Managing the health care solid waste in selected districts of Punjab, Pakistan

International Nuclear Information