Provocarea Facebook pentru bibliotecile publice din România

Directory of Open Access Journals (Sweden)

Octavia-Luciana Madge

2014-01-01

Full Text Available Reţelele sociale şi-au câştigat rapid un loc în viaţa noastră şi în activitatea multor organizaţii şi instituţii publice şi private. La nivelul bibliotecilor, reţelele sociale şi-au demonstrat utilitatea şi rolul în calitate de instrumente de marketing pentru o mai bună comunicare cu utilizatorii. Bibliotecile publice din România au cunoscut în ultimul timp transformări mari în ceea ce priveşte modul de abordare a relaţiei cu utilizatorii şi îmbunătăţirea activităţii lor. Au lansat, de asemenea, o serie de noi servicii pentru a răspunde nevoilor comunităţii pe care o servesc şi pentru a atrage noi utilizatori. Implementarea şi utilizarea de noi aplicaţii precum reţelele de socializare online, mai exact Facebook, a fost una dintre aceste dezvoltări recente. Această lucrare analizează modul în care reţelele sociale sunt utilizate la nivelul bibliotecilor publice din România prin exemplul a trei biblioteci publice mari şi a modului în care aceste biblioteci îşi promovează serviciile prin intermediul reţelei Facebook.

Biblioteca Naţională a României: obiective şi perspective în valorificarea patrimoniului cultural

Directory of Open Access Journals (Sweden)

Elena Tîrziman

2008-01-01

Biblioteca Naţională a României este implicată în proiecte internaţionale care au ca scop crearea de conţinut digital relevant pentru memoria culturală europeană: The European Library – TEL (Biblioteca europeană, Manuscriptorium şi ENRICH – European Networking Resources and Information concerning Cultural Heritage, proiecte coordonate de Biblioteca Naţională a Cehiei. Biblioteca Naţională a României a contribuit la proiectele Manuscriptorium / ENRICH prin carte românească veche din perioada corespunzătoare secolelor XVI-XVII.

The Novice User and CD-ROM Database Services. ERIC Digest.

Science.gov (United States)

Schamber, Linda

This digest answers the following questions that beginning or novice users may have about CD-ROM (a compact disk with read-only memory) database services: (1) What is CD-ROM? (2) What databases are available? (3) Is CD-ROM difficult to use? (4) How much does CD-ROM cost? and (5) What is the future of CD-ROM? (15 references) (MES)

The Nuclear CD-Rom

International Nuclear Information System (INIS)

James, J.Z.

1993-01-01

September 1992 will see the publication of the first open-quotes Nuclear CD-ROMclose quotes-a Compact Disk Read-Only Memory (CD-ROM) containing both the entire Evaluated Nuclear Data Files (ENDF) library and the Evaluated Nuclear Structure Data Files (ENSDF) library. The CD-ROM will also contain codes for processing and visualizing the data, and some nuclear physics codes to use the ENDF data. Finally, the data and program files will be accompanied by fully-formatted documentation that can be read on many different workstations and microcomputers

Distributing the Wealth: Sliding CD-ROM into the Consumer Channel.

Science.gov (United States)

Bowers, Richard A.

1994-01-01

Examines retail sales of CD-ROMs. Topics addressed include the current situation in CD-ROM retailing; channel distribution options; myths and realities of CD-ROM distribution; the distributor; affiliate labels; sales representatives; copublishers; distribution options; distributing resources; and recommendations for new CD-ROM publishers. (LRW)

Natural Tasking of Robots Based on Human Interaction Cues (CD-ROM)

National Research Council Canada - National Science Library

Brooks, Rodney A

2005-01-01

...: 1 CD-ROM; 4 3/4 in.; 207 MB. ABSTRACT: We proposed developing the perceptual and intellectual abilities of robots so that in the field, war-fighters can interact with them in the same natural ways as they do with their human cohorts...

Mawul Rom Project: Openness, obligation and reconciliation

NARCIS (Netherlands)

Brigg, M.; Tonnaer, A.A.C.

2008-01-01

Aboriginal Australian initiatives to restore balanced relationships with White Australians have recently become part of reconciliation efforts. This paper provides a contextualised report on one such initiative, the Mawul Rom cross-cultural mediation project. Viewing Mawul Rom as a diplomatic

Food Chains & Webs. A Multimedia CD-ROM. [CD-ROM].

Science.gov (United States)

2001

This CD-ROM is designed for classroom and individual use to teach and learn about food chains and food webs. Integrated animations, custom graphics, three-dimensional representations, photographs, and sound are featured for use in user-controlled activities. Interactive lessons are available to reinforce the subject material. Pre- and post-testing…

Adventures in Evaluation: Reviewing a CD-ROM Based Adventure Game Designed for Young People Recovering from Psychosis

Science.gov (United States)

Shrimpton, Bradley; Hurworth, Rosalind

2005-01-01

Recently the Centre for Program Evaluation (CPE) at the University of Melbourne was approached by a mental health agency to undertake the unique and challenging task of evaluating a prototype CD-ROM based adventure game designed for young people recovering from psychosis. This unusual and inventive game, titled Pogo's Pledge, used…

In company pre-intermediate student's book with CD-ROM

CERN Document Server

Clarke, Simon; Sharma, Pete

2009-01-01

In Company has established itself as the Business English course for professionals because of its immediate results through topic-based content, active skills, and real-world tasks that are instantly relevant to everyday business English development. In Company Second Edition builds on the success of the original but is now updated and improved with a host of new features. For extra online practice for your students, take a look at the new Second Edition In Company Practice Online solution. Accompanying the popular In Company series in British English, these online courses provide carefully designed resources to supplement the Student's Books at all levels. Units are clearly defined as Topic or Skills based NEW phrase banks with useful phrases for reference and revision 5 NEW case studies, within the Student's Book reflect real-life business scenarios Second Edition CD-ROM now includes a new interactive glossary and the class audio as a donwloadable MP3.

Comment scolariser les enfants Roms? Les enfants Roms dans les dispositifs mis en place à Bordeaux Métropole.

OpenAIRE

Øhlund, Ida

2016-01-01

Dans ce mémoire, je m intéresse à la scolarisation des enfants Roms en France. Je présente la place des enfants Roms dans la scolarisation en Europe et en France. Je discute les efforts qu on fait en France pour scolariser ces enfants, et je prends comme exemple les mesures d intégration prises par les autorités de Bordeaux Métropole en expliquant les rôles des différents acteurs locaux. Dans la première partie, j essaye de présenter le groupe minoritaire européen appelé « Rom ». J aborde l h...

Ambient Temperature Based Thermal Aware Energy Efficient ROM Design on FPGA

DEFF Research Database (Denmark)

Saini, Rishita; Bansal, Neha; Bansal, Meenakshi

2015-01-01

Thermal aware design is currently gaining importance in VLSI research domain. In this work, we are going to design thermal aware energy efficient ROM on Virtex-5 FPGA. Ambient Temperature, airflow, and heat sink profile play a significant role in thermal aware hardware design life cycle. Ambient...

The planetary data system educational CD-ROM

Science.gov (United States)

Guinness, E. A.; Arvidson, R. E.; Martin, M.; Dueck, S.

1993-01-01

The Planetary Data System (PDS) is producing a special educational CD-ROM that contains samples of PDS datasets and is expected to be released in 1993. The CD-ROM will provide university-level instructors with PDS-compatible materials and information that can be used to construct student problem sets using real datasets. The main purposes of the CD-ROM are to facilitate wide use of planetary data and to introduce a large community to the PDS. To meet these objectives the Educational CD-ROM will also contain software to manipulate the data, background discussions about scientific questions that can be addressed with the data, and a suite of exercises that illustrate analysis techniques. Students will also be introduced to the SPICE concept, which is a new way of maintaining geometry and instrument information. The exercises will be presented at the freshman through graduate student levels. With simplification, some of the material should also be of use at the high school level.

Noziegums un sods Grama Svifta romānā "Dienas gaisma" un Fjodora Dostojevska romānā "Noziegums un sods"

OpenAIRE

Hohlova, Marija

2008-01-01

Šis bakalaura darbs pēta nozieguma un soda tēmu Fjodora Dostojevska romānā "Noziegums un sods" un Grema Svifta romānā "Dienas gaisma". Darbs sastāv no četrām nodaļām. Pirmajā nodaļā, kura pamatīgi aplūko nozieguma folozofiju, autore piemin integrēto pieeju nozieguma parādībai folozofijas skatījumā, kā arī analīzē nozieguma metafiziskās un socioloģiskās īpatnības uz Fjodora Dostojevska romāna "Noziegums un sods" pamata. Otrā nodaļa apraksta Fjodora Dostojevska romāna "Noziegums un sods" un Gre...

Computer Based Radiation Protection- A New Cd-Rom

International Nuclear Information System (INIS)

Geringer, T.; Bammer, M.; Ablber, M.

2004-01-01

Within the next few years, there'll be a lot of new challenges required from radiation protection. According to EU regulation[1] and the new austrian radiation protection law [2] regular additional training are requested. Patients protection in diagnostic and therapeutic usage of ionising radiation gains also more and more importance.[3] Not really surprisingly, the general population is definitely highly aware of the risks coming with the usage of radionuclides and x-rays in medicine. Furthermore, the nuclear power plant in Temelin, near the austrian border initiated a lively discussion about risks, necessity and use of ionising radiation in medicine and industry. It turned out to be a really hard job handling these topics in public. A brilliant didactics based on independent information and viewpoints was required. ARC Seibersdorf Research GmbH, represented by the department of medical technical applications and the radiation protection academy, developed an interactive CD-ROM covering several applications: Basics on radiation protection for medical and technical personnel ; preparation for a radiation protection training. Repetition of the main topics for graduates of a radiation protection training. Basics on radiation protection and emergency management for medical staff as well as for the general public. (Author)

OCONUS Compliance Assessment Protocols - Qatar (Army Version) (CD-ROM)

National Research Council Canada - National Science Library

Krooks, David A

2004-01-01

...: 1 CD-ROM; 4 3/4 in.; 578 KB. ABSTRACT: This environmental compliance assessment manual is based on the Final Governing Standards for Environmental Security of United States Forces in the State of Qatar, 21 May 1999, and the Overseas...

CD-ROM Stress.

Science.gov (United States)

Bunge, Charles A.

1991-01-01

Discussion of stress in library reference departments focuses on stress caused by CD-ROM reference tools. Topics discussed include work overload; nonreference duties; patron attitudes and behavior; staff attitudes; the need for proper staff training; and the need for library administrators to be sensitive to reference staff needs. (LRW)

CD-ROM: towards a strategy for teaching and learning.

Science.gov (United States)

Aarvold, J; Walton, G

1992-12-01

Compact Disc Read Only Memory (CD-ROM) represents an exciting innovation in nurse education yet paradoxically has a potential to induce disillusionment and frustration. Purchasers of systems may well find that their investment does not bring the benefits they had been lead to expect. CD-ROM systems have the capacity to generate huge quantities of data on an equally large number of nursing topics. Arguably this very capability ensures certain 'built-in' problems. The purpose of this articles is to provide nurse teachers with information about CD-ROM, to highlight the resource implications of CD-ROM use and to consider the relative merits of various teaching and learning methods. To be worthwhile, strategies developed must be part of an information retrieval skills programme.

IDC Reengineering Phase 2 & 3 Rough Order of Magnitude (ROM) Cost Estimate Summary (Leveraged NDC Case).

Energy Technology Data Exchange (ETDEWEB)

Harris, James M.; Prescott, Ryan; Dawson, Jericah M.; Huelskamp, Robert M.

2014-11-01

Sandia National Laboratories has prepared a ROM cost estimate for budgetary planning for the IDC Reengineering Phase 2 & 3 effort, based on leveraging a fully funded, Sandia executed NDC Modernization project. This report provides the ROM cost estimate and describes the methodology, assumptions, and cost model details used to create the ROM cost estimate. ROM Cost Estimate Disclaimer Contained herein is a Rough Order of Magnitude (ROM) cost estimate that has been provided to enable initial planning for this proposed project. This ROM cost estimate is submitted to facilitate informal discussions in relation to this project and is NOT intended to commit Sandia National Laboratories (Sandia) or its resources. Furthermore, as a Federally Funded Research and Development Center (FFRDC), Sandia must be compliant with the Anti-Deficiency Act and operate on a full-cost recovery basis. Therefore, while Sandia, in conjunction with the Sponsor, will use best judgment to execute work and to address the highest risks and most important issues in order to effectively manage within cost constraints, this ROM estimate and any subsequent approved cost estimates are on a 'full-cost recovery' basis. Thus, work can neither commence nor continue unless adequate funding has been accepted and certified by DOE.

Energy & Environmental Issues Interactive CD-ROM. Version 2.0. [CD-ROM].

Science.gov (United States)

Florida State Univ., Tallahassee.

This CD-ROM presents various energy and environmental topics. "Great Energy Debate" uses video clips to explore the pros and cons of solar, coal, nuclear, and oil energy sources. "Energy Plant Tour" presents a virtual tour through a plant that converts solid waste into energy. "How Stuff Works" explains energy…

DNA: The Molecule of Life. A Multimedia CD-ROM. [CD-ROM].

Science.gov (United States)

2001

This CD-ROM is designed for classroom and individual use to teach and learn about DNA. Integrated animations, custom graphics, three-dimensional representations, photographs, and sound are featured for use in user-controlled activities. Interactive lessons are available to reinforce the subject material. Pre- and post-testing sections are also…

Reactive oxygen metabolites (ROMs) are associated with cardiovascular disease in chronic hemodialysis patients.

Science.gov (United States)

Bossola, Maurizio; Vulpio, Carlo; Colacicco, Luigi; Scribano, Donata; Zuppi, Cecilia; Tazza, Luigi

2012-02-11

The aim of our study was to measure reactive oxygen metabolites (ROMs) in chronic hemodialysis (HD) patients and evaluate the possible association with cardiovascular disease (CVD) and mortality. We measured ROMs in 76 HD patients and correlated with CVD, cardiovascular (CV) events in the follow-up and all-cause and CVD-related mortality. The levels of ROMs presented a median value of 270 (238.2-303.2) CARR U (interquartile range). We created a ROC curve (ROMs levels vs. CVD) and we identified a cut-off point of 273 CARR U. Patients with ROMs levels ≥273 CARR U were significantly older, had higher C-reactive protein levels and lower creatinine concentrations. The prevalence of CVD was higher in patients with ROMs levels ≥273 (87.1%) than in those with ROMs levels <273 CARR U (17.7%; p<0.0001). ROMs levels were significantly higher in patients with CVD (317±63.8) than in those without (242.7±49.1; p<0.0001). At multiple regression analysis, age, creatinine and C-reactive protein were independent factors associated with ROMs. At multiple logistic regression analysis the association between ROMs and CVD was independent (OR: 1.02, 95% CI: 1.00-1.05; p=0.03). Twenty six patients developed cardiovascular (CV) events during the follow-up. Of these, seven were in the group with ROMs levels <273 CARR U and 19 in the group with ROMs levels ≥273 CARR U. The logistic regression analysis showed that both age (OR: 1.06, 95% CI: 1.01-1.12; p=0.013) and ROMs levels (OR: 1.10, 95% CI: 1.00-1.02; p=0.045) were independently associated with CV events in the follow-up. ROMs are independently associated with CVD and predict CV events in chronic HD patients.

Enhancing Your CD-ROM Services with Signage Systems.

Science.gov (United States)

Ekhaml, Leticia

1994-01-01

Describes how to use effective signage, or visual guidance, for more efficient use of CD-ROM technology in elementary and secondary school library media centers. Setting CD-ROM policies and procedures is considered; the use of posters, brochures, flowcharts, and other formats is discussed; and examples are included. (LRW)

The systems prioritization method (SPM) CD-ROM demonstration for Waste Management '96

International Nuclear Information System (INIS)

Harris, C.L.; Boak, D.M.; Prindle, N.H.; Beyeler, W.

1996-01-01

In March 1994, the Department of Energy Carlsbad Area Office (DOE/CAO) implemented a performance-based planning method to assist in prioritization within the Waste Isolation Pilot Plant (WIPP). Probabilistic performance calculations were required for the Systems Prioritization Method (SPM) and roughly 46,700 combinations of activities were analyzed, generating a large volume of information to be documented, analyzed, and communicated. A self-contained information management system consisting of a relational database on a 600-megabyte CD-ROM was built to meet this need. The CD-ROM was used to store performance assessment results, data analysis and visualization tools, information about the activities, electronic copies of 40 ILFR 191 and 40 CFR 268, technical reference papers, and the final SPM report. Copies of the CD-ROM were distributed to interested members of the public, WIPP participants, and the Environmental Protection Agency (EPA)

Data base management system and display software for the National Geophysical Data Center geomagnetic CD-ROM's

Science.gov (United States)

Papitashvili, N. E.; Papitashvili, V. O.; Allen, J. H.; Morris, L. D.

1995-01-01

The National Geophysical Data Center has the largest collection of geomagnetic data from the worldwide network of magnetic observatories. The data base management system and retrieval/display software have been developed for the archived geomagnetic data (annual means, monthly, daily, hourly, and 1-minute values) and placed on the center's CD-ROM's to provide users with 'user-oriented' and 'user-friendly' support. This system is described in this paper with a brief outline of provided options.

Syd for Rom

DEFF Research Database (Denmark)

Frandsen, Steen Bo

Bogen fortæller historien om et af Europas mest berømte vildnisser, De Pontinske Sumpe, der strakte sig i kystlandet umiddelbart syd for Rom fra romertiden til tørlægningen og forvandlingen til landbrugsland i 1930'erne. Allerede under romerne vandt sumpen uophørligt terræn og forvandlede det fla...

ROMS/TOMS Tangent Linear and Adjoint Models: Testing and Applications

National Research Council Canada - National Science Library

Miller, Arthur J; Cornuelle, Bruce D

2004-01-01

... (Regional Ocean Modeling System/Terrain-Following Ocean Modeling System) that is suitable for general use by the ROMS/TOMS community and to develop computational platforms based on the TLM and ADM for 4D variational data assimilation (4DVar...

Our God is Gold: Vlashika Rom at a Crossroads?

Directory of Open Access Journals (Sweden)

Andrš Zbyněk

2016-12-01

Full Text Available This article explicates the sociocultural dynamics in the changing lives of the Vlashika Rom group in the Czech and Slovak Republics and contemplates the prospective development of this Roma subculture. To provide a better insight into the endeavour of the Vlashika Rom to maintain their integrity and into their adaptation strategies, the author outlines the genesis of this subethnic group, pointing out the historical circumstances that have formed them in the past. Contrary to former descriptions, the author provides an entirely new concept for dividing the Vlashika Rom into subgroups, identifying three distinct levels that create social boundaries within this community. He describes the way of living of this subgroup in the past as well as the relationships between the Vlashika Rom and the dominant society. Frequently antagonistic, these relationships depend on their way of life, substantially determined by the way they earn their living. The author analyses the inner resources that keep sustaining the contemporary Vlashika Rom culture and, drawing on his own experience and impulses from literature, inquires how long this anachronistic yet at the same time very adaptable culture will be able to resist the assimilation pressures deriving from the very nature of the modern national state.

CD-ROM storing JENDL-3.2 plots and data

Energy Technology Data Exchange (ETDEWEB)

Fukahori, Tokio; Iwamoto, Osamu; Nakagawa, Tsuneo; Shibata, Keiichi; Narita, Tsutomu; Katakura, Jun-ichi; Hasegawa, Akira [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

1998-01-01

Numerical data and graphs of Japanese Evaluated Nuclear Data Library, Version 3, Revision 2 (JENDL-3.2) have been stored into CD-ROM. JENDL-3.2 is an evaluated nuclear data library which is highly rated in the world, and consists of neutron nuclear data and secondary gamma-ray data for 340 nuclides. JENDL-3.2 has been already released through World Wide Web (WWW, http://cracker.tokai.jaeri.go.jp). For users` convenience and to promote further utilization, this CD-ROM has been produced. The data stored in CD-ROM are the original data and point-wise data (0 K and 300 K) of JENDL-3.2 and graphs of cross sections in gif, PostScript and PDF formats. These data can be retrieved by users` personal computers and engineering workstations, and also can be seen by using WWW browsers. This CD-ROM makes user completely free from downloading, which takes a lot of time, and tedious management such a treating big amount of data. (author)

OCONUS Compliance Assessment Protocols (OCAP) - Saudi Arabia (Army Version) (CD-ROM)

National Research Council Canada - National Science Library

Krooks, David A; Schell, Donna J

2004-01-01

...: 1 CD-ROM; 4 3/4 in.; 670 KB. ABSTRACT: This environmental compliance assessment manual is based on the Final Governing Standards for Environmental Security by United States Forces in the Kingdom of Saudi Arabia (FGS-SA...

Scaffolding or Distracting: CD-ROM Storybooks and Young Readers

Science.gov (United States)

Pearman, Cathy J.; Chang, Ching-Wen

2010-01-01

CD-ROM storybooks, often referred to as electronic texts, e-books, and interactive stories, are learning tools with supplemental features such as automatic reading of text, sound effects, word pronunciations, and graphic animations which support the development of reading skills and comprehension in beginning readers. Some CD-ROM storybooks also…

Review of CD Rom

African Journals Online (AJOL)

"The Virtual Surgeon consists of a ground breaking series of CD-ROMs, which aims to provide surgeons with a new and powerful training tool. It provides surgeons with the most accurate and realistic model of the knee available, and our developments in animation allow them to see all aspects of the surgical procedure.

Thoracic ROM measurement system with visual bio-feedback: system design and biofeedback evaluation.

Science.gov (United States)

Ando, Takeshi; Kawamura, Kazuya; Fujitani, Junko; Koike, Tomokazu; Fujimoto, Masashi; Fujie, Masakatsu G

2011-01-01

Patients with diseases such as chronic obstructive pulmonary disease (COPD) need to improve their thorax mobility. Thoracic ROM is one of the simplest and most useful indexes to evaluate the respiratory function. In this paper, we have proposed the prototype of a simple thoracic ROM measurement system with real-time visual bio-feedback in the chest expansion test. In this system, the thoracic ROM is measured using a wire-type linear encoder whose wire is wrapped around the thorax. In this paper, firstly, the repeatability and reliability of measured thoracic ROM was confirmed as a first report of the developed prototype. Secondly, we analyzed the effect of the bio-feedback system on the respiratory function. The result of the experiment showed that it was easier to maintain a large and stable thoracic ROM during deep breathing by using the real-time visual biofeedback system of the thoracic ROM.

Marketing and Selling CD-ROM Products on the World-Wide Web.

Science.gov (United States)

Walker, Becki

1995-01-01

Describes three companies' approaches to marketing and selling CD-ROM products on the World Wide Web. Benefits include low overhead for Internet-based sales, allowance for creativity, and ability to let customers preview products online. Discusses advertising, information delivery, content, information services, and security. (AEF)

Planning and Preparation for CD-ROM Implementation: The Citadel Library.

Science.gov (United States)

Maynard, J. Edmund

Management guidelines for library planning and a strategic planning program profile based on the literature were used in the planning process for implementing access to databases on CD-ROM at the Daniel Library of the Citadel, Military College of South Carolina. According to this model, the planning process would consist of five stages: (1)…

New Access Points to ERIC--CD-ROM Versions. ERIC Digest.

Science.gov (United States)

McLaughlin, Pamela W.

This digest reviews three CD-ROM (compact disc-read only memory) versions of the ERIC (Educational Resources Information Center) database currently being delivered or tested and provides information for comparison. However, no attempt is made to recommend any one product. The advantages and disadvantages of the acquisition of CD-ROM databases are…

Regional Ocean Modeling System (ROMS): CNMI

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 7-day, 3-hourly forecast for the region surrounding the Commonwealth of the Northern Mariana Islands (CNMI) at approximately...

Regional Ocean Modeling System (ROMS): Samoa

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 7-day, 3-hourly forecast for the region surrounding the islands of Samoa at approximately 3-km resolution. While considerable...

Regional Ocean Modeling System (ROMS): Guam

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 6-day, 3-hourly forecast for the region surrounding Guam at approximately 2-km resolution. While considerable effort has been...

Regional Ocean Modeling System (ROMS): Oahu

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 7-day, 3-hourly forecast for the region surrounding the island of Oahu at approximately 1-km resolution. While considerable...

Data on the environment. Accompanying brochure of the CD ROM; Daten zur Umwelt. Begleitbroschuere zur CD-ROM

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-07-15

During the past 25 years, the Federal Environmental Office (UBA) has been publishing annual data on the environmental situation in Germany. This is the most recent publication; it contains data on climate protection, resources management, environment, health and quality of life, natural cycles and environmental media, and the economic importance of environmental protection. The CD-ROM contains data and facts on all of these subjects. It provides detailed and comprehensive information on the current condition of the environment in Germany, strategies and goals of environmental policy, books and other publications for further reading, and links. The CD-ROM also contains a system of key environmental indicators which illustrates successful activities and needs for action of environmental policy. Integrated internet access ensures access to current information on the internet. (orig.)

Nanomechanical recognition of prognostic biomarker suPAR with DVD-ROM optical technology

DEFF Research Database (Denmark)

Bache, Michael; Bosco, Filippo; Brøgger, Anna Line

2013-01-01

In this work the use of a high-throughput nanomechanical detection system based on a DVD-ROM optical drive and cantilever sensors is presented for the detection of urokinase plasminogen activator receptor inflammatory biomarker (uPAR). Several large scale studies have linked elevated levels...

SCUTREA Conference Proceedings, 1970-1997. 25th Anniversary CD-ROM.

Science.gov (United States)

Standing Conference on Univ. Teaching and Research in the Education of Adults.

This CD-ROM contains 693 papers on university teaching and research in the education of adults that were presented during the 27-year period from 1970 through 1997. The CD-ROM is designed to be used with the Macintosh, Windows 95, and Windows 3.1 operating systems and Adobe Acrobat Portable Document Format (version 3), which is included along with…

Poemele homerice în veșminte românești. O analiză diacronică (I

Directory of Open Access Journals (Sweden)

Petre Gheorghe Bârlea

2015-07-01

Full Text Available Lucrarea pe care o propunem vizează istoria traducerilor românești ale poemelor homerice, din perspectiva evoluției limbii române literare. Pornim de la premisa că orice asemenea traducere reprezintă o probă de virtuozitate nu numai pentru traducătorul în cauză, ci și pentru limba și cultura modernă respectivă, așa încît este interesant de studiat modul în care dezvoltarea exegezei homerice și a teoriilor traductologice se manifestă în paralel cu etapele evoluției limbilor moderne. Grila de analiză va include, așadar, principii, metode și instrumente de lucru ale domeniilor amintite aici (istoria limbii, traductologie, dar și elemente împrumutate din gramatica constrastiv-tipologică, din filologie, în sensul restrîns al conceptului, din teoria mentalităților, istoria culturală ș.a. Demersul nostru evidențiază faptul că evoluția istorică a actului traducerii este marcată, în mod firesc, de personalitatea traducătorului (opțiuni teoretice, ideologice, pe lîngă competențe lingvistice, har poetic etc., dar și de contextul cultural al epocii și al spațiului respectiv. Pentru cultura română, cel puțin, putem constata că, în ansamblu, versiunea cea mai recentă este și cea mai reușită.

A condensed review of the manageral aspects of CD-ROM network system

Energy Technology Data Exchange (ETDEWEB)

Choi, Kwang

2001-10-01

This report discussed manageral aspects of CD-ROM Network system to reduce executing errors and to provide effective information services to users. The results of this study are follows. 1) Library has to decide the type fo cd-rom network system compatible to the library. 2) A way of acquiring of system purchasing budget is commom utility budgets and has to include system maintenance budget. 3) When decides a provider, it is needed to review price, maintenance ability, statistics s/w, anti-virus functions.4) System manager would be a one wide-range of knowledge about network, equipment, s/w and needs continuous education about system. 5) The system users are required to have more basic knowledge than general users other users, library has to provide various user educations and minute user manuals. 6) Purchasing of CD-ROM for network use is essential and cost-benefit analysis between on-line DB and cd-rom for one user are needed. 7) when constructing Local DB using CD-RM NETWORK SYSTEM, library give attention to copyrigths of the cd-rom. 8) To provide good services through the system, cross cooperation between library and related departments is required.

NODC Standard Product: NODC Taxonomic Code on CD-ROM (NODC Accession 0050418)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The content of the NODC Taxonomic Code, Version 8 CD-ROM (CD-ROM NODC-68) distributed by NODC is archived in this accession. Version 7 of the NODC Taxonomic Code...

Experience teaching CD-ROM-based course on CANDU nuclear-power-plant systems and operation

International Nuclear Information System (INIS)

Rouben, Benjamin

2008-01-01

This paper presents personal experience garnered from teaching a CD-ROM-based course on CANDU Power-Plant Systems and Operation. This course was originally developed by Prof. G.T. Bereznai as research in distance-learning techniques when he was directing the Thai-Canadian Human Resources Development Project at Chulalongkorn University in Bangkok. The course has been offered in a number of universities, including McMaster University and the University of Ontario Institute of Technology. All the course material, including lectures, assignments, and a simulator, is provided on a CD-ROM. Lectures include a spoken soundtrack covering the material. The class often includes both undergraduate and graduate students. I found that most students appreciate having the material on electronic format, which they can view and review at will and on their own time. Students find this course quite intensive - it covers all major systems in the CANDU reactor and power plant in detail. A very important component of the course is the simulator, which teaches students how systems operate in normal operation, in power manoeuvres, and during process-system malfunctions. Effort in absorbing the material and performing assignments can often exceed 10 hours per week. Some of the simulator assignments involve tricky manoeuvres, requiring several tries to achieve the expected result. Some assignments may take several hours, especially if the manoeuvres requiring repetition take 30 minutes or more in real time. I found that some instruction in the basic theory of reactor physics and systems is appreciated by students. A few possible enhancements to the simulator model were identified. Graduate students taking the course are required to do an additional project; I assigned an investigation of the effects of xenon-concentration changes during 1 week of load cycling. In summary, this course provides to students the opportunity to learn a great deal about the workings of CANDU-plant systems. (author)

Development and Evaluation of a Multimedia CD-ROM for Exercise During Pregnancy and Postpartum

Science.gov (United States)

Hausenblas, Heather A.; Brewer, Britton W.; Van Raalte, Judy L.; Cook, Brian; Downs, Danielle Symons; Weis, Carol Ann; Nigg, Claudio; Cruz, Amelia

2008-01-01

Objective To meet the need for an interactive product on exercise during pregnancy and postpartum, we developed and evaluated a personally-tailored multimedia CD-ROM. Methods Pregnant and postpartum women, who were randomly assigned to either the experimental group (PregXercise™ CD-ROM) or the control group (CD-ROM with neutral content), navigated through the CD-ROM for 1 hour. Main outcomes were exercise self-efficacy and knowledge. Results In analyses of covariance, compared with the control group, the experimental group had significant increases in self-efficacy and knowledge. Conclusion The multimedia CD-ROM delivering information about exercise motivation, guidelines, and prescription was effective in improving exercise self-efficacy and knowledge. Practice Implications Our preliminary results illustrate that healthcare professionals and researchers may use interactive multimedia for improving exercise behavior and related outcomes with pregnant and postpartum women. PMID:18068940

Validation of accuracy and reliability of a simple measurement device for the lumber range of motion (SMD-L-ROM)

International Nuclear Information System (INIS)

Kato, Nakayuki; Fujiwara, Atsushi; Honda, Toshio; Taneichi, Hiroshi

2007-01-01

It is important to evaluate mobility of the lumbar spine for assessment of lumbar spinal disorders and their therapeutic effects. We developed a simple measurement device for the lumbar range of motion (SMD-L-ROM) which can be installed on the trunk. SMD-L-ROM allows to evaluate mobility of the lumbar spine without x-ray exposure. Accuracy and reliability of the measurement device was assessed in this article. SMD-L-ROM comprises two metallic immobilization plates (IPs) with a vertically installed bar and a rubber band for fixation of IP to the trunk. Two IPs were installed at the level of Th12 and the sacrum. Range of motion (ROM) of the lumbar spine was measured by using SMD-L-ROM and radiographic modalities (X-ray and CT). Consistency of the measured values by both of SMD-L-ROM and radiographic modalities was evaluated. Furthermore, inter- and intra-observer agreement of measured values by SMD-L-ROM was assessed. Regarding measurement of ROM, there was a high correlation between SMD-L-ROM and X-ray/CT especially in the sagittal and axial plane. There was no significant difference in the average values of ROM between the two methods. On the other hand, SMD-L-ROM did not detect accurate position of the lumbar spine in all dimensions. There were no inter- and intra-observer errors of measured values by SMD-L-ROM. ROM of the lumbar spine was simply and economically measured with SMD-L-ROM. Accuracy and reliability of SMD-L-ROM was good enough for ROM measurement in the lumbar spine. (author)

Development and testing of a CD-ROM program for improving adolescent knowledge of inflammatory bowel disease.

Science.gov (United States)

Boamah, Lynelle M; Bohren, Janet R; Pentiuk, Scott; Baker, Raymond; Yi, Michael; Moyer, M Susan

2010-05-01

The aim of this study was to design a theory-based educational program for adolescents with inflammatory bowel disease (IBD) using an interactive multimedia CD-ROM and to test its effectiveness in improving knowledge in IBD. Curriculum-based instruction using educational theory and principles was designed for adolescents on an interactive multimedia CD-ROM. Twenty subjects completed summative evaluation of the CD-ROM measuring gain in knowledge about IBD immediately and 9 months after instruction. Subjects found the CD-ROM to be informative, appealing, and easy to use. The mean baseline score of the adolescents on the Crohn's and Colitis Knowledge questionnaire was 12.2 (standard deviation 5.14, range 3-24). After an average of 30 minutes of self-directed learning, adolescent subjects increased their posttest score to a mean of 19.8, a gain of 7.6 points over baseline (95% confidence interval 5.2-10.1, P < 0.0001). Knowledge of medications, disease complications, and gastrointestinal structure and function was gained and retained upon retesting at 9 months with a mean Crohn's and Colitis Knowledge questionnaire score of 17.5 (standard deviation 3.9, range 12-26), which was still an improvement over the mean pretest knowledge score of 12.2 (P < 0.001). Adolescents with IBD have low baseline knowledge about their disease. A rigorously developed interactive educational tool is now available for instructing adolescent patients about their IBD.

Reta'maxik Qatzij--Conociendo Nuestro Idioma (Knowing Our Language). [CD-ROM].

Science.gov (United States)

Academy for Educational Development, Washington, DC.

This CD-ROM is part of an interactive and dynamic multimedia package of information and games for learning K'iche' and Ixil. This CD-ROM includes six books in electronic format with interactive exercises that support improved bilingual and intercultural education and teacher training, specifically in the languages of K'iche' and Ixil. Books…

Usability evaluation of a web-based support system for people with a schizophrenia diagnosis.

Science.gov (United States)

van der Krieke, Lian; Emerencia, Ando C; Aiello, Marco; Sytema, Sjoerd

2012-02-06

Routine Outcome Monitoring (ROM) is a systematic way of assessing service users' health conditions for the purpose of better aiding their care. ROM consists of various measures used to assess a service user's physical, psychological, and social condition. While ROM is becoming increasingly important in the mental health care sector, one of its weaknesses is that ROM is not always sufficiently service user-oriented. First, clinicians tend to concentrate on those ROM results that provide information about clinical symptoms and functioning, whereas it has been suggested that a service user-oriented approach needs to focus on personal recovery. Second, service users have limited access to ROM results and they are often not equipped to interpret them. These problems need to be addressed, as access to resources and the opportunity to share decision making has been indicated as a prerequisite for service users to become a more equal partner in communication with their clinicians. Furthermore, shared decision making has been shown to improve the therapeutic alliance and to lead to better care. Our aim is to build a web-based support system which makes ROM results more accessible to service users and to provide them with more concrete and personalized information about their functioning (ie, symptoms, housing, social contacts) that they can use to discuss treatment options with their clinician. In this study, we will report on the usability of the web-based support system for service users with schizophrenia. First, we developed a prototype of a web-based support system in a multidisciplinary project team, including end-users. We then conducted a usability study of the support system consisting of (1) a heuristic evaluation, (2) a qualitative evaluation and (3) a quantitative evaluation. Fifteen service users with a schizophrenia diagnosis and four information and communication technology (ICT) experts participated in the study. The results show that people with a

An x ray archive on your desk: The Einstein CD-ROM's

Science.gov (United States)

Prestwich, A.; Mcdowell, J.; Plummer, D.; Manning, K.; Garcia, M.

1992-01-01

Data from the Einstein Observatory imaging proportional counter (IPC) and high resolution imager (HRI) were released on several CD-ROM sets. The sets released so far include pointed IPC and HRI observations in both simple image and detailed photon event list format, as well as the IPC slew survey. With the data on these CD-ROMS's the user can perform spatial analysis (e.g., surface brightness distributions), spectral analysis (with the IPC event lists), and timing analysis (with the IPC and HRI event lists). The next CD-ROM set will contain IPC unscreened data, allowing the user to perform custom screening to recover, for instance, data during times of lost aspect data or high particle background rates.

Pricing Strategies for CD-ROM Products.

Science.gov (United States)

Rowley, J. E.

