporation of CB into HCD decreased the cholesterol saturation index in bile, increased bile flow and biliary glycoproteins. Dietary CB prolonged cholesterol nucleation time in bile. Electrophoresis of biliary proteins showed the presence of high concentration of 27 kDa protein which might be responsible for the prolongation of cholesterol nucleation time in the CB fed group. Proteins of 20 kDa and 18 kDa were higher in CB treated animals, while the same were less expressed in HCD group. Biliary proteins from CB fed animals reduced cholesterol crystal growth index which was elevated in the presence of proteins from HCD group. Cholesterol-7α-hydroxylase and cholesterol-27-hydroxylase mRNA expression was increased in CB treated animals contributing to the bile acid synthesis. Thus, the beneficial anti-lithogenic effect of dietary CB which primarily is due to reduced cholesterol saturation index was additionally affected through a modulation of the nucleating and anti-nucleating proteins that affect cholesterol crystallization. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. [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.

  1. American Health Care Association

    Science.gov (United States)

    ... MO - St. Louis, Qualifications Required: Bachelor’s degree in business, marketing, health care administration or a related field Current ... Work for AHCA/NCAL News Provider Daily Publications Social Media News Releases LTC Leader Blog Research and Data ...

  2. Closure requirements

    International Nuclear Information System (INIS)

    Hutchinson, I.P.G.; Ellison, R.D.

    1992-01-01

    Closure of a waste management unit can be either permanent or temporary. Permanent closure may be due to: economic factors which make it uneconomical to mine the remaining minerals; depletion of mineral resources; physical site constraints that preclude further mining and beneficiation; environmental, regulatory or other requirements that make it uneconomical to continue to develop the resources. Temporary closure can occur for a period of several months to several years, and may be caused by factors such as: periods of high rainfall or snowfall which prevent mining and waste disposal; economic circumstances which temporarily make it uneconomical to mine the target mineral; labor problems requiring a cessation of operations for a period of time; construction activities that are required to upgrade project components such as the process facilities and waste management units; and mine or process plant failures that require extensive repairs. Permanent closure of a mine waste management unit involves the provision of durable surface containment features to protect the waters of the State in the long-term. Temporary closure may involve activities that range from ongoing maintenance of the existing facilities to the installation of several permanent closure features in order to reduce ongoing maintenance. This paper deals with the permanent closure features

  3. Tender for printing annual report

    Indian Academy of Sciences (India)

    Technology, Govt. of India, needs book “Annual Report” to be printed as per below mentioned specification .Eligible vendors (as ... any one of the documents asked is not enclosed, the quotation will not be considered. ... The EMD of selected bidder(s) will be kept as security deposit till ... contract by telephonically or E-Mail.

  4. Tender for procurement of computers

    Indian Academy of Sciences (India)

    2018-06-12

    Jun 12, 2018 ... quality papers and articles by scientists from India and abroad. Sealed bids are invited for ... document. Prospective bidders may submit their offers to ..... training, warranty maintenance and after sales service. This is the sole.

  5. Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans. Final rule.

    Science.gov (United States)

    2016-03-30

    This final rule will address the application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children’s Health Insurance Programs.

  6. Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

    Science.gov (United States)

    Namba, Hirofumi; Kawasaki, Motohiro; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro; Koizumi, Norihiro