1994-01-01

Pricing strategies for subscriptions and licenses for CD-ROMs are different for single users and networks. The basic components of pricing strategies are charges for subscription, connect line, display/print, telecommunication, session rate, special commands, and special services. Highlights selected supplier pricing strategies for single users…

Evaluation of the acceptability of a CD-Rom as a health promotion tool for Inuit in Ottawa.

Science.gov (United States)

McShane, Kelly E; Smylie, Janet K; Hastings, Paul D; Prince, Conrad; Siedule, Connie

2013-01-01

There are few health promotion tools for urban Inuit, and there is a specific dearth of evaluations on such tools. The current study used a community-specific approach in the evaluation of a health promotion tool, based on an urban Inuit community's preferences of health knowledge sources and distribution strategies. In partnership with the Tungasuvvingat Inuit Family Health Team in Ottawa, a CD-Rom was developed featuring an Inuk Elder presenting prenatal health messages in both Inuktitut and English. Also, relevant evaluation materials were developed. Using a mixed methods approach, 40 participants completed interviews prior to viewing the CD-Rom and participated in a focus group at follow-up. Questionnaires were also completed pre- and post-viewing to assess changes between expectations and reactions in order to document acceptability. Significant increases were found on satisfaction, acceptability of medium and relevance of content ratings. Qualitative findings also included (a) interest, uncertainty and conditional interest prior to viewing; and (b) positive evaluations of the CD-Rom. This suggests that CD-Rom technology has the potential for health promotion for urban Inuit, and the community-specific evaluation approach yielded useful information.

Molecular Cloning, Expression and Characterization of Plasmid Encoding Rhomboid 4 (ROM4 of Tachyzoite of Toxoplasma gondii RH Strain

Directory of Open Access Journals (Sweden)

Mohammad Taghi RAHIMI

2017-12-01

Full Text Available AbstractBackground: The objective of this study was to clone, express and characterize the gene encoding rhomboid 4 (ROM4 proteins, a vital gene in surface adhesion and host cell invasion process of tachyzoite of T. gondii in an appropriate expression vector and eukaryotic cell for production of recombinant protein.Methods: Toxoplasma RNA was isolated from tachyzoites (RH strain and complementary DNA was synthesized. Oligonucleotide primer pair was designed based on Toxoplasma ROM4 gene sequence with XhoI and EcoRI restriction sites at 5´ end of forward and reverse primers, respectively. ROM4 gene was amplified by PCR, cloned into pTG19-T vector and the recombinant plasmid was sequenced. The gene was subcloned into pcDNA3 plasmid and expressed in CHO cells as eukaryotic cell. SDS-PAGE and western blotting were performed for protein determination and verification.Results: Cloning of ROM4 gene in pTG19-T vector was confirmed by colony-PCR and enzymatic digestion. The results of enzymatic digestion and gene sequencing confirmed successful cloning and subcloning procedures. The nucleotide sequence of the cloned ROM4 gene showed 99% homology compared to the corresponding sequences of original gene. SDS-PAGE and western blotting analyses of the purified protein revealed a single band having expected size of 65 kDa.Conclusion: This eukaryotic expression system is an appropriate system for high-level recombinant protein production of ROM4 gene from T. gondii tachyzoites used as antigenic component for serological assay and vaccine development.

Diabetes Care in Republic of Macedonia: Challenges and Opportunities.

Science.gov (United States)

Smokovski, Ivica; Milenkovic, Tatjana; Trapp, Caroline; Mitov, Aleksandar

2015-01-01

The Republic of Macedonia (RoM) has experienced a rapid rise in the prevalence of type 2 diabetes (T2D) over the past 2 decades, a period characterized by significant social, political, and economic change. RoM now has one of the highest rates of diabetes in Europe. To explore the modifiable conditions that may underlie and exacerbate the T2D epidemic; describe the state of diabetes care; and consider improved mechanisms for prevention and treatment, including research priorities, in RoM. Methods included data mining from reliable sources and collaboration of authors to consider and describe applications of research from outside RoM and to identify evidence-based strategies to reduce the burden of T2D in RoM. In 2014, the national prevalence of diabetes was 11.44% of the population (20-79 years) of RoM. Per capita caloric intake has increased significantly over the past 2 decades, with the majority of these calories coming from sugar, pork, chicken, beef, and sunflower oil. Excess calories, in the form of nutrient-deficient foods, animal products, and added oils promote insulin resistance and T2D. Tobacco use and lack of physical activity also contribute to the diabetes epidemic. Insulin, especially insulin analogues, are widely available and used to manage diabetes, often over other interventions that are more appropriate for patients with T2D, and more frequently than in other more developed countries, resulting in higher and unsustainable related costs. A new National eHealth System allows for better identification and monitoring of citizens with diabetes. However, the rapidly growing expense of insulin in the past has been unsustainable. The potential exists for a stronger role for lifestyle interventions in prevention and treatment of T2D. Significant changes in dietary patterns parallel the rise in diabetes prevalence and are likely a leading cause of diabetes and its complications. Research in RoM is needed to determine the impact and acceptability of

Whole Language, Computers and CD-ROM Technology: A Kindergarten Unit on "Benjamin Bunny."

Science.gov (United States)

Balajthy, Ernest

A kindergarten teacher, two preservice teachers, and a college consultant on educational computer technology designed and developed a 10-day whole-language integrated unit on the theme of Beatrix Potter's "Benjamin Bunny." The project was designed as a demonstration of the potential of integrating the CD-ROM-based version of…

Networking CD-ROMs: The Decision Maker's Guide to Local Area Network Solutions.

Science.gov (United States)

Elshami, Ahmed M.

In an era when patrons want access to CD-ROM resources but few libraries can afford to buy multiple copies, CD-ROM local area networks (LANs) are emerging as a cost-effective way to provide shared access. To help librarians make informed decisions, this manual offers information on: (1) the basics of LANs, a "local area network primer";…

CD-ROM-aided Databases

Science.gov (United States)

Kusama, Hideo; Matsumoto, Toshiaki

The CD-ROM system can be used independently or as a compliment to an on-line data system. It has many of the same features as an on-line system. Nippan developed the CD-NOCS system as a reinforcement or substitute for the on-line systems of the customers (bookstores). CD-NOCS is not necessarily designed just for bookstores, it is also applicable to libraries and companies. Authors would also like to emphasize that it is important to understand the development and background of the CD-NOCS system, as well as its operations.

Intertekstualitāte Dž.K. Roulingas "Harija Potera" romānu serijā

OpenAIRE

Strunga-Raude, Aija

2009-01-01

Šī bakalaura darba tēma ir „Intertekstualitāte Dž. K. Roulingas "Harija Potera" romānu sērijā”. Es izvēlējos šo tēmu, jo 2008. gadā tika izdota pēdējā septītā grāmata šajā romānu sērijā un šīs grāmatas jau ir izraisījušas plašas diskusijas dažādās sabiedrības grupās. Šī ir lieliska iespēja izpētīt ko tieši Džoanna Ketlīna Roulinga ir izmantojusi savā romānā “Harijs Poters”. Šī darba mērķis ir ilustrēt kā Dž. K. Roulinga, rakstot „Harija Potera” romānu sēriju, ir izmantojusi intertekstualit...

Regional Ocean Modeling System (ROMS): Main Hawaiian Islands

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 7-day, 3-hourly forecast for the region surrounding the main Hawaiian islands at approximately 4-km resolution. While...

Regional Ocean Modeling System (ROMS): CNMI: Data Assimilating

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 3-day, 3-hourly data assimilating hindcast for the region surrounding the Commonwealth of the Northern Mariana Islands (CNMI)...

Regional Ocean Modeling System (ROMS): Samoa: Data Assimilating

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 3-day, 3-hourly data assimilating hindcast for the region surrounding the islands of Samoa at approximately 3-km resolution....

Regional Ocean Modeling System (ROMS): Oahu: Data Assimilating

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 2-day, 3-hourly data assimilating hindcast for the region surrounding the island of Oahu at approximately 1-km resolution....

The Basic Economics of CD-ROM Pricing.

Science.gov (United States)

Erkkila, John E.

1991-01-01

This explanation of how the basic economic model of pricing applies to the CD-ROM industry considers the supply and demand sides of the market and compares three distinct pricing strategies: (1) pricing to maximize profits; (2) average cost pricing; and (3) marginal cost pricing. (EAM)

Regional Ocean Modeling System (ROMS): Oahu South Shore

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 2-day, 3-hourly forecast for the region surrounding the south shore of the island of Oahu at approximately 200-m resolution....

Between Freedom and Constraint: ROM Hacking of Pokémon Games

OpenAIRE

Barnabé, Fanny

2018-01-01

This paper aims to study a creative practice widespread in video game cultures: “ROM hacking”. By examining with the tools of rhetoric a defined corpus of ROM hacks derived from 『Pokémon』 games, the presentation will show that the formal construction of these derivative works demonstrates less a free or subversive transformation than a fairly strict respect for the original games’ conventions. By reproducing the structure of official 『Pokémon 』games, these fan productions become mirrors revea...

Studi Korelasi Motivasi Pengguna Dengan Pemanfaatan Koleksi CD-ROM Di UPT Pusat Perpustakaan UII Yogyakarta (Study on Correlation Between The Motivation of Users and The Use of CD-ROM Collection At The Main Library of Indonesia Islamic University of Yogyakarta

Directory of Open Access Journals (Sweden)

Keni Hesti Handayani

2015-12-01

Full Text Available The research addresses three main issues: student motivation of Indonesia Islamic University of Yogyakarta, the use of CD-ROM collection at the main library of Indonesia Islamic University of Yogyakarta, and the correlation between student motivation and the use of CD-ROM collection at the library. The study uses a field research. The sample is accidental sampling which involves students using the collection of CD-ROM at the library. In the term of data collection, the writer uses some techniques those of which are documentation, observation, interview and questionnaire. The result of the research shows that, there are correlation between the motivation and the use of CD-ROM collection at the main library of Indonesia Islamic University of Yogyakarta. The research is hoped to contribute to the improvement of services of CD-ROM collection at library in particular and to the development of through collection at the library. Keyword: user motivation, the use of CD-ROM collection

Investigating the use of CD-Rom CBT for bulimia nervosa and binge eating disorder in an NHS adult outpatient eating disorders service.

Science.gov (United States)

Graham, Lisa; Walton, Mark

2011-07-01

Many patients who experience bulimia nervosa (BN) and binge eating disorder (BED) find it hard to access evidence-based treatments. Rates of failure to enter outpatient services following initial assessment are high, as are dropout rates from specialist outpatient eating disorders services. To offer CD-Rom CBT, a cognitive-behavioural multi-media supported self-help treatment, in a locality-based outpatient NHS Eating Disorders Service to patients who have binge eating disorder and bulimia nervosa. Patients referred to a catchment-based NHS outpatient eating disorders service who were assessed and had an eating disorder with a binge-eating component were offered CD-Rom based CBT (Overcoming Bulimia) whilst on the waiting list for individual CBT. Forty patients completed the 8 sessions and attended the evaluation appointment (13 had BN, 27 had BED). For both groups, there were significant improvements in well-being and functioning, as well as significant reductions in problems and risk. There was also a significant reduction on the "Bulimic Subscale" of the EDI. These results were comparable with the original study findings (Schmidt, Treasure and Williams, 2001). Dropouts from the CD-Rom reflected rates common to other EDS treatments suggesting that CD-Rom did not directly impact upon service dropout rates. Computer assisted CBT for Eating Disorders offers a promising, feasible and acceptable first step for patients who have bulimia nervosa or binge eating disorder and access treatment from specialist eating disorders services.

Review of Cornaline de l'Inde/Carnelian in India CD-Rom.

Directory of Open Access Journals (Sweden)

Peter Grave

2002-10-01

Full Text Available The CD-Rom format has been around for some time now with CD-Rom readers a standard fitting on even the most basic PC. The strength of this technology is that it enables large amounts of data to be stored (650-700 MB on a reliable, portable and economical medium. The character of data stored is virtually only dependant on developments in the hardware and software used to generate and manage datasets, whether numeric arrays, databases, digital imagery or multimedia. These features have made it a popular mode for a diverse range of interactive educational, reference and entertainment software. As a medium that can hold thousand of 'pages' of text, spreadsheets, colour images, animations and digital movies, CD-Rom technology also offers obvious benefits for the delivery of the diversity of data produced by archaeological research. It is surprising then that projects such as the bilingual Cornaline de l'Inde/Carnelian in India are few and far between.

Development and Utilization of Regional Oceanic Modeling System (ROMS) & Delicacy, Imprecision, and Uncertainty of Oceanic Simulations: An Investigation with ROMS

Science.gov (United States)

2010-09-30

and Ecosystems: An important community use for ROMS is biogeochemisty: chemical cycles, water quality, blooms , micro-nutrients, larval dispersal... Chile current system. J. Climate, submitted. Colas, F., X. Capet, and J. McWilliams, 2010b: Mesoscale eddy buoyancy flux and eddy-induced

Ģimene Mārgaretas Atvudas romānos

OpenAIRE

Voitiņa, Laura

2009-01-01

Mūsdienās diskusijas par ģimeni, tās vērtībām, mainīgo uzbūvi un problēmām, kas ietekmē šo institūtu, ir sastopamas ne tikai mutvārdu runā, bet arī rakstos. Dotā pētījuma mērķis bija veikt saturisku analīzi par ģimenes aprakstiem Margaretas Atvudas romānos “Istabenes Stāsts” un “Oriksa un Kreiks”, lai identificētu romānos aprakstītos ģimenes modeļus, vērtības, paražas un notikumus, kas ietekmē šo institūtu. Tika izmantotas gan teorētiskas, gan empīriskas pētījuma metodes. Lai sniegtu teorētis...

On-line vs DC-ROM delivery of information

NARCIS (Netherlands)

Waaijers, L.

1992-01-01

Considers the use of new technologies in library information delivery systems. Discusses the virtues of paper, CD-ROM, and online media in terms of accessibility, timeliness, compactness, searchability, preservability, authenticity, and appearance, as well as end user benefit. Surmises that

Use of CD-Rom databases by staff and students in the University of ...

African Journals Online (AJOL)

The focus of this study is the use of CD-ROM databases by staff and students in the university of Jos library. This is of interest as CD-ROM database services is in consonant with the vision of providing excellent and effective information services to all staff and students of university of Jos. The study was guided by six ...

Dea Computrix - another deity for the Roman Pantheon? Journeys in the Roman Empire CD-Rom

Directory of Open Access Journals (Sweden)

T. Sam N. Moorhead

2002-08-01

Full Text Available This article outlines a personal view on the content and production of a CD-Rom on the Roman world produced by The British Museum, Channel 4, Verulamium Museum and Braunarts: Journeys in the Roman Empire. I discuss some of the benefits of and problems with multimedia production and outline feedback from various evaluation projects of the CD-Rom. I also briefly discuss the future of CD-Roms in the face of a rapidly expanding internet with reference to other multimedia projects at The British Museum.

SSTL I/O Standard Based Environment Friendly Energy Efficient ROM Design on FPGA

DEFF Research Database (Denmark)

Bansal, Neha; Bansal, Meenakshi; Saini, Rishita

2014-01-01

are operating ROM with the highest operating frequency of 4th generation i7 processor to test the compatibility of this design with the latest hardware in use. When there is no demand of peak performance, then we can save 74.5% clock power, 75% signal power, and 30.83% I/O power by operating our device with 1......Stub Series Terminated Logic (SSTL) is an Input/output standard. It is used to match the impedance of line, port and device of our design under consideration. Therefore, selection of energy efficient SSTL I/O standard among available different class of SSTL logic family in FPGA, plays a vital role...

Public census data on CD-ROM at Lawrence Berkeley Laboratory

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1992-07-02

In connection with the Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing Sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socioeconomic and geographic data files which are available to CEDR and PAREP collaborators via LBL's computing network. At this time 67 CD-ROM diskettes (approximately 35 gigabytes) are on line via the Unix file server cedrcd.lbl.gov. Most of the files are from the US Bureau of the Census, and most pertain to the 1990 Census of Population and Housing. This paper contains a list of the CD-ROMs available.

En teoretisk utdyping av rom og materialitet som pedagogisk ressurs i barnehagen

Directory of Open Access Journals (Sweden)

Solveig Nordtømme

2015-07-01

Full Text Available Abstract: This article is a theoretical exploration with the aim of discussing an ontological basis for space and materiality as educational resources in kindergarten. Attention is directed on children’s play experiences interacting with space and materiality, and how children use and create space. The metaphors front stage, space in between, and backstage (inspired from Erving Goffman, 1969, which form the study's main findings, are used as the backdrop for the issue and analyzes. The empirical material used in this exploration has been collected with an ethnographic methodological approach in two kindergartens. Maurice Merleau-Ponty’s (1962 focus on bodily experience and presence in space, along with concepts from Latour’s (2005 actor-network theory, is used to explore the data. The article contributes with theoretical tools for professionals in kindergarten teaching, to shed light on the importance of space, materiality and play in children's everyday life in kindergarten.Sammendrag: Denne artikkelen diskuterer et ontologisk grunnlag og er en teoretisk utforskning av rom og materialitet som en pedagogisk ressurs i barnehagen. Oppmerksomheten er rettet mot barns lekeerfaringer i samspill med rom og materialitet, og hvordan barn bruker og skaper rom. Metaforene hovedrom, mellomrom, og bakrom (inspirert fra Erving Goffman, 1969, som danner studiens hovedfunn, blir brukt som et bakteppe for problemstilling og analyser av det empiriske materialet fra to barnehager. Maurice Merleau-Ponty publikasjoner The Phenomenology of Perception (Merleau-Ponty, 1962 med sitt fokus på kroppslig erfaring i levd rom, blir brukt sammen med begreper fra Latours aktør-nettverksteori (Latour 2005 til å utforske hvordan rom og materialitet kan være pedagogiske ressurser. Artikkelens kunnskapsbidrag er å presentere et teoretisk verktøy for barnehageprofesjonen og kunnskaper om lekens betydning i barns hverdag i barnehagen.

Is there a role for rifampicin, ofloxacin and minocycline (ROM) therapy in the treatment of leprosy? Systematic review and meta-analysis.

Science.gov (United States)

Setia, Maninder S; Shinde, Santosh S; Jerajani, Hemangi R; Boivin, Jean-François

2011-12-01

A combination of rifampicin, ofloxacin and minocycline (ROM) is one of the newer recommendations for treatment of leprosy. We performed a systematic review and a meta-analysis of studies that had evaluated the efficacy of ROM therapy in treatment of paucibacillary and multibacillary leprosy patients. Studies were identified by searching the PubMed, Embase, LILACS and Cochrane databases. Data were abstracted from all relevant studies, and fixed effects models were used to calculate the summary estimate of effect in paucibacillary and multibacillary leprosy patients. Six studies comparing ROM therapy to multidrug therapy and eight studies that evaluated the effect of ROM therapy alone (no comparison group) were included in the review and meta-analysis. The combined estimate for single dose ROM vs. multidrug therapy in paucibacillary leprosy patients suggested that ROM was less effective than multidrug therapy in these patients [relative risk: 0.91, 95% confidence intervals (CI): 0.86-0.97]. However, the combined estimate for multiple doses of ROM vs. multidrug therapy in multibacillary leprosy patients suggested that ROM was as effective as multidrug therapy in reducing bacillary indices in these patients (proportion change: -4%, 95% CI -31% to 23%). No major side effects were reported in either the ROM or the multidrug treatment groups. Single-dose ROM therapy was less effective than multidrug therapy in paucibacillary patients. However, there are insufficient data to come to a valid conclusion on the efficacy of multidose ROM therapy in multibacillary leprosy, and additional studies with ROM therapy in multibacillary leprosy are needed. Furthermore, multiple doses may be considered as another alternative even for paucibacillary patients, and randomised controlled trials of this therapy may be useful to understand its contribution in the treatment and control of leprosy. © 2011 Blackwell Publishing Ltd.

Utilizing the Evaluation Process in CD-ROM Development.

Science.gov (United States)

Crews, Tena B.; Chalupa, Marilyn R.

1999-01-01

While a CD-ROM on network topologies was being developed, it was evaluated formatively by 14 office systems teachers and summatively by 23 students using it in class. Improvements in ease of use, performance, and the accuracy and clarity of content were made. (SK)

Accurate Point-of-Care Detection of Ruptured Fetal Membranes: Improved Diagnostic Performance Characteristics with a Monoclonal/Polyclonal Immunoassay

Directory of Open Access Journals (Sweden)

Linda C. Rogers

2016-01-01

Full Text Available Objective Accurate and timely diagnosis of rupture of membranes (ROM is imperative to allow for gestational age-specific interventions. This study compared the diagnostic performance characteristics between two methods used for the detection of ROM as measured in the same patient. Methods Vaginal secretions were evaluated using the conventional fern test as well as a point-of-care monoclonal/polyclonal immunoassay test (ROM Plus® in 75 pregnant patients who presented to labor and delivery with complaints of leaking amniotic fluid. Both tests were compared to analytical confirmation of ROM using three external laboratory tests. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV, and accuracy. Results Diagnostic performance characteristics uniformly favored ROM detection using the immunoassay test compared to the fern test: sensitivity (100% vs. 77.8%, specificity (94.8% vs. 79.3%, PPV (75% vs. 36.8%, NPV (100% vs. 95.8%, and accuracy (95.5% vs. 79.1%. Conclusions The point-of-care immunoassay test provides improved diagnostic accuracy for the detection of ROM compared to fern testing. It has the potential of improving patient management decisions, thereby minimizing serious complications and perinatal morbidity.

Calculation method of passive tracer using regional ocean modeling system (ROMS)

International Nuclear Information System (INIS)

Tubono, Takaki; Tsumune, Daisuke; Misumi, Kazuhiro; Yoshida, Yoshikatsu

2010-01-01

A dose assessments method for packages shipping radioactive materials was developed to calculate concentrations of radioactive materials discharged from the hypothetically sinking point using Regional Ocean Modeling System (ROMS). The programs of ROMS were improved for simultaneously calculating the flow fields around Japan and the concentrations discharged from several bottom points in the continental shelf. The model domain covered the northeast pacific region around Japan, 20degN-65degN, 120degE-165degE, with 1/10 degree horizontal resolution and 30 sigma-levels. The ROMS model captured main features such as Kuroshio currents, including the separation location and the Kuroshio extension, and Oyashio currents. The calculated volume transports through the main straits such as Tokara strait, Tsushima strait and Tsugaru strait were compared well to the measured or estimated that. The calculated concentrations discharged from 12 bottom points showed mixing associated with the eddies of ocean currents. This method is available to evaluate effectively the concentrations of radioactive materials only by setting the subsidence location and the concentrations and volume discharged. (author)

Fine mapping of Best`s macular dystrophy localises the gene in close proximity to, but distinct from, the D115480/ROM1

Energy Technology Data Exchange (ETDEWEB)

Graff, C.; Ahlbom, B.E.; Anneren, G. [University Hospital, Uppsala (Sweden)] [and others

1994-09-01

Best`s macular dystrophy (BMD) is an autosomal dominant disease characterized by accumulation of lipofuscin beneath the pigment epithelium of the macula, leading to early-onset impairment of central vision. The gene has previously been mapped to 11q13. Based on DNA from 191 people from a large 12-generation family, the gene now has been mapped to a 1.5 cM interval between the markers Fc{epsilon}RI and D11S480/ROM1. By disequilibrium analysis the gene was estimated to be 0.321 cM centromeric to the marker D11S480. Since this on average corresponds to 300 kb, the gene may be at a distance contained in YAC molecules. To physically characterize this region, YAC clones positive for markers flanking BMD have been identified. Sequence analysis of the candidate gene ROM1 did not reveal any mutation. However, one recombination between intragenic ROM1 polymorphisms and BMD was detected, which make it highly unlikely that mutations in ROM1 are causing BMD.

Usability Evaluation of a Web-Based Support System for People With a Schizophrenia Diagnosis

NARCIS (Netherlands)

van der Krieke, Lian; Emerencia, Ando C.; Aiello, Marco; Sytema, Sjoerd

2012-01-01

Background: Routine Outcome Monitoring (ROM) is a systematic way of assessing service users' health conditions for the purpose of better aiding their care. ROM consists of various measures used to assess a service user's physical, psychological, and social condition. While ROM is becoming

Public census data on CD-ROM at Lawrence Berkeley Laboratory

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1993-01-16

The Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing Sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socioeconomic and geographic data files which are available to CEDR and PAREP collaborators via LBL's computing network. At this time 72 CD-ROM diskettes (approximately 37 gigabytes) are on line via the Unix file server cedrcd.lbl.gov''. Most of the files are from the US Bureau of the Census, and many of these pertain to the 1990 Census of Population and Housing. All the CD-ROM diskettes contain documentation in the form of ASCII text files. In addition, printed documentation for most files is available for inspection at University of California Data and Technical Assistance (UC DATA), tel. (510) 642-6571, or the UC Documents Library, tel. (510) 642-2569, both located on the UC Berkeley Campus. Many of the CD-ROM diskettes distributed by the Census Bureau contain software for PC compatible computers, for easily accessing the data. Shared access to the data is maintained through a collaboration among the CEDR and PAREP projects at LBL, and UC DATA, and the UC Documents Library. LBL is grateful to UC DATA and the UC Documents Library for the use of their CD-ROM diskettes. Shared access to LBL facilities may be restricted in the future if costs become prohibitive. Via the Sun Network File System (NFS), these data can be exported to Internet computers for direct access by the user's application program(s). Due to the size of the files, this access method is preferred over File Transfer Protocol (FTP) access. Please contact Deane Merrill (dwmerrill lbl.gov) if you wish to make use of the data.

CD roms and multimedia projector as complimentary educational ...

African Journals Online (AJOL)

This paper examines the potentials of utilizing Compact Disk Read Only Memory (CD-ROM) and the multimedia projector as complimentary educational technology for teaching music in colleges of education in Nigeria. While recognizing the problem of ineffective methods of teaching in Nigeria's educational system, the ...

Public census data on CD-ROM at Lawrence Berkeley Laboratory

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1992-10-01

The Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing Sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socio-economic and geographic data files which are available to CEDR and PAREP collaborators via LBL's computing network. At this time 70 CD-ROM diskettes (approximately 36 gigabytes) are on line via the Unix file server cedrcd. lbl. gov. Most of the files are from the US Bureau of the Census, and most pertain to the 1990 Census of Population and Housing. All the CD-ROM diskettes contain documentation in the form of ASCII text files. Printed documentation for most files is available for inspection at University of California Data and Technical Assistance (UC DATA), or the UC Documents Library. Many of the CD-ROM diskettes distributed by the Census Bureau contain software for PC compatible computers, for easily accessing the data. Shared access to the data is maintained through a collaboration among the CEDR and PAREP projects at LBL, and UC DATA, and the UC Documents Library. Via the Sun Network File System (NFS), these data can be exported to Internet computers for direct access by the user's application program(s).

Public census data on CD-ROM at Lawrence Berkeley Laboratory

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1992-10-01

The Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing Sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socio-economic and geographic data files which are available to CEDR and PAREP collaborators via LBL`s computing network. At this time 70 CD-ROM diskettes (approximately 36 gigabytes) are on line via the Unix file server cedrcd. lbl. gov. Most of the files are from the US Bureau of the Census, and most pertain to the 1990 Census of Population and Housing. All the CD-ROM diskettes contain documentation in the form of ASCII text files. Printed documentation for most files is available for inspection at University of California Data and Technical Assistance (UC DATA), or the UC Documents Library. Many of the CD-ROM diskettes distributed by the Census Bureau contain software for PC compatible computers, for easily accessing the data. Shared access to the data is maintained through a collaboration among the CEDR and PAREP projects at LBL, and UC DATA, and the UC Documents Library. Via the Sun Network File System (NFS), these data can be exported to Internet computers for direct access by the user`s application program(s).

Effects of Using Human Patient Simulator (HPS versus a CD-ROM on Cognition and Critical Thinking

Directory of Open Access Journals (Sweden)

Don Johnson, PhD

2008-01-01

Full Text Available Background: Very little prospective randomized experimental research exists on the use of simulation as a teaching method, and no studies have compared the two strategies of using the HPS and a CD-ROM. In addition, no researchers have investigated the effects of simulation on various levels of cognition, specifically lower-level and higher-level cognition or critical thinking.Objectives: A prospective pretest-posttest experimental mixed design (within and between was used to determine if there were statistically significant differences in HPS and CD-ROM educational strategies in lower-level, higher-level cognition and critical thinking.Results: A repeated measures multivariate analysis of variance (RMANOVA with LSD post-hoc tests were used to analyze the data. There were no significant differences between the HPS and CD-ROM groups on lower-level cognition scores. The HPS group did significantly better than the CD-ROM group on higher-level cognition and critical thinking scores.Conclusion: This study demonstrated that the choice of teaching strategies for lower-level cognition does not make a statistically significant difference in outcome. However, the HPS is superior to using CD-ROM and should be considered as the choice in teaching.

The Application of a Modified d-ROMs Test for Measurement of Oxidative Stress and Oxidized High-Density Lipoprotein

Directory of Open Access Journals (Sweden)

Fumiaki Ito

2017-02-01

Full Text Available Reactive oxygen species (ROS are involved in the initiation and progression of atherosclerosis. ROS-derived hydroperoxides, as an indicator of ROS production, have been measured by using the diacron reactive oxygen metabolites (d-ROMs test, which requires iron-containing transferrin in the reaction mixture. In this study we developed a modified d-ROMs test, termed the Fe-ROMs test, where iron ions were exogenously added to the reaction mixture. This modification is expected to exclude the assay variation that comes from different blood iron levels in individuals. In addition, this Fe-ROMs test was helpful for determining the class of plasma lipoproteins that are hydroperoxidized. Low-density lipoprotein/very low-density lipoprotein (LDL/VLDL and high-density lipoprotein (HDL were purified by use of an LDL/VLDL purification kit and the dextran sulfate-Mg2+ precipitation method, respectively; their hydroperoxide contents were assessed by performing the Fe-ROMs test. The majority of the hydroperoxides were detected only in the HDL fraction, not in the LDL/VLDL. Further detailed analysis of HDLs by size-exclusion high-performance liquid chromatography revealed that the hydroperoxide-containing molecules were small-sized HDLs. Because HDL was shown to be the principal vehicle for the plasma hydroperoxides, this Fe-ROMs test is a beneficial method for the assessment of oxidized-HDL levels. Indeed, Fe-ROMs levels were strongly associated with the levels of oxidized HDL, which were determined by performing the malondialdehyde-modified HDL enzyme immunoassay. In conclusion, the Fe-ROMs test using plasma itself or the HDL fraction after dextran sulfate-Mg2+ precipitation is useful to assess the functionality of HDL, because the oxidation of HDL impairs its antiatherogenic capacity.

Conserving Earth's Biodiversity. [CD-ROM and] Instructor's Manual.

Science.gov (United States)

2000

This CD-ROM is designed as an interactive learning tool to support teaching in highly interdisciplinary fields such as conservation of biodiversity. Topics introduced in the software include the impact of humans on natural landscapes, threats to biodiversity, methods and theories of conservation biology, environmental laws, and relevant economic…

Cd-Rom and Access to Information

OpenAIRE

Chacón Alvarado, Lucía

2011-01-01

The scientific and technological advances in the world and its application in different areas of knowledge have developed a new electronic age.Computers and telecommunications have created a new scenario for libraries and information centers leading to further changes in the use of its collections and its services increased. Libraries and information centers must address these changes because users demand access to information quickly and efficiently.The CD-ROM is a new technology that has be...

Adolescencia, relaciones románticas y actividad sexual: una revisión

OpenAIRE

Vargas Trujillo, Elvia; Barrera, Fernando

2008-01-01

Se presenta una revisión de algunas de las investigaciones más recientes sobre la adolescencia y los factores asociados a las relaciones románticas y la actividad sexual durante la adolescencia. Se parte de la premisa de que el análisis de la iniciación romántica y sexual durante la adolescencia requiere de modelos de causalidad múltiple que permitan dar cuenta, conjuntamente, de los factores que se encuentran en los contextos individual, familiar y social asociados con estos dos procesos. Se...

Experimental study on x-rays dose enhancement effects for floating gate ROMs

CERN Document Server

Guo Hong Xia; Chen Yu Sheng; Han Fu Bin; He Chao Hui; Zhao Hui

2002-01-01

Experimental results of x-ray dose enhancement effects are given for floating gate read-only memory (ROMs) irradiated in the Beijing Synchrotron Radiation Facility. The wrong byte numbers vs. total irradiation dose have been tested and the equivalent relation of total dose damage is provided compared the response of devices irradiated with sup 6 sup 0 Co gamma-ray source. The x-ray dose enhancement factors for floating gate ROMs are obtained firstly in China. These results can be an effective evaluation data for x-rays radiation hardening technology

Dificultăți de traducere în limba română a Aforismelor lui Arthur Schopenhauer. O analiză contrastiv-diacronică (I

Directory of Open Access Journals (Sweden)

Cecilia-Iuliana Vârlan

2016-02-01

Full Text Available Lucrarea de față se concentrează asupra unei opere de maturitate a filozofului german Arthur Schopenhauer, Aforisme asupra înțelepciunii în viață, și asupra singurei versiuni românești a acesteia, realizate de Titu Maiorescu la sfîrșitul secolului al XIX-lea. Existența a cinci variante ale versiunii românești, publicate de traducătorul însuși de-a lungul a patru decenii, reprezintă o dovadă clară a faptului că transpunerea în românește a acestui text de filozofie practică a incumbat o serie întreagă de dificultăți de traducere. Urmărind modul în care Titu Maiorescu a încercat să rezolve aceste dificultăți, prin adoptarea anumitor soluții traductologice, am realizat o analiză a acestora, din perspectivă lingvistică, cercetarea urmînd concomitent două direcții: contrastivă (rezultată din supra- punerea textului-sursă și a textului-țintă și diacronică (urmărind intervențiile realizate de același traducător asupra propriului text, la intervale de timp diferite. Demersul de analiză lingvistică a traducerii unui text filozofic ni s-a părut util nu doar studiului nostru, ci și viitorilor eventuali traducători ai Aforismelor, a căror intenție ar putea fi aceea de a adapta discursul versiunii românești a lui Titu Maiorescu la limba română contemporană, ținînd seama de evoluția evidentă a acesteia și, mai ales, a componentei sale de limbaj filozofic.

The Market Place: An Internal View of the Future of CD-ROM--The Perspective of the H. W. Wilson Company.

Science.gov (United States)

Miller, Frank W.; Loeding, Deborah Voigt

1989-01-01

Discussion of technological developments in library reference services focuses on contributions of the H. W. Wilson Company and highlights CD-ROM technology. Topics discussed include online access; menu-driven systems; CD-ROM hardware and software concerns; user response to CD-ROM; quality control of databases; pricing considerations; and future…

A Look at Dialog's First CD-ROM Product.

Science.gov (United States)

Duggan, Mary Kay

1987-01-01

Discusses reasons for selecting ERIC with the Dialog OnDisc software for training information professionals in online searching at the University of California, Berkeley, and analyzes some of the features of the CD-ROM software. Pros and cons of online and OnDisc access are summarized, and three references are listed. (Author/MES)

CD ROM 'Natural heritage of Slovakia'

International Nuclear Information System (INIS)

Uradnikova, B.

2005-01-01

Centre of Environmental Education Geopark ('Centre') applied environmental education into school and out-of-school institutions. The 'Centre' is working in the fields: environmental education, eco-tourism development, presentation of the cultural landscape and world heritage. The CD ROM 'Natural heritage of Slovakia' was created with aim enhancement of environmental awareness, pedagogy, education and development of eco-tourism on the Slovakia. It abets general review about environment, its components, legislative, history and the present day of nature and landscape protection

Lab Manual & Resources for Materials Science, Engineering and Technology on CD-Rom

Science.gov (United States)

Jacobs, James A.; McKenney, Alfred E.

2001-01-01

The National Educators' Workshop (NEW:Update) series of workshops has been in existence since 1986. These annual workshops focus on technical updates and laboratory experiments for materials science, engineering and technology, involving new and traditional content in the field. Scores of educators and industrial and national laboratory personnel have contributed many useful experiments and demonstrations which were then published as NASA Conference Proceedings. This "out poring of riches" creates an ever-expanding shelf of valuable teaching tools for college, university, community college and advanced high school instruction. Now, more than 400 experiments and demonstrations, representing the first thirteen years of NEW:Updates have been selected and published on a CD-ROM, through the collaboration of this national network of materials educators, engineers, and scientists. The CD-ROM examined in this document utilizes the popular Adobe Acrobat Reader format and operates on most popular computer platforms. This presentation provides an overview of the second edition of Experiments in Materials Science, Engineering and Technology (EMSET2) CD-ROM, ISBN 0-13-030534-0.

Regional Ocean Modeling System (ROMS): Main Hawaiian Islands: Data Assimilating

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Regional Ocean Modeling System (ROMS) 3-day, 3-hourly data assimilating hindcast for the region surrounding the main Hawaiian islands at approximately 4-km...

An end-to-end coupled model ROMS-N 2 P 2 Z 2 D 2 -OSMOSE of ...

African Journals Online (AJOL)

An end-to-end coupled model ROMS-N 2 P 2 Z 2 D 2 -OSMOSE of the southern Benguela foodweb: parameterisation, calibration and pattern-oriented validation. ... We also highlight the capacity of this model for tracking indicators at various hierarchical levels. Keywords: individual-based model, model validation, ...

Tidal simulation using regional ocean modeling systems (ROMS)

Science.gov (United States)

Wang, Xiaochun; Chao, Yi; Li, Zhijin; Dong, Changming; Farrara, John; McWilliams, James C.; Shum, C. K.; Wang, Yu; Matsumoto, Koji; Rosenfeld, Leslie K.;

The Writing Process for "Edutaining" CD-ROM Adventures.

Science.gov (United States)

Mountain, Lee

2000-01-01

Describes a CD-ROM adventure story written by the author to educate her students about the word relationships of synonyms and antonyms. Discusses how this interactive medium put a different twist on each of the stages of the writing process itself. Relates how two students enthusiastically used the program, and were inspired to write one of their…

Land and Marine Gravity Data on CD-ROM - 1999 Edition

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Land and Marine Gravity 1999 Edition 2-volume CD-ROM set contains observed and derived land and marine gravity data contributed by many national and...

Significance of measuring oxidative stress in lifestyle-related diseases from the viewpoint of correlation between d-ROMs and BAP in Japanese subjects

International Nuclear Information System (INIS)

Fukui, Toshiki; Yamauchi, Kazuhiro; Maruyama, Mie; Yasuda, Tadashi; Abe, Youichi; Kohno, Masakazu

2011-01-01

In recent years, oxidative stress has been postulated to be an important factor in the pathogenesis and development of lifestyle-related diseases. In this study, we investigated the association between the derivatives of reactive oxygen metabolites (d-ROMs), as an index of products of reactive oxygen species (ROS), and biological antioxidant potential (BAP), as an index of antioxidant potential. We also investigated the associations between d-ROMs or BAP and the risk factors for lifestyle-related diseases or metabolic syndrome-associated factors to evaluate their usefulness in preventive medicine. There were 442 subjects who underwent health checkup examination in our facilities. In addition to standard medical checkup items, we analyzed d-ROMs, BAP, brachial-ankle pulse wave velocity, high-sensitivity C-reactive protein level and visceral fat area (VFA) visualized on a computed tomography scan. The mean d-ROM value in females was significantly higher than that in males. There was a positive correlation between the d-ROM and VFA levels. On correlation analysis, there was a negative correlation between the d-ROM and creatinine levels. As factors that influence d-ROMs, the level of VFA was selected, suggesting the significance of oxidative stress measurement with d-ROMs. In addition, there was a positive correlation between d-ROMs and BAP values. Further research is required to resolve whether increased production of ROS or the antioxidant potential that can compensate for such an increase of ROS is more important in vivo. (author)

Nanotechnology Aerospace Applications (Applications aerospatiales de la nanotechnologie) (CD-ROM)

National Research Council Canada - National Science Library

2007-01-01

...: 1 CD-ROM; 4 3/4 in.; 116 MB. ABSTRACT: The Educational Notes contain the abstracts and the lecture material of ten presentations, which provide a general introduction into nanotechnologies with selected topics, such as nanotechnology...

Alois Riegl, Die Entstehung der Barockkunst in Rom, 1908

NARCIS (Netherlands)

Witte, A.; Bacchi, A.; Barroero, L.

2017-01-01

In 1908, Alois Riegl's unfinished text on the Italian Baroque was published by Max Dvorak and Arthur Burda; they edited part of his notes for three consecutive series of lectures at Vienna University. Riegl's book title aply reads Entstehung der Barockkunst in Rom: Akademische Vorlesungen and deals

Car Builder: Design, Construct and Test Your Own Cars. School Version with Lesson Plans. [CD-ROM].

Science.gov (United States)

Highsmith, Joni Bitman

Car Builder is a scientific CD-ROM-based simulation program that lets students design, construct, modify, test, and compare their own cars. Students can design sedans, four-wheel-drive vehicles, vans, sport cars, and hot rods. They may select for aerodynamics, power, and racing ability, or economic and fuel efficiency. It is a program that teaches…

Nanotechnology Aerospace Applications (Applications aerospatiales de la nanotechnologie) (CD-ROM)

National Research Council Canada - National Science Library

2005-01-01

...: 1 CD-ROM; 4 3/4 in.; 59.1 MB. ABSTRACT: The Educational Notes contain the abstracts and the lecture material of ten presentations, which provide a general introduction into nanotechnologies with selected topics, such as nanotechnology...

[Does routine outcome monitoring have a promising future? An investigation into the use of shared decision-making combined with ROM for patients with a combination of physical and psychiatric symptoms].

Science.gov (United States)

van der Feltz-Cornelis, C M; Andrea, H; Kessels, E; Duivenvoorden, H J; Biemans, H; Metz, M

2014-01-01

Although routine outcome monitoring (ROM) has been developed and widely used in the course of patient centered outcome research in the Netherlands, so far the technique has hardly ever been used to improve the treatment of individual patients. To describe how a rom technique based on the principles of shared decision-making (SDM) was developed and evaluated at the Center for Body, Mind and Health at GGz Breburg, a specialised mental health institution in the Netherlands. We have developed a conceptual model for SDM that involves patient participation and the use of evidence-based decision-aids with cut-off scores. According to the conceptual model for SDM that we developed, the patient and the health professional involved took 'shared' decisions in three phases; the decisions related to triage, the drawing-up of a treatment plan and a follow-up treatment course. At the end of the 6 month intake-phase 7 of the 67 patients who were deemed eligible for ROM/SDM were dropped from the study because they were incapable of performing ROM assessments. Due to diagnostic advice and referral at the end of the intake-phase, 25 patients did not require further treatment. Of the remaining 35 patients, 33 delivered at least one follow-up ROM assessment during the subsequent treatment phases. In these patients somatic and psychiatric symptoms were found to be significantly reduced. ROM combined with sdm can be used successfully with patients who have a combination of physical and psychiatric symptoms and the technique can be applied by the professional in charge. Very few patients dropped out of the follow-up measurements and somatic as well as depressive or psychiatric symptoms diminished significantly. These findings indicate that a Randomised Clinical Trial is warranted in order to test the effectiveness of sdm combined with ROM as a decision-making instrument.

Management of CD-ROM Resources in Nigeria Academic Libraries ...

African Journals Online (AJOL)

The study is on management of CD-ROM resources in Nigerian academic libraries with reference to Federal Polytechnic Nekede Library, Owerri. A descriptive survey method was adopted random sampling technique was used in selecting twenty five (25) staff from the library under study. The questionnaire was the major ...

Stretching & Flexibility: An Interactive Encyclopedia of Stretching. [CD-ROM].

Science.gov (United States)

2002

This CD-ROM offers 140 different stretches in full-motion video sequences. It focuses on the proper techniques for overall physical fitness, injury prevention and rehabilitation, and 23 different sports (e.g., golf, running, soccer, skiing, climbing, football, and baseball). Topics include stretching for sports; stretching awareness and education…

Guide Structures in CD-ROM Dic- tionaries, with Specific Reference ...

African Journals Online (AJOL)

Not all the search options in CD-ROM dictionaries necessarily maintain the boundaries ... In this article all derivatives of lase are highlighted in the microstructure, ... searches frustrates the user and should be addressed in future editions of the.

Public census data on CD-ROM at Lawrence Berkeley Laboratory. Revision 4

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1993-03-12

The Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socioeconomic and geographic data files which are available to CEDR and PAREP collaborators via LBL`s computing network. At this time 89 CD-ROM diskettes (approximately 45 gigabytes) are on line via the Unix file server cedrcd.lbl.gov. Most of the files are from the US Bureau of the Census, and many of these pertain to the 1990 Census of Population and Housing. All the CD-ROM diskettes contain documentation in the form of ASCII text files. In addition, printed documentation for most files is available for inspection at University of California Data and Technical Assistance (UC DATA), tel. (510) 642-6571, or the UC Documents Library, tel. (510) 642-2569, both located on the UC Berkeley Campus. Many of the CD-ROM diskettes distributed by the Census Bureau contain software for PC compatible computers, for easily accessing the data. Shared access to the data is maintained through a collaboration among the CEDR and PAREP projects at LBL, and UC DATA, and the UC Documents Library. LBL is grateful to UC DATA and the UC Documents Library for the use of their CD-ROM diskettes. Shared access to LBL facilities may be restricted in the future if costs become prohibitive. Via the Sun Network File System (NFS), these data can be exported to Internet computers for direct access by the user`s application program(s). Due to the size of the files, this access method is preferred over File Transfer Protocol (FTP) access.

Analysis of User Need with CD-ROM Databases: A Case Study Based on Work Sampling at One University Library.

Science.gov (United States)

Wells, Amy Tracy

Analysis of the needs of users of Compact Disk-Read Only Memory (CD-ROM) was performed at the Tampa campus of the University of South Florida. A review of the literature indicated that problems associated with selecting the appropriate database, searching, and requiring technical assistance were the probable areas of user need. The library has 17…

Effects of using simulation versus CD-ROM in the performance of ultrasound-guided regional anesthesia.

Science.gov (United States)

Gasko, John; Johnson, Arthur; Sherner, John; Craig, John; Gegel, Brian; Burgert, James; Sama, Samuel; Franzen, Thomas

2012-08-01

The purpose of this study was to determine which method of teaching, CD-ROM, simulation, or a combination of both, was more effective in increasing the performance of ultrasound-guided regional anesthesia. No studies have investigated these methods. The framework for this study was critical thinking. The study was a prospective, mixed (between and within) subjects, experimental design. The sample consisted of 29 student registered nurse anesthetists randomly assigned to 1 of 3 groups: CD-ROM (n = 11), simulation (n = 11), and combination (n = 7). All groups were evaluated by the use of cadavers before and 2 months after the intervention using a valid and reliable instrument of performance. A repeated-measures analysis of variance indicated that the combination was significantly better than the CD-ROM and simulation (P teaching ultrasound-guided regional anesthesia techniques.

Public census data on CD-ROM at Lawrence Berkeley Laboratory. Revision 1

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1992-07-02

In connection with the Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing Sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socioeconomic and geographic data files which are available to CEDR and PAREP collaborators via LBL`s computing network. At this time 67 CD-ROM diskettes (approximately 35 gigabytes) are on line via the Unix file server cedrcd.lbl.gov. Most of the files are from the US Bureau of the Census, and most pertain to the 1990 Census of Population and Housing. This paper contains a list of the CD-ROMs available.

The Correlation of Exercise and Range of Motion (ROM on Elderly Knee Observasional Study on Elderly People in Pedurungan Semarang

Directory of Open Access Journals (Sweden)

Adhitya Putra Widyantoro

2012-06-01

Design and Method: Observastional study with a cross sectional design 80 elderly men and women were divided into 2 groups: gymnastics group in the Social Rehabilitation Unit Of Pucang Gading (n=40 and unexcercises group in the Penggaron village (n=40. In both groups, the degree of ROM of knee was assessed using the Goniometer. To evaluate the value of its significance, the data were analyzed using the Mann Withney test followed by Spearmann’s rho test. Result: ROM for gymnastic(exercised group and unexercised group were 115.50°±11.591°, 95.38°±12.780° respectively with p<0. 001. Resuts showed that doing exercise was useful for maintaining ROM of knee in elderly people. Spearmann’s rho test resulted in a strong correlation between ROM and exercise with r value of 0.652. Conclusion: exercise correlates with ROM of knee in elderly (Sains Medika, 4(1:39-45.

Managing nuclear knowledge: IAEA activities and international coordination. Including resource material full text CD-ROM

International Nuclear Information System (INIS)

2005-06-01

The present CD-ROM summarizes some activities carried out by the Departments of Nuclear Energy and Nuclear Safety and Security in the area of nuclear knowledge management in the period 2003-2005. It comprises, as open resource, most of the relevant documents in full text, including policy level documents, reports, presentation material by Member States and meeting summaries. The collection starts with a reprint of the report to the IAEA General Conference 2004 on Nuclear Knowledge [GOV/2004/56-GC(48)/12] summarizing the developments in nuclear knowledge management since the 47th session of the General Conference in 2003 and covers Managing Nuclear Knowledge including safety issues and Information and Strengthening Education and Training for Capacity Building. It contains an excerpt on Nuclear Knowledge from the General Conference Resolution [GC(48)/RES/13] on Strengthening the Agency's Activities Related to Nuclear Science, Technology and Applications. On the CD-ROM itself, all documents can easily be accessed by clicking on their titles on the subject pages (also printed at the end of this Working Material). Part 1 of the CD-ROM covers the activities in the period 2003-2005 and part 2 presents a resource material full text CD-ROM on Managing Nuclear Knowledge issued in October 2003

CD-ROM for the PGAA-IAEA database

International Nuclear Information System (INIS)

Firestone, R.B.; Zerking, V.

2007-01-01

Both the database of prompt gamma rays from slow neutron capture for elemental analysis and the results of this CRP are available on the accompanying CD-ROM. The file index.html is the home page for the CD-ROM, and provides links to the following information: (a) The CRP - General information, papers and reports relevant to this CRP. (b) The PGAA-IAEA database viewer - An interactive program to display and search the PGAA database by isotope, energy or capture cross-section. (c) The Database of Prompt Gamma Rays from Slow Neutron Capture for Elemental Analysis - This report. (d) The PGAA database files - Adopted PGAA database and associated files in EXCEL, PDF and Text formats. The archival databases by Lone et al. and by Reedy and Frankle are also available. (e) The Evaluated Gamma-Ray Activation File (EGAF) - The adopted PGAA database in ENSDF format. Data can be viewed with the Isotope Explorer 2.2 ENSDF Viewer. (f) The PGAA database evaluation - ENSDF format versions of the adopted PGAA database, and the Budapest and ENSDF isotopic input files. Decay scheme balance and statistical analysis summaries are provided. (g) The Isotope Explorer 2.2 ENSDF viewer - Windows software for viewing the level scheme drawings and tables provided in ENSDF format. The complete ENSDF database is included, as of December 2002. The databases and viewers are discussed in greater detail in the following sections

Operating Experience with Nuclear Power Stations in Member States. 2016 Edition (CD-ROM)

International Nuclear Information System (INIS)

2016-06-01

This CD-ROM contains the 47th edition of the IAEA’s series of annual reports on operating experience with nuclear power plants in Member States. It is a direct output from the IAEA’s Power Reactor Information System (PRIS) and contains information on electricity production and overall performance of individual plants during 2015. In addition to annual information, the report contains a historical summary of performance during the lifetime of individual plants and figures illustrating worldwide performance of the nuclear industry. The CD-ROM contains also an overview of design characteristics and dashboards of all operating nuclear power plants worldwide

Public census data on CD-ROM at Lawrence Berkeley Laboratory. Revision 3

Energy Technology Data Exchange (ETDEWEB)

Merrill, D.W.

1993-01-16

The Comprehensive Epidemiologic Data Resource (CEDR) and Populations at Risk to Environmental Pollution (PAREP) projects, of the Information and Computing Sciences Division (ICSD) at Lawrence Berkeley Laboratory (LBL), are using public socioeconomic and geographic data files which are available to CEDR and PAREP collaborators via LBL`s computing network. At this time 72 CD-ROM diskettes (approximately 37 gigabytes) are on line via the Unix file server ``cedrcd.lbl.gov``. Most of the files are from the US Bureau of the Census, and many of these pertain to the 1990 Census of Population and Housing. All the CD-ROM diskettes contain documentation in the form of ASCII text files. In addition, printed documentation for most files is available for inspection at University of California Data and Technical Assistance (UC DATA), tel. (510) 642-6571, or the UC Documents Library, tel. (510) 642-2569, both located on the UC Berkeley Campus. Many of the CD-ROM diskettes distributed by the Census Bureau contain software for PC compatible computers, for easily accessing the data. Shared access to the data is maintained through a collaboration among the CEDR and PAREP projects at LBL, and UC DATA, and the UC Documents Library. LBL is grateful to UC DATA and the UC Documents Library for the use of their CD-ROM diskettes. Shared access to LBL facilities may be restricted in the future if costs become prohibitive. Via the Sun Network File System (NFS), these data can be exported to Internet computers for direct access by the user`s application program(s). Due to the size of the files, this access method is preferred over File Transfer Protocol (FTP) access. Please contact Deane Merrill (dwmerrill@lbl.gov) if you wish to make use of the data.

Development and Utilization of Regional Oceanic Modeling System (ROMS). Delicacy, Imprecision, and Uncertainty of Oceanic Simulations: An Investigation with the Regional Oceanic Modeling System (ROMS). Mixing in the Ocean Surface Layer Using the Regional Oceanic Modeling System (ROMS).

Science.gov (United States)

2011-09-30

community use for ROMS is biogeochemisty: chemical cycles, water quality, blooms , micro-nutrients, larval dispersal, biome transitions, and coupling to...J.C. McWilliams, X. Capet, and J. Kurian, 2010: Heat balance and eddies in the Peru- Chile Current System. Climate Dynamics, 37, in press. doi10.1007

Reservoir and civil engineering geophysics (CD-Rom); Geophysique de gisement et de genie civil (CD-Rom)

Energy Technology Data Exchange (ETDEWEB)

Mari, J.L.; Chapellier, D.

1999-07-01

This CD-Rom is a pedagogical tool developed from the book 'field and civil engineering geophysics' (Technip ed., 1998). It presents the geophysical methods (surface and well geophysical surveys, radar surveys and well logging) and their application in the study of oil fields and also in civil engineering. Several cartoons illustrate the principle of methods, their domain of use and their limitations. It covers the following topics: surface seismic surveys (waves propagation, equipments, reflexion and refraction seismic surveys, surface waves); well seismic surveys (operation, data processing, imaging); well logging (acoustic, nuclear,electrical and others, methods of interpretation); radar surveys (principle, surface, wells, possibilities and limitations). (J.S.)

A Community Terrain-Following Ocean Modeling System (ROMS)

Science.gov (United States)

2015-09-30

funded NOPP project titled: Toward the Development of a Coupled COAMPS-ROMS Ensemble Kalman filter and adjoint with a focus on the Indian Ocean and the...surface temperature and surface salinity daily averages for 31-Jan-2014. Similarly, Figure 3 shows the sea surface height averaged solution for 31-Jan... temperature (upper panel; Celsius) and surface salinity (lower panel) for 31-Jan-2014. The refined solution for the Hudson Canyon grid is overlaid on

Arquitectura románica en la provincia de Soria, 1856-2014. Marco historiográfico y metodológico

Directory of Open Access Journals (Sweden)

Lorenzo Arribas, Josemi

2014-12-01

Full Text Available The historiography of Romanesque in the province of Soria has three different stages. The former one begins with Eduardo Saavedra’s researches (1856 and it extends until 1934, when Gaya Nuño defends his PhD Thesis (La arquitectura románica en la provincia de Soria, which will not be published until 1946. The Spanish Civil War and the post-war period mark the beginning of the second stage, which is merely transitional, lacking any important contribution. The last stage begins with the publication of the three volumes of the Enciclopedia del Románico en Castilla y León (2002. These works have largely improved the knowledge of Romanesque architectural heritage, enhanced besides by the task undertaken by the technical office of the Cultural Project Soria Románica (2007- 2012, responsible for studying and restoring more than thirty Romanesque buildings in the Southern part of province. It is within this working frame that the building recording of the churches here presented must be understood. This historiographical assessment about provincial Romanesque does not include those buildings sited in the capital city, the Cathedral of El Burgo de Osma, the Monastery of Santa Maria de Huerta and the hermitage of San Baudelio (Casillas de Berlanga.La historiografía del Románico en la provincia de Soria tiene tres etapas diferenciadas. Una inicial, que parte de los estudios de Eduardo Saavedra (1856 y se extiende hasta 1934, fecha de la lectura de la tesis doctoral de Gaya Nuño (La arquitectura románica en la provincia de Soria, cuya publicación, no obstante, se demora hasta 1946. La Guerra Civil y posguerra marcan el comienzo de la segunda etapa, transicional y sin grandes aportaciones. La última etapa se inaugura con la publicación de los tres volúmenes sorianos de la Enciclopedia del Románico en Castilla y León (2002. Esta obra ha multiplicado el conocimiento del patrimonio edilicio románico, acrecentado, después, por la labor de la

NODC Standard Product: World Ocean Circulation Experiment (WOCE) Global Data Resource (GDR), versions 1-3, on CD-ROM and DVD

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — NODC produced twelve (12) CD-ROMs containing WOCE Version 1 project data in the summer of 1998. NODC produced fifteen (15) CD-ROMs containing WOCE Version 2 project...

Experimental study on gamma irradiation effects of floating gate ROMs The ROM is stated for Read-only Memory

CERN Document Server

He Chao Hui; Chen Xiao Hua; Wang Yan Ping; Peng Hong Lun

2002-01-01

Experimental results of gamma irradiation effects are given for Floating gate ROMs. There is an accumulated dose threshold. Errors occur when accumulated dose is above the threshold, no error occurs when below the threshold. The errors go up with the increase of the accumulated dose. Errors occur in devices that are measured during irradiation and irradiated in power on, moreover, new data cannot be written in these devices with programmer. However, under more accumulated dose, there is no error in devices in power off mode and new data can be written in these devices with programmer

Ionospheric data available on CD-ROM and on NDADS

International Nuclear Information System (INIS)

Bilitza, D.

1996-01-01

Information is provided on two CD-ROMs (for PCs) with ionospheric data: the ionosonde CD issued by NGDC/WDC-A-STP/NOAA/Boulder and the Atmosphere Explorer CD produced by NSSDC/WDC-A-R and S/NASA/Greenbelt. We also briefly describe the ionospheric/thermospheric data available through NSSDC's automated mail retrieval system (NDADS) and explain the procedure for obtaining NDADS data. (author). 3 figs

Canister Design for Deep Borehole Disposal of Nuclear Waste (CD-ROM)

National Research Council Canada - National Science Library

Hoag, Christopher I

2006-01-01

...: 1 CD-ROM; 4 3/4 in.; 28.7 MB. ABSTRACT: The objective of this thesis was to design a canister for the disposal of spent nuclear fuel and other high-level waste in deep borehole repositories using currently available and proven oil, gas...

CD-ROM technology at the EROS data center

Science.gov (United States)

Madigan, Michael E.; Weinheimer, Mary C.

1993-01-01

The vast amount of digital spatial data often required by a single user has created a demand for media alternatives to 1/2" magnetic tape. One such medium that has been recently adopted at the U.S. Geological Survey's EROS Data Center is the compact disc (CD). CD's are a versatile, dynamic, and low-cost method for providing a variety of data on a single media device and are compatible with various computer platforms. CD drives are available for personal computers, UNIX workstations, and mainframe systems, either directly connected, or through a network. This medium furnishes a quick method of reproducing and distributing large amounts of data on a single CD. Several data sets are already available on CD's, including collections of historical Landsat multispectral scanner data and biweekly composites of Advanced Very High Resolution Radiometer data for the conterminous United States. The EROS Data Center intends to provide even more data sets on CD's. Plans include specific data sets on a customized disc to fulfill individual requests, and mass production of unique data sets for large-scale distribution. Requests for a single compact disc-read only memory (CD-ROM) containing a large volume of data either for archiving or for one-time distribution can be addressed with a CD-write once (CD-WO) unit. Mass production and large-scale distribution will require CD-ROM replication and mastering.

Air Force Research Laboratorv Success Stories: A Review of 2004 (CD-ROM)

National Research Council Canada - National Science Library

2004-01-01

...). PHYSICAL DESCRIPTION: 1 CD-ROM; 4 3/4 in.; 43.5 MB. ABSTRACT: The Air Force Science and Technology Success Stories herein often represent the combined effort of several scientists and engineers working as a team...

Shared Decision Making in mental health care using Routine Outcome Monitoring as a source of information: a cluster randomised controlled trial.

Science.gov (United States)

Metz, Margot J; Franx, Gerdien C; Veerbeek, Marjolein A; de Beurs, Edwin; van der Feltz-Cornelis, Christina M; Beekman, Aartjan T F

2015-12-15

Shared Decision Making (SDM) is a way to empower patients when decisions are made about treatment. In order to be effective agents in this process, patients need access to information of good quality. Routine Outcome Monitoring (ROM) may provide such information and therefore may be a key element in SDM. This trial tests the effectiveness of SDM using ROM, primarily aiming to diminish decisional conflict of the patient while making decisions about treatment. The degree of decisional conflict, the primary outcome of this study, encompasses personal certainty about choosing an appropriate treatment, information about options, clarification of patient values, support from others and patients experience of an effective decision making process. Secondary outcomes of the study focus on the working alliance between patient and clinician, adherence to treatment, and clinical outcome and quality of life. This article presents the study protocol of a multi-centre two-arm cluster randomised controlled trial (RCT). The research is conducted in Dutch specialised mental health care teams participating in the ROM Quality Improvement Collaborative (QIC), which aims to implement ROM in daily clinical practice. In the intervention teams, ROM is used as a source of information during the SDM process between the patient and clinician. Control teams receive no specific SDM or ROM instructions and apply decision making as usual. Randomisation is conducted at the level of the participating teams within the mental health organisations. A total of 12 teams from 4 organisations and 364 patients participate in the study. Prior to data collection, the intervention teams are trained to use ROM during the SDM process. Data collection will be at baseline, and at 3 and 6 months after inclusion of the patient. Control teams will implement the SDM and ROM model after completion of the study. This study will provide useful information about the effectiveness of ROM within a SDM framework

In Praise of Mr. S. Platter and His Marvelous, Magnificent CD ROM Laser Disc Index for ERIC and PSYCHLIT.

Science.gov (United States)

Huffman, Robert F.

These instructions are designed to help patrons of the University of Missouri-Columbia library perform searches on PSYCHLIT, a CD-ROM (compact disc, read only memory) version of the Psych Abstracts database, and a CD-ROM version of the ERIC database, both produced by SilverPlatter Information Services. Basic information is provided about the disk…

An electrically reprogrammable 1024 bits MNOS ROM using MNOS-SOS e/d technology

International Nuclear Information System (INIS)

Mackowiak, E.; Le Goascoz, V.

1976-01-01

A 1024 bits fully decoded electrically writable and erasable non volatile ROM is described. Memory cells and peripheral circuits are made using P channel silicon on sapphire enhancement depletion technology [fr

Students' Attitudes toward ABI/INFORM on CD-ROM: A Factor Analysis.

Science.gov (United States)

Wang, Vicky; Lau, Shuk-fong

Two years after the introduction of CD-ROM bibliographic database searching in the Memphis State University libraries (Tennessee), a survey was conducted to examine students' attitudes toward the business database, ABI/INFORM. ABI/INFORM contains indexes and abstracts of articles from over 800 journals on management, accounting, banking, human…

Energy-Smart Choices for Schools. An HVAC Comparison Tool. [CD-ROM].

Science.gov (United States)

Geothermal Heat Pump Consortium, Inc., Washington, DC.

A CD ROM program provides comparison construction cost capabilities for heating, ventilation, and air conditioning (HVAC) systems in educational facilities. The program combines multiple types of systems with square footage data on low and high construction cost and school size to automatically calculate HVAC comparative construction costs. (GR)

Operating Experience with Nuclear Power Stations in Member States in 2014. 2015 Edition (CD-ROM)

International Nuclear Information System (INIS)

2015-01-01

This CD-ROM contains the 46th edition of the IAEA’s series of annual reports on operating experience with nuclear power plants in Member States. It is a direct output from the IAEA’s Power Reactor Information System (PRIS) and contains information on electricity production and overall performance of individual plants during 2014. In addition to annual information, the report contains a historical summary of performance during the lifetime of individual plants and figures illustrating worldwide performance of the nuclear industry. The CD-ROM contains also an overview of design characteristics and dashboards of all operating nuclear power plants worldwide

SM-ROM-GL (Strong Motion Romania Ground Level Database

Directory of Open Access Journals (Sweden)

Ioan Sorin BORCIA

2015-07-01

Full Text Available The SM-ROM-GL database includes data obtained by the processing of records performed at ground level by the Romanian seismic networks, namely INCERC, NIEP, NCSRR and ISPH-GEOTEC, during recent seismic events with moment magnitude Mw ≥ 5 and epicenters located in Romania. All the available seismic records were re-processed using the same basic software and the same procedures and options (filtering and baseline correction, in order to obtain a consistent dataset. The database stores computed parameters of seismic motions, i.e. peak values: PGA, PGV, PGD, effective peak values: EPA, EPV, EPD, control periods, spectral values of absolute acceleration, relative velocity and relative displacement, as well as of instrumental intensity (as defined bz Sandi and Borcia in 2011. The fields in the database include: coding of seismic events, stations and records, a number of associated fields (seismic event source parameters, geographical coordinates of seismic stations, links to the corresponding ground motion records, charts of the response spectra of absolute acceleration, relative velocity, relative displacement and instrumental intensity, as well as some other representative parameters of seismic motions. The conception of the SM-ROM-GL database allows for an easy maintenance; such that elementary knowledge of Microsoft Access 2000 is sufficient for its operation.

The effects of neural mobilization on cervical radiculopathy patients' pain, disability, ROM, and deep flexor endurance.

Science.gov (United States)

Kim, Dong-Gyu; Chung, Sin Ho; Jung, Ho Bal

2017-09-22

Cervical radiculopathy (CR) is a disease of the cervical spine and a space-occupying lesion that occurs because of pathological problems with cervical nerve roots. Nerve root injury to produce functional disability. The purpose of this study was to examine the effects of neural mobilization with manual cervical traction (NMCT) compared with manual cervical traction (MCT) on pain, functional disability, muscle endurance, and range of motion (ROM) in individuals with CR patients. A blinded randomized clinical trial was conducted. Thirty CR patients were divided into two groups - those who received NMCT and those who received MCT. The intervention was applied three times per week for eight weeks. It was measured in order to determine the pain and functional disability in patients with CR. The numeric pain rating scale (NPRS), neck disability index (NDI), ROM, and deep flexor endurance of patients were measured prior to the experiment, four weeks, and eight weeks after the experiment to compare the time points. A repeated-measures analysis of variance was used to compare differences within each group prior to the experiment. And Bonferroni test was performed to examine the significance of each time point. There were significant differences within each group prior to the intervention, four weeks after the intervention, and eight weeks after the intervention in NPRS, NDI, ROM, and deep flexor endurance (Ppain relief, recovery from neck disability, ROM, and deep flexor endurance for patients with CR.

經由校園網路存取圖書館光碟資料庫之研究 Studies on Multiuser Access Library CD-ROM Database via Campus Network

Directory of Open Access Journals (Sweden)

Ruey-shun Chen

1992-06-01

Full Text Available 無Library CD-ROM with its enormous storage, retrieval capabilities and reasonable price. It has been gradually replacing some of its printed counterpart. But one of the greatest limitation on the use of stand-alone CD-ROM workstation is that only one user can access the CD-ROM database at a time. This paper is proposed a new method to solve this problem. The method use personal computer via standard network system Ethernet high speed fiber network FADDY and standard protocol TCP/IP can access library CD-ROM database and perform a practical CD-ROM campus network system. Its advantage reduce redundant CD-ROM purchase fee and reduce damage by handed in and out and allows multiuser to access the same CD-ROM disc simultaneously.

Adolescencia, relaciones románticas y actividad sexual: una revisión

Directory of Open Access Journals (Sweden)

Elvia Vargas

2002-01-01

Full Text Available Se presenta una revisión de algunas de las investigaciones más recientes sobre la adolescencia y los factores asociados a las relaciones románticas y la actividad sexual durante la adolescencia. Se parte de la premisa de que el análisis de la iniciación romántica y sexual durante la adolescencia requiere de modelos de causalidad múltiple que permitan dar cuenta, conjuntamente, de los factores que se encuentran en los contextos individual, familiar y social asociados con estos dos procesos. Se destaca el papel de los padres en el desarrollo de hijos adolescentes autónomos, capaces de manejar la influencia negativa del grupo de pares. Se hacen algunas recomendaciones a los responsables de diseñar programas de prevención y a los interesados en el estudio de la adolescencia y en el desarrollo de la disciplina

Community-Based Care

Science.gov (United States)

... our e-newsletter! Aging & Health A to Z Community-Based Care Basic Facts & Information A variety of healthcare options ... day care centers are either in churches or community centers. Adult day care is commonly used to care for people who ...

Note despre numele proprii în traducerile românești din secolul al XVIII-lea ale Vieții lui Petru (de Antonio Catiforo

Directory of Open Access Journals (Sweden)

Cristian Ungureanu

2017-01-01

Full Text Available Vita di Pietro este o lucrare alcătuită de grecul Antonio Catiforo în limba italiană, publicată la Veneția, în 1736; o versiune a sa în limba greacă a fost publicată tot la Veneția, un an mai tîrziu, de către Alexandros Kankellarios. Lucrarea conține șase cărți și sintetizează informațiile oferite de surse referitoare la epoca și personalitatea țarului rus. În română, ea a cunoscut mai multe traduceri la jumătatea și în a doua perioadă a secolului al XVIII-lea, în toate cele trei provincii românești. Numărul mare de copii arată interesul de care s-a bucurat această lucrare în epocă.Articolul de față prezintă cîteva particularități ale transferului numelor proprii din limba-sursă în limba-țintă. Am analizat patru tipuri de nume proprii: horonimul Moscovia și etnonimul aferent, horonime occidentale, antroponime rusești, antroponime de alte origini, urmărind felul în care traducătorii se raportează la sursă și diferențele dintre versiuni din acest punct de vedere.

CD-ROM training course in quality assurance in diagnostic imaging

International Nuclear Information System (INIS)

Khoury, H.J.; Machado, P.; Drexler, G.

2001-01-01

This paper discusses the CD-ROM elaborated to provide a continuous professional formation and a practical guidance on the implementation and operation of routine quality assurance (QA) programme for medical physicists, regulator authorities and for those personnel concerned with the daily provision of diagnostic radiology services. The CD-ROM contains topics on the basic concepts of QA in radiodiagnostic, and it also allows the user to visualise effects on the variation of technical parameters (tube potential (kV) and current (mA), filtration) in the quality of the image. This possibility will contribute to the better understanding of the phenomena associated with the quality of the image. Besides, the program contains the procedures for the execution of the tests of the equipment and the route of implantation of program of quality assurance. It is interactive with the user, it fills a gap in the medical physics area and it allows the student's continuous formation because it assists the beginner, with the basic concepts, and the professional, with the aid in the implantation of the program of QA. The presentation is in the Portuguese language. (author)

A reduced order aerothermodynamic modeling framework for hypersonic vehicles based on surrogate and POD

Directory of Open Access Journals (Sweden)

Chen Xin

2015-10-01

Full Text Available Aerothermoelasticity is one of the key technologies for hypersonic vehicles. Accurate and efficient computation of the aerothermodynamics is one of the primary challenges for hypersonic aerothermoelastic analysis. Aimed at solving the shortcomings of engineering calculation, computation fluid dynamics (CFD and experimental investigation, a reduced order modeling (ROM framework for aerothermodynamics based on CFD predictions using an enhanced algorithm of fast maximin Latin hypercube design is developed. Both proper orthogonal decomposition (POD and surrogate are considered and compared to construct ROMs. Two surrogate approaches named Kriging and optimized radial basis function (ORBF are utilized to construct ROMs. Furthermore, an enhanced algorithm of fast maximin Latin hypercube design is proposed, which proves to be helpful to improve the precisions of ROMs. Test results for the three-dimensional aerothermodynamic over a hypersonic surface indicate that: the ROMs precision based on Kriging is better than that by ORBF, ROMs based on Kriging are marginally more accurate than ROMs based on POD-Kriging. In a word, the ROM framework for hypersonic aerothermodynamics has good precision and efficiency.

Operating Experience with Nuclear Power Stations in Member States in 2013. 2014 Edition (CD-ROM)

International Nuclear Information System (INIS)

2014-07-01

This CD-ROM contains the 45th edition of the IAEA's series of annual reports on operating experience with nuclear power plants in Member States. It is a direct output from the IAEA's Power Reactor Information System (PRIS) and contains information on electricity production and overall performance of individual plants during 2013. In addition to annual information, the report contains a historical summary of performance during the lifetime of individual plants and figures illustrating worldwide performance of the nuclear industry. The CD-ROM contains also an overview of design characteristics and dashboards (not included into the web version) of all operating nuclear power plants worldwide

Multimedia CD-Rom on hydrogen and fuel cells. 2. rev. ed.; Die Multimedia CD-Rom zum Thema Wasserstoff und Brennstoffzellen

Energy Technology Data Exchange (ETDEWEB)

Anon.

2007-07-01

This CD-Rom contains well-presented information with informative illustrations, as well as a large download section with publications, reports, and presentations in.pdf form for in-depth studies. There is also a list of links to selected websites, with short explanations. [German] Die CD zum Thema ''Wasserstoff und Brennstoffzellen'' bietet sowohl gut gegliederte Informationen mit anschaulichen Bildern fuer die Lektuere am Monitor als auch eine grosse Download-Rubrik, in der zahlreiche Publikationen, Fachberichte, Praesentationen als PDF-Dateien abgelegt sind und fuers Studium bereitstehen. Ausserdem gibt es ein Link-Verzeichnis mit Verweisen und Erlaeuterungen zu ausgewaehlten Internet-Seiten.

Pitfalls in the Assessment, Analysis, and Interpretation of Routine Outcome Monitoring (ROM) Data : Results from an Outpatient Clinic for Integrative Mental Health

NARCIS (Netherlands)

Hoenders, Rogier H. J.; Bos, Elisabeth H.; Bartels-Velthuis, Agna A.; Vollbehr, Nina K.; van der Ploeg, Karen; de Jonge, Peter; de Jong, Joop T. V. M.