    2017-03-01

    It has been reported that MRgFUS has pain palliative effects on the local pain in patients with bone metastasis. In general, a severity of pain has been evaluated using only subjective method with numerical rating scale (NRS) or visual analogue scale (VAS). It is important to evaluate local pain-palliative effects of MRgFUS treatment with objective and quantitative method. The aim of this study is to investigate changes in the severity of local pain of bone metastasis before and after MRgFUS treatments, measuring pressure pain threshold (PPT) using pressure algometer, and pain intensity using electrical stimulation device (the Pain Vision system) at most painful site of bone metastasis. We have conducted MRgFUS for pain palliation of bone metastasis for 8 patients, and evaluated the local tenderness quantitatively for 8 patients, and evaluated local pain intensity for 7 patients. Before the treatments, PPTs were 106.3kPa [40.0-431.5] at metastatic site and 344.8 kPa [206.0-667.0] at normal control site, which showed a significant difference. The PPTs at metastatic site shows a significant increase from 106.3 kPa [40.0-431.5] at the baseline to 270.5 kPa [93.5-533.5] at 3 months after the treatment. The NRS score shows a significant decrease from 6.0 [4-8] at baseline to 1 [0-3] at 3 months after the treatment. Similarly, the pain intensity shows a significant decrease 245 [96.3-888.7] at baseline to 55.9 [2.8-292] at 3 months after the treatment. The results of our study illustrate the pain-relieving effects of MRgFUS for the treatment of painful bone metastasis. PPT might be a useful parameter not only for assessing a treatment's effect, but also for the decision of the painful area to treat with MRgFUS. Pain Vision seems to be useful for quantitative and objective evaluation of local pain of painful bone metastasis.

  7. Residential Care

    Science.gov (United States)

    ... Kids For Teens For Parents & Teachers Resolving Family Conflicts The Holidays and Alzheimer's Glossary Virtual Library Online ... longer an option Costs Choosing a care setting Types of residential care A good long-term care ...

  8. Palliative Care

    Science.gov (United States)

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

  9. Critical Care

    Science.gov (United States)

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

  10. 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

  11. 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…

  12. Domestic and donor financing for tuberculosis care and control in low-income and middle-income countries: an analysis of trends, 2002-11, and requirements to meet 2015 targets.

    Science.gov (United States)

    Floyd, Katherine; Fitzpatrick, Christopher; Pantoja, Andrea; Raviglione, Mario

    2013-08-01

    Progress in tuberculosis control worldwide, including achievement of 2015 global targets, requires adequate financing sustained for many years. WHO began yearly monitoring of tuberculosis funding in 2002. We used data reported to WHO to analyse tuberculosis funding from governments and international donors (in real terms, constant 2011 US$) and associated progress in tuberculosis control in low-income and middle-income countries between 2002 and 2011. We then assessed funding needed to 2015 and how this funding could be mobilised. We included low-income and middle-income countries that reported data about financing for tuberculosis to WHO and had at least three observations between 2002 and 2011. When data were missing for specific country-year combinations, we imputed the missing data. We aggregated country-specific results for eight country groups defined according to income level, political and economic profile, geography, and tuberculosis burden. We compared absolute changes in total funding with those in the total number of patients successfully treated and did cross-country comparisons of cost per successfully treated patient relative to gross domestic product. We estimated funding needs for tuberculosis care and control for all low-income and middle-income countries to 2015, and compared these needs with domestic funding that could be mobilised. Total funding grew from $1·7 billion in 2002 to $4·4 billion in 2011. It was mostly spent on diagnosis and treatment of drug-susceptible tuberculosis. 43 million patients were successfully treated, usually for $100-500 per person in countries with high burdens of tuberculosis. Domestic funding rose from $1·5 billion to $3·9 billion per year, mostly in Brazil, Russia, India, China, and South Africa (BRICS), which collectively account for 45% of global cases, where national contributions accounted for more than 95% of yearly funding. Donor funding increased from $0·2 billion in 2002 to $0·5 billion in 2011, and

  13. Maternity Care Update: Postpartum Care.

    Science.gov (United States)

    Smith, Andrew; Barr, Wendy B; Bassett-Novoa, Erin; LeFevre, Nicholas

    2018-04-01

    Family physicians are uniquely situated to play a major role in postpartum care. Postpartum issues that should be monitored and addressed include reproductive and contraceptive planning, breastfeeding counseling and support, and maternal mental health. All women should be screened for postpartum depression using a validated tool at the postpartum visit and/or at well-child visits. Patients with positive screening results should be offered support and treatment. Women are more likely to breastfeed if they are provided with breastfeeding support and counseling routinely during the prenatal and postpartum periods. All women should be asked about their reproductive life plans, counseled about potential risks associated with short and prolonged interpregnancy intervals, and offered contraception. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  14. Palliative Care

    Science.gov (United States)

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

  15. Palliative Care.

    Science.gov (United States)

    Swetz, Keith M; Kamal, Arif H

    2018-03-06

    Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.