There is considerable debate about routine outcome monitoring (ROM) for scientific or benchmarking purposes. We discuss pitfalls associated with the assessment, analysis, and interpretation of ROM data, using data of 376 patients. 206 patients (55 %) completed one or more follow-up measurements.

Optimization and Implementation of Scaling-Free CORDIC-Based Direct Digital Frequency Synthesizer for Body Care Area Network Systems

Directory of Open Access Journals (Sweden)

Ying-Shen Juang

2012-01-01

Full Text Available Coordinate rotation digital computer (CORDIC is an efficient algorithm for computations of trigonometric functions. Scaling-free-CORDIC is one of the famous CORDIC implementations with advantages of speed and area. In this paper, a novel direct digital frequency synthesizer (DDFS based on scaling-free CORDIC is presented. The proposed multiplier-less architecture with small ROM and pipeline data path has advantages of high data rate, high precision, high performance, and less hardware cost. The design procedure with performance and hardware analysis for optimization has also been given. It is verified by Matlab simulations and then implemented with field programmable gate array (FPGA by Verilog. The spurious-free dynamic range (SFDR is over 86.85 dBc, and the signal-to-noise ratio (SNR is more than 81.12 dB. The scaling-free CORDIC-based architecture is suitable for VLSI implementations for the DDFS applications in terms of hardware cost, power consumption, SNR, and SFDR. The proposed DDFS is very suitable for medical instruments and body care area network systems.

The New York Trade Publishers and CD-ROM: Where Are They Heading?

Science.gov (United States)

Newmark, Eileen

1994-01-01

Discusses the strategies top trade publishers, including Putnam New Media, Paramount Communications, Random House, Penguin USA, and Reader's Digest, are taking toward CD-ROM publishing. Strategies include purchasing electronic media companies; setting up an independent business; and building a new media business by integrating new efforts into the…

Validation of a photography-based goniometry method for measuring joint range of motion.

Science.gov (United States)

Blonna, Davide; Zarkadas, Peter C; Fitzsimmons, James S; O'Driscoll, Shawn W

2012-01-01

A critical component of evaluating the outcomes after surgery to restore lost elbow motion is the range of motion (ROM) of the elbow. This study examined if digital photography-based goniometry is as accurate and reliable as clinical goniometry for measuring elbow ROM. Instrument validity and reliability for photography-based goniometry were evaluated for a consecutive series of 50 elbow contractures by 4 observers with different levels of elbow experience. Goniometric ROM measurements were taken with the elbows in full extension and full flexion directly in the clinic (once) and from digital photographs (twice in a blinded random manner). Instrument validity for photography-based goniometry was extremely high (intraclass correlation coefficient: extension = 0.98, flexion = 0.96). For extension and flexion measurements by the expert surgeon, systematic error was negligible (0° and 1°, respectively). Limits of agreement were 7° (95% confidence interval [CI], 5° to 9°) and -7° (95% CI, -5° to -9°) for extension and 8° (95% CI, 6° to 10°) and -7° (95% CI, -5° to -9°) for flexion. Interobserver reliability for photography-based goniometry was better than that for clinical goniometry. The least experienced observer's photographic goniometry measurements were closer to the reference measurements than the clinical goniometry measurements. Photography-based goniometry is accurate and reliable for measuring elbow ROM. The photography-based method relied less on observer expertise than clinical goniometry. This validates an objective measure of patient outcome without requiring doctor-patient contact at a tertiary care center, where most contracture surgeries are done. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Support-Vector-Machine-Based Reduced-Order Model for Limit Cycle Oscillation Prediction of Nonlinear Aeroelastic System

Directory of Open Access Journals (Sweden)

Gang Chen

2012-01-01

Full Text Available It is not easy for the system identification-based reduced-order model (ROM and even eigenmode based reduced-order model to predict the limit cycle oscillation generated by the nonlinear unsteady aerodynamics. Most of these traditional ROMs are sensitive to the flow parameter variation. In order to deal with this problem, a support vector machine- (SVM- based ROM was investigated and the general construction framework was proposed. The two-DOF aeroelastic system for the NACA 64A010 airfoil in transonic flow was then demonstrated for the new SVM-based ROM. The simulation results show that the new ROM can capture the LCO behavior of the nonlinear aeroelastic system with good accuracy and high efficiency. The robustness and computational efficiency of the SVM-based ROM would provide a promising tool for real-time flight simulation including nonlinear aeroelastic effects.

Şcoli şi biserici româneşti din Peninsula Balcanică 1864-1948. Documente de arhivă

Directory of Open Access Journals (Sweden)

Adina Berciu-Drăghicescu

2006-01-01

Full Text Available Articolul de faţă privind şcolile şi bisericile româneşti din Peninsula Balcanică în perioada 1918-1948 este realizat pe baza unor documente identificate în fonduri păstrate la Arhivele Diplomatice ale Ministerului Afacerilor Externe şi la Direcţia Arhivelor Naţioanle Istorice Centrale din Bucureşti. Au fost studiate şi selectate documente de cea mai mare semnificaţie în scopul prezentării evoluţiei situaţiei şcolilor şi bisericilor comunităţilor româneşti situate la sud de Dunăre începând cu anul 1864, când a fost înfiinţată prima şcoală în Târnova (Macedonia şi până în 1948 când statul român a abandonat acţiunea iniţiată de conducătorul Al. Ioan Cuza. Articolul prezintă această situaţie, foarte dramatică, a comunităţilor româneşti din Balcani pe baza documentelor de arhivă.

Factors Affecting Pre-Service TESOL Teachers' Attitudes towards Using CD-ROM Dictionary

Science.gov (United States)

Issa, Jinan Hatem; Jamil, Hazri

2011-01-01

Rapid technological advances in communication technologies and computational power are altering the nature of knowledge, skills, talents and the know-how of individuals. A CD-ROM dictionary is an interesting and effective teaching tool, which captures pre-service teachers' interest and does much more than just translates especially with the…

Advanced grammar in use a self-study reference and practice book for advanced students of English : with answers and CD-ROM

CERN Document Server

Hewings, Martin

2013-01-01

An updated version of the highly successful Advanced Grammar in Use. This third edition, with answers and CD-ROM, is ideal for self-study. The book contains 100 units of grammar reference and practice materials, with illustrations in full colour and a user-friendly layout. It is ideal for learners preparing for the Cambridge Advanced, Proficiency or IELTS examinations, and is informed by the Cambridge International Corpus, which ensures the language is authentic and up-to-date. The CD-ROM includes 200 interactive exercises to reinforce the language learned in the book, plus customised tests and audio recordings to accompany the main exercises. Versions without answers and without the CD-ROM are available to purchase separately.

Guide Structures in CD-ROM Dictionaries, with Specific Reference to the EWED and the ELHAT

Directory of Open Access Journals (Sweden)

Philip Louw

2011-10-01

Full Text Available

macro- and microstructural information. In order to evaluate the methods which lexicographers employ to improve dictionary accessibility, the concept of guide structures was introduced by Hausmann and Wiegand (1989. Since the appearance of that article, various academics have written articles and read papers on guide structures in print dictionaries, but few studies have focussed on the tremendous potential of guide structures in electronic dictionaries. In this article it will be shown that electronic dictionaries add dimensions to the implementation of guide structures not possible in print versions. The role of two of the guide structures in the transfer of infonnation in CD-ROM dictionaries will be discussed. The access and mediostructures of the Microsoft Encarta World English Dictionary and the Elektroniese Handwoordeboek van die Afrikaanse Taal will be analysed and critically evaluated to illustrate the advantages of electronic dictionaries over print dictionaries and the urgent need for metalexicographical discussion of this publication medium.

Keywords: ACCESS STRUCTURE; ACTIVE CROSS-REFERENCES; CD-ROM DICTIONARY; DICTIONARY ACCESSIBILITY; ENCYCLOPAEDIC DICTIONARY; GUIDE STRUCTURES; INNER ACCESS STRUCTURE; INNER SEARCH PATH; INTERNET; MEDIOSTRUCTURE; MULTIMEDIA; OUTER ACCESS STRUCTURE; OUTER SEARCH PATH; PASSIVE CROSSREFERENCING; USER-FRIENDLINESS

Opsomming: Gidsstrukture in CD-ROM-woordeboeke, met spesifieke verwysingna EWED en ELHA T. Die sukses van modeme woordeboeke hang grootliles af vandie toeganklikheid van hulle makro- en mikrostrukturele inligting. Hausmann en Wiegand (1989het die konsep van gidsstrukture ingevoer om die metodes te evalueer wat leksikograwe gebruikom woordeboektoeganklikheid Ie verbeter. Sedert hierdie artikel verskyn het, het verskeie akademic:i artikels gepubliseer en referate gelewer oor gidsstrukture in gedrukte woordeboeke, maarmin studies het gefokus op die geweldige potensiaal van

Occupational Analysis Products: Space Systems Operations - AFSC 1C6X1 (CD-ROM)

National Research Council Canada - National Science Library

Boerstler, Robert E

2004-01-01

...: 1 CD-ROM; 4 3/4 in.; 30.4 MB. SYSTEMS DETAIL NOTE: ABSTRACT: The Space Systems Operations career ladder was surveyed to obtain current task and equipment data for use in evaluating current training programs...

Introducing students to ocean modeling via a web-based implementation for the Regional Ocean Modeling System (ROMS) river plume case study

Science.gov (United States)

Harris, C. K.; Overeem, I.; Hutton, E.; Moriarty, J.; Wiberg, P.

2016-12-01

Numerical models are increasingly used for both research and applied sciences, and it is important that we train students to run models and analyze model data. This is especially true within oceanographic sciences, many of which use hydrodynamic models to address oceanographic transport problems. These models, however, often require a fair amount of training and computer skills before a student can run the models and analyze the large data sets produced by the models. One example is the Regional Ocean Modeling System (ROMS), an open source, three-dimensional primitive equation hydrodynamic ocean model that uses a structured curvilinear horizontal grid. It currently has thousands of users worldwide, and the full model includes modules for sediment transport and biogeochemistry, and several options for turbulence closures and numerical schemes. Implementing ROMS can be challenging to students, however, in part because the code was designed to provide flexibility for the choice of model parameterizations and processes, and to run on a variety of High Performance Computing (HPC) platforms. To provide a more accessible tool for classroom use, we have modified an existing idealized ROMS implementation to be run on a High Performance Computer (HPC) via the WMT (Web Modeling Toolkit), and developed a series of lesson plans that explore sediment transport within the idealized model domain. This has addressed our goal to provide a relatively easy introduction to the numerical modeling process that can be used within upper level undergraduate and graduate classes to explore sediment transport on continental shelves. The model implementation includes wave forcing, along-shelf currents, a riverine source, and suspended sediment transport. The model calculates suspended transport and deposition of sediment delivered to the continental shelf by a riverine flood. Lesson plans lead the students through running the model on a remote HPC, modifying the standard model. The lesson

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy.

Science.gov (United States)

Cerrahoglu, Lale; Koşan, Umut; Sirin, Tuba Cerrahoglu; Ulusoy, Aslihan

2016-05-01

We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P .05). A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Caspian Sea Energy: Oil, Politics and Development in the Caspian Sea Region (CD-ROM)

National Research Council Canada - National Science Library

Light, Chris

2004-01-01

...: 1 CD-ROM; 4 3/4 in.; 5.0 MB. ABSTRACT: The purpose of this paper is to present the major issues impacting Caspian hydrocarbon development Specifically, a number of topics including the regions geography, history, governments, politics...

Galvenais varonis Dž.K.Roulingas romānu sērijā "Harijs Poters"

OpenAIRE

Kalsone, Ineta

2012-01-01

Dotā bakalaura darba temats ir "Galvenais varonis Dž.K. Roulingas romānu sērijā "Harijs Poters". Pirmajā nodaļā es analizēju sērijas popularitāti, publicēšanas datus un apbalvojumus, ko saņēmusi Dž.K. Roulinga. Otrajā nodaļā tiek analizēti dažādi raksturojuma veidi. Sīkāk tiek pētīta galvenā varoņa un citu nozīmīgāko tēlu loma. Meklējuma literatūras elementi,kas dod pamatu galvenā varoņa izaugsmei, tika analizēti detalizēti. Trešajā nodaļā tiek analizēta galvenā varoņa izaugsme šajā romānu sē...

COPPER RESISTANT STRAIN CANDIDA TROPICALIS RomCu5 INTERACTION WITH SOLUBLE AND INSOLUBLE COPPER COMPOUNDS

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Ie. P. Prekrasna

2015-10-01

Full Text Available The focus of the study was interaction of Candida tropicalis RomCu5 isolated from highland Ecuador ecosystem with soluble and insoluble copper compounds. Strain C. tropicalis RomCu5 was cultured in a liquid medium of Hiss in the presence of soluble (copper citrate and CuCl2 and insoluble (CuO and CuCO3 copper compounds. The biomass growth was determined by change in optical density of culture liquid, composition of the gas phase was measured on gas chromatograph, redox potential and pH of the culture fluid was defined potentiometrically. The concentration of soluble copper compounds was determined colorimetrically. Maximal permissible concentration of Cu2+ for C. tropicalis RomCu5 was 30 000 ppm of Cu2+ in form of copper citrate and 500 ppm of Cu2+ in form of CuCl2. C. tropicalis was metabolically active at super high concentrations of Cu2+, despite the inhibitory effect of Cu2+. C. tropicalis immobilized Cu2+ in the form of copper citrate and CuCl2 by it accumulation in the biomass. Due to medium acidification C. tropicalis dissolved CuO and CuCO3. High resistance of C. tropicalis to Cu2+ and ability to interact with soluble and insoluble copper compounds makes it biotechnologically perspective.

Year 5 Pupils Reading an "Interactive Storybook" on CD-ROM: Losing the Plot?

Science.gov (United States)

Trushell, John; Burrell, Clare; Maitland, Amanda

2001-01-01

This study examined whether small groups of grade 5 students in a London primary school, without teacher supervision, progressed linearly through an interactive storybook on CD-ROM, and whether such diversions as cued animations affected pupil comprehension. Results showed students' recall of the storyline was poor. (Author/LRW)

Setting Up CD-ROM Work Areas. Part I: Ergonomic Considerations, User Furniture, Location.

Science.gov (United States)

Vasi, John; LaGuardia, Cheryl

1992-01-01

The first of a two-part series on design of CD-ROM work areas in libraries discusses (1) space and location considerations; (2) ergonomics, including work surface, chairs, lighting, printers, other accessories, and security; and (3) other considerations, including staff assistance, reference tools, literature racks, and promotional materials. (MES)

Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care.

Science.gov (United States)

Ritchie, Christine S; Leff, Bruce

2018-03-01

With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Helping Family Physicians Improve Their Cardiac Auscultation Skills with an Interactive CD-ROM.

Science.gov (United States)

Roy, Douglas; Sargeant, Joan; Gray, Jean; Hoyt, Brian; Allen, Michael; Fleming, Michael

2002-01-01

Physicians (n=42) studied cardiac auscultation using a 15-hour CD-ROM program. Nine months later, 21 who completed a posttest showed significant improvement in identifying heart sounds. CDs were valued for opportunities to review material at an individual pace. Lack of computer skills hindered use. (Contains 26 references.) (SK)

How To Use the SilverPlatter Software To Search the ERIC CD ROM.

Science.gov (United States)

Merrill, Paul F.

This manual provides detailed instructions for using SilverPlatter software to search the ERIC CD ROM (Compact Disk Read Only Memory), a large bibliographic database relating to education which contains reference information on numerous journal articles from over 750 journals cited in the "Current Index to Journals in Education" (CIJE),…

Dāvida Lodža „Mazā pasaule” un „Paradīzes jaunumi” kā piedzīvojumu romāni

OpenAIRE

Kaušakīte, Inessa

2007-01-01

Maģistra darbā „Deivida Lodža „Mazā pasaule” un „Paradīzes Jaunumi” kā piedzīvojumu romāni” mērķis ir pievērst uzmanību piedzīvojuma žanra dažādām īpatnībām mūsdienu angļu romānista darbos. Darbs arī atklāj postmodernā piedzīvojumu romāna varoņa rakstura īpatnības. Pirmā nodaļa izceļ klasiskā 16. gadsimta spāņu literatūras piedzīvojumu romāna svarīgākās īpatnības. Šī nodaļa pēta apstākļus, kas palīdzējuši žanra attīstībai Anglijā. Otrā nodaļa pievērš uzmanību Deivida Lodža liktenim, kas kā...

Team-Based Care: A Concept Analysis.

Science.gov (United States)

Baik, Dawon

2017-10-01

The purpose of this concept analysis is to clarify and analyze the concept of team-based care in clinical practice. Team-based care has garnered attention as a way to enhance healthcare delivery and patient care related to quality and safety. However, there is no consensus on the concept of team-based care; as a result, the lack of common definition impedes further studies on team-based care. This analysis was conducted using Walker and Avant's strategy. Literature searches were conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, with a timeline from January 1985 to December 2015. The analysis demonstrates that the concept of team-based care has three core attributes: (a) interprofessional collaboration, (b) patient-centered approach, and (c) integrated care process. This is accomplished through understanding other team members' roles and responsibilities, a climate of mutual respect, and organizational support. Consequences of team-based care are identified with three aspects: (a) patient, (b) healthcare professional, and (c) healthcare organization. This concept analysis helps better understand the characteristics of team-based care in the clinical practice as well as promote the development of a theoretical definition of team-based care. © 2016 Wiley Periodicals, Inc.

Caring for home-based care workers | de Saxe Zerden | Southern ...

African Journals Online (AJOL)

care workers provide critical services, which include physical, psychosocial, and palliative care activities.1 A quantitative and qualitative study of home-based care workers in South Africa was conducted in 2005 to better understand the needs, fears and motivations of front-line care workers at Thembalethu Home Based ...

[Five years of ROM in substance abuse treatment centres in the Netherlands].

Science.gov (United States)

Oudejans, S C C; Schippers, G M; Spits, M E; Stollenga, M; van den Brink, W

2012-01-01

Three substance abuse treatment centres set up a benchmarking project for routine outcome management (ROM) of structured cognitive behavioral treatments for outpatients with a substance use disorder. To present the results of five years benchmarking. All patients were included at intake and the follow-up assessment was performed by a call-center nine months later. Twice a year aggregated data were fed back to management and treatment teams. Since 2005, clinical outcome data, including substance abuse data, have been collected for more than half of all 15.786 treated patients. At follow-up, nine months after intake, 23% was abstinent, 28% reported moderate substance use and 49% reported excessive substance use. The Dutch centres for the treatment of substance abuse were successful in setting up ROM projects to monitor and compare the development and the effects of outpatient addiction treatments. The clinical results are acceptable and correspond to the results of the American project called match. It is not yet clear whether the biannual feedback of aggregated outcomes to management and treatment teams has contributed to the creation of learning organisations, but it has provided transparency and has made it possible for teams to learn from the outcomes.

LOYALTY – THE NUCLEUS OF BRAND CAPITAL. CASE STUDY: ROM CHOCOLATE BAR

Directory of Open Access Journals (Sweden)

Brindusa Mariana Amalancei

2013-12-01

Full Text Available It is considered that loyalty to the brand of some primary customers is the core of the brand capital. A brand, however, may have substantial value, which is given to it by its symbol and slogans, if it is continued with the purchase of a brand after the buyers have made a comparison with the competing products that have superior characteristics. Structured on several levels, which are each a different marketing challenge, the loyalty to the brand consists of many factors, among which the most important is the user experience. The paper aims to highlight, starting from a series of articles in online media, the manner in which a traditional Romanian brand, ROM chocolate bar, continuously repositions itself, attempting to maintain and even increase the loyalty of its consumers, as well as to answer the consumer’s authenticity, accessibility, credibility and modernity needs. Even though in specialized literature there are opinions according to which traditional brands are commonly old-fashioned or dull, ROM chocolate bar shows the opposite view, being considered a successful brand which is appreciated both at national and international levels.

Occupational Analysis Products: Operations Management- AFSC 3E6X1 (CD-ROM)

Science.gov (United States)

computer laser optical disc (CD-ROM); 4 3/4 in.; 23.4 MB. SYSTEMS DETAIL NOTE: ABSTRACT: This is a report of an occupational survey of the Operations ... Management (AFSC 3E6X1, OSSN 2560, Feb 04) career ladder, conducted by the Occupational Analysis Flight, AFOMS. The OSR reports the findings of current

SEM REGRA NEM FREIOS - Loucura e criação na discussão romântica em torno do gênio

Directory of Open Access Journals (Sweden)

Yuri Cerqueira dos Anjos

2014-12-01

Full Text Available A relação entre genialidade e loucura, tópos bastante antigo, parece ganhar contornos peculiares no pensamento romântico. Inspirado, ultrassensível, isolado e visionário, o gênio romântico transita com certa frequência no campo semântico da loucura. Entre oráculo, profeta e louco, ele se caracteriza pela sua capacidade de transgredir o estado atual das coisas e criar um novo mundo de possibilidades e experiências. Nesse sentido, exploraremos no presente artigo alguns aspectos dessa relação entre o gênio e o louco no contexto do debate romântico francês do início do século XIX e no livro William Shakespeare, de Victor Hugo.

The development and pilot testing of a multimedia CD-ROM for diabetes education.

Science.gov (United States)

Castaldini, M; Saltmarch, M; Luck, S; Sucher, K

1998-01-01

The multimedia CD-ROM program, Take Charge of Diabetes, was found to be accurate, easy to use, and enjoyable by the clients and health professionals who completed the pilot study. Participants perceived an increase in knowledge after completing the five modules. Two of the participants verbally stated that the program clarified information for them and they wished they had had such a program when they were first diagnosed with diabetes. Further evaluation is needed to generalize the effect of the program on knowledge of diabetes because the pilot study was not designed to fully evaluate the effectiveness of the program on knowledge level or behavior change. Behavior change resulting in better control of blood sugar levels and hemoglobin A1c within normal range is the goal for diabetes education. The person who lives with diabetes must learn self-care methods. To accomplish that, the person must be able to comprehend the material presented. CAI programs provide an individualized, interactive, and interesting way to learn about diabetes and self-care, using visual effects and audio to support the written text. CAI can provide an element of excitement that is not available with other conventional methods. Providing prompt reinforcement of correct answers in quiz sections and including positive written messages can increase patients' self-confidence and self-esteem. Computer-assisted instruction is not intended to replace personal contact with physicians and diabetes educators, but rather complement this contact, reinforce learning, and possibly increase self-motivation to take charge of one's diabetes.

Nanomechanical recognition of prognostic biomarker suPAR with DVD-ROM optical technology

International Nuclear Information System (INIS)

Bache, Michael; Bosco, Filippo G; Brøgger, Anna L; Frøhling, Kasper B; Boisen, Anja; Alstrøm, Tommy Sonne; Hwu, En-Te; Chen, Ching-Hsiu; Hwang, Ing-Shouh; Eugen-Olsen, Jesper

2013-01-01

In this work the use of a high-throughput nanomechanical detection system based on a DVD-ROM optical drive and cantilever sensors is presented for the detection of urokinase plasminogen activator receptor inflammatory biomarker (uPAR). Several large scale studies have linked elevated levels of soluble uPAR (suPAR) to infectious diseases, such as HIV, and certain types of cancer. Using hundreds of cantilevers and a DVD-based platform, cantilever deflection response from antibody–antigen recognition is investigated as a function of suPAR concentration. The goal is to provide a cheap and portable detection platform which can carry valuable prognostic information. In order to optimize the cantilever response the antibody immobilization and unspecific binding are initially characterized using quartz crystal microbalance technology. Also, the choice of antibody is explored in order to generate the largest surface stress on the cantilevers, thus increasing the signal. Using optimized experimental conditions the lowest detectable suPAR concentration is currently around 5 nM. The results reveal promising research strategies for the implementation of specific biochemical assays in a portable and high-throughput microsensor-based detection platform. (paper)

Evaluation of the use of CD-ROM upload into the PACS or institutional web server

NARCIS (Netherlands)

van Ooijen, P. M. A.; Roosjen, R.; de Blecourt, M. J.; van Dam, R.; Broekema, A.; Oudkerk, M.

2006-01-01

Purpose: Patient data are increasingly distributed between hospitals using CD-ROMs instead of actual films. This introduces problems because different viewers from different vendors are provided, and sometimes viewers are unusable because local software installation is not allowed. In 2004, we

Rojas Zorrilla ante la crítica romántica

Directory of Open Access Journals (Sweden)

Pedraza Jiménez, Felipe B

2007-06-01

Full Text Available To Romantic Criticism, Rojas Zorrilla’s fame becomed obscure by the figure of his contemporary, friend and collaborator, Pedro Calderón de la Barca. This logical situation is clearly evident in the great german critics: Rojas Zorrilla is scarcely mentioned by the Schlegel brothers. To other historians he occupied a secondary place and the only exception was Johann Ludwig Tieck, who exalted his works even above Calderón masterpieces. It can be affirmed that Rojas Zorrilla reception was irregular. If we examine Musso Valiente’s library, Agustín Durán’s Discurso, and the romantic period editions, we will find some interest in his figure and that it was situated in a secondary place in relation to our great theater. It seems clear that Martínez de la Rosa and Alberto Lista were the critics who pay more attention to him. Martínez de la Rosa established an approach based in the neoclassic topics about our writer, meanwhile Alberto Lista developed a closer and original reading, specially centered in the poet’s tragic dimension and elements that, from his point of view, anticipated romantic Aesthetics. Rojas Zorrilla inclusion in romantic Literary Histories, and his edition in the «Biblioteca de Autores Españoles», prepared by Mesonero Romanos, make him enter the canon among the «six great stars» in Spanish Golden Age Theater.Para la crítica romántica, la fama de Rojas Zorrilla quedó oscurecida, de forma perfectamente lógica, por la de su coetáneo, amigo y colaborador don Pedro Calderón de la Barca. Esta situación es muy patente en los grandes críticos alemanes. Los hermanos Schlegel apenas citan a nuestro dramaturgo. Otros historiadores le conceden un lugar secundario, con la excepción de Johann Ludwig Tieck, que lo exaltó incluso por encima del autor de La vida es sueño. La recepción de su obra en España fue irregular. Del análisis de la biblioteca y escritos de Musso Valiente, del discurso de Agustín Durán, de las

DICOM storage into PACS of out-hospital CD-ROMs - a half year experience report

NARCIS (Netherlands)

van Ooijen, PMA; ten Bhomer, PJM; Blecourt, MJ; Roosjen, R; van Dam, R; Oudkerk, A; Lemke, HU; Inamura, K; Doi, K; Vannier, MW; Farman, AG

2005-01-01

With the advance of digitalization of radiology departments, the interchange of data between institutions is shifting towards shipment of CD-ROMs instead of physical film. Although this is a positive change in terms of costs, it also has its downsides. One of the main problems is how to integrate

Abordagens do amor romântico: aspectos históricos, sociais e literários

Directory of Open Access Journals (Sweden)

Luana Grasiela Schonarth

2015-06-01

Full Text Available O presente estudo vincula-se ao projeto de pesquisa Narrativas e conhecimentos: especificidades teóricas e constituição de sentido, coordenado pela Prof.ª Dra. Eunice Terezinha Piazza Gai. Considerando os caminhos cursados no desenvolvimento da pesquisa, utilizamos o tema do amor para refletir sobre os possíveis conhecimentos que o processo narrativo propicia, os aspectos históricos e sociais nos quais a temática foi abordada na literatura, assim como um resgate de informações acerca das origens do tema e personagens consolidados nos romances românticos. Nessa perspectiva, delimitamos o estudo entre os amores irrealizados, os impasses responsáveis pelos impedimentos amorosos, bem como os conflitos entre a paixão e o casamento nas narrativas românticas. Para bem fundamentar esta pesquisa, tomamos o mito considerado matriz das histórias de amor, o próprio nascimento da paixão na literatura ocidental: Tristão e Isolda. O mito apresenta a visão do amor cortês e as contradições que se manifestaram desde a segunda metade do século XII entre a regra cavalheiresca e os costumes feudais. Diante da teoria do amor, abstraída do mito do amor romântico, partimos para a literatura do século XIX, considerando a presença dos amores não correspondidos. Nesta etapa, analisamos o romance de Balzac, Eugênia Grandet, que se torna exemplo da irrealização amorosa na literatura, vivida de modo mais contundente pela personagem que intitula a obra. A escolha dessa narrativa, para a análise do amor-paixão, deve-se ao fato de que o casamento é tratado como mero interesse financeiro, desconsiderando todo e qualquer envolvimento amoroso entre o casal em questão: Eugênia e Charles. Tratamos, pois, desta pluralidade significativa, deste amplo caminho trilhado não só pela literatura, mas por todos aqueles que se deixam despertar pela eternidade e fascínio dos romances românticos.

A Fuel-Sensitive Reduced-Order Model (ROM) for Piston Engine Scaling Analysis

Science.gov (United States)

2017-09-29

of high Reynolds number nonreacting and reacting JP-8 sprays in a constant pressure flow vessel with a detailed chemistry approach . J Energy Resour...for rapid grid generation applied to in-cylinder diesel engine simulations. Society of Automotive Engineers ; 2007 Apr. SAE Technical Paper No.: 2007...ARL-TR-8172 ● Sep 2017 US Army Research Laboratory A Fuel-Sensitive Reduced-Order Model (ROM) for Piston Engine Scaling Analysis

Recovery of Data from the Narragansett Bay Project, 1985-1992: User's Manual and CD-ROM

Science.gov (United States)

Data from the 1985-1992 era of the Narragansett Bay Project, an estuary of the National Estuary Program, were recovered from numerous storage media, updated to modern software, and burned to CD-ROM. The data will be used by, among others, EPA researchers working on long-term tren...

Exploiting the Potential of CD-ROM Databases: Staff Induction at the University of East Anglia.

Science.gov (United States)

Guillot, Marie-Noelle; Kenning, Marie-Madeleine

1995-01-01

Overviews a project exploring the possibility of using CD-ROM applications and the design of exploratory didactic materials to introduce academic staff to the field of computer-assisted instruction. The project heightened the staff's awareness of electronic resources and their potential as research, teaching, and learning aids, with particular…

Asociación entre relaciones románticas y la calidad de sueño percibida por jóvenes universitarios

OpenAIRE

EcheverrÍa-Palacio, Carlos-Mario

2013-01-01

Introducción: Uno de los aspectos con mayor variación durante la adolescencia es el sueño, el cual se ve afectado por factores biológicos así como por los estados afectivos y emocionales. En esta etapa, los individuos establecen sus primeras relaciones sentimentales románticas, vínculos esenciales para la maduración de las relaciones sociales y psicosexuales. Este trabajo busca determinar la asociación existente entre las relaciones sentimentales románticas y sus características, con la calid...

Adding-point strategy for reduced-order hypersonic aerothermodynamics modeling based on fuzzy clustering

Science.gov (United States)

Chen, Xin; Liu, Li; Zhou, Sida; Yue, Zhenjiang

2016-09-01

Reduced order models(ROMs) based on the snapshots on the CFD high-fidelity simulations have been paid great attention recently due to their capability of capturing the features of the complex geometries and flow configurations. To improve the efficiency and precision of the ROMs, it is indispensable to add extra sampling points to the initial snapshots, since the number of sampling points to achieve an adequately accurate ROM is generally unknown in prior, but a large number of initial sampling points reduces the parsimony of the ROMs. A fuzzy-clustering-based adding-point strategy is proposed and the fuzzy clustering acts an indicator of the region in which the precision of ROMs is relatively low. The proposed method is applied to construct the ROMs for the benchmark mathematical examples and a numerical example of hypersonic aerothermodynamics prediction for a typical control surface. The proposed method can achieve a 34.5% improvement on the efficiency than the estimated mean squared error prediction algorithm and shows same-level prediction accuracy.

Submesoscale Flows and Mixing in the Oceanic Surface Layer Using the Regional Oceanic Modeling System (ROMS)

Science.gov (United States)

2014-09-30

IMPACT/APPLICATIONS Geochemistry and Ecosystems: An important community use for ROMS is biogeochemisty: chemical cycles, water quality, blooms ...published, refereed] Colas, F., J.C. McWilliams, X. Capet, and J. Kurian, 2012: Heat balance and eddies in the Peru- Chile Current System. Climate

Precarious Situations of Care Workers in Home-Based Elder Care in Slovenia.

Science.gov (United States)

Hrženjak, Majda

2018-02-01

Based on policy analysis and individual interviews, the author analyzes the care workers' precarious situations in home-based elder care in Slovenia, a post-socialist, European Union country characterized by a rapidly aging population and delays in adapting a long-term care system to this new social risk. Employment and quasi-employment positions which coexist in home-based care can be sorted along two continuums: between public and market service; between formal and informal work. The author argues that working conditions in home-based care differ according to the position of the care worker on these two continuums, that is, being employed in public services, being self-employed, working in informal care markets, holding a status of family assistant, or being an informal family caregiver. Although the working conditions in public services are deteriorating, the analysis shows that precarity is more severe in market and informal care, while formalization and socialization of care bring about less precarious conditions.

Flight Experiments for Hypersonic Vehicle Development (Experimentations envol pour le developpement d'un vehicule hypersonique) (CD-ROM)

National Research Council Canada - National Science Library

2007-01-01

...: 1 CD-ROM; 4 3/4 in.; 124 MB. ABSTRACT: This RTO-AVT/VKI Lecture Series brought together specialists from Europe, USA, and Russia to discuss flight experiments that pertain to the development of hypersonic vehicles...

Delicacy, Imprecision, and Uncertainty of Oceanic Simulations: An Investigation with the Regional Oceanic Modeling System (ROMS)

Science.gov (United States)

2013-09-30

Geochemistry and Ecosystems: An important community use for ROMS is biogeochemisty: chemical cycles, water quality, blooms , micro-nutrients, larval...Sci., submitted. Colas, F., J.C. McWilliams, X. Capet, and J. Kurian, 2012: Heat balance and eddies in the Peru- Chile Current System. Climate

[Medical knowledge in immunological security of red blood cells transfusion in Tunisia: evaluation of a CD-ROM of auto-learning].

Science.gov (United States)

Ben Salah, N; El Borgi, W; Aounallah Skhiri, H; Ben Lakhal, F; Mouelhi, H; Zoueri, B; Gouider, E; Hafsia, R

2013-09-01

In Tunisia, red blood cells (RBC) transfusion joins in a statutory frame but remains subject to failures because of the misunderstanding of legislation and regulations. Our purpose is to estimate the knowledge of the medical staff in the immunological safety of RBC transfusion before and after reading an auto-education CD-ROM. It is a study of evaluation of an intervention. Eighty physicians participated to the study. The evaluation was done using an anonymous questionnaire, containing seven questions with multiple choices (QMC) relating to several items. The rate of good answers (RGA) calculated by questions and by items took into account the impact of the CD-ROM on the improvement of the answers after reading. The global average mark is 2.9/7. The RGA to questions varies from 22.5 % to 76.3%. All participants answered correctly to more than 50% of all items. Two answered correctly to all items. Among the participants, 31.3% answered to all "important" items, concerning ABO blood groups compatibility and ultimate bedside test. The rate of participation to the final evaluation was 83%. The impact of the CD-ROM was important and statistically significant. In the final evaluation, the global mark raised from 2.9 to 5.8/7, 31.5% (vs 2%) answered correctly all the questions and 95.5% (vs 31.3%) answered correctly all "important" items. This study revealed a misunderstanding of the doctors in immunological safety of RBC transfusions. Auto-teaching by CD-ROM was efficient. An improvement of the knowledge by continuous training is necessary in our country. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The Impact of Animation in CD-ROM Books on Students' Reading Behaviors and Comprehension.

Science.gov (United States)

Okolo, Cindy; Hayes, Renee

This study evaluated the use of children's literature presented via one of three conditions: an adult reading a book to the child; the child reading a CD-ROM version of a book on the computer but without animation; and the child reading the book on the computer with high levels of animation. The study, in one primary grade classroom, involved 10…

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis

Science.gov (United States)

Kim, Seong-Gil

2018-01-01

Background The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. Material/Methods This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. Results In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (pregression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). Conclusions Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement. PMID:29760375

Diffusivity database (DDB) system for major rocks (Version of 2006/specification and CD-ROM)

International Nuclear Information System (INIS)

Tochigi, Yoshikatsu; Sasamoto, Hirosi; Shibata, Masahiro; Sato, Haruo; Yui, Mikazu

2006-03-01

The development of the database system has been started to manage with the generally used. The database system has been constructed based on datasheets of the effective diffusion coefficient of the nuclides in the rock matrix in order to be applied on the 'H12: Project to Establish the Scientific and Technical Basis for HLW Disposal in Japan'. In this document, the examination and expansion of the datasheet structure and the process of construction of the database system and conversion of all data existing on datasheets are described. As the first step of the development of the database, this database system and its data will continue to be updated and the interface will be revised to improve the availability. The developed database system is attached on the CD-ROM as the file format of Microsoft Access. (author)

Total hip arthroplasty (S-ROM stem and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip

Directory of Open Access Journals (Sweden)

Liangtao Li

2016-01-01

Conclusions: In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.

The use of U.S. Geological Survey CD-ROM-based petroleum assessments in undergraduate geology laboratories

Science.gov (United States)

Eves, R.L.; Davis, L.E.; Dyman, T.S.; Takahashi, K.I.

2002-01-01

Domestic oil production is declining and United States reliance on imported oil is increasing. America will be faced with difficult decisions that address the strategic, economic, and political consequences of its energy resources shortage. The geologically literate under-graduate student needs to be aware of current and future United States energy issues. The U.S. Geological Survey periodically provides energy assessment data via digitally-formatted CD-ROM publications. These publications are free to the public, and are well suited for use in undergraduate geology curricula. The U.S. Geological Survey (USGS) 1995 National Assessment of United States Oil and Gas Resources (Digital Data Series or DDS-30) (Gautier and others, 1996) is an excellent resource for introducing students to the strategies of hydrocarbon exploration and for developing skills in problem-solving and evaluating real data. This paper introduces the reader to DDS-30, summarizes the essential terminology and methodology of hydrocarbon assessment, and offers examples of exercises or questions that might be used in the introductory classroom. The USGS contact point for obtaining DDS-30 and other digital assessment volumes is also provided. Completing the sample exercises in this report requires a copy of DDS-30.

Defense Information for All: DTIC 2007 Conference Held in Alexandria, Virginia on March 26-28, 2007 (CD-ROM)

National Research Council Canada - National Science Library

2007-01-01

...: 1 CD-ROM; 4 3/4 in.; 88.6 MB. ABSTRACT: The conference will bring together information professionals from the science, technology, research and development, and acquisition communities who create, disseminate and use DoD scientific...

Diastereoselective Synthesis of Novel Heterocyclic Scaffolds through Tandem Petasis 3-Component/Intramolecular Diels-Alder and ROM-RCM Reactions

DEFF Research Database (Denmark)

Ishøy, Mette; Petersen, Rico; Petersen, Michael Åxman

2017-01-01

A high-yielding, stereoselective and extraordinarily complexity generatingPetasis 3-component/intramolecular Diels-Alderreaction has been developed. In combination with ROM-RCM, rapid access to complex sp3-rich heterocyclic scaffolds amenableto subsequent functionalization and library synthesis...

Analysis of Users' Searches of CD-ROM Databases in the National and University Library in Zagreb.

Science.gov (United States)

Jokic, Maja

1997-01-01

Investigates the search behavior of CD-ROM database users in Zagreb (Croatia) libraries: one group needed a minimum of technical assistance, and the other was completely independent. Highlights include the use of questionnaires and transaction log analysis and the need for end-user education. The questionnaire and definitions of search process…

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis.

Science.gov (United States)

Kim, Seong-Gil; Kim, Wan-Soo

2018-05-15

BACKGROUND The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. MATERIAL AND METHODS This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. RESULTS In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (psimple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (plinear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). CONCLUSIONS Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement.

Value Based Care and Patient-Centered Care: Divergent or Complementary?

Science.gov (United States)

Tseng, Eric K; Hicks, Lisa K

2016-08-01

Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

Read-only-memory-based quantum computation: Experimental explorations using nuclear magnetic resonance and future prospects

International Nuclear Information System (INIS)

Sypher, D.R.; Brereton, I.M.; Wiseman, H.M.; Hollis, B.L.; Travaglione, B.C.

2002-01-01

Read-only-memory-based (ROM-based) quantum computation (QC) is an alternative to oracle-based QC. It has the advantages of being less 'magical', and being more suited to implementing space-efficient computation (i.e., computation using the minimum number of writable qubits). Here we consider a number of small (one- and two-qubit) quantum algorithms illustrating different aspects of ROM-based QC. They are: (a) a one-qubit algorithm to solve the Deutsch problem; (b) a one-qubit binary multiplication algorithm; (c) a two-qubit controlled binary multiplication algorithm; and (d) a two-qubit ROM-based version of the Deutsch-Jozsa algorithm. For each algorithm we present experimental verification using nuclear magnetic resonance ensemble QC. The average fidelities for the implementation were in the ranges 0.9-0.97 for the one-qubit algorithms, and 0.84-0.94 for the two-qubit algorithms. We conclude with a discussion of future prospects for ROM-based quantum computation. We propose a four-qubit algorithm, using Grover's iterate, for solving a miniature 'real-world' problem relating to the lengths of paths in a network

Team-based primary care: The medical assistant perspective.

Science.gov (United States)

Sheridan, Bethany; Chien, Alyna T; Peters, Antoinette S; Rosenthal, Meredith B; Brooks, Joanna Veazey; Singer, Sara J

Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs. The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences. In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction. Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged. Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels. To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.

AmniSure: A Point of Care Diagnostic for Preterm, Term Prelabor ...

African Journals Online (AJOL)

membranes (ROM) are obvious leakage of fluid from the ... technology, diagnosis of ROM still requires integration of ... alpha‑microglobulin‑1 test for accurate diagnosis of true ROM in women with watery discharge after 28 weeks gestation,.

EFFECTS OF POSTEROANTERIOR LUMBAR SPINE MOBILIZATIONS ON PAIN, ROM AND FUNCTIONAL DISABILITY IN FEMALE SUBJECTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN

Directory of Open Access Journals (Sweden)

C. Shanthi

2014-12-01

Full Text Available Background: Chronic nonspecific low back pain (CNSLBP i.e., low back pain of at least 12 weeks duration without a specific cause is a major cause of activity limitation, absenteeism , and high health care expenses. The prevalence of CNSLBP is estimated approximately 23% and activity limitation due to LBP have been found to be 11% to 12% of the population. Previous studies comparing the efficacy of postero-anterior mobilisation and prone-press ups were done and revealed statistically significant improvements in extension ranges but not clinical relevant improvements. This is possibly attributable to single session of interventions. So long term gains in pain reduction and lumbar extension cannot be assumed. Hence this study would be intending to prove the effect of postero-anterior mobilisation and prone press ups on chronic non-specific low back pain after 6 weeks and their clinical application. Method: 30 subjects who met the inclusion criteria were selected randomly from the department of physiotherapy, SVIMS and BIRRD, Tirupati. The study conducted for a period of 6 weeks.2 groups were formed with 15 in each group. PA lumbar glide and prone press up's was given to group I and only prone press up's was given to group II. Subjects were evaluated pre and post treatment for VAS, extension ROM of lumbar spine and functional disability. Result: Results showed that there exists a statistical significance between the groups in all the 3 parameters. Present randomized clinical trial provided evidence to support the use of postero-anterior mobilisation and prone press-ups in relieving pain, improving ROM and reducing disability in subjects with non-specific low back pain. In addition, results supported that postero-anterior mobilisation was more effective than prone press-ups.

Grafiskā stāstījuma uzbūve un trauma Hāleda Hoseinī grafiskajā romānā “Pūķa ķērājs”

OpenAIRE

Vanaga, Alīna

2016-01-01

Hāleda Hoseinī grafiskais romāns “Pūķa ķērājs”demonstrē grafisko romānu spēju vienlaicīgi uzrunāt lielu cilvēku daudzumu un tajā pašā laikā izteikt neaprakstāmo, kas apliecina to, ka grafiskie romāni ļoti labi prot darīt saprotamas tādas neaprakstāmas tēmas, kā trauma. Tādēļ, šī maģistra darba mērķis ir noteikt, kā grafiskā stāstījuma uzbūve attēlo traumu Hāleda Hoseinī grafiskajā romāna “Pūķa ķērājs” un kādu rezultātu tas rada. Iepriekš minētā mērķa sasniegšanai tika izvēlētas divas pētīšana...

Montessori-based dementia care.

Science.gov (United States)

Cline, Janet

2006-10-01

Montessori-based Dementia Care is an approach used in Alzheimer's care that does not involve chemical or physical restraints. This program works by giving the elder with Alzheimer/Dementia a purpose by getting them involved. When staff/families care for a confused Alzheimer/Dementia patient, who is having behaviors, the Montessori program teaches them to look at what is causing the behavior. When assessing the elder to determine what is causing the behavior, the goal is to find the answer, but the answer cannot be dementia. The goal of the program is to bring meaning to the life of an Alzheimer/Dementia elder.

Web-based resources for critical care education.

Science.gov (United States)

Kleinpell, Ruth; Ely, E Wesley; Williams, Ged; Liolios, Antonios; Ward, Nicholas; Tisherman, Samuel A

2011-03-01

To identify, catalog, and critically evaluate Web-based resources for critical care education. A multilevel search strategy was utilized. Literature searches were conducted (from 1996 to September 30, 2010) using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature with the terms "Web-based learning," "computer-assisted instruction," "e-learning," "critical care," "tutorials," "continuing education," "virtual learning," and "Web-based education." The Web sites of relevant critical care organizations (American College of Chest Physicians, American Society of Anesthesiologists, American Thoracic Society, European Society of Intensive Care Medicine, Society of Critical Care Medicine, World Federation of Societies of Intensive and Critical Care Medicine, American Association of Critical Care Nurses, and World Federation of Critical Care Nurses) were reviewed for the availability of e-learning resources. Finally, Internet searches and e-mail queries to critical care medicine fellowship program directors and members of national and international acute/critical care listserves were conducted to 1) identify the use of and 2) review and critique Web-based resources for critical care education. To ensure credibility of Web site information, Web sites were reviewed by three independent reviewers on the basis of the criteria of authority, objectivity, authenticity, accuracy, timeliness, relevance, and efficiency in conjunction with suggested formats for evaluating Web sites in the medical literature. Literature searches using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature resulted in >250 citations. Those pertinent to critical care provide examples of the integration of e-learning techniques, the development of specific resources, reports of the use of types of e-learning, including interactive tutorials, case studies, and simulation, and reports of student or learner satisfaction, among other general

A multimedia case based approach to the study of office ergonomics.

Science.gov (United States)

August-Dalfen, Sharon; Snider, Laurie

2003-01-01

Multimedia technology has the capacity to provide students with an interactive approach to problem based learning and to bridge the gap between theoretical knowledge and clinical practice. The present paper describes the design and development of the program ErgoROM, a CD which presents a case study to assist occupational therapy students in their studies of office ergonomics. A pilot study showed that overall, 91% of respondents rated the ErgoROM as either "Excellent" or "Very Good". Additionally they reported that ErgoROM had a positive impact on active learning and critical thinking.

Home-based intermediate care program vs hospitalization

Science.gov (United States)

Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

2008-01-01

OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

Making the semiconductor-metal transition in a growth-dominant phase-change alloy InSb for double density blu-ray super-RENS-ROM disc

Energy Technology Data Exchange (ETDEWEB)

Hyot, Berangere [CEA, LETI, MINATEC, F- 38054 Grenoble (France)

2012-10-15

Phenomenologically, a semiconductor-metal transition is characterized by a sudden change in electrical properties but also in optical behaviours, as a consequence of a change in electron behaviour. The ability to induce a reversible semiconductor-metal transition in a material by varying conditions such as applied temperature or electrical field, results in attractive changes in properties that have fuelled the curiosity of scientists. In this paper, we discuss the interest of such materials exhibiting the reversible semiconductor-metal transition in the development of the next generation of optical Bly-ray discs (BD), the so-called super-resolution near field structure (super-RENS) discs and we show that InSb semiconductor material exhibits huge variations of its optical properties during the optically (thermally)-induced solid-to-liquid change corresponding to a semiconductor-metal transition. First success in the video playback on HDTV (High Definition TeleVision) display from 50 GB (BD capacity x 2) InSb-based super-RENS-ROM discs including a high definition video content with 1920 x 1080 pixels was realized in September 2009 by the super-RENS consortium joining three partners: AIST (National Institute of Advanced Industrial Science and Technology), Mitsubishi Electric Co. and LETI. Snapshot of high definition video content from InSb-based super-RENS-ROM disc corresponding to 50 GB per layer (BD capacity x 2) displayed on HDTV. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

Quality Management Audits in Nuclear Medicine Practices. 2. Ed. Companion CD-ROM

International Nuclear Information System (INIS)

2015-01-01

Quality management systems are essential and should be maintained with the intent to continuously improve effectiveness and efficiency, enabling nuclear medicine to achieve the expectations of its quality policy, satisfy its customers and improve professionalism. The quality management (QM) audit methodology in nuclear medicine practice, introduced in this publication, is designed to be applied to a variety of economic circumstances. A key outcome is a culture of reviewing all processes of the clinical service for continuous improvement in nuclear medicine practice. Regular quality audits and assessments are vital for modern nuclear medicine services. More importantly, the entire QM and audit process has to be systematic, patient oriented and outcome based. The management of services should also take into account the diversity of nuclear medicine services around the world and multidisciplinary contributions. The latter include clinical, technical, radiopharmaceutical, medical physics and radiation safety procedures. This companion CD-ROM is attached to the printed STI/PUB/1683 and contains the full-text of STI/PUB/1683 as well as checklists in PDF and Excel format and a table with the contents of a standardized audit report

The Lunar Source Disk: Old Lunar Datasets on a New CD-ROM

Science.gov (United States)

Hiesinger, H.

1998-01-01

A compilation of previously published datasets on CD-ROM is presented. This Lunar Source Disk is intended to be a first step in the improvement/expansion of the Lunar Consortium Disk, in order to create an "image-cube"-like data pool that can be easily accessed and might be useful for a variety of future lunar investigations. All datasets were transformed to a standard map projection that allows direct comparison of different types of information on a pixel-by pixel basis. Lunar observations have a long history and have been important to mankind for centuries, notably since the work of Plutarch and Galileo. As a consequence of centuries of lunar investigations, knowledge of the characteristics and properties of the Moon has accumulated over time. However, a side effect of this accumulation is that it has become more and more complicated for scientists to review all the datasets obtained through different techniques, to interpret them properly, to recognize their weaknesses and strengths in detail, and to combine them synoptically in geologic interpretations. Such synoptic geologic interpretations are crucial for the study of planetary bodies through remote-sensing data in order to avoid misinterpretation. In addition, many of the modem datasets, derived from Earth-based telescopes as well as from spacecraft missions, are acquired at different geometric and radiometric conditions. These differences make it challenging to compare or combine datasets directly or to extract information from different datasets on a pixel-by-pixel basis. Also, as there is no convention for the presentation of lunar datasets, different authors choose different map projections, depending on the location of the investigated areas and their personal interests. Insufficient or incomplete information on the map parameters used by different authors further complicates the reprojection of these datasets to a standard geometry. The goal of our efforts was to transfer previously published lunar

Mars Navigator: An Interactive Multimedia Program about Mars, Aerospace Engineering, Astronomy, and the JPL Mars Missions. [CD-ROM

Science.gov (United States)

Gramoll, Kurt

This CD-ROM introduces basic astronomy and aerospace engineering by examining the Jet Propulsion Laboratory's (JPL) Mars Pathfinder and Mars Global Surveyor missions to Mars. It contains numerous animations and narrations in addition to detailed graphics and text. Six interactive laboratories are included to help understand topics such as the…

Improving long-term care provision: towards demand-based care by means of modularity

Directory of Open Access Journals (Sweden)

Meijboom Bert

2010-09-01

Full Text Available Abstract Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to

Improving long-term care provision: towards demand-based care by means of modularity

Science.gov (United States)

2010-01-01

Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further

Static aeroelastic analysis including geometric nonlinearities based on reduced order model

Directory of Open Access Journals (Sweden)

Changchuan Xie

2017-04-01

Full Text Available This paper describes a method proposed for modeling large deflection of aircraft in nonlinear aeroelastic analysis by developing reduced order model (ROM. The method is applied for solving the static aeroelastic and static aeroelastic trim problems of flexible aircraft containing geometric nonlinearities; meanwhile, the non-planar effects of aerodynamics and follower force effect have been considered. ROMs are computational inexpensive mathematical representations compared to traditional nonlinear finite element method (FEM especially in aeroelastic solutions. The approach for structure modeling presented here is on the basis of combined modal/finite element (MFE method that characterizes the stiffness nonlinearities and we apply that structure modeling method as ROM to aeroelastic analysis. Moreover, the non-planar aerodynamic force is computed by the non-planar vortex lattice method (VLM. Structure and aerodynamics can be coupled with the surface spline method. The results show that both of the static aeroelastic analysis and trim analysis of aircraft based on structure ROM can achieve a good agreement compared to analysis based on the FEM and experimental result.

Association of Neuromuscular Attributes With Performance-Based Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis.

Science.gov (United States)

Schmidt, Catherine T; Ward, Rachel E; Suri, Pradeep; Kiely, Dan K; Ni, Pengsheng; Anderson, Dennis E; Bean, Jonathan F

2017-07-01

To identify differences in health factors, neuromuscular attributes, and performance-based mobility among community-dwelling older adults with symptomatic lumbar spinal stenosis; and to determine which neuromuscular attributes are associated with performance-based measures of mobility. Cross-sectional; secondary data analysis of a cohort study. Outpatient rehabilitation center. Community-dwelling adults aged ≥65 years with self-reported mobility limitations and symptomatic lumbar spinal stenosis (N=54). Not applicable. Short Physical Performance Battery score, habitual gait speed, and chair stand test. Symptomatic lumbar spinal stenosis was classified using self-reported symptoms of neurogenic claudication and imaging. Among 430 community-dwelling older adults, 54 (13%) met criteria for symptomatic lumbar spinal stenosis. Compared with participants without symptomatic lumbar spinal stenosis, those with symptomatic lumbar spinal stenosis had more comorbidities, higher body mass index, greater pain, and less balance confidence. Participants with symptomatic lumbar spinal stenosis had greater impairment in trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion range of motion (ROM), knee extension ROM, and ankle ROM compared with participants without symptomatic lumbar spinal stenosis. Five neuromuscular attributes were associated with performance-based mobility among participants with symptomatic lumbar spinal stenosis: trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry. Community-dwelling older adults with self-reported mobility limitations and symptomatic lumbar spinal stenosis exhibit poorer health characteristics, greater neuromuscular impairment, and worse mobility when compared with those without symptomatic lumbar spinal stenosis. Poorer trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry

Home-based care

African Journals Online (AJOL)

Mrs. Patience Edoho Samson-Akpan

study was to ascertain the relationship between home-based care and quality of life of PLWHA in support groups in. Calabar South Local Government Area. A correlational design was utilized and a purposive sample of 74 PLWHA participated in the study. A self developed and well validated questionnaire was used for data ...

HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

Directory of Open Access Journals (Sweden)

E Amoran

2012-05-01

Full Text Available Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66-3.06]. Conclusion The practice of home based care for HIV/AIDS among the study population is low

A Deep Learning based Approach to Reduced Order Modeling of Fluids using LSTM Neural Networks

Science.gov (United States)

Mohan, Arvind; Gaitonde, Datta

2017-11-01

Reduced Order Modeling (ROM) can be used as surrogates to prohibitively expensive simulations to model flow behavior for long time periods. ROM is predicated on extracting dominant spatio-temporal features of the flow from CFD or experimental datasets. We explore ROM development with a deep learning approach, which comprises of learning functional relationships between different variables in large datasets for predictive modeling. Although deep learning and related artificial intelligence based predictive modeling techniques have shown varied success in other fields, such approaches are in their initial stages of application to fluid dynamics. Here, we explore the application of the Long Short Term Memory (LSTM) neural network to sequential data, specifically to predict the time coefficients of Proper Orthogonal Decomposition (POD) modes of the flow for future timesteps, by training it on data at previous timesteps. The approach is demonstrated by constructing ROMs of several canonical flows. Additionally, we show that statistical estimates of stationarity in the training data can indicate a priori how amenable a given flow-field is to this approach. Finally, the potential and limitations of deep learning based ROM approaches will be elucidated and further developments discussed.

Țările române în sistemul relațiilor diplomatice medievale

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Silvia DULSCHI

2016-09-01

Full Text Available Elementul de bază al aparatului diplomatic medieval al Ţărilor Române l-au reprezentat solii. În categoria selectă a solilor intrau oameni distinşi, cultivaţi, fini, rafinaţi. Cunoşteau limbile de circulaţie ale timpului, bunele maniere, arta conversaţiei, dar şi arta mânuirii sabiei. Istoria a reţinut numele unor soli celebri, cum ar fi Ion Ţamblac - solul lui Ştefan cel Mare, Luca Cârje - solul lui Ştefăniţă Vodă, banul Mihalcea - solul lui Mihai Viteazul, David şi Teodor Corbea - solii lui Constantin Brâncoveanu sau Nicolae Milescu Spătarul - solul ţarului rus Aleksei Mihailovici în îndepărtata Chină. Prin materialul de față ne propunem să aducem în atenţie figura mai puţin cunoscută a paharnicului Ion Caraiman - solul la Constantinopol al familiei domnitoare a Movileştilor, la sf. sec. al XVI-lea şi începutul sec. al XVII-lea, a cărui activitate diplomatică de succes a fost apreciată nu numai de demnitarii otomani, ci şi de ambasadorii unor mari puteri la Constantinopol, care scriau în repetate rânduri în rapoartele lor despre realizările sale.

Method for a dummy CD mirror server based on NAS

Science.gov (United States)

Tang, Muna; Pei, Jing

2002-09-01

With the development of computer network, information sharing is becoming the necessity in human life. The rapid development of CD-ROM and CD-ROM driver techniques makes it possible to issue large database online. After comparing many designs of dummy CD mirror database, which are the embodiment of a main product in CD-ROM database now and in near future, we proposed and realized a new PC based scheme. Our system has the following merits, such as, supporting all kinds of CD format; supporting many network protocol; the independence of mirror network server and the main server; low price, super large capacity, without the need of any special hardware. Preliminarily experiments have verified the validity of the proposed scheme. Encouraged by the promising application future, we are now preparing to put it into market. This paper discusses the design and implement of the CD-ROM server detailedly.

Glenohumeral range of motion (ROM) and isometric strength of professional team handball athletes, part III: changes over the playing season.

Science.gov (United States)

Fieseler, Georg; Jungermann, Philipp; Koke, Alexander; Irlenbusch, Lars; Delank, Karl-Stefan; Schwesig, René

2015-12-01

The aim of our study was to investigate the relation of workload on range of motion and isometric strength of team handball athletes' shoulders over a competitive season. 31 Professional male handball athletes underwent clinical shoulder examinations. Athletes were examined subsequently during the complete playing season (week 0, 6, 22 and 40) to determine bilateral isometric shoulder rotational strength and active range of motion (ROM). In addition, relative (intraclass correlation coefficients (ICC) and absolute (standard error of measurement) reliability were calculated. Intraobserver reliability was excellent (ICC 0.76-0.98) for isometric strength and flexibility measurements. Internal rotation (IR) and total arc ROM in the throwing shoulder (TS) decreased significantly (p handball players' shoulders changed significantly from the beginning to the end of a season. More specifically, the repetitive forces accumulated during the competitive season resulted in altered GIRD, ERG and isometric strength of the dominant glenohumeral joint.

Machado: do discurso romântico da nacionalidade à crítica radical da nação

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João Hernesto Weber

Full Text Available O artigo se detém, inicialmente, numa leitura da camada aparente de "Instinto de nacionalidade", destacando sua vinculação com as teses românticas sobre o sentido de "nação" e "literatura nacional", insistindo Machado na literatura indigenista, na cor local, na feição americana como paradigma para detectar a nacionalidade do texto literário. Em outra camada de leitura, apontam-se as reticências, as negações, o estilo carregado de adversativas que permeiam o texto, a ponto de Machado vir a negar as teses românticas em sua exclusividade, para, finalmente, abrir o leque do que poderia significar "literatura nacional": tudo é matéria de poesia. Na sequência, analisa-se a formação do Machado ficcionista, quando viria a exercitar o que já se encontrava, em tese, no "Instinto". Por fim, lançam-se algumas questões sobre a importância do ensaio para a crítica e a historiografia literária locais.

The frequency of outdoor play for preschool age children cared for at home-based child care settings.

Science.gov (United States)

Tandon, Pooja S; Zhou, Chuan; Christakis, Dimitri A

2012-01-01

Given that more than 34% of U.S. children are cared for in home-based child care settings and outdoor play is associated with physical activity and other health benefits, we sought to characterize the outdoor play frequency of preschoolers cared for at home-based child care settings and factors associated with outdoor play. Cross-sectional study of 1900 preschoolers (representing approximately 862,800 children) cared for in home-based child care settings (including relative and nonrelative care) using the nationally representative Early Childhood Longitudinal Study, Birth Cohort. Only 50% of home-based child care providers reported taking the child outside to walk or play at least once/day. More than one-third of all children did not go outside to play daily with either their parent(s) or home-based child care provider. There were increased odds of going outside daily for children cared for by nonrelatives in the child's home compared with care from a relative. Children with ≥3 regular playmates had greater odds of being taken outdoors by either the parents or child care provider. We did not find statistically significant associations between other child level (age, sex, screen-time), family level (highest education in household, mother's race, employment, exercise frequency), and child care level (hours in care, provider's educational attainment, perception of neighborhood safety) factors and frequency of outdoor play. At a national level, the frequency of outdoor play for preschoolers cared for in home-based child care settings is suboptimal. Further study and efforts to increase outdoor playtime for children in home-based child care settings are needed. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Protocol-based care: the standardisation of decision-making?

Science.gov (United States)

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as

Paying more for faster care? Individuals' attitude toward price-based priority access in health care.

Science.gov (United States)

Benning, Tim M; Dellaert, Benedict G C

2013-05-01

Increased competition in the health care sector has led hospitals and other health care institutions to experiment with new access allocation policies that move away from traditional expert based allocation of care to price-based priority access (i.e., the option to pay more for faster care). To date, little is known about individuals' attitude toward price-based priority access and the evaluation process underlying this attitude. This paper addresses the role of individuals' evaluations of collective health outcomes as an important driver of their attitude toward (price-based) allocation policies in health care. The authors investigate how individuals evaluate price-based priority access by means of scenario-based survey data collected in a representative sample from the Dutch population (N = 1464). They find that (a) offering individuals the opportunity to pay for faster care negatively affects their evaluations of both the total and distributional collective health outcome achieved, (b) however, when health care supply is not restricted (i.e., when treatment can be offered outside versus within the regular working hours of the hospital) offering price-based priority access affects total collective health outcome evaluations positively instead of negatively, but it does not change distributional collective health outcome evaluations. Furthermore, (c) the type of health care treatment (i.e., life saving liver transplantation treatment vs. life improving cosmetic ear correction treatment - priced at the same level to the individual) moderates the effect of collective health outcome evaluations on individuals' attitude toward allocation policies. For policy makers and hospital managers the results presented in this article are helpful because they provide a better understanding of what drives individuals' preferences for health care allocation policies. In particular, the results show that policies based on the "paying more for faster care" principle are more

Nuclides 2000: an electronic chart of the nuclides on CD-ROM

International Nuclear Information System (INIS)

Magill, J.

2000-01-01

The 'Nuclides 2000' software package is an electronic chart of the nuclides, available on CD-ROM for Microsoft Windows operating systems, which offers extensive basic information on physics and radiology of the familiar nuclides. Moreover, 'Nuclides 2000' contains codes for a number of applications which allow the required data to be computed quickly and reliably by means of interactive user guidance. The data and codes are supplemented by information in the format of contributions on the history of radioactivity and radiochemistry, and on subjects of interest in physics, such as C-14 dating and the generation of Ti-44 in a supernova, and by a link collection of Internet addresses. As a detailed database, 'Nuclides 2000' can be used for teaching, research, and for practical applications. (orig.) [de

History, Development and Future of TRIGA Research Reactors. Companion CD-ROM

International Nuclear Information System (INIS)

2016-01-01

Due to its particular fuel design and resulting enhanced inherent safety features, TRIGA reactors (Training, Research, Isotopes, General Atomics) constitute a ‘class of their own’ among the large variety of research reactors built world-wide. This publication summarizes in a single document the information on the past and present of TRIGA research reactors and presents an outlook in view of potential issues to be solved by TRIGA operating organizations in the near future. It covers the historical development and basic TRIGA characteristics, followed by utilization, fuel conversion and ageing management of TRIGA research reactors. It continues with issues and challenges, introduction to the global TRIGA research reactor network and concludes with future perspectives. This CD-ROM illustrates the historical developments of TRIGA research reactors through individual facility examples and experiences

Prenatal Care: A Content-Based ESL Curriculum.

Science.gov (United States)

Hassel, Elissa Anne

A content-based curriculum in English as a Second Language (ESL) focusing on prenatal self-care is presented. The course was designed as a solution to the problem of inadequate prenatal care for limited-English-proficient Mexican immigrant women. The first three sections offer background information on and discussion of (1) content-based ESL…

Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

Directory of Open Access Journals (Sweden)

Bailey Kerry A

2010-08-01

Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

Status and trends of nuclear technologies - Report of the International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO). Additional information (Companion CD-ROM)

International Nuclear Information System (INIS)

2009-09-01

The International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO) was launched in the year 2000, based on a resolution by the IAEA General Conference (GC(44)/RES/21). INPRO intends to help to ensure that nuclear energy is available in the 21st century in a sustainable manner, and seeks to bring together all interested Member States, both technology holders and technology users, to consider, jointly, actions to achieve desired innovations. INPRO is taking care of the specific needs of developing countries. This IAEA publication is part of Phase 1 of INPRO. It intends to provide an overview on history, present situation and future perspectives of nuclear fuel cycle technologies. While this overview focuses on technical issues, nevertheless, the aspects of economics, environment, and safety and proliferation resistance are important background issues for this study. After a brief description about the INPRO project and an evaluation of existing and future reactor designs the publication covers nuclear fuel cycle issues in detail. It is expected that this documentation will provide IAEA Member States and their nuclear engineers and designers, as well as policy makers with useful information on status and trends of future nuclear fuel cycle technologies. Due to the size of the full report it was decided to attach a CD-ROM in the back of the summary report

Principle-based concept analysis: Caring in nursing education.

Science.gov (United States)

Salehian, Maryam; Heydari, Abbas; Aghebati, Nahid; Karimi Moonaghi, Hossein; Mazloom, Seyed Reza

2016-03-01

The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as "caring pedagogy," "value-based education," and "teaching excellence," caring in nursing education does not have exact and clear conceptual boundaries (logic principle). Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development.

Intercomparison of Antarctic ice-shelf, ocean, and sea-ice interactions simulated by MetROMS-iceshelf and FESOM 1.4

Science.gov (United States)

Naughten, Kaitlin A.; Meissner, Katrin J.; Galton-Fenzi, Benjamin K.; England, Matthew H.; Timmermann, Ralph; Hellmer, Hartmut H.; Hattermann, Tore; Debernard, Jens B.

2018-04-01

An increasing number of Southern Ocean models now include Antarctic ice-shelf cavities, and simulate thermodynamics at the ice-shelf/ocean interface. This adds another level of complexity to Southern Ocean simulations, as ice shelves interact directly with the ocean and indirectly with sea ice. Here, we present the first model intercomparison and evaluation of present-day ocean/sea-ice/ice-shelf interactions, as simulated by two models: a circumpolar Antarctic configuration of MetROMS (ROMS: Regional Ocean Modelling System coupled to CICE: Community Ice CodE) and the global model FESOM (Finite Element Sea-ice Ocean Model), where the latter is run at two different levels of horizontal resolution. From a circumpolar Antarctic perspective, we compare and evaluate simulated ice-shelf basal melting and sub-ice-shelf circulation, as well as sea-ice properties and Southern Ocean water mass characteristics as they influence the sub-ice-shelf processes. Despite their differing numerical methods, the two models produce broadly similar results and share similar biases in many cases. Both models reproduce many key features of observations but struggle to reproduce others, such as the high melt rates observed in the small warm-cavity ice shelves of the Amundsen and Bellingshausen seas. Several differences in model design show a particular influence on the simulations. For example, FESOM's greater topographic smoothing can alter the geometry of some ice-shelf cavities enough to affect their melt rates; this improves at higher resolution, since less smoothing is required. In the interior Southern Ocean, the vertical coordinate system affects the degree of water mass erosion due to spurious diapycnal mixing, with MetROMS' terrain-following coordinate leading to more erosion than FESOM's z coordinate. Finally, increased horizontal resolution in FESOM leads to higher basal melt rates for small ice shelves, through a combination of stronger circulation and small-scale intrusions of

Metafísica romântica (verniz científico: a Gestalt não é uma teoria da comunicação visual

Directory of Open Access Journals (Sweden)

Marcelo Santos

2014-06-01

Full Text Available Não é difícil encontrar em trabalhos devotados ao estudo da comunicação visual referência a autores provenientes da Gestalt, notadamente Donis A. Dondis e Rudolf Arnheim. Neste artigo, as bases goetheanas que fundamentam o pensamento gestáltico são investigadas. O objetivo é explicitar que a Gestalt, abordagem sustentada por postulados românticos não comprovados cientificamente, apresenta sérios problemas epistemológicos. Tudo exposto, nas considerações finais, a pertinência do mencionado campo à análise das imagens é colocada em suspenso.

Hospital-based home care for children with cancer

DEFF Research Database (Denmark)

Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K

2012-01-01

, as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory......The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment...

Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.

Science.gov (United States)

Hermes, Eric; Burrone, Laura; Perez, Elliottnell; Martino, Steve; Rowe, Michael

2018-05-18

Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop

Home-based palliative care: challenges in the care of technology-dependent children.

Science.gov (United States)

Floriani, Ciro A

2010-01-01

To conceptualize palliative care and its indications in Pediatrics; to describe the difficulties involved in the delivery of such care at home for technology-dependent children; and to analyze, from a bioethical perspective, the moral dilemmas of palliative care assistance. A literature review of palliative care for technology-dependent children and a bioethical analysis of moral dilemmas. There are several obstacles to palliative care for technology-dependent children: structural difficulties at home; social isolation of both children and families; health professionals' sense of disbelief regarding this type of care; an excessive number of medical devices at home; uncertainty of a terminal prognosis; physical, emotional, social, material, and financial burden for parents and family; changes in family dynamics to adjust to these children; paternalistic relationship between professionals and family; changes in family roles, with shifts in the caregiver role. It is essential to outline an agenda based on the premise that the medical apparatus for technology-dependent children will change the landscape of the home, and such a change might become a problem to be faced by all those living together. Based on this assumption, actions performed in a setting other than a health care facility might exert an actual protective effect on children and family, offering support in their several needs and developing a model of care delivery that includes interventions in the different levels of burden on these vulnerated and unprotected individuals.

Time providing care outside visits in a home-based primary care program.

Science.gov (United States)

Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V

2014-06-01

To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

The evidence base for diabetes care

National Research Council Canada - National Science Library

Williams, D. R. R. (David Robert Rhys)

2002-01-01

... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix 1. The Evidence Base for Diabetes Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhys Williams, William Herman, Ann-Louise Kinmonth...

El realismo científico en Rom Harré (análisis crítico)

OpenAIRE

Carman, Christián Carlos

2004-01-01

Universidad Nacional de Quilmes Carman, C. (2016). El Realismo Científico en Rom Harré (análisis crítico) (Tesis de posgrado). Universidad Nacional de Quilmes, Bernal, Argentina El trabajo se propone recorrer tres objetivos principales, a saber, el relativo a elucidar el problema del realismo científico; el de abordar una sistematización del pensamiento de Harré respecto del problema del realismo científico y por último, un análisis crítico de la posición de su posición.

Nature-based supportive care opportunities: a conceptual framework.

Science.gov (United States)

Blaschke, Sarah; O'Callaghan, Clare C; Schofield, Penelope

2018-03-22

Given preliminary evidence for positive health outcomes related to contact with nature for cancer populations, research is warranted to ascertain possible strategies for incorporating nature-based care opportunities into oncology contexts as additional strategies for addressing multidimensional aspects of cancer patients' health and recovery needs. The objective of this study was to consolidate existing research related to nature-based supportive care opportunities and generate a conceptual framework for discerning relevant applications in the supportive care setting. Drawing on research investigating nature-based engagement in oncology contexts, a two-step analytic process was used to construct a conceptual framework for guiding nature-based supportive care design and future research. Concept analysis methodology generated new representations of understanding by extracting and synthesising salient concepts. Newly formulated concepts were transposed to findings from related research about patient-reported and healthcare expert-developed recommendations for nature-based supportive care in oncology. Five theoretical concepts (themes) were formulated describing patients' reasons for engaging with nature and the underlying needs these interactions address. These included: connecting with what is genuinely valued, distancing from the cancer experience, meaning-making and reframing the cancer experience, finding comfort and safety, and vital nurturance. Eight shared patient and expert recommendations were compiled, which address the identified needs through nature-based initiatives. Eleven additional patient-reported recommendations attend to beneficial and adverse experiential qualities of patients' nature-based engagement and complete the framework. The framework outlines salient findings about helpful nature-based supportive care opportunities for ready access by healthcare practitioners, designers, researchers and patients themselves. © Article author(s) (or their

Proceedings of the High Performance Embedded Computing Workshop (HPEC 2006) (10th). Held in Lexington, Massachusetts on September 19-21, 2006 (CD-ROM)

National Research Council Canada - National Science Library

Kepner, Jeremy

2007-01-01

...: 1 CD-ROM; 4 3/4 in.; 78.3 MB. ABSTRACT: The High-Performance Embedded Computing (HPEC) technical committee announced the tenth annual HPEC Workshop held in September 2006 at MIT Lincoln Laboratory in Lexington, MA...

Guiding Principles for Team-Based Pediatric Care.