  16. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    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 2016. Some of these 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), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of 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 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.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) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  17. 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

  18. System level action required for wide-scale improvement in quality of primary healthcare: synthesis of feedback from an interactive process to promote dissemination and use of aggregated quality of care data

    Directory of Open Access Journals (Sweden)

    Jodie eBailie

    2016-05-01

    Full Text Available IntroductionThere is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary healthcare (PHC centres in delivery of care. Where aspects of care are not being done well across a range of PHC centres, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders’ perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement.MethodsThis paper draws on data collected as part of a large scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analysed to develop a ‘driver diagram’, an improvement tool used to locate barriers and enablers within causal pathways, (as primary and secondary drivers, enabling them to be targeted by tailored interventions. ResultsWe identified five primary drivers and eleven secondary drivers of high quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data driven decision making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilisation for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service

  19. Group prenatal care.

    Science.gov (United States)

    Mazzoni, Sara E; Carter, Ebony B

    2017-06-01

    Patients participating in group prenatal care gather together with women of similar gestational ages and 2 providers who cofacilitate an educational session after a brief medical assessment. The model was first described in the 1990s by a midwife for low-risk patients and is now practiced by midwives and physicians for both low-risk patients and some high-risk patients, such as those with diabetes. The majority of literature on group prenatal care uses CenteringPregnancy, the most popular model. The first randomized controlled trial of CenteringPregnancy showed that it reduced the risk of preterm birth in low-risk women. However, recent meta-analyses have shown similar rates of preterm birth, low birthweight, and neonatal intensive care unit admission between women participating in group prenatal care and individual prenatal care. There may be subgroups, such as African Americans, who benefit from this type of prenatal care with significantly lower rates of preterm birth. Group prenatal care seems to result in increased patient satisfaction and knowledge and use of postpartum family planning as well as improved weight gain parameters. The literature is inconclusive regarding breast-feeding, stress, depression, and positive health behaviors, although it is theorized that group prenatal care positively affects these outcomes. It is unclear whether group prenatal care results in cost savings, although it may in large-volume practices if each group consists of approximately 8-10 women. Group prenatal care requires a significant paradigm shift. It can be difficult to implement and sustain. More randomized trials are needed to ascertain the true benefits of the model, best practices for implementation, and subgroups who may benefit most from this innovative way to provide prenatal care. In short, group prenatal care is an innovative and promising model with comparable pregnancy outcomes to individual prenatal care in the general population and improved outcomes in some

  20. 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.

  1. 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.

  2. 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

  3. Medições instrumentais e sensoriais de dureza e suculência na carne caprina Instrumental and sensorial assessment of tenderness and juiciness in goat meat

    Directory of Open Access Journals (Sweden)

    Ângela da Silva Borges

    2006-12-01

    semimembranosus and biceps femoris muscles were tenderer than those from longissimus dorsi muscle. Meat from the semimembranosus muscle decreased in firmness during aging. Shear force values in meat showed positive correlation with firmness and negative correlation with juiciness as evaluated by the panelists. A negative correlation between firmness and juiciness was observed. Aging of the meat over seven days decreased firmness in goat meat from muscles, but did not affect cooking losses.

  4. 17 CFR 240.14d-102 - Schedule 14D-1F. Tender offer statement pursuant to rule 14d-1(b) under the Securities Exchange...

    Science.gov (United States)

    2010-04-01

    ... satisfy the legibility requirements for the required legends relating to type size and font by presenting... bold-face roman type at least as high as ten-point modern type and at least two points leaded: “This...

  5. [Primary care in France].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Should heart failure be regarded as a terminal illness requiring palliative care? A study of heart failure patients', carers' and clinicians' understanding of heart failure prognosis and its management.