Science.gov (United States)

Katkin, Julie P; Kressly, Susan J; Edwards, Anne R; Perrin, James M; Kraft, Colleen A; Richerson, Julia E; Tieder, Joel S; Wall, Liz

2017-07-24

The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family. Copyright © 2017 by the American Academy of Pediatrics.

School Survey on Crime and Safety (SSOCS) 2000 Public-Use Data Files, User's Manual, and Detailed Data Documentation. [CD-ROM].

Science.gov (United States)

National Center for Education Statistics (ED), Washington, DC.

This CD-ROM contains the raw, public-use data from the 2000 School Survey on Crime and Safety (SSOCS) along with a User's Manual and Detailed Data Documentation. The data are provided in SAS, SPSS, STATA, and ASCII formats. The User's Manual and the Detailed Data Documentation are provided as .pdf files. (Author)

Understanding the agency of home-based care volunteers ...

African Journals Online (AJOL)

In traditional Zulu communities, caregiving is rooted in compassionate and hardworking personal identity precepts and the traditional identity expectations of women. Home-based-care volunteerism in the community represents the performance of this identity. Data from a series of interviews with 15 home-based care ...

Effects of Contract Delivery Method on the LEED(trademark) Score of U.S. Navy Military Construction Projects (Fiscal Years 2004-2006) (CD-ROM)

National Research Council Canada - National Science Library

Carpenter, Deanna S

2005-01-01

...: 1 CD-ROM; 4 3/4 in.; 484 KB. ABSTRACT: This research study focused on determining the effects that the two major contract delivery methods had on the LEED score of projects over the design and construction time horizon...

[Research on the range of motion measurement system for spine based on LabVIEW image processing technology].

Science.gov (United States)

Li, Xiaofang; Deng, Linhong; Lu, Hu; He, Bin

2014-08-01

A measurement system based on the image processing technology and developed by LabVIEW was designed to quickly obtain the range of motion (ROM) of spine. NI-Vision module was used to pre-process the original images and calculate the angles of marked needles in order to get ROM data. Six human cadaveric thoracic spine segments T7-T10 were selected to carry out 6 kinds of loads, including left/right lateral bending, flexion, extension, cis/counterclockwise torsion. The system was used to measure the ROM of segment T8-T9 under the loads from 1 Nm to 5 Nm. The experimental results showed that the system is able to measure the ROM of the spine accurately and quickly, which provides a simple and reliable tool for spine biomechanics investigators.

[The current situation regarding guarantees of legal rights to social welfare and nursing care in Japan: based on an analysis of adjudications spanning the period 1960 to 2005].

Science.gov (United States)

Matsuzawa, Akemi; Tamiya, Nanako; Wakino, Koutaro

2009-06-01

To clarify whether people who need social care are legally guaranteed a "right to receive nursing-care services" as a living right in Japan. Using the database "Judicial Information System on CD-ROM" and journals which cover judicial precedents, such as "Supreme Court Reports" and "Judicial Reports", we searched for adjudications from 1960 to 2005 with 'living rights' as key words. The complete content of these adjudications was ascertained by reference to the journals. We then assessed whether a "right to receive nursing-care services" was specifically discussed in each of the adjudications by determining how the courts interpreted Article 25 of the Constitution in the verdicts and whether or not there was specific discussion of legal rights in each case. Of 210 adjudications extracted from the database, 23 (11.0%) specifically discussed the right to some sort of social security. No specific reference was made in the remaining 187 decisions (89.0%), and plaintiffs' claims were rejected. Whereas the "right to nursing care" was specifically discussed in no decisions before 1992, it was discussed in 4 decisions (40.0%) from 1993 onwards, resulting in plaintiffs' demands being partly granted. The content of the decisions covered issues that included anxiety about future nursing care, the practice of nursing homes of placing several elderly people in one room, ill-defined standards and low pay for home nursing-care workers, provision of nursing-care services based on the assumption that nursing care would be provided by family members, and self-determination and independence of the severely handicapped. A "right to receive nursing-care services" has not been fully guaranteed in the legal sense. However, such a right, included as a living right, is a primary right with a constitutional basis. Although this right has been specifically discussed in only a minority of adjudications, there has been a recent tendency for more emphasis. Both elderly and handicapped persons

Development of a hospital-based care coordination program for children with special health care needs.

Science.gov (United States)

Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

2013-01-01

A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

NODC Standard Product: Coastal Change Analysis Program (C-CAP) Chesapeake Bay Region Data from 1984 to 1989 on CD-ROM (NODC Accession 9200303)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The data set on this CD-ROM shows changes in land cover for the Chesapeake Bay region over the 5-year interval from 1984 to 1988-89. The data set was produced...

Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care.

Science.gov (United States)

Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S

2018-02-01

Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.

Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

Science.gov (United States)

Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

2017-09-01

To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Strategia integrării economiei românești în Uniunea Europeană

Directory of Open Access Journals (Sweden)

Mihaela LUȚAȘ

1999-01-01

Full Text Available Confruntată cu existenţa unor dezechilibre macroeconomice majore, cu existenţa unor capacităţi de producţie învechite şi necompetitive, cu lipsa unei infrastructuri moderne, cu un grad scăzut de dezvoltare a pieţei factorilor de producţie, cu fragilitatea structurilor instituţional-legislative, cu o productivitate a muncii mult scăzută comparativ cu celelalte state din zonă dar şi cu deteriorarea factorilor naturali prin aplicarea de-a lungul timpului de măsuri antiecologice, cu lipsa unui sector bancar şi de asigurări extins, cu inexistenţa unui model clar structurat al economiei de piaţă spre care ne îndreptăm precum şi cu perceperea complet greşită a pluralismului politic şi a democraţiei, economia românească a fost obligată să facă faţă, în ultimii nouă ani, unui set de provocări paralele: de natură politică, dictată de trecerea spre democraţie, pluralism politic, existenţa şi funcţionarea statului de drept: de natură strategico-militară, dictată de nevoia de securitate în interior şi în relaţiile cu partenerii şi de natură economică, dictată de înlocuirea economiei de comandă cu un tip nou de organizare economică.

Intensive care survivors' experiences of ward-based care: Meleis' theory of nursing transitions and role development among critical care outreach services.

Science.gov (United States)

Ramsay, Pam; Huby, Guro; Thompson, Andrew; Walsh, Tim

2014-03-01

To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed

Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

Science.gov (United States)

Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

2011-01-01

Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

Implementing Evidenced Based Oral Care for Critically Ill Patients

Science.gov (United States)

2016-02-28

practice . In G. LoBiondo-Wood & J Haber (Eds.), Nursing Research (5th ed.). St. Louis: Mosby-Year Book , Inc. 5. Titler, M., & Everett, L. (2001...determined if an evidence-based oral care program resulted in increased nurses’ knowledge and improved oral care practices compliance. Design: The project...process, and project specific oral care evidence-based practice instruction. Knowledge evaluations were conducted at three time points: before, immediately

Adolescent Health Care in School-Based Health Centers. Position Statement

Science.gov (United States)

National Assembly on School-Based Health Care, 2008

2008-01-01

School-based health centers (SBHCs) are considered one of the most effective strategies for delivering preventive care, including reproductive and mental health care services, to adolescents--a population long considered difficult to reach. National Assembly on School-Based Health Care (NASBHC) recommends practices and policies to assure…

Water, sanitation and hygiene in community based care ...

African Journals Online (AJOL)

Majority of the HIV/AIDS patients in South Africa receive health care services at home. However, limited studies have been conducted to examine the water, sanitation and hygiene (WASH) situation in the homes of the care receivers and its impact on community-based care. The main objective of this study was to explore ...

Die polnischen Bücher (Bücherbestände in den Bibliotheken Roms. Eine Auswahl

Directory of Open Access Journals (Sweden)

Ligia ALeksandra Henczel-Wróblewska

2017-11-01

Full Text Available Die italienisch-polnischen Beziehungen haben eine lange Geschichte hinter sich. Seit dem Mittelalter, in dem die polnischen Scholaren ihre Ausbildung an den italienischen Universitäten genießen konnten, dominierte darin der wissenschaftliche und bildende Charakter. In den folgenden Jahrhunderten wurde der gegenseitige Kontakt um die künstlerische Ebene erweitert, zumal die polnischen Künstler nach Italien reisten, um bei den besten Meistern ihre Fertigkeiten zu vervollkommnen. Seit dem Ende des 18. bis zur Mitte des 19. Jahrhunderts kam zu den bereits bestehenden, tradierten italienischpolnischen Beziehungen im Bereich der Wissenschaft und Kultur der militärische und der sozialpolitische Aspekt hinzu, und mit der Zeit auch der wirtschaftliche. Auf dem italienischen Boden beteiligten sich die Polen zunächst an den Unabhängigkeitskämpfen, die mit der Vereinigung Italiens (die Risorgimento-Zeit endeten, und nachher an den Waffeninterventionen während der zwei Weltkriege. Seit der Mitte des 20. Jahrhunderts kehrte man zum früheren beiderseitigen Kontakt auf verschiedenen Ebenen zurück.In jeder dieser Zeitspannen wurde die polnische Anwesenheit in Italien in den schriftlichen, ikonografischen, künstlerischen Quellen belegt. Die meisten davon bewährten sich in den Archiven und Bibliotheken Roms, dem Zentrum der europäischen Wissenschaft, Kultur und Christenheit. Erst im 20. Jahrhundert, seit der Entstehung der ersten wissenschaftlichen polnischen Institutionen in Rom und dank der breiten Zusammenarbeit war es möglich, die Polonica, die sich in den römischen Bibliotheken, Archiven, Kulturinstitutionen und Privatbeständen befinden, offiziell zu registrieren, bearbeiten und ordnen. Die schriftlichen Denkmäler aus den vergangenen Jahrhunderten weisen auf eine breite gegenseitige Beziehung sowohl im Bereich des sacrum als auch des profanum hin. Dieses gemeinsame historische Gedächtniserbe zeugt von einer langen Zugehörigkeit Polens zur

Mātes-meitas -attiecības Elfrīdes Jelinekas romānā "Klavierspēlētāja"

OpenAIRE

Martiņuka, Jekaterina

2014-01-01

Elfrīdes Jelinekas romānā visvairāk uzminība tiek koncentrēta uz attiecībām starp māti un meitu, kā arī šo attiecību tālāko ietekmi uz galvenās varones dzīvi. Šis darbs sniedz ieskatu pašas rakstnieces dzīvē, kā arī viņas bērnībā, no kurienes arī nākušas romānas vēsmas. Galvenās varones Ērikas uzvedībai ir cēloņi, kas nāk no viņas bērnibas, bet galvenokārt no viņas attiecībām ar pašas māti. Jelineka izveidoja autoritāru tēlu, māti, kura audzina savu bērnu savtīgiem nolūkiem, tajā pašā laik...

Incentive-Based Primary Care: Cost and Utilization Analysis.

Science.gov (United States)

Hollander, Marcus J; Kadlec, Helena

2015-01-01

In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study.

Science.gov (United States)

Wang, Ning; Yu, Ping; Hailey, David

2015-08-01

The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, Ppaper-based system (Ppaper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright �

Efeito antifúngico de tinturas de própolis e romã sobre espécies de Candida

Directory of Open Access Journals (Sweden)

Leopoldina de Fátima Dantas de Almeida

2012-06-01

Full Text Available A utilização de produtos naturais na odontologia tem se mostrado como uma fonte alternativa no combate às patologias orais, incluindo as infecções fúngicas, causadas, geralmente, por Candida spp. Avaliar a ação antifúngica de tinturas de própolis Apis milifera e romã Punica granatum sobre Candida albicans (ATCC 76618, Candida krusei (ATCC 6538 e Candida tropicalis (ATCC 13803. A ação antifúngica das tinturas foi avaliada pelo método da Concentração Inibitória Mínima em meio de cultura sólido Ágar Saburaud Dextrose (Difco®. Foram confeccionados poços, com 6 mm de diâmetro, destinados a inserção de 50 µL das tinturas. Foram avaliadas seis concentrações seriadas das tinturas, sendo a concentração inicial para a tintura de própolis 200 mg/mL e 300 mg/mL a concentração inicial para a tintura de romã. Posteriormente, as placas de Petri foram incubadas em estufa bacteriológica por 48 h a 37 ºC. A análise dos dados para a Concentração Inibitória Mínima foi feita através da mensuração dos halos de inibição, sendo considerados quando iguais ou superiores a 10 mm de diâmetro. Para a tintura de romã observou-se que as Concentração Inibitória Mínima sobre Candida albicans, Candida krusei e Candida tropicalis foram 9,37 mg/mL, 9,37 mg/mL e 18,75 mg/mL, respectivamente. Em relação à tintura da própolis, constatou-se que apenas em sua forma pura apresentou ação antifúngica sobre Candida krusei e Candida tropicalis, entretanto a mesma ação não foi observada sobre Candida albicans. As tinturas avaliadas apresentam ação antifúngica sobre as cepas avaliadas, exceto a tintura da própolis sobre Candida albicans.

Medical Assistant-based care management for high risk patients in small primary care practices

DEFF Research Database (Denmark)

Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

2016-01-01

Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

PUBLICITY IN TOURISM - RELATION BETWEEN ROMANIA AND UKRAINE

Directory of Open Access Journals (Sweden)

Adriana Mihaela PORCUŢAN

2010-06-01

Full Text Available Publicitatea în turism - Relaţia dintre România şi Ucraina. Euroregiunile sunt un fapt în lumea modernă, cât şi în turismul care se poate dezvolta între ţările care împart aceeaşi graniţă. În lucrarea de faţă noi vom face referire la România şi Ucraina. Ele împart aceeaşi graniţă, o parte din atracţiile naturale, culturale, etnice, religioase, dar nu au acceaşi importanţă în turismul internaţional. În cazul promovării în turism, internetul este o cale foarte importantă de a prezenta o atracţie, o sursă foarte rapidă, ieftină şi disponibilă oricând pentru turişti şi pentru a găsi informaţiile pe care le caută. Dacă facem o comparaţie între promovarea turismului în România şi Ucraina, găsim mari diferenţe pentru că România este o ţară care se concentrează pe turismul extern, iar Ucraina se concentrează pe cel intern, fiind a şaptea ţară în lume ca receptoare de turişti. Acest lucru este arătat şi de limba care este folosită de site-urile fiecărei ţări: aproape numai română în România, engleză şi ucraineană în Ucraina.

Variability in ADHD care in community-based pediatrics.

Science.gov (United States)

Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua

2014-12-01

Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined. Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatrician-delivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change. Copyright © 2014 by the American Academy of Pediatrics.

Shelter-based palliative care for the homeless terminally ill.

Science.gov (United States)

Podymow, Tiina; Turnbull, Jeffrey; Coyle, Doug

2006-03-01

The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.

Optimizing the use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02

Science.gov (United States)

2014-02-01

Bagley S , Kragh JF Jr, Cap AP, Dubick MA, Morrison JJ, Midwinter MJ, Butler FK, Kotwal RS, Holcomb JB. Military medical revolution: Prehospital combat...MD; John F. Kragh Jr., MD; Rom A. Stevens, MD; Jason M. Seery, MD; Donald L. Parsons, PA-C; Harold R. Montgomery, NREMT/ATP; Russ S . Kotwal, MD...Care: TCCC Guidelines Change 14-02. 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) Shackelford S . A., Butler Jr. F

Developing evidence-based maternity care in Iran: a quality improvement study

Directory of Open Access Journals (Sweden)

Mohammad Kazem

2008-06-01

Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

Science.gov (United States)

2014-01-01

Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees

Oxidative stress ecology and the d-ROMs test: facts, misfacts and an appraisal of a decade’s work

OpenAIRE

Costantini, David

2016-01-01

In recent years, behavioural ecologists have taken to studying oxidative stress in free-ranging organisms because it has been proposed as an important mediator of life-history trade-offs. A plethora of methodological approaches to quantify biomarkers associated with oxidative stress exist, each one with its own strengths and weaknesses. The d-ROMs test has emerged as one of the favoured assays in ecological studies because of its reliability, sensitivity to specific perturbations of the organ...

The Effect of Community-Based Specialist Palliative Care Teams on Place of Care.

Science.gov (United States)

Seow, Hsien; Dhaliwal, Gagan; Fassbender, Konrad; Rangrej, Jagadish; Brazil, Kevin; Fainsinger, Robin

2016-01-01

Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. The study objective was to examine the place of care in the last 30 days of life. In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p care. Examining place of care in the last month can effectively illustrate the service use trajectory over time.

Desponta novo ator no campo religioso brasileiro? O Padre Cícero Romão Batista

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Pierre Sanchis

2007-12-01

Full Text Available É em torno dos vários sentidos possíveis do qualificativo de "popular" que gira a problemática deste artigo. A figura carismática do Pe. Cícero Romão Batista, patriarca de Juazeiro, integra de há muito o panteão da devoção popular de milhões de romeiros, mas era objeto até hoje de amplas reservas no seio da Igreja oficial. O momento parece ser de revisão destas perspectivas. A reabilitação institucional do "padrinho" pode estar em curso. Pergunta-se aqui em que medida e com que condições esta transformação da sua imagem pode confluir com certa metamorfose do que se convencionou chamar de "Igreja Popular", de modo a dotar inesperadamente de novo ícone o catolicismo brasileiro em seu conjunto.The discussion presented in this paper turns around the several possible meanings of the qualifying adjective "popular". The charismatic figure of Father Cícero Romão Batista, Juazeiro's patriarch, has belonged, for many decades, to the pantheon of popular devotion of millions of pilgrims, but it is nevertheless still regarded with strong reserve inside the official Church. At the moment, it seems that this official position is being reviewed. An institutional rehabilitation of the "godfather" may well being under way. This being the case, the paper asks if, to what extent and under what conditions, can this transformation of Father Cícero's image flow together with certain metamorphosis of what has been named "Popular Church", so as to endow, even though unexpectedly, the Brazilian Catholicism with a new icon.

Comparing a quasi-3D to a full 3D nearshore circulation model: SHORECIRC and ROMS

Science.gov (United States)

Haas, Kevin A.; Warner, John C.

2009-01-01

Predictions of nearshore and surf zone processes are important for determining coastal circulation, impacts of storms, navigation, and recreational safety. Numerical modeling of these systems facilitates advancements in our understanding of coastal changes and can provide predictive capabilities for resource managers. There exists many nearshore coastal circulation models, however they are mostly limited or typically only applied as depth integrated models. SHORECIRC is an established surf zone circulation model that is quasi-3D to allow the effect of the variability in the vertical structure of the currents while maintaining the computational advantage of a 2DH model. Here we compare SHORECIRC to ROMS, a fully 3D ocean circulation model which now includes a three dimensional formulation for the wave-driven flows. We compare the models with three different test applications for: (i) spectral waves approaching a plane beach with an oblique angle of incidence; (ii) monochromatic waves driving longshore currents in a laboratory basin; and (iii) monochromatic waves on a barred beach with rip channels in a laboratory basin. Results identify that the models are very similar for the depth integrated flows and qualitatively consistent for the vertically varying components. The differences are primarily the result of the vertically varying radiation stress utilized by ROMS and the utilization of long wave theory for the radiation stress formulation in vertical varying momentum balance by SHORECIRC. The quasi-3D model is faster, however the applicability of the fully 3D model allows it to extend over a broader range of processes, temporal, and spatial scales.

water, sanitation and hygiene in community- based care

African Journals Online (AJOL)

PUBLICATIONS1

in home-based care and the implications on people living with HIV/AIDS/TB, their ... Data was collected using participant observation of care-giving activities; ... this affects the work of CHW. ..... Using water and sanitation as an entry point.

ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

Science.gov (United States)

Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

2011-05-01

Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

The use of CD-ROMs for storage and document delivery at the British Library Document Supply Centre

International Nuclear Information System (INIS)

Bradbury, D.

1990-05-01

The British Library Document Supply Centre (BLDSC) has been in the forefront of international document delivery for 20 years. During the last 5 years it has been very actively involved in the ADONIS Project, through which the full text of some 200 journals in the life sciences have been stored, accessed, and delivered through the medium of CD-ROM. The BLDSC's involvement in this project is described and indications of the lessons learned and of the implications for international document delivery systems in the future are given. (author)

The use of CD-ROMs for storage and document delivery at the British Library Document Supply Centre

Energy Technology Data Exchange (ETDEWEB)

Bradbury, D [British Library Document Supply Centre, Boston SPA (United Kingdom)

1990-05-01

The British Library Document Supply Centre (BLDSC) has been in the forefront of international document delivery for 20 years. During the last 5 years it has been very actively involved in the ADONIS Project, through which the full text of some 200 journals in the life sciences have been stored, accessed, and delivered through the medium of CD-ROM. The BLDSC`s involvement in this project is described and indications of the lessons learned and of the implications for international document delivery systems in the future are given. (author).

Quality evaluation in health care services based on customer-provider relationships.

Science.gov (United States)

Eiriz, Vasco; Figueiredo, José António

2005-01-01

To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

Integrating evidence-based interventions into client care plans.

Science.gov (United States)

Doran, Diane; Carryer, Jennifer; Paterson, Jane; Goering, Paula; Nagle, Lynn; Kushniruk, Andre; Bajnok, Irmajean; Clark, Carrie; Srivastava, Rani

2009-01-01

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada.

Science.gov (United States)

Chai, Huamin; Guerriere, Denise N; Zagorski, Brandon; Coyte, Peter C

2014-01-01

With increasing emphasis on the provision of home-based palliative care in Canada, economic evaluation is warranted, given its tremendous demands on family caregivers. Despite this, very little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. The aims of this study were to (i) assess the magnitude and share of unpaid care costs in total healthcare costs for home-based palliative care patients, from a societal perspective and (ii) examine the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to care-giving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component - $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. Seemingly unrelated regression estimation suggested that the share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future. © 2013 John Wiley & Sons Ltd.

Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project

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Rosemann Thomas

2008-01-01

Full Text Available Abstract Background Due to technological progress and improvements in medical care and health policy the average age of patients in primary care is continuously growing. In equal measure, an increasing proportion of mostly elderly primary care patients presents with multiple coexisting medical conditions. To properly assess the current situation of co- and multimorbidity, valid scientific data based on an appropriate data structure are indispensable. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork is an ambitious project in Germany to establish a system for adequate record keeping and analysis in primary care based on episodes of care. An episode is defined as health problem from its first presentation by a patient to a doctor until the completion of the last encounter for it. The study aims to describe co- and multimorbidity as well as health care utilization based on episodes of care for the study population of the first participating general practices. Methods The analyses were based on a total of 39,699 patients in a yearly contact group (YCG out of 17 general practices in Germany for which data entry based on episodes of care using the International Classification of Primary Care (ICPC was performed between 1.1.2006 and 31.12.2006. In order to model the relationship between the explanatory variables (age, gender, number of chronic conditions and the response variables of interest (number of different prescriptions, number of referrals, number of encounters that were applied to measure health care utilization, we used multiple linear regression. Results In comparison to gender, patients' age had a manifestly stronger impact on the number of different prescriptions, the number of referrals and number of encounters. In comparison to age (β = 0.043, p Conclusion Documentation in primary care on the basis of episodes of care facilitates an insight to concurrently existing health problems and related medical procedures

A review of instruments to measure interprofessional team-based primary care.

Science.gov (United States)

Shoemaker, Sarah J; Parchman, Michael L; Fuda, Kathleen Kerwin; Schaefer, Judith; Levin, Jessica; Hunt, Meaghan; Ricciardi, Richard

2016-07-01

Interprofessional team-based care is increasingly regarded as an important feature of delivery systems redesigned to provide more efficient and higher quality care, including primary care. Measurement of the functioning of such teams might enable improvement of team effectiveness and could facilitate research on team-based primary care. Our aims were to develop a conceptual framework of high-functioning primary care teams to identify and review instruments that measure the constructs identified in the framework, and to create a searchable, web-based atlas of such instruments (available at: http://primarycaremeasures.ahrq.gov/team-based-care/ ). Our conceptual framework was developed from existing frameworks, the teamwork literature, and expert input. The framework is based on an Input-Mediator-Output model and includes 12 constructs to which we mapped both instruments as a whole, and individual instrument items. Instruments were also reviewed for relevance to measuring team-based care, and characterized. Instruments were identified from peer-reviewed and grey literature, measure databases, and expert input. From nearly 200 instruments initially identified, we found 48 to be relevant to measuring team-based primary care. The majority of instruments were surveys (n = 44), and the remainder (n = 4) were observational checklists. Most instruments had been developed/tested in healthcare settings (n = 30) and addressed multiple constructs, most commonly communication (n = 42), heedful interrelating (n = 42), respectful interactions (n = 40), and shared explicit goals (n = 37). The majority of instruments had some reliability testing (n = 39) and over half included validity testing (n = 29). Currently available instruments offer promise to researchers and practitioners to assess teams' performance, but additional work is needed to adapt these instruments for primary care settings.

The critical role of social workers in home-based primary care.

Science.gov (United States)

Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine

2014-01-01

The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

A Home-Based Palliative Care Consult Service for Veterans.

Science.gov (United States)

Golden, Adam G; Antoni, Charles; Gammonley, Denise

2016-11-01

We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

Estudos com o extrato da Punica granatum Linn. (romã: efeito antimicrobiano in vitro e avaliação clínica de um dentifrício sobre microrganismos do biofilme dental = Studies with the extract of the punica granatum linn. (pomegranate: effect antimicrobial “in vitro” and trial avaliation of a toothpaste upon microrganisms of the oral biofilm

Directory of Open Access Journals (Sweden)

Pereira, Jozinete Vieira

2005-01-01

Full Text Available A atividade antimicrobiana in vitro, CIM (Concentração Inibitória Mínima, CIMA (Concentração Inibitória Mínima de Aderência e a CBM (Concentração Mínima Bactericida do extrato da romã (Punica granatum Linn. foi avaliada em cinco linhagens bacterianas do biofilme dental: Streptococcus mutans, Streptococcus mitis, Streptococcus sanguis, Streptococcus sobrinus e Lactobacillus casei. Em estudo comparativo com o gluconato de clorexidina, os resultados demonstraram efetiva ação inibitória de ambas as substâncias. O extrato da romã foi efetivo na CIMA das cinco linhagens ensaiadas, representada pela ausência de aderência ao vidro na presença de sacarose. A atividade antimicrobiana in vivo do extrato da romã foi testada em 13 pacientes, através do uso de um dentrifício a base desse extrato e foi observadas redução do número de Streptococcus mutans (53,84% e Índice de Sangramento Gengival. Conclui-se, portanto, que o extrato da Punica granatum Linn. , apresentou potente atividade antimicrobiana in vivo e in vitro sobre as linhagens do biofilme dental. Os resultados sugerem a utilização do extrato da romã em indicações terapêuticas na prática odontológica

The logic of tax-based financing for health care.

Science.gov (United States)

Bodenheimer, T; Sullivan, K

1997-01-01

Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

Principiile organizării administrației publice locale consacrate de Constituția României și de legea nr. 69/1991

Directory of Open Access Journals (Sweden)

Rodica PETRESCU

1999-01-01

Full Text Available Constituţia României în art. 119 prevede că administraţia publică din unităţile administrativ-teritoriale se întemeiază pe principiul autonomiei locale şi pe cel al descentralizării serviciilor publice.

A pilot survey of post-deployment health care needs in small community-based primary care clinics

Directory of Open Access Journals (Sweden)

Pugh Mary J

2011-07-01

Full Text Available Abstract Background Relatively little is known regarding to what extent community-based primary care physicians are encountering post-deployment health care needs among veterans of the Afghanistan or Iraq conflicts and their family members. Methods This pilot study conducted a cross-sectional survey of 37 primary care physicians working at small urban and suburban clinics belonging to a practice-based research network in the south central region of Texas. Results Approximately 80% of the responding physicians reported caring for patients who have been deployed to the Afghanistan or Iraq war zones, or had a family member deployed. Although these physicians noted a variety of conditions related to physical trauma, mental illnesses and psychosocial disruptions such as marital, family, financial, and legal problems appeared to be even more prevalent among their previously deployed patients and were also noted among family members of deployed veterans. Conclusions Community-based primary care physicians should be aware of common post-deployment health conditions and the resources that are available to meet these needs.

An investigation of care-based vs. rule-based morality in frontotemporal dementia, Alzheimer's disease, and healthy controls.

Science.gov (United States)

Carr, Andrew R; Paholpak, Pongsatorn; Daianu, Madelaine; Fong, Sylvia S; Mather, Michelle; Jimenez, Elvira E; Thompson, Paul; Mendez, Mario F

2015-11-01

Behavioral changes in dementia, especially behavioral variant frontotemporal dementia (bvFTD), may result in alterations in moral reasoning. Investigators have not clarified whether these alterations reflect differential impairment of care-based vs. rule-based moral behavior. This study investigated 18 bvFTD patients, 22 early onset Alzheimer's disease (eAD) patients, and 20 healthy age-matched controls on care-based and rule-based items from the Moral Behavioral Inventory and the Social Norms Questionnaire, neuropsychological measures, and magnetic resonance imaging (MRI) regions of interest. There were significant group differences with the bvFTD patients rating care-based morality transgressions less severely than the eAD group and rule-based moral behavioral transgressions more severely than controls. Across groups, higher care-based morality ratings correlated with phonemic fluency on neuropsychological tests, whereas higher rule-based morality ratings correlated with increased difficulty set-shifting and learning new rules to tasks. On neuroimaging, severe care-based reasoning correlated with cortical volume in right anterior temporal lobe, and rule-based reasoning correlated with decreased cortical volume in the right orbitofrontal cortex. Together, these findings suggest that frontotemporal disease decreases care-based morality and facilitates rule-based morality possibly from disturbed contextual abstraction and set-shifting. Future research can examine whether frontal lobe disorders and bvFTD result in a shift from empathic morality to the strong adherence to conventional rules. Published by Elsevier Ltd.

Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism.

Science.gov (United States)

Bultas, Margaret W; McMillin, Stephen Edward; Zand, Debra H

2016-01-01

The purpose of this survey-design research study was to evaluate the usefulness of a researcher-developed tool designed to improve office-based health care services and to assess the barriers and resources affecting office-based health care services for children with autism spectrum disorder. Fifty-four health care providers (HCPs) and 59 parents participated in the study. HCPs reported child behaviors, communication, and fears as barriers to providing care, whereas parents reported child behavior, sensory issues, and feelings of a disconnect with the HCP as barriers. HCPs identified the parent as a key resource. Parent-identified resources included provider adaptations to the patient, including slowing down the delivery of care and environmental adaptations to the office. In addition, both HCPs and parents indicated that the researcher-developed tool would be useful in reducing barriers during the HCE. Reducing barriers and improving health care interactions during delivery of care for children with autism spectrum disorder has the potential to improve health outcomes. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

Science.gov (United States)

Helfrich, Christian D; Dolan, Emily D; Fihn, Stephan D; Rodriguez, Hector P; Meredith, Lisa S; Rosland, Ann-Marie; Lempa, Michele; Wakefield, Bonnie J; Joos, Sandra; Lawler, Lauren H; Harvey, Henry B; Stark, Richard; Schectman, Gordon; Nelson, Karin M

2014-12-01

Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care. We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity. 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, Pteam processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (β=0.16-0.34, P=Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures. Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics. Published by Elsevier Inc.

Información relevante que pasa a ser anecdótica: aerinita en las pinturas murales románicas de San Martín de Elines (Cantabria

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M. Rosa Tera Saavedra

2015-12-01

Full Text Available Ante la dificultad de consultar datos materiales y analíticas provenientes de intervenciones existentes relacionadas con el Patrimonio Cultural, el presente artículo plantea la necesidad de establecer parámetros normalizados y accesibles que aglutinen información de memorias técnicas. Como ejemplo de la funcionalidad que podría derivarse de esta propuesta se analiza cómo podría beneficiar su uso en el caso de las pinturas románicas de San Martín de Elines (Cantabria cuya analítica de materiales presenta dos parámetros fuera del contexto geográfico donde están ubicadas y que las relaciona matéricamente con las pinturas románicas del Valle del Boí.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

Science.gov (United States)

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-02-01

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

Students' and teachers' perceptions of motivation and learning through the use in schools of multimedia encyclopaedias on CD-ROM

OpenAIRE

Wishart , Jocelyn

2000-01-01

This article is the result of interviews with teachers, students, and school librarians in eight UK secondary schools regarding their use of multimedia encyclopaedias on CD-ROM. It focuses on a content analysis of their comments on how having access to multimedia encyclopaedias changes the way students work and learn in school, how they perceive it enhances their learning, and how it hinders it. Teachers reported that they used multimedia encyclopaedias as an additional information resource, ...

An Integrated Model of Co-ordinated Community-Based Care.

Science.gov (United States)

Scharlach, Andrew E; Graham, Carrie L; Berridge, Clara

2015-08-01

Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources. This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization. Over the period of this study, participants showed greater mobility, greater ability to meet household needs, greater access to health care, reduced social isolation, reduced home hazards, fewer falls, and greater perceived ability to obtain assistance needed to age in place. This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care. The findings suggest the need for multisite controlled studies to more rigorously evaluate program impacts and the optimal mix of various program components. © The Author 2014. 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.

National Survey of Emergency Physicians Concerning Home-Based Care Options as Alternatives to Emergency Department-Based Hospital Admissions.

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Stuck, Amy R; Crowley, Christopher; Killeen, James; Castillo, Edward M

2017-11-01

Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium. The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care. A group of 1200 EPs nationwide were e-mailed a six-question survey. Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia. Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Mandatory bundled payment getting into formation for value-based care.

Science.gov (United States)

Fink, John

2015-10-01

Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.

75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

Science.gov (United States)

2010-11-03

...] Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare... guidance and ask questions about the upcoming Community-based Care Transitions Program. The meeting is open... conference will also provide an overview of the Community-based Care Transitions Program (CCTP) and provide...

El violón de Domingo Román (Valladolid, 1724

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Reula Baquero, Pedro

2009-12-01

Full Text Available Domingo Roman’s cello is one of the very few surviving Spanish bowed instruments from the eighteenth century. This article basically pretends to present and describe this recently rediscovered instrument by analising it’s very peculiar way of construction, comparing it with the informations we have about the Spanish school of making from sixteen till eighteenth century and other contemporary schools like the fl amish and the german one.

El violón de Domingo Román (Valladolid, 1724 viene a enriquecer la escasa nómina de instrumentos de arco españoles conservados del siglo XVIII. Este artículo pretende ser, básicamente, una presentación y descripción del violón. El análisis del contexto estilístico trata de poner en relación sus peculiares características constructivas con las de la escuela española de los violeros de los siglos XVI a XVIII y con otras europeas como la fl amenca y alemana.

[Implementation of evidence based medicine in primary care].

Science.gov (United States)

Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

2009-01-01

The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

SOFIA: MQ-based signatures in the QROM

NARCIS (Netherlands)

Chen, Ming Shing; Hülsing, Andreas; Rijneveld, Joost; Samardjiska, Simona; Schwabe, Peter

2018-01-01

We propose SOFIA, the first MQ -based signature scheme provably secure in the quantum-accessible random oracle model (QROM). Our construction relies on an extended version of Unruh’s transform for 5-pass identification schemes that we describe and prove secure both in the ROM and QROM. Based on a

Values-based recruitment in health care.

Science.gov (United States)

Miller, Sam Louise

2015-01-27

Values-based recruitment is a process being introduced to student selection for nursing courses and appointment to registered nurse posts. This article discusses the process of values-based recruitment and demonstrates why it is important in health care today. It examines the implications of values-based recruitment for candidates applying to nursing courses and to newly qualified nurses applying for their first posts in England. To ensure the best chance of success, candidates should understand the principles and process of values-based recruitment and how to prepare for this type of interview.

Propagação vegetativa de romã com material vegetal de diferentes origens sob tipos de substratos

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Romulo Magno Oliveira de Freitas

2017-02-01

Full Text Available Objetivou-se com o presente trabalho verificar a influência de diferentes procedências do material vegetal e substratos na propagação vegetativa de romã (Punica granatum L.. Foi usado o delineamento estatístico inteiramente casualizado em esquema fatorial 2x3, sendo duas origens do material vegetal (Barreiras, CE e Mossoró, RN e três substratos (Tropstrato®, Fibra de coco e Solo, constituindo 6 tratamentos em quatro repetições de cinco estacas. As estacas foram preparadas com o auxilio de uma tesoura de poda, coletadas na posição mediana do ramo, padronizadas para o diâmetro de 2 a 4 mm. Aos 45 dias foram avaliados o número de brotos por estaca, comprimento do maior broto, número de folhas por estacas, comprimento da maior raiz, percentagem de estacas enraizadas, número de raízes por estaca, massa seca da brotação e massa seca do sistema radicular. A propagação por estaquia de romã é influenciada pela origem do material vegetal e o melhor material é de Barreiras, CE. Recomenda-se o substrato Tropstrato® para a produção de mudas de romã por estaquia.Vegetative propagation of pomegranate with vegetal material of different origins under types of substratesAbstract: The objective of this study to investigate the influence of different sources of plant material and substrates in the vegetative propagation of pomegranate (Punica granatum L.. The statistical design was completely randomized in a 2x3 factorial, with two origins of the plant material collected (Barreiras, CE and Mossoró, RN and three substrates (Tropstrato®, Coconut fiber and soil, constituting six treatments and four replications. Each replication consisted of five cuttings. Cuttings were prepared with the aid of a pruning shears collected in the median position of the branch for the standardized diameter of 2 to 4 mm. At 45 days, we assessed the number of shoots per cutting, length of the longest shoot, number of leaves per cutting, length of roots

España y sus castillos : la Guerra de Independencia y la iconografía romántica

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Lily Litvak

2012-01-01

Full Text Available En los primeros años del siglo XIX, España era considerada como un país atrasado, peligroso y fanático. Esta opinión cambió con la Guerra de Independencia (1808-1814. El levantamiento del pueblo contra el poderoso invasor francés ratificaba la idea romántica de la nación como ser vivo. La alianza con Inglaterra hizo que esa revalorización se llevara a cabo en ese país a nivel político, literario y artístico. La consideración de España como país romántico atrajo a muchos viajeros que descubrieron su herencia medieval y su pasado islámico, entre ellos a diversos pintores y dibujantes ingleses que en sus escritos, láminas y pinturas revelaron las bellezas monumentales de España.Before the Peninsular War, Spain was considered a backward, dangerous and fanatical country. The war, waged by the Spanish people against the powerful French invader, revealed a different image, and confirmed the Romantic idea of a nation. In England this reconsideration was political, literary and artistic. The reputation of Spain as the archetypal Romantic country attracted many travelers that discovered Spain’s magnificent Medieval and Islamic heritage.Amongst them were several British artists who in their work revealed Spain’s monumental treasures.

Barriers to compliance with evidence-based care in trauma.

Science.gov (United States)

Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

2012-03-01

We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

Moral distress experienced by health care professionals who provide home-based palliative care.

Science.gov (United States)

Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

2010-11-01

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

Computational modeling of biodegradable starch based polymer composites

Science.gov (United States)

Joshi, Sachin Sudhakar

2007-12-01

Purpose. The goal of this study is to improve the favorable molecular interactions between starch and PPC by addition of grafting monomers MA and ROM as compatibilizers, which would advance the mechanical properties of starch/PPC composites. Methodology. DFT and semi-empirical methods based calculations were performed on three systems: (a) starch/PPC, (b) starch/PPC-MA, and (c) starch-ROM/PPC. Theoretical computations involved the determination of optimal geometries, binding-energies and vibrational frequencies of the blended polymers. Findings. Calculations performed on five starch/PPC composites revealed hydrogen bond formation as the driving force behind stable composite formation, also confirmed by the negative relative energies of the composites indicating the existence of binding forces between the constituent co-polymers. The interaction between starch and PPC is also confirmed by the computed decrease in stretching CO and OH group frequencies participating in hydrogen bond formation, which agree qualitatively with the experimental values. A three-step mechanism of grafting MA on PPC was proposed to improve the compatibility of PPC with starch. Nine types of 'blends' produced by covalent bond formation between starch and MA-grafted PPC were found to be energetically stable, with blends involving MA grafted at the 'B' and 'C' positions of PPC indicating a binding-energy increase of 6.8 and 6.2 kcal/mol, respectively, as compared to the non-grafted starch/PPC composites. A similar increase in binding-energies was also observed for three types of 'composites' formed by hydrogen bond formation between starch and MA-grafted PPC. Next, grafting of ROM on starch and subsequent blend formation with PPC was studied. All four types of blends formed by the reaction of ROM-grafted starch with PPC were found to be more energetically stable as compared to the starch/PPC composite and starch/PPC-MA composites and blends. A blend of PPC and ROM grafted at the ' �

El suicidio en la novela romántica cubana

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Abdeslam Azougarh

2012-08-01

Full Text Available Souligner les traits spécifiques de pays récemment indépendants, avec l'intention de créer chez les différents secteurs de la population hispano-américaine une mentalité appropriée pour la consolidation de nations nouvelles et souveraines est une des caractéristiques les plus importantes du romantisme hispano-américain. Il s’agit d’examiner la dimension idéologique de l’exposition nationaliste et américaniste des écrivains en nous basant sur la représentation du suicide principalement dans le roman romantique cubain Cecilia Valdés o la Loma del ángel de Cirilo Villaverde.Destacar los rasgos diferenciales de los países recién independizados con el objetivo de crear entre los distintos sectores de la población hispanoamericana de una mentalidad apropiada para la consolidación de naciones nuevas y soberanas es una de las características más importantes del romanticismo hispanoamericano.Se trata de examinar la dimensión ideológica del planteamiento nacionalista y americanista de los escritores basándonos en la representación del suicidio principalmente en la novela romántica cubana Cecilia Valdés o la Loma del ángel de Cirilo Villaverde.

Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study.

Science.gov (United States)

Ballangrud, Randi; Hall-Lord, Marie Louise; Persenius, Mona; Hedelin, Birgitta

2014-08-01

To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

The use of care robots in aged care: A systematic review of argument-based ethics literature.

Science.gov (United States)

Vandemeulebroucke, Tijs; Dierckx de Casterlé, Bernadette; Gastmans, Chris

2018-01-01

As care robots become more commonplace in aged-care settings, the ethical debate on their use becomes increasingly important. Our objective was to examine the ethical arguments and underlying concepts used in the ethical debate on care robot use in aged care. We conducted a systematic literature search for argument-based ethics publications focusing on care robot use in aged-care practices. We used an innovative methodology that consisted of three steps: (a) identifying conceptual-ethical questions, (b) conducting a literature search, and (c) identifying, describing and analyzing the ethical arguments in connection with the conceptual-ethical questions. Twenty-eight appropriate publications were identified. All were published between 2002 and 2016. Four primary ethical approaches were distinguished: (a) a deontological, (b) a principlist, (c) an objective-list, and (d) a care-ethical. All approaches were equally represented across the articles, and all used similar concepts that grounded their diverse ethical arguments. A small group of publications could not be linked to an ethical approach. All included publications presented a strong ethical rationale based on fully elaborated normative arguments. Although the reviewed studies used similar grounding concepts, the studies' arguments were very diverse and sometimes diametrically opposed. Our analysis shows how one envisions care robot use in aged-care settings is influenced by how one views the traditional boundaries of the ethical landscape in aged care. We suggest that an ethical analysis of care robot use employs "democratic spaces," in which all stakeholders in aged care, especially care recipients, have a voice in the ethical debate. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

Henry, Linda S; Henry, James D

2007-12-01

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

Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

Science.gov (United States)

Valentijn, Pim P; Schepman, Sanneke M; Opheij, Wilfrid; Bruijnzeels, Marc A

2013-01-01

Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care.

Science.gov (United States)

Randhawa, Gurvaneet S; Ahern, David K; Hesse, Bradford W

2017-03-01

The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system. This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients. We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.

Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes.

Science.gov (United States)

Hasson, Henna; Arnetz, Judith E

2008-02-01

The aims of this study were to: (1) compare older people care nursing staff's perceptions of their competence, work strain and work satisfaction in nursing homes and home-based care; and (2) to examine determinants of work satisfaction in both care settings. The shift in older people care from hospitals to community-based facilities and home care has had implications for nursing practice. Lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff in both care settings have been associated with high turnover. Few studies have compared staff perceptions of their competence and work in nursing homes as opposed to home-based care. A cross-sectional questionnaire survey. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire in 2003 in two older people care organizations in Sweden. Comparisons of all outcome variables were made between care settings both within and between the two organizations. Multiple regression analysis was used to determine predictors of work satisfaction in home care and nursing homes respectively. In general, staff in home-based care reported significantly less sufficient knowledge compared with staff in nursing homes. However, home care staff experienced significantly less physical and emotional strain compared with staff in nursing homes. Ratings of work-related exhaustion, mental energy and overall work satisfaction did not differ significantly between care settings. In both care settings, work-related exhaustion was the strongest (inverse) predictor of work satisfaction. Future interventions should focus on counteracting work-related exhaustion and improving competence development to improve work satisfaction among older people care nursing staff in both care settings. Relevance to clinical practice. Work-related exhaustion and lack of competence development may have significant negative implications for work satisfaction among

Caring for home-based care workers

African Journals Online (AJOL)

Winnie

Explore the emotional impacts of care work for THBC frontline care workers to determine what ... Although rates of testing are low, 83% of participants would consider undergoing ... to promote the importance of VCT and the benefits of ARV.

Value-based resource management: a model for best value nursing care.

Science.gov (United States)

Caspers, Barbara A; Pickard, Beth

2013-01-01

With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.

Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

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Nishikitani Mariko

2010-06-01

Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

The Cerefy registered clinical brain atlas on CD-ROM. Based on the classic Talairach-Tournoux and Schaltenbrand-Wahren brain atlases. 2. ed.

International Nuclear Information System (INIS)

Nowinski, W.L.; Thirunavuukarasuu, A.

2001-01-01

This remarkable CD-ROM provides enhanced and extended versions of three world-famous Thieme atlases, (Schaltenbrand and Wahren's Atlas for Stereotaxy of the Human Brain, Talairach and Tournoux's Co-Planar Stereotaxis Atlas of the Human Brain and Referentially Oriented Cerebral MRI Anatomy). It contains the electronic atlases as well as an easy navigation system to facilitate searching for and displaying more than 525 anatomical structures. Revolutionizing the field of brain anatomy, the authors have segmented, labeled, and cross referenced all the information contained in the books, and created contours for all three atlases. The Cerefy registered Clinical Brain Atlas now allows you to electronically navigate these atlases simultaneously on axial, coronal, and sagittal planes, and enjoy the ability to: 1. Access 210 high-quality, fully segmented, and labeled atlas images with corresponding contours, 2. Display and manipulate spatially co-registered atlases, 3. Dynamically label images with structure names and descriptions, and then highlight selected structures in the atlas image, 4. Image zoom in five different levels, mensurate, search, set triplanar, get coordinates, save, and print, 5. Access on-line help, glossary, and supportive atlas materials. (orig.)

Hospital-based home care for children with cancer

DEFF Research Database (Denmark)

Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer

2013-01-01

BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety...... children and 43 parents in the home care group, and 47 children and 66 parents receiving standard hospital care. RESULTS: All parents in the HBHC program were satisfied and preferred home care. There were no serious adverse events associated with HBHC, and costs did not increase. When adjusting for age......, gender, diagnosis and time since diagnosis, we found significant higher HRQOL scores in parent-reported physical health (P = 0.04; 95% confidence interval (CI): -0.2-19.5) and worry (P = 0.04; 95% CI: -0.4-20.6) in the home-care group indicating better physical health and less worry for children...

An Investigation of Care-Based vs. Rule-Based Morality in Frontotemporal Dementia, Alzheimer’s Disease, and Healthy Controls

Science.gov (United States)

Carr, Andrew R.; Paholpak, Pongsatorn; Daianu, Madelaine; Fong, Sylvia S.; Mather, Michelle; Jimenez, Elvira E.; Thompson, Paul; Mendez, Mario F.

2015-01-01

Behavioral changes in dementia, especially behavioral variant frontotemporal dementia (bvFTD), may result in alterations in moral reasoning. Investigators have not clarified whether these alterations reflect differential impairment of care-based vs. rule-based moral behavior. This study investigated 18 bvFTD patients, 22 early onset Alzheimer’s disease (eAD) patients, and 20 healthy age-matched controls on care-based and rule-based items from the Moral Behavioral Inventory and the Social Norms Questionnaire, neuropsychological measures, and magnetic resonance imaging (MRI) regions of interest. There were significant group differences with the bvFTD patients rating care-based morality transgressions less severely than the eAD group and rule-based moral behavioral transgressions more severely than controls. Across groups, higher care-based morality ratings correlated with phonemic fluency on neuropsychological tests, whereas higher rule-based morality ratings correlated with increased difficulty set-shifting and learning new rules to tasks. On neuroimaging, severe care-based reasoning correlated with cortical volume in right anterior temporal lobe, and rule-based reasoning correlated with decreased cortical volume in the right orbitofrontal cortex. Together, these findings suggest that frontotemporal disease decreases care-based morality and facilitates rule-based morality possibly from disturbed contextual abstraction and set-shifting. Future research can examine whether frontal lobe disorders and bvFTD result in a shift from empathic morality to the strong adherence to conventional rules. PMID:26432341

Bridging the gap to evidence-based eye care

Directory of Open Access Journals (Sweden)

Richard Wormald

2004-10-01

Full Text Available In the first article in this series, I touched on the enormous challenge to make access to information equal for those who need it at the time and place when they need it. Only if this is achieved can we successfully promote an evidence-based approach to health care. The move towards open access publishing is taking us some way to achieving this. However, there are further gaps to be bridged if we are to turn eye care workers into evidence-based practitioners. We can define an evidence-based practitioner as one who combines their individual knowledge and expertise with the best available external clinical evidence from systematic research.

The transition to value-based care.

Science.gov (United States)

Ray, Jordan C; Kusumoto, Fred

2016-10-01

Delivery of medical care is evolving rapidly worldwide. Over the past several years in the USA, there has been a rapid shift in reimbursement from a simple fee-for-service model to more complex models that attempt to link payment to quality and value. Change in any large system can be difficult, but with medicine, the transition to a value-based system has been particularly hard to implement because both quality and cost are difficult to quantify. Professional societies and other medical groups are developing different programs in an attempt to define high value care. However, applying a national standard of value for any treatment is challenging, since value varies from person to person, and the individual benefit must remain the central tenet for delivering best patient-centered medical care. Regardless of the specific operational features of the rapidly changing healthcare environment, physicians must first and foremost always remain patient advocates.

Task-role-based Access Control Model in Smart Health-care System

Directory of Open Access Journals (Sweden)

Wang Peng

2015-01-01

Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

Science.gov (United States)

Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

2015-01-01

The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

Nurse led home-based care for people with HIV/AIDS.

Science.gov (United States)

Wood, Elizabeth M; Zani, Babalwa; Esterhuizen, Tonya M; Young, Taryn

2018-03-27

Home-based care is used in many countries to increase quality of life and limit hospital stay, particularly where public health services are overburdened. Home-based care objectives for HIV/AIDS can include medical care, delivery of antiretroviral treatment and psychosocial support. This review assesses the effects of home-based nursing on morbidity in people infected with HIV/AIDS. The trials studied are in HIV positive adults and children, regardless of sex or setting and all randomised controlled. Home-based care provided by qualified nurses was compared with hospital or health-facility based treatment. The following electronic databases were searched from January 1980 to March 2015: AIDSearch, CINAHL, Cochrane Register of Controlled Trials, EMBASE, MEDLINE and PsycINFO/LIT, with an updated search in November 2016. Two authors independently screened titles and abstracts from the electronic search based on the study design, interventions and types of participant. For all selected abstracts, full text articles were obtained. The final study selection was determined with use of an eligibility form. Data extraction was performed independently from assessment of risk of bias. The results were analysed by narrative synthesis, in order to be able to obtain relevant effect measures plus 95% confidence intervals. Seven studies met the inclusion criteria. The trial size varied from 37 to 238 participants. Only one trial was conducted in children. Five studies were conducted in the USA and two in China. Four studies looked at home-based adherence support and the rest at providing home-based psychosocial support. Reported adherence to antiretroviral drugs improved with nurse-led home-based care but did not affect viral load. Psychiatric nurse support in those with existing mental health conditions improved mental health and depressive symptoms. Home-based psychological support impacted on HIV stigma, worry and physical functioning and in certain cases depressive symptoms

CD-Based Microfluidics for Primary Care in Extreme Point-of-Care Settings

Directory of Open Access Journals (Sweden)

Suzanne Smith

2016-01-01

Full Text Available We review the utility of centrifugal microfluidic technologies applied to point-of-care diagnosis in extremely under-resourced environments. The various challenges faced in these settings are showcased, using areas in India and Africa as examples. Measures for the ability of integrated devices to effectively address point-of-care challenges are highlighted, and centrifugal, often termed CD-based microfluidic technologies, technologies are presented as a promising platform to address these challenges. We describe the advantages of centrifugal liquid handling, as well as the ability of a standard CD player to perform a number of common laboratory tests, fulfilling the role of an integrated lab-on-a-CD. Innovative centrifugal approaches for point-of-care in extremely resource-poor settings are highlighted, including sensing and detection strategies, smart power sources and biomimetic inspiration for environmental control. The evolution of centrifugal microfluidics, along with examples of commercial and advanced prototype centrifugal microfluidic systems, is presented, illustrating the success of deployment at the point-of-care. A close fit of emerging centrifugal systems to address a critical panel of tests for under-resourced clinic settings, formulated by medical experts, is demonstrated. This emphasizes the potential of centrifugal microfluidic technologies to be applied effectively to extremely challenging point-of-care scenarios and in playing a role in improving primary care in resource-limited settings across the developing world.

Value-Based Care and Strategic Priorities.

Science.gov (United States)

Gross, Wendy L; Cooper, Lebron; Boggs, Steven; Gold, Barbara

2017-12-01

The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals. Anesthesiologists can survive and thrive in a value-based health care environment if they are capable of providing services differently and able to deliver cost-effective care. Copyright © 2017 Elsevier Inc. All rights reserved.

Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature.

Science.gov (United States)

Kennelty, Korey A; Polgreen, Linnea A; Carter, Barry L

2018-01-18

We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics. Little information was found on factors influencing sustainability of team-based care interventions to improve BP control. Future work is needed to determine the best populations to target with team-based BP programs and how to implement team-based approaches utilizing pharmacists in diverse clinical settings. Future studies need to not only identify unmet clinical needs but also address reimbursement issues and stakeholder engagement that may impact sustainment of team-based care interventions.

Health Care Professionals’ Beliefs About Using Wiki-Based Reminders to Promote Best Practices in Trauma Care

OpenAIRE

Archambault, Patrick Michel; Bilodeau, Andrea; Gagnon, Marie-Pierre; Aubin, Karine; Lavoie, André; Lapointe, Jean; Poitras, Julien; Croteau, Sylvain; Pham-Dinh, Martin; Légaré, France

2012-01-01

Background Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals’ use of wikis. Objectives To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Methods Drawing on the theory of planned behavior, we conducted semistructured int...

[Time based management in health care system: the chosen aspects].

Science.gov (United States)

Kobza, Joanna; Syrkiewicz-Świtała, Magdalena

2014-01-01

Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001-2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary.

Time based management in health care system: The chosen aspects

Directory of Open Access Journals (Sweden)

Joanna Kobza

2014-08-01

Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

Effects of the CD-Rom Version of the "Self-Advocacy Strategy" on Quality of Contributions in IEP Meetings of High School Students with Intellectual Disability

Science.gov (United States)

Cease-Cook, Jennifer; Test, David W.; Scroggins, La' Shawndra

2013-01-01

This study used a multiple-probe across participants design to examine the effects of the CD-Rom version of the "Self-Advocacy Strategy" on quality of contributions in Individual Education Plan (IEP) meetings of five high school students with intellectual disability. Results indicated a functional relationship between using the CD-Rom…

Home-based Self-care: Understanding and Designing Pervasive Technology to Support Care Management Work at Home

DEFF Research Database (Denmark)

Verdezoto, Nervo

the self-care management work at home. People need to know which care activities to perform, when to perform them, how to proceed and why these are important. While at home, an active lifestyle and comorbidity not only challenge self-care activities but also the use of self-care technologies in non...... that fit into people’s everyday life. Through a design research approach applying user-centered design methods and prototyping, the main focus of this dissertation is on exploring and providing a holistic understanding of the self-care work practices in non-clinical settings. Several home-based care...... practices are investigated to (a) further understand the self-care management work in nonclinical settings, and (b) inform future design of pervasive healthcare technology that accounts for people’s perspectives on self-care and everyday life. First, we explore two selfcare practices of medication...

Effect of the Individual Strengthening Exercises for Posterior Pelvic Tilt Muscles on Back Pain, Pelvic Angle, and Lumbar ROM of a LBP Patient with Excessive Lordosis: A Case Study.

Science.gov (United States)

Yoo, Won-Gyu

2014-02-01

[Purpose] The purpose of this study was to document the effect of individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic tilt angle, and lumbar ROM of a low back pain (LBP) patient with excessive lordosis. [Subjects] The subject was a 28 year-old male with excessive lordosis who complained of severe LBP at the L3 level. [Methods] He performed individual strengthening exercises for the posterior pelvic tilt muscles (rectus abdominis, gluteus maximus, hamstring). [Results] Pelvic tilt angles on the right and left sides recovered to his normal ranges. Limited lumbar ROM increased, and low back pain decreased. [Conclusion] We suggest that an approach of individual resistance exercises is necessary for the effective and fast strengthening of the pelvic posterior tilt muscles in case of LBP with excessive lordosis.

Research on the cultivation path of smart home-based care service mode in Internet+ vision

Directory of Open Access Journals (Sweden)

Peng Qingchao

2016-01-01

Full Text Available Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

Organizational factors and depression management in community-based primary care settings

Directory of Open Access Journals (Sweden)

Kilbourne Amy M

2009-12-01

Full Text Available Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT infrastructure, and external incentives and process features (e.g., staff performance, degree of integrated depression care, and IT performance. Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

OpenAIRE

Fisher Beth E; Kulig Kornelia; Davenport Todd E

2010-01-01

Abstract Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains...

Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial

Science.gov (United States)

Rakel, Barbara; Zimmerman, M. Bridget; Geasland, Katharine; Embree, Jennie; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Herr, Keela; Walsh, Deirdre; Sluka, Kathleen A

2014-01-01

This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) have better function than participants receiving Placebo-TENS or Standard Care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses on 317 subjects after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) than Standard Care participants. TENS and Placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) than Standard Care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS. PMID:25270585

Integrated community-based dementia care: the Geriant model

Directory of Open Access Journals (Sweden)

Ludo Glimmerveen

2015-09-01

Full Text Available This article gives an in-depth description of the service delivery model of Geriant, a Dutch organization providing community-based care services for people suffering from dementia. Core to its model is the provision of clinical case management, embedded in multidisciplinary dementia care teams. As Geriant's client group includes people from the first presumption of dementia until they can no longer live at home, its care model provides valuable lessons about how different mechanisms of integration are flexibly put to use if the complexity of clients” care needs increases. It showcases how the integration of services for a specific sub-population is combined with alignment of these services with generalist network partners. After a detailed description of the programme and its results, this article builds on the work of Walter Leutz for a conceptual discussion of Geriant's approach to care integration. 

Factors related to the provision of home-based end-of-life care among home-care nursing, home help, and care management agencies in Japan.

Science.gov (United States)

Igarashi, Ayumi; Kurinobu, Takeshi; Ko, Ayako; Okamoto, Yuko; Matsuura, Shino; Feng, Mei; Yamamoto-Mitani, Noriko

2015-09-12

To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0-60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0-7) and CM agencies had 1.5 (SD = 2.2; range 0-18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. The agency's size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.

Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies.

Science.gov (United States)

Einstein, David J; DeSanto-Madeya, Susan; Gregas, Matthew; Lynch, Jessica; McDermott, David F; Buss, Mary K

2017-09-01

Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model's implementation. Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P 7 days before death-a core Quality Oncology Practice Initiative metric-was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

Eumenes II. als persona non grata: Pergamon, Rom und der 3. Makedonische Krieg

Directory of Open Access Journals (Sweden)

Christoph Kenkel

2012-11-01

Full Text Available Christoph Kenkel treads on difficult terrain with his Bachelor Thesis Eumenes II als persona non grata: Pergamon, Rom und der 3. Makedonische Krieg ( Eumenes II as persona non grata: Pergamon, Rome and the Third Macedonian War, but manages to develop his own convincing interpretation of a research topic subjected to strong discourse.Starting with the deprecatory demeanor of the Roman Senate towards Eumenes II Sotor (197-159 in 167 B.C., the author begins a search for this unusual rejection, facing the challenge of a confusing array of sources and the many diverging opinions of researchers. Further complications arise from the complex political situation at the eve of the Third Macedonian War that raises a variety of new issues.Nevertheless Kenkel manages to see through the machinations and rumors of Roman politics by applying logical thought, and explains plausibly why Eumenes, who unjustly got caught in the crossfire, has always been an ally of Rome, despite of many contemporary rumors and keen allegations.

Can Team-Based Care Improve Patient Satisfaction? A Systematic Review of Randomized Controlled Trials

Science.gov (United States)

Wen, Jin; Schulman, Kevin A.

2014-01-01

Background Team-based approaches to patient care are a relatively recent innovation in health care delivery. The effectiveness of these approaches on patient outcomes has not been well documented. This paper reports a systematic review of the relationship between team-based care and patient satisfaction. Methods We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and PSYCHOINFO for eligible studies dating from inception to October 8, 2012. Eligible studies reported (1) a randomized controlled trial, (2) interventions including both team-based care and non-team-based care (or usual care), and (3) outcomes including an assessment of patient satisfaction. Articles with different settings between intervention and control were excluded, as were trial protocols. The reference lists of retrieved papers were also evaluated for inclusion. Results The literature search yielded 319 citations, of which 77 were screened for further full-text evaluation. Of these, 27 articles were included in the systematic review. The 26 trials with a total of 15,526 participants were included in this systematic review. The pooling result of dichotomous data (number of studies: 10) showed that team-based care had a positive effect on patient satisfaction compared with usual care (odds ratio, 2.09; 95% confidence interval, 1.54 to 2.84); however, combined continuous data (number of studies: 7) demonstrated that there was no significant difference in patient satisfaction between team-based care and usual care (standardized mean difference, −0.02; 95% confidence interval, −0.40 to 0.36). Conclusions Some evidence showed that team-based care is better than usual care in improving patient satisfaction. However, considering the pooling result of continuous data, along with the suboptimal quality of included trials, further large-scale and high-quality randomized controlled trials comparing team-based care and usual care are needed. PMID:25014674

Meteonorm. Global meteorological database for solar energy and applied climatology. Version 4.0: edition 2000. Software and data on CD-ROM

International Nuclear Information System (INIS)

1999-01-01

This is a comprehensive meteorological planning tool for system design, targeted at engineers, architects, teachers, planners and anyone interested in solar energy and climatology. METEONORM includes data from 2400 meteorological stations worldwide. Version V4.0 is based on over 15 years in the development of meteorological databases for energy. It may be used for solar applications at any desired location in the world, as an interpolation model of solar radiation and additional parameters for any site in the world is included. Also, with up-to-date algorithms, solar radiation incident on surfaces of arbitrary orientation may be calculated at the touch of a button. The local skyline profile may be specified. Five languages are supported: English, French, German, Italian, Spanish. Sites may be selected on map by means of a graphical interface. User data may be imported. 16 different output formats are available. Data, programme, manual, maps and illustrations are incorporated on the CD-ROM which is available for sale

Gendered home-based care in South Africa: more trouble for the troubled.

Science.gov (United States)

Akintola, Olagoke

2006-11-01

This study investigates the experiences of informal caregivers of people living with HIV in two semi-rural communities in South Africa. Ethnographic methods were used to collect and analyse data on the gendered nature and consequences of home-based care from 21 primary caregivers and 20 volunteer caregivers as well as 10 key informants. It was generally women who were poor, unemployed and unmarried who combined the care-giving role with their traditional role as homemaker and that of being the household head and breadwinner. The caregivers experienced physical strains and emotional problems, and were at elevated risk of being infected with HIV and TB. Men were largely absent in HIV/AIDS-affected homes and usually did not assist because of rigid gendered divisions of labour. Home-based care, by creating a disproportionate burden on women, is exacerbating existing gender inequities. It is argued that a thorough understanding of how home-based care undermines the physical health and psychological wellbeing of already vulnerable women is crucial for informing policies on home-based care. Thus, there is a need to incorporate gender perspectives when planning and implementing home-based care programmes.

Cryosphere-hydrosphere interactions: numerical modeling using the Regional Ocean Modeling System (ROMS) at different scales

Science.gov (United States)

Bergamasco, A.; Budgell, W. P.; Carniel, S.; Sclavo, M.

2005-03-01

Conveyor belt circulation controls global climate through heat and water fluxes with atmosphere and from tropical to polar regions and vice versa. This circulation, commonly referred to as thermohaline circulation (THC), seems to have millennium time scale and nowadays--a non-glacial period--appears to be as rather stable. However, concern is raised by the buildup of CO2 and other greenhouse gases in the atmosphere (IPCC, Third assessment report: Climate Change 2001. A contribution of working group I, II and III to the Third Assessment Report of the Intergovernmental Panel on Climate Change (Cambridge Univ. Press, UK) 2001, http://www.ipcc.ch) as these may affect the THC conveyor paths. Since it is widely recognized that dense-water formation sites act as primary sources in strengthening quasi-stable THC paths (Stommel H., Tellus131961224), in order to simulate properly the consequences of such scenarios a better understanding of these oceanic processes is needed. To successfully model these processes, air-sea-ice-integrated modelling approaches are often required. Here we focus on two polar regions using the Regional Ocean Modeling System (ROMS). In the first region investigated, the North Atlantic-Arctic, where open-ocean deep convection and open-sea ice formation and dispersion under the intense air-sea interactions are the major engines, we use a new version of the coupled hydrodynamic-ice ROMS model. The second area belongs to the Antarctica region inside the Southern Ocean, where brine rejections during ice formation inside shelf seas origin dense water that, flowing along the continental slope, overflow becoming eventually abyssal waters. Results show how nowadays integrated-modelling tasks have become more and more feasible and effective; numerical simulations dealing with large computational domains or challenging different climate scenarios can be run on multi-processors platforms and on systems like LINUX clusters, made of the same hardware as PCs, and

Cryosphere-hydrosphere interactions: Numerical modeling using the Regional Ocean Modeling System (ROMS) at different scales

International Nuclear Information System (INIS)

Bergamasco, A.; Carniel, S.; Sclavo, M.; Budgell, W.P.

2005-01-01

Conveyor belt circulation controls global climate through heat and water fluxes with atmosphere and from tropical to polar regions and vice versa. This circulation, commonly referred to as thermohaline circulation (THC), seems to have millennium time scale and nowadays-a non-glacial period-appears to be as rather stable. However, concern is raised by the buildup of CO 2 and other greenhouse gases in the atmosphere (IPCC, Third assessment report: Climate Change 2001. A contribution 01 working group I, n and In to the Third Assessment Report of the intergovernmental Panel on Climate Change (Cambridge Univ. Press, UK) 2001, http://www.ipcc.ch) as these may affect the THC conveyor paths. Since it is widely recognized that dense water formation sites ad as primary sources in strengthening quasi-stable THC paths (Stommel H., Tellus, 13 (1961) 224), in order to simulate properly the consequences of such scenarios a better understanding of these oceanic processes is needed. To successfully model these processes, air sea-ice-integrated modelling approaches are often required. Here we focus on two polar regions using the Regional Ocean Modeling System (ROMS). In the first region investigated, the North Atlantic-Arctic, where open-ocean Jeep convection and open-sea ire formation and dispersion under the intense air-sea interactions are the major engines, we use a new version of the coupled hydrodynamic-ice ROMS model. The second area belongs to the Antarctica region inside the Southern Ocean, where brine rejections during ice formation inside shelf seas origin dense water that, flowing along the continental slope, overflow becoming eventually abyssal waters. Results show how nowadays integrated-modelling tasks have become more and more feasible and effective; numerical simulations dealing with large computational domains or challenging different climate scenarios can be run on multi-processors platforms and on systems like LINUX clusters, made of the same hardware as PCs, and

The social construction of identity in HIV/AIDS home-based care ...

African Journals Online (AJOL)

Thirusha Naidu * Thirusha Naidu is a practising clinical psychologist and lecturer in Behavioural Medicine at the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal. She is a practitioner and advocate for Narrative Therapy and narrative methods in research.  Her research interests include social and cultural psychology in relation to health, psychotherapy models and methods, psychotherapy training, narrative methodology and narrative medicine.  Her doctoral research involves identity, culture and context with home-based care volunteers. naidut10@ukzn.ac.za, Yvonne Sliep Yvonne Sliep is a critical community health specialist and currently associate Professor at the School of Psychology, University KwaZulu-Natal (UKZN). Her PhD focused on community based counselling in relation to HIV/AIDS within a rural African context. She is an international scholar with a keen interest to translate good research into sound practice. & Wenche Dageid Wenche Dageid is a post-doctoral researcher at the Dep

2012-06-20

Jun 20, 2012 ... ... give any warranty express or implied or make any representation that the contents ... Keywords: HIV/AIDS care and support, volunteers, narratives, social .... ing community-based care as the basis of palliative care for HIV.

Home Care Quality Indicators (HCQIS) Based on the MDS-HC

Science.gov (United States)

Hirdes, John P.; Fries, Brant E.; Morris, John N.; Ikegami, Naoki; Zimmerman, David; Dalby, Dawn M.; Aliaga, Pablo; Hammer, Suzanne; Jones, Richard

2004-01-01

Purpose: This study aimed to develop home care quality indicators (HCQIs) to be used by a variety of audiences including consumers, agencies, regulators, and policy makers to support evidence-based decision making related to the quality of home care services. Design and Methods: Data from 3,041 Canadian and 11,252 U.S. home care clients assessed…

Electronic Health Record for Intensive Care based on Usual Windows Based Software.

Science.gov (United States)

Reper, Arnaud; Reper, Pascal

2015-08-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Home-based care, technology, and the maintenance of selves.

Science.gov (United States)

Parks, Jennifer A

2015-06-01

In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons (especially older persons) to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann's notion of "holding" persons' identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this "holding" work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be "held" in place.

Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

Science.gov (United States)

Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

2015-10-01

To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

Le Bon Samaritain: A Community-Based Care Model Supported by Technology.

Science.gov (United States)

Gay, Valerie; Leijdekkers, Peter; Gill, Asif; Felix Navarro, Karla

2015-01-01

The effective care and well-being of a community is a challenging task especially in an emergency situation. Traditional technology-based silos between health and emergency services are challenged by the changing needs of the community that could benefit from integrated health and safety services. Low-cost smart-home automation solutions, wearable devices and Cloud technology make it feasible for communities to interact with each other, and with health and emergency services in a timely manner. This paper proposes a new community-based care model, supported by technology, that aims at reducing healthcare and emergency services costs while allowing community to become resilient in response to health and emergency situations. We looked at models of care in different industries and identified the type of technology that can support the suggested new model of care. Two prototypes were developed to validate the adequacy of the technology. The result is a new community-based model of care called 'Le Bon Samaritain'. It relies on a network of people called 'Bons Samaritains' willing to help and deal with the basic care and safety aspects of their community. Their role is to make sure that people in their community receive and understand the messages from emergency and health services. The new care model is integrated with existing emergency warning, community and health services. Le Bon Samaritain model is scalable, community-based and can help people feel safer, less isolated and more integrated in their community. It could be the key to reduce healthcare cost, increase resilience and drive the change for a more integrated emergency and care system.

Value based health care real estate strategies

NARCIS (Netherlands)

van der Voordt, Theo; van der Voordt, DJM; Dijkstra, K

2009-01-01

Subject/Research problem
The healthcare sector in the Netherlands is shifting from a governmentally steered domain towards regulated market forces and performance-based financing. Organizational changes, new ideas about care and cure, demographical developments and technological innovations play

Health economic evaluation of home and hospital-based care in ...

African Journals Online (AJOL)

... diabetes treatment satisfaction, diabetes knowledge and costs during three months ... Results: The cost of home-based care in insulin therapy diabetes was 61% ... Conclusions: The care at home approach for type 2 diabetic patients can be ...

Twelve evidence-based principles for implementing self-management support in primary care.

Science.gov (United States)

Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

2010-12-01

Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

A resource-based view of partnership strategies in health care organizations.

Science.gov (United States)

Yarbrough, Amy K; Powers, Thomas L

2006-01-01

The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given.

Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

Science.gov (United States)

Sears, Nancy A

2002-01-01

Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

Research on the cultivation path of smart home-based care service mode in Internet+ vision

OpenAIRE

Peng Qingchao

2016-01-01

Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explor...

Evidence-based medicine and quality of care.

Science.gov (United States)

Dickenson, Donna; Vineis, Paolo

2002-01-01

In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients.

Science.gov (United States)

Kato, Koki; Fukuda, Haruhisa

2017-11-01

To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254. © 2017 Japan Geriatrics Society.

Introducing the Index of Care: A web-based application supporting archaeological research into health-related care.

Science.gov (United States)

Tilley, Lorna; Cameron, Tony

2014-09-01

The Index of Care is a web-based application designed to support the recently proposed four-stage 'bioarchaeology of care' methodology for identifying and interpreting health-related care provision in prehistory. The Index offers a framework for guiding researchers in 'thinking through' the steps of a bioarchaeology of care analysis; it continuously prompts consideration of biological and archaeological evidence relevant to care provision; it operationalises key concepts such as 'disability' and 'care'; and it encourages transparency in the reasoning underlying conclusions, facilitating review. This paper describes the aims, structure and content of the Index, and provides an example of its use. The Index of Care is freely available on-line; it is currently in active development, and feedback is sought to improve its utility and usability. This is the first time in bioarchaeology that an instrument for examining behaviour as complex as caregiving has been proposed. Copyright © 2014 Elsevier Inc. All rights reserved.

76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

Science.gov (United States)

2011-04-15

...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions.... 111-148, enacted on March 23, 2010) (Affordable Care Act) authorized the Medicare Community-based Care...

The knowledge and practices of primary care givers regarding home-based care of HIV/AIDS children in Blantyre (Malawi.