    Science.gov (United States)

    Stocker, Rachel; Close, Helen; Hancock, Helen; Hungin, A Pali S

    2017-12-01

    Communication and planning for heart failure (HF) care near the end of life is known to be complex. Little is known about how the patient experience of palliative assessment and communication needs change over time, and how this might inform management. Our aim was to explore experiences of giving or receiving a prognosis and advanced palliative care planning (ACP) for those with HF. We carried out a longitudinal grounded theory study, employing in-depth interviews with 14 clinicians (primary and secondary care) and observations of clinic and home appointments, followed by a series of interviews with 13 patients with HF and 9 carers. Overall, the majority of participants rejected notions of HF as a terminal illness in favour of a focus on day-to-day management and maintenance, despite obvious deterioration in disease stage and needs over time. Clinicians revealed frustration about the uncertain nature of HF prognosis, leading to difficulties in planning. Others highlighted the need to deliver problem-based, individualised care but felt constrained sometimes by the lack of multidisciplinary ACP. Patients reported an absence of prognostic discussions with clinicians. This is the first study exploring the experiences of prognostic communication at all stages of HF. Findings raise questions regarding the pragmatic utility of the concept of HF as a terminal illness and have implications for future HF care pathway development. Findings support the incorporation of a problem-based approach to management, which recognises the importance of everyday functioning for patients and carers as well as the opportunity for ACP. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... the performance of specific home care services by means of video conversations rather than physical visits in the citizens’ homes. As scholars within the STS tradition maintain, technologies do not simply replace a human function; they rather transform care work, redistributing tasks between citizens, technology...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  8. 76 FR 25519 - National Foster Care Month, 2011

    Science.gov (United States)

    2011-05-05

    ... people in foster care. Through the American Recovery and Reinvestment Act, we have significantly... Agriculture child nutrition programs. Additionally, beginning in 2014, the Affordable Care Act will require...

  9. 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…

  10. 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.

  11. NF EN ISO 11137-1, July 2006. Sterilization of health care products - Irradiation - Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

    International Nuclear Information System (INIS)

    2006-01-01

    This part of the ISO 11137 standard specifies requirements for the development, validation and routine control of a radiation sterilization process for medical devices. Although the scope of this part of the ISO 11137 standard is limited to medical devices, it specifies requirements and provides guidance that may be applicable to other products and equipment. This part of the international standard covers radiation processes employing irradiators using the radionuclide 60 Co or 137 Cs, a beam from an electron generator or a beam from an X-ray generator. This part of the international standard does not: - specify requirements for development, validation and routine control of a process for inactivating the causative agents of spongiform encephalopathies such as scrapie, bovine spongiform encephalopathy and Creutzfeldt-Jakob disease; - detail specified requirements for designating a medical device as sterile; - specify a quality management system for the control of all stages of production of medical devices; - specify requirements for occupational safety associated with the design and operation of irradiation facilities; - specify requirements for the sterilization of used or reprocessed devices

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Subverting Sanity by Madness --A Psychoanalysis of the Central Figures in Tender is the Night%疯癫对文明的颠覆——对《夜色温柔》主人公的精神分析

    Institute of Scientific and Technical Information of China (English)

    杨澜

    2012-01-01

    In the novel Tender is the Night, the hero and the heroine exchange their roles of patient and doctor, in- sanity and culture. The interchange between madness and normality is the keynote of the book, as well as a meta- phor. From the perspective of psychoanalysis, the interchange also echoes the complex relations between ego and id, those of domination and counter-strike, of control and break-off.%《夜色温柔》中的男女主人公完成了各自从医生到“疯子”与从病人到正常人的角色互换。疯癫即是小说的主题,也是重要隐喻。从心理分析的角度看,二人的关系接近本能与自我互相制约、互相对抗的关系。

  14. 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.

  15. Improving palliative care.

    LENUS (Irish Health Repository)

    Moran, Sue

    2009-05-01

    Any service improvement project requires planning, action and evaluation. Using a recognised quality improvement framework can offer a structured approach to implementing and assessing changes to patient care. This article describes how use of the Deming Cycle has helped to identify nurses\\' learning needs.

  16. 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...

  17. 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...

  18. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    Science.gov (United States)

    2014-08-22

    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 these 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), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, 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 are effective for cost reporting periods beginning on or after October 1, 2014. 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 to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. 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 revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that

  19. 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.)

  20. Managing care.

    Science.gov (United States)

    Sandifer, Q D

    1997-09-01

    The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.

  1. Employee Care

    OpenAIRE

    Zavadilová, Eva

    2014-01-01

    The theme of the bachelor's thesis is the issue of employee care and related provision of employee benefits. The main objective is to analyze the effective legislation and characterize the basic areas of employee care. First of all, the thesis focuses on the matter of employee care and related legislation analyzing the working conditions, professional growth of the employees, catering of employees and special conditions for some employees. Furthermore, the special attention is paid to the vol...

  2. Advocacy for eye care

    Directory of Open Access Journals (Sweden)

    Thulasiraj D Ravilla

    2012-01-01

    Full Text Available The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services - such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support - either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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. ...

  8. 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-.

  9. 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...

  10. Pin care

    Science.gov (United States)

    ... Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Pin care URL of this page: //medlineplus.gov/ency/patientinstructions/000481.htm Pin care To use the sharing features on this page, please enable JavaScript. Broken bones can be fixed in surgery with metal ...

  11. ["Care" and public nutrition].

    Science.gov (United States)

    Martin-Prével, Yves

    2002-01-01

    national or international level. As the mother is the primary caregiver, most of the obstacles to care are the constraints to the mothers, the most common characteristic of which being the low status of women in many societies. More studies are required to better understand the causal relationship between care and nutrition. Methods to measure the qualitative aspects of care and indicators that capture the complexity of care must be developed and cross-culturally tested. These will also be useful to design and monitor more effective interventions incorporating care. These programmes should first identify and support the good traditional care practices rather than simply ask for change; the activities proposed should not break the balance between the time women spend on care and the time they spend on work. Therefore one must be sure that enough resources are available. Finally, to achieve sustainable changes a participatory and comprehensive approach is definitely needed.

  12. 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.

  13. Rural maternity care.

    Science.gov (United States)

    Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

    2012-10-01

    To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

  14. 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.

  15. 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.

  16. A literature review exploring role transitions in caring for a child requiring long-term ventilationIn recent years, the UK and other high-income countries have seen an increase in the use of long-term ventilation (LTV) in paediatric intensive care ( Neupane et al 2015 ). Children who need LTV often stay in hospital for 28 days or more.

    Science.gov (United States)

    Goss, Emily

    2017-06-12

    Government policies advocate that children should be cared for at home ( Noyes et al 2006 ), although medically stable LTV children often stay in hospital months longer than is necessary ( NHS England 2015 ). Research shows that parents of these children develop a dual role as parents and nurses, which leads to role conflict and ambiguity ( Hewitt-Taylor 2011 ).

  17. Monitoring Outpatient Care

    Science.gov (United States)

    2003-01-01

    Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

  18. 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...

  19. 17 CFR 240.13e-102 - Schedule 13E-4F. Tender offer statement pursuant to section 13(e) (1) of the Securities Exchange...

    Science.gov (United States)

    2010-04-01

    ... enforcement by investors of civil liabilities under the federal securities laws may be affected adversely by... disclosure requirements of the country in which the issuer is incorporated or organized, investors should be... directors are residents of a foreign country. “Investors should be aware that the issuer or its affiliates...

  20. 17 CFR 240.14d-100 - Schedule TO. Tender offer statement under section 14(d)(1) or 13(e)(1) of the Securities Exchange...

    Science.gov (United States)

    2010-04-01

    ... incorporated by reference is not filed with this schedule, an indication is made where the information may be... holders. If pro forma financial information is required by this instruction, the historical financial... general or limited partnership, syndicate or other group, the information called for by Items 3 and 5-8...