Directory of Open Access Journals (Sweden)

EW Zimba

2001-09-01

Full Text Available Knowledge is one of the major factors that promotes adherence to treatment regimens. With the current trends worldwide of home and community-based services for the management of HIV/AIDS patients, knowledge of care givers about the home care of these patients will determine the success of the programs. The purpose of this descriptive study was to explore the knowledge and practices of primary care givers of HIV/AIDS children in the provision of home care services. In this study an attempt was made to describe the factors which are associated with knowledge. Thirty-six primary care givers were randomly selected from three major home based care centres in Blantyre City, Malawi. A structured interview schedule was used to collect data. Data were analysed manually and by computer, using the Statistical Package for Social Science (SPSS. The findings revealed a gap in knowledge since in many instances taking a child to the hospital for the management of minor ailments was the action of choice, thus perpetuating the problem of overburdening hospital resources. Lack of prior preparation for home based care was found to be the major factor contributing to the lack of knowledge. Recommendations proposed include the need to put into place mechanisms that will ensure that all the primary care givers are adequately prepared in good time for home care service. Ensuring regular home visits was also thought to be helpful for efficient and effective supervision and reinforcement of information given to fill the gaps in knowledge wherever necessary.

netCare, a new collaborative primary health care service based in Swiss community pharmacies.

Science.gov (United States)

Erni, Pina; von Overbeck, Jan; Reich, Oliver; Ruggli, Martine

2016-01-01

The Swiss Pharmacists Association has launched a new collaborative project, netCare. Community pharmacists provide a standard form with structured triage based on decision trees and document findings. As a backup, they can collaborate with physicians via video consultation. The aim of the study was to evaluate the impact of this service on the Swiss health care system. All pharmacists offering netCare completed two training courses, a course covering the most common medical conditions observed in primary health care and a specific course on all of the decision trees. The pharmacists were free to decide whether they would provide the usual care or offer netCare triage. The patient was also free to accept or refuse netCare. Pharmacists reported the type of ailment, procedure of the consultation, treatment, patient information and outcomes of the follow-up call on a standardized form submitted to the study center. Pharmacists from 162 pharmacies performed 4118 triages over a period of 21 months. A backup consultation was needed for 17% of the cases. In follow-up calls, 84% of the patients who were seen only by pharmacists reported complete relief or symptom reduction. netCare is a low-threshold service by which pharmacists can manage common medical conditions with physician backup, if needed. This study showed that a pharmacist could resolve a large proportion of the cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system. Copyright © 2015 Elsevier Inc. All rights reserved.

Organizational culture, team climate and diabetes care in small office-based practices

OpenAIRE

Bosch, Marije; Dijkstra, Rob; Wensing, Michel; van der Weijden, Trudy; Grol, Richard

2008-01-01

Abstract Background Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices. Methods We conducted cross-sectional analyses of d...

Processing of Irradiated Graphite to Meet Acceptance Criteria for Waste Disposal. Results of a Coordinated Research Project. Companion CD-ROM

International Nuclear Information System (INIS)

2016-05-01

Graphite is widely used in the nuclear industry and in research facilities and this has led to increasing amounts of irradiated graphite residing in temporary storage facilities pending disposal. This publication arises from a coordinated research project (CRP) on the processing of irradiated graphite to meet acceptance criteria for waste disposal. It presents the findings of the CRP, the general conclusions and recommendations. The topics covered include, graphite management issues, characterization of irradiated graphite, processing and treatment, immobilization and disposal. Included on the attached CD-ROM are formal reports from the participants

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

Science.gov (United States)

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Nurses' beliefs and values about doing cue-based care in an NICU in Taiwan.

Science.gov (United States)

Liaw, Jen-Jiuan; Chen, Shu-Yueh; Yin, Ying-Ti

2004-12-01

Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.

Effects of 6-week sling-based training of the external-rotator muscles on the shoulder profile in elite female high school handball players.

Science.gov (United States)

Genevois, Cyril; Berthier, Philippe; Guidou, Vincent; Muller, Franck; Thiebault, Boris; Rogowski, Isabelle

2014-11-01

In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. Crossover study. National elite handball training center. 25 elite female high school handball players. The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area.

Science.gov (United States)

Koike, Soichi; Furui, Yuji

2013-04-01

The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications. We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level. After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

Science.gov (United States)

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

Basing care reforms on evidence: the Kenya health sector costing model.

Science.gov (United States)

Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

2011-05-27

The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead

Basing care reforms on evidence: The Kenya health sector costing model

Science.gov (United States)

2011-01-01

Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health

Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.

Science.gov (United States)

Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N

2018-02-01

Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to

Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers.

Science.gov (United States)

Philip, Rekha Rachel; Philip, Sairu; Tripathy, Jaya Prasad; Manima, Abdulla; Venables, Emilie

2018-02-14

The well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013-2015. A descriptive study was conducted in the oldest community-based palliative clinic in Kerala. Data were collected from annual patient registers from 1996 to 2016 and patient case records during the period 2013-2015. While 91% of the patients registered in the clinic in 1996 had cancer, its relative proportion came down to 32% in 2016 with the inclusion of dementia-related illness (19%) cardiovascular accidents (17%) and severe mental illness (5%).Among patients registered during 2013-15, the median number of home visits from nurses and doctors in 12 months were five and one respectively. In the same cohort, twelve months' post-enrolment, 56% of patients died, 30% were in continuing in active care and 7% opted out. Those who opted out of care were likely to be aged care-giver at home, 85% of these care-givers being female. The changing dynamics over a 20-year period of this palliative care programme in Kerala, India, highlights the need for similar programmes to remain flexible and adapt their services in response to a growing global burden of Non Communicable Diseases. While a high death rate is expected in this population, the high proportion of patients choosing to stay in the programme suggests that home-based care is valued within this particular group. A diverse range of clinical and psycho-social support skills are required to assist families and their caregivers when caring for a

Reduced-order modeling with sparse polynomial chaos expansion and dimension reduction for evaluating the impact of CO2 and brine leakage on groundwater

Science.gov (United States)

Liu, Y.; Zheng, L.; Pau, G. S. H.

2016-12-01

A careful assessment of the risk associated with geologic CO2 storage is critical to the deployment of large-scale storage projects. While numerical modeling is an indispensable tool for risk assessment, there has been increasing need in considering and addressing uncertainties in the numerical models. However, uncertainty analyses have been significantly hindered by the computational complexity of the model. As a remedy, reduced-order models (ROM), which serve as computationally efficient surrogates for high-fidelity models (HFM), have been employed. The ROM is constructed at the expense of an initial set of HFM simulations, and afterwards can be relied upon to predict the model output values at minimal cost. The ROM presented here is part of National Risk Assessment Program (NRAP) and intends to predict the water quality change in groundwater in response to hypothetical CO2 and brine leakage. The HFM based on which the ROM is derived is a multiphase flow and reactive transport model, with 3-D heterogeneous flow field and complex chemical reactions including aqueous complexation, mineral dissolution/precipitation, adsorption/desorption via surface complexation and cation exchange. Reduced-order modeling techniques based on polynomial basis expansion, such as polynomial chaos expansion (PCE), are widely used in the literature. However, the accuracy of such ROMs can be affected by the sparse structure of the coefficients of the expansion. Failing to identify vanishing polynomial coefficients introduces unnecessary sampling errors, the accumulation of which deteriorates the accuracy of the ROMs. To address this issue, we treat the PCE as a sparse Bayesian learning (SBL) problem, and the sparsity is obtained by detecting and including only the non-zero PCE coefficients one at a time by iteratively selecting the most contributing coefficients. The computational complexity due to predicting the entire 3-D concentration fields is further mitigated by a dimension

Technical and Scientific Support Organizations Providing Support to Regulatory Functions. Companion CD-ROM

International Nuclear Information System (INIS)

2018-01-01

This publication introduces the general principles underlying the provision of technical and scientific support to a regulatory body and the characteristics of organizations providing such support. It describes the services provided to support regulatory functions as well as the associated activities and processes to maintain the needed level of expertise, state of the art tools and equipment. The publication is intended for use primarily by organizations that provide technical and scientific support in the field of nuclear and radiation safety. This also includes organizations that acquire such support, and regulatory bodies and governments, as they make decisions on the model of technical and scientific support to be developed at the national level, for example in the case of a country embarking on the development of a nuclear power programme. It is the first IAEA publication dedicated to the specific practices and challenges to be met by the technical and scientific support organizations. This CD-ROM includes the annexes to the printed publication of examples of TSOs and their interactions with key stakeholders.

ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore.

Science.gov (United States)

Mittal, Chikul; Lee, Hsien Chieh Daniel; Goh, Kiat Sern; Lau, Cheng Kiang Adrian; Tay, Leeanna; Siau, Chuin; Loh, Yik Hin; Goh, Teck Kheng Edward; Sandi, Chit Lwin; Lee, Chien Earn

2018-05-30

To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months. VC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

Health care information systems and formula-based reimbursement: an empirical study.

Science.gov (United States)

Palley, M A; Conger, S

1995-01-01

Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

Funds Flow in the Era of Value-Based Health Care.

Science.gov (United States)

Itri, Jason N; Mithqal, Ayman; Krishnaraj, Arun

2017-06-01

Health care reform is creating significant challenges for hospital systems and academic medical centers (AMCs), requiring a new operating model to adapt to declining reimbursement, diminishing research funding, market consolidation, payers' focus on higher quality and lower cost, and greater cost sharing by patients. Maintaining and promoting the triple mission of clinical care, research, and education will require AMCs to be system-based with strong alignment around governance, operations, clinical care, and finances. Funds flow is the primary mechanism whereby an AMC maintains the triple mission through alignment of the hospital, physician practices, school of medicine, undergraduate university, and other professional schools. The purpose of this article is to discuss challenges with current funds flow models, impact of funds flow on academic and private practice radiology groups, and strategies that can increase funds flow to support radiology practices achieving clinical, research, and teaching missions in the era of value-based health care. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Testing a computer-based ostomy care training resource for staff nurses.

Science.gov (United States)

Bales, Isabel

2010-05-01

Fragmented teaching and ostomy care provided by nonspecialized clinicians unfamiliar with state-of-the-art care and products have been identified as problems in teaching ostomy care to the new ostomate. After conducting a literature review of theories and concepts related to the impact of nurse behaviors and confidence on ostomy care, the author developed a computer-based learning resource and assessed its effect on staff nurse confidence. Of 189 staff nurses with a minimum of 1 year acute-care experience employed in the acute care, emergency, and rehabilitation departments of an acute care facility in the Midwestern US, 103 agreed to participate and returned completed pre- and post-tests, each comprising the same eight statements about providing ostomy care. F and P values were computed for differences between pre- and post test scores. Based on a scale where 1 = totally disagree and 5 = totally agree with the statement, baseline confidence and perceived mean knowledge scores averaged 3.8 and after viewing the resource program post-test mean scores averaged 4.51, a statistically significant improvement (P = 0.000). The largest difference between pre- and post test scores involved feeling confident in having the resources to learn ostomy skills independently. The availability of an electronic ostomy care resource was rated highly in both pre- and post testing. Studies to assess the effects of increased confidence and knowledge on the quality and provision of care are warranted.

Task-role-based Access Control Model in Smart Health-care System

OpenAIRE

Wang Peng; Jiang Lingyun

2015-01-01

As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

Value based care and bundled payments: Anesthesia care costs for outpatient oncology surgery using time-driven activity-based costing.

Science.gov (United States)

French, Katy E; Guzman, Alexis B; Rubio, Augustin C; Frenzel, John C; Feeley, Thomas W

2016-09-01

With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures. Using the anesthesia record, drugs, supplies and equipment costs were identified and calculated. The current staffing model was used to determine baseline personnel costs for each procedure. Using the costs identified through TDABC analysis, the effect of different staffing ratios on anesthesia costs could be predicted. Costs for each of the procedures were determined. Process time and costs are linearly related. Personnel represented 79% of overall cost while drugs, supplies and equipment represented the remaining 21%. Changing staffing ratios shows potential savings between 13% and 28% across the 11 procedures. TDABC can be used to estimate the costs of anesthesia care. This costing information is critical to assessing the anesthesiology component in a bundled payment. It can also be used to identify areas of cost savings and model costs of anesthesia care. CRNA to anesthesiologist staffing ratios profoundly influence the cost of care. This methodology could be applied to other medical specialties to help determine costs in the setting of bundled payments. Copyright © 2015 Elsevier Inc. All rights reserved.

Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?

Science.gov (United States)

Zygmunt, Austin; Asada, Yukiko; Burge, Frederick

2017-10-01

As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.

Activity-based costing of health-care delivery, Haiti.

Science.gov (United States)

McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

2018-01-01

To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

Science.gov (United States)

Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

2016-07-01

To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

Using the Regional Ocean Modelling System (ROMS to improve the sea surface temperature predictions of the MERCATOR Ocean System

Directory of Open Access Journals (Sweden)

Pedro Costa

2012-09-01

Full Text Available Global models are generally capable of reproducing the observed trends in the globally averaged sea surface temperature (SST. However, the global models do not perform as well on regional scales. Here, we present an ocean forecast system based on the Regional Ocean Modelling System (ROMS, the boundary conditions come from the MERCATOR ocean system for the North Atlantic (1/6° horizontal resolution. The system covers the region of the northwestern Iberian Peninsula with a horizontal resolution of 1/36°, forced with the Weather Research and Forecasting Model (WRF and the Soil Water Assessment Tool (SWAT. The ocean model results from the regional ocean model are validated using real-time SST and observations from the MeteoGalicia, INTECMAR and Puertos Del Estado real-time observational networks. The validation results reveal that over a one-year period the mean absolute error of the SST is less than 1°C, and several sources of measured data reveal that the errors decrease near the coast. This improvement is related to the inclusion of local forcing not present in the boundary condition model.

The uniqueness of elderly care: registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care.

Science.gov (United States)

Carlson, Elisabeth; Bengtsson, Mariette

2014-04-01

The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments. © 2013.

The Care and Feeding of Evidence Based Medicine

OpenAIRE

Tabrah, Frank L

2012-01-01

Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment.

Ionospheric Electron/Ion Densities Temperatures on CD-ROM and WWW

Science.gov (United States)

Bilitza, Dieter; Papitashvili, Natasha; Schar, Bill; Grebowsky, Joseph

2002-01-01

As part of this project a large volume of ionospheric satellite insitu data from the sixties, seventies and early eighties were made accessible online in ASCII format for public use. This includes 14 data sets from the BE-B, Alouette 2, DME-A, AE-B, ISIS-1, ISIS-2, OGO-6, DE-2, AEROS-A, AE-C, AE-D, AE-E, and Hinotori satellites. The original data existed in various machine-specific, highly compressed, binary encoding on 7-, or 9-track magnetic tapes. The data were decoded and converted to a common ASCII data format, solar and magnetic indices were added, and some quality control measures were taken. The original intent of producing CD-ROMs with these data was overtaken by the rapid development of the Internet. Most users now prefer to obtain the data directly online and greatly value WWW-interfaces to browse, plot and subset the data. Accordingly the data were made available online on the anonymous ftp site of NASA's National Space Science Data Center (NSSDC) at ftp://nssdcftp.gsfc.nasa.gov/spacecraft data/ and on NSSDC's ATMOWeb (http://nssdc.gsfc.nasa.gov/atmoweb/), a WWW-interface for plotting, subsetting, and downloading the data. Several new features were implemented into ATMOWeb as part of this project including a filtering and scatter plot capability. The availability of this new database and WWW system was announced through several electronic mailer (AGU, CEDAR, IRI, etc) and through talks and posters during scientific meetings.

Toward the Development of a Coupled COAMPS-ROMS Ensemble Kalman Filter and Adjoint with a focus on the Indian Ocean and the Intraseasonal Oscillation

Science.gov (United States)

2015-09-30

1 Approved for public release; distribution is unlimited. Toward the Development of a Coupled COAMPS-ROMS Ensemble Kalman Filter and Adjoint...system at NCAR. (2) Compare the performance of the Ensemble Kalman Filter (EnKF) using the Data Assimilation Research Testbed (DART) and 4...undercurrent is clearly visible. Figure 2 shows the horizontal temperature structure and circulation at a depth of 50 m within the surface mixed layer

Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

Science.gov (United States)

Vos, Leti; Dückers, Michel L A; Wagner, Cordula; van Merode, Godefridus G

2010-11-01

Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Implementation of outcomes-driven and value-based mental health care in the UK.

Science.gov (United States)

Wallang, Paul; Kamath, Sanjith; Parshall, Alice; Saridar, Tahani; Shah, Mahek

2018-06-02

Health-care companies around the world face an unprecedented challenge of rising health-care costs, increasing life expectancy and escalating demand. Although national health-care budgets have increased (as a percentage of gross domestic product) health care continues to impart significant upward pressure on national expenditure, particularly in the UK ( Licchetta and Stelmach, 2016 ). Additionally a substantial funding gap will continue to grow ( Gainsbury, 2016 ). In response to this challenge a 'value' based strategy has gained momentum over the last two decades. Several pioneers of this approach (Sir Muir Gray at Oxford University, Professor Michael Porter at Harvard University and Professor Elizabeth Teisberg at Dell Medical School) emphasize the importance of organizations focusing on 'value'. Porter and Teisberg (2006) highlight the 'value equation' as obtaining the very best patient outcomes for each unit of currency spent. Gray expands on this model, describing three types of value: allocative, technical and personal ( Gray, 2011 ). Although some global health-care organizations have embraced the value-based agenda to transform acute care facilities, mental health providers have been slow to consider the benefits of this approach. This article gives a broad overview of implementing a value-based model in mental health care, the significant development resources needed, organizational issues, and finally concludes with the benefits and a vision of value-based mental health care for the future.

RCRA and operational monitoring (ROM): Multi-year program plan and fiscal year 96 work plan. WBS 1.5.3, Revision 1

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-09-01

The RCRA & Operational Monitoring (ROM) Program Office manages the Hanford Site direct funded Resource Conservation and Recovery Act (RCRA) and Operational Monitoring under Work Breakdown Structure (WBS) 1.01.05.03. The ROM Program Office is included in Hanford Technical Services, a part of Projects & Site Services of Westinghouse Hanford Company (WHC). The 1996 Multi-Year Program Plan (MYPP) includes the Fiscal Year Work Plan (FYWP). The Multi-Year Program Plan takes its direction from the Westinghouse Planning Baseline Integration Organization. The MYPP provides both the near term, enhanced details and the long term, projected details for the Program Office to use as baseline Cost, Scope and Schedule. Change Control administered during the fiscal year is against the baseline provided by near term details of this document. The MYPP process has been developed by WHC to meet its internal planning and integration needs and complies with the requirements of the US Department of Energy, Richland Operations Office (RL) Long Range Planning Process Directive (RLID 5000.2). Westinghouse Hanford Company (WHC) has developed the multi-year planning process for programs to establish the technical, schedule and cost baselines for program and support activities under WHC`s scope of responsibility. The baseline information is developed by both WHC indirect funded support services organization, and direct funded programs in WHC. WHC Planning and Integration utilizes the information presented in the program specific MYPP and the Program Master Baseline Schedule (PMBS) to develop the Site-Wide Integrated Schedule.

RCRA and operational monitoring (ROM): Multi-year program plan and fiscal year 96 work plan. WBS 1.5.3, Revision 1

International Nuclear Information System (INIS)

1995-09-01

The RCRA ampersand Operational Monitoring (ROM) Program Office manages the Hanford Site direct funded Resource Conservation and Recovery Act (RCRA) and Operational Monitoring under Work Breakdown Structure (WBS) 1.01.05.03. The ROM Program Office is included in Hanford Technical Services, a part of Projects ampersand Site Services of Westinghouse Hanford Company (WHC). The 1996 Multi-Year Program Plan (MYPP) includes the Fiscal Year Work Plan (FYWP). The Multi-Year Program Plan takes its direction from the Westinghouse Planning Baseline Integration Organization. The MYPP provides both the near term, enhanced details and the long term, projected details for the Program Office to use as baseline Cost, Scope and Schedule. Change Control administered during the fiscal year is against the baseline provided by near term details of this document. The MYPP process has been developed by WHC to meet its internal planning and integration needs and complies with the requirements of the US Department of Energy, Richland Operations Office (RL) Long Range Planning Process Directive (RLID 5000.2). Westinghouse Hanford Company (WHC) has developed the multi-year planning process for programs to establish the technical, schedule and cost baselines for program and support activities under WHC's scope of responsibility. The baseline information is developed by both WHC indirect funded support services organization, and direct funded programs in WHC. WHC Planning and Integration utilizes the information presented in the program specific MYPP and the Program Master Baseline Schedule (PMBS) to develop the Site-Wide Integrated Schedule

CD-ROM nutrient analysis database assists self-monitoring behavior of active duty Air Force personnel receiving nutrition counseling for weight loss.

Science.gov (United States)

Heetderks-Cox, M J; Alford, B B; Bednar, C M; Heiss, C J; Tauai, L A; Edgren, K K

2001-09-01

This study observed the effect of using a computerized vs manual method of self-monitoring among Air Force personnel receiving nutrition counseling for weight loss. Subjects who enrolled during the first 2 weeks of the 4-week recruitment period completed food records for 6 weeks using a CD-ROM nutrient database (intervention group) whereas those who enrolled during the last 2 weeks used a food record booklet (comparison group). Of the 42 subjects (n = 23 intervention group and n = 19 comparison group), only 113 intervention and 11 comparison group subjects (57% of study enrollees) submitted at least 1 food record during the study and were included in the analysis, which included review of pre- and poststudy questionnaires, food records, and focus group data. There were no significant differences between the number of days per week documented or average number of items recorded daily. All 9 intervention as compared to 2 comparison group subjects who completed a poststudy questionnaire searched for lower-energy and lower-fat items and reported changing their dietary intake as a result. All intervention group subjects who participated in a focus group (n=6) had favorable comments about using the CD-ROM for monitoring and changing eating habits, indicating that it is a beneficial self-monitoring tool. Participants enjoyed the immediate dietary feedback, and computerized food records may be easier to interpret by nutrition counselors. A number of computerized nutrient databases are available to assist patients and consumers in managing nutritional concerns.

Genetics, mental illness, and complex disease: development and distribution of an interactive CD-ROM for genetic counselors. Final report for period 15 August 2000 - 31 December 2002

Energy Technology Data Exchange (ETDEWEB)

McInerney, Joseph D.

2003-03-31

"Genetics and Major Psychiatric Disorders: A Program for Genetic Counselors" provides an introduction to psychiatric genetics, with a focus on the genetics of common complex disease, for genetics professionals. The program is available as a CD-ROM and an online educational resource. The on-line version requires a direct internet connection. Each educational module begins with an interactive case study that raises significant issues addressed in each module. In addition, case studies provided throughout the educational materials support teaching of major concepts. Incorporated throughout the content are expert video clips, video clips from individuals affected by psychiatric illness, and optional "learn more" materials that offer greater depth about a particular topic. The structure of the CD-ROM permits self-navigation, but we have suggested a sequence that allows materials to build upon each other. At any point in the materials, users may pause and look up terms in the glossary or review the DSM-IV criteria for selected psychiatric disorders. A detailed site map is available for those who choose to self navigate through the content.

Nuclear medicine installations supervisors interactive course (CD-ROM)

International Nuclear Information System (INIS)

Williart, A.; Shaw, M.; Tellez, M.

2000-01-01

The professionals who work as Nuclear Medicine Installations Supervisors need a suitable training. This training must be based on the guidelines of the C.S.N. (the Spanish Agency for Nuclear Safety). The traditional training courses must comply with a set of requirements, that not always is possible to get: They are given in a settled place. They are developed during a time, more or less lengthy. This time is pre-established. However, the persons willing to follow these courses have some difficulties with the place and the time. Many of them do not live near the places where the courses are given, in general in big cities, while there are Nuclear Medicine Installations scattered through all Spain. Moreover in some occasions they have not available time to attend the courses. Many times, faced with so many obstacles, the option is not to do the suitable training course. In order to solve this kind of problems we offer an Interactive Training Course (supported by CD-ROM). The course contents are based on Spanish Regulations and on the Safety Guide, established by C.S.N., for approval Radioactive Installations Supervisors Training Courses. This guide includes General Topics for Radioactive Installations and Specific Subjects for Nuclear Medicine. (General topics) Basic knowledge on the fundamental concepts on the action and nature of Ionizing Radiations, their risks and preventions. The ionizing radiations. Biological effects of ionizing radiations. Radiological protection. Legislation on radioactive installations. (Specific Subjects) Knowledge on the radiological risks associated to the proper techniques in the specific field of application. In our case the specific field is Nuclear Medicine Installations, where the radioactive sources are used for diagnostic or for therapy. Specific legal and administrative aspects. Non-encapsulated radioactive sources. Associated radiological risks to the use of non-encapsulated sources. Installations design. Operative procedures

Health Care Leadership: Managing Knowledge Bases as Stakeholders.

Science.gov (United States)

Rotarius, Timothy

Communities are composed of many organizations. These organizations naturally form clusters based on common patterns of knowledge, skills, and abilities of the individual organizations. Each of these spontaneous clusters represents a distinct knowledge base. The health care knowledge base is shown to be the natural leader of any community. Using the Central Florida region's 5 knowledge bases as an example, each knowledge base is categorized as a distinct type of stakeholder, and then a specific stakeholder management strategy is discussed to facilitate managing both the cooperative potential and the threatening potential of each "knowledge base" stakeholder.

Development of Low Density CaMg-A1-Based Bulk Metallic Glasses (Preprint)

National Research Council Canada - National Science Library

Senkov, O. N; Scott, J. M; Miracle, D. B

2006-01-01

Low density Ca-Mg-Al-based bulk metallic glasses containing additionally Cu and Zn, were produced by a copper mold casting method as wedge-shaped samples with thicknesses varying from 0.5 mm to 10 rom...

Future Directions of Applying Healthcare Cloud for Home-based Chronic Disease Care

OpenAIRE

Hu, Yan; Eriksén, Sara; Lundberg, Jenny

2017-01-01

The care of chronic disease has become the main challenge for healthcare institutions around the world. To meet the growing needs of patients, moving the front desk of healthcare from hospital to home is essential. Recently, cloud computing has been applied to healthcare domain; however, adapting to and using this technology effectively for home-based care is still in its initial phase. We have proposed a conceptual hybrid cloud model for home-based chronic disease care, and have evaluated it...

English grammar in use a self-study reference and practice book for intermediate learners of English : with answers and CD-ROM

CERN Document Server

Murphy, Raymond

2012-01-01

English Grammar in Use Fourth edition is an updated version of the world's best-selling grammar title. It has a fresh, appealing new design and clear layout, with revised and updated examples, but retains all the key features of clarity and accessibility that have made the book popular with millions of learners and teachers around the world. The CD-ROM contains lots of additional practice exercises to consolidate learning, ideal for self-study but also suitable for reinforcement work in the classroom. An online version and book without answers are available separately.

Jerónimo Román de la higuera y la epigrafía de Ibahernando (Cáceres

Directory of Open Access Journals (Sweden)

María del Rosario HERNANDO SOBRINO

2010-08-01

Full Text Available : En este artículo se presentan y analizan cinco inscripciones romanas procedentes de Ibahernando (Cáceres, algunas de ellas inéditas, que se registran en un manuscrito autógrafo de Jerónimo Román de la Higuera que se conserva en la Biblioteca Nacional (Ms. 1.642 con el título Historia Eclesiástica de España (tomo V. Una vez más, se pone de relieve que, si se estudia con la debida precaución, la información epigráfica transmitida por el jesuita puede y debe ser aprovechada por los historiadores e investigadores de la Antigüedad hispana.

Quality-based procedures in Ontario: exploring health-care leaders' responses.

Science.gov (United States)

Baxter, Pamela; Cleghorn, Laura; Alvarado, Kim; Cummings, Greta; Kennedy, Deborah; McKey, Colleen; Pfaff, Kathy

2016-01-01

To examine health-care leaders' initial response to the implementation of orthopaedic quality based procedures (QBPs) in hospitals across Ontario, Canada. In 2012, Ontario, Canada shifted 91 hospitals to a patient-based funding (PBF) approach. This approach funds health-care organisations based on the number of patients treated with select procedures known as QBPs. An exploratory descriptive design was employed to better understand health-care leaders' early implementation experiences. Seventy organisational leaders from 20 hospitals participated in six focus groups and four interviews to discuss their initial responses to the implementation of two QBPs (primary unilateral hip replacement and primary unilateral knee replacement). Qualitative data underwent content analysis. Three key major themes emerged; (1) responding to change, (2) leading the change and (3) managing the change. Within each of these themes, barriers and benefits were identified. Leaders are accepting of PBF and QBPs. However, challenges exist that require further exploration including the need for a strong infrastructure, accurate and timely clinical and financial data, and policies to prevent unintended consequences. Implementing QBPs requires careful planning, adequate and appropriate resources, vertical and horizontal communication strategies, and policies to ensure that unintended consequences are avoided and positive outcomes achieved. © 2014 John Wiley & Sons Ltd.

Primary care practice-based care management for chronically ill patients (PraCMan: study protocol for a cluster randomized controlled trial [ISRCTN56104508

Directory of Open Access Journals (Sweden)

Baldauf Annika

2011-06-01

Full Text Available Abstract Background Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising results. Care management programmes based on health care assistants (HCAs targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need. Methods/Design PraCMan is a cluster randomized controlled trial with primary care practices as unit of randomisation. The study evaluates a complex primary care practice-based care management of patients at high risk for future hospitalizations. Eligible patients either suffer from type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure or any combination. Patients with a high likelihood of hospitalization within the following 12 months (based on insurance data will be included in the trial. During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and resources as well as regular structured monitoring of symptoms. Assessment and monitoring will be performed by trained HCAs from the participating practices. Additionally, patients will receive written information, symptom diaries, action plans and a medication plan to improve self-management capabilities. This intervention is addition to usual care. Patients from the control group receive usual care. Primary outcome is the number of all-cause hospitalizations at 12 months follow-up, assessed by insurance claims data. Secondary outcomes are health-related quality of life (SF12, EQ5D, quality of chronic illness care (PACIC, health care utilisation and costs, medication adherence (MARS, depression

Integration of problem-based learning and innovative technology into a self-care course.

Science.gov (United States)

McFalls, Marsha

2013-08-12

To assess the integration of problem-based learning and technology into a self-care course. Problem-based learning (PBL) activities were developed and implemented in place of lectures in a self-care course. Students used technology, such as computer-generated virtual patients and iPads, during the PBL sessions. Students' scores on post-case quizzes were higher than on pre-case quizzes used to assess baseline knowledge. Student satisfaction with problem-based learning and the use of technology in the course remained consistent throughout the semester. Integrating problem-based learning and technology into a self-care course enabled students to become active learners.

Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia.

Science.gov (United States)

Yasuda, Mami; Sakakibara, Hisataka

2017-09-01

To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home. An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention). The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.

Mothers' Transition Back to Work and Infants' Transition to Child Care: Does Work-Based Child Care Make a Difference?

Science.gov (United States)

Skouteris, Helen; McCaught, Simone; Dissanayake, Cheryl

2007-01-01

The overall aim in this study was twofold: to compare the use of work-based (WB) and non-work-based (NWB) child care on the transition back to the workplace for women after a period of maternity leave, and on the transition into child care for the infants of these women. Thirty-five mothers with infants in WB centres and 44 mothers with infants in…

Endocrine surgery as a model for value-based health care delivery.

Science.gov (United States)

Abdulla, Amer G; Ituarte, Philip H G; Wiggins, Randi; Teisberg, Elizabeth O; Harari, Avital; Yeh, Michael W

2012-01-01

Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume. Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC). The mean cost per endocrine case performed from 2005 to 2010 was determined at each of three care settings: A tertiary care inpatient facility, a community inpatient facility, and an ambulatory facility. Blood tumor marker levels (thyroglobulin, Tg) and reoperation rates were compared between PTC patients who underwent routine central neck dissection (CND) and those who did not. Surgical patient volume and regional market share were analyzed over time. The cost of care was substantially lower in both the community inpatient facility (14% cost savings) and the ambulatory facility (58% cost savings) in comparison with the tertiary care inpatient facility. Patients who underwent CND had lower Tg levels (6.6 vs 15.0 ng/mL; P = 0.024) and a reduced need for re-operation (1.5 vs 6.1%; P = 0.004) compared with those who did not undergo CND. UCLA maintained its position as the market leader in endocrine procedures while expanding its market share by 151% from 4.9% in 2003 to 7.4% in 2010. A value-driven health care delivery system can deliver improved clinical outcomes while reducing costs within a subspecialty surgical service. Broader application of these principles may contribute to resolving current dilemmas in the provision of care nationally.

Adolescent health care: improving access by school-based service.

Science.gov (United States)

Gonzales, C; Mulligan, D; Kaufman, A; Davis, S; Hunt, K; Kalishman, N; Wallerstein, N

1985-10-01

Participants in this discussion of the potential of school-based health care services for adolescents included family medicine physicians, school health coordinators, a school nurse, and a community worker. It was noted that health care for adolescents tends to be either inaccessible or underutilized, largely because of a lack of sensitivity to adolescent culture and values. An ideal service for adolescents would offer immediate services for crises, strict confidentiality, ready access to prescribed medications, a sliding-scale scheme, and a staff that is tolerant of divergent values and life-styles. School-based pilot adolescent clinics have been established by the University of New Mexico's Department of Family, Community, and Emergency Medicine to test the community-oriented health care model. On-site clinics provide urgent medical care, family planning, pregnancy testing, psychological counseling, alcohol and drug counseling, and classroom health education. Experience with these programs has demonstrated the necessity for an alliance among the health team and the school administration, parents, and students. Financial, ethical, and political factors can serve as constraints to school-based programs. In some cases, school administrators have been resistant to the provision of contraception to students on school grounds and parents have been unwilling to accept the adolescent's right to confidentiality. These problems in part stem from having 2 separate systems, each with its own values, orientation, and responsibilities, housed in 1 facility. In addition, there have been problems generating awareness of the school-based clinic among students. Health education theater groups, peer counseling, and student-run community services have been effective, however, in increasing student participation. It has been helpful to mold clinic services to meet the needs identified by teenagers themselves. There is an interest not only in curative services, but in services focused

Categoria etnică din perspectivă lingvistică

Directory of Open Access Journals (Sweden)

Răzvan Săftoiu

2017-03-01

Full Text Available În această lucrare, propun analiza din perspectivă lingvistică a construcției unei categorii etnice din România care este denumită prin cel puțin doi termeni: țigan și rom. Conceptul de categorie se referă la membrii unui anumit grup care se diferențiază de alte grupuri printr-un set de elemente specifice recunoscute la nivelul unei comunități mai largi. În interacțiune, indivizii apelează frecvent la categorii și la setul de trăsături pe care îl poartă o anumită categorie, deoarece este mai ușor de operat cu seturi de cunoștințe decît cu referințe pentru fiecare individ în parte. Analiza are la bază o serie de expresii și locuțiuni, proverbe și glume care au circulat (sau încă mai circulă în spațiul românesc și care au conturat, la nivelul mentalității colective, imaginea unei categorii etnice a cărei denumire (încă oscilează între doi termeni. Textele au fost grupate în funcție de diverse stereotipuri asociate categoriei etnice avute în vedere, evidențiind conotațiile peiorative ale utilizărilor termenului țigan în raport cu categoria etnică rom, o categorie „goală” de semnificație, care poate fi „umplută” cu elemente ce pot creiona o imagine pozitivă.

Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

Science.gov (United States)

Spoorenberg, Sophie L W; Wynia, Klaske; Fokkens, Andrea S; Slotman, Karin; Kremer, Hubertus P H; Reijneveld, Sijmen A

2015-01-01

Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

[Glocalization: the outlook for Taiwan evidence based health care].

Science.gov (United States)

Chen, Chiehfeng

2014-12-01

Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.

A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

Directory of Open Access Journals (Sweden)

Francis Rebecca

2010-01-01

Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

Simulation of Lake Victoria Circulation Patterns Using the Regional Ocean Modeling System (ROMS.

Directory of Open Access Journals (Sweden)

Chrispine Nyamweya

Full Text Available Lake Victoria provides important ecosystem services including transport, water for domestic and industrial uses and fisheries to about 33 million inhabitants in three East African countries. The lake plays an important role in modulating regional climate. Its thermodynamics and hydrodynamics are also influenced by prevailing climatic and weather conditions on diel, seasonal and annual scales. However, information on water temperature and circulation in the lake is limited in space and time. We use a Regional Oceanographic Model System (ROMS to simulate these processes from 1st January 2000 to 31st December 2014. The model is based on real bathymetry, river runoff and atmospheric forcing data using the bulk flux algorithm. Simulations show that the water column exhibits annual cycles of thermo-stratification (September-May and mixing (June-August. Surface water currents take different patterns ranging from a lake-wide northward flow to gyres that vary in size and number. An under flow exists that leads to the formation of upwelling and downwelling regions. Current velocities are highest at the center of the lake and on the western inshore waters indicating enhanced water circulation in those areas. However, there is little exchange of water between the major gulfs (especially Nyanza and the open lake, a factor that could be responsible for the different water quality reported in those regions. Findings of the present study enhance understanding of the physical processes (temperature and currents that have an effect on diel, seasonal, and annual variations in stratification, vertical mixing, inshore-offshore exchanges and fluxes of nutrients that ultimately influence the biotic distribution and trophic structure. For instance information on areas/timing of upwelling and vertical mixing obtained from this study will help predict locations/seasons of high primary production and ultimately fisheries productivity in Lake Victoria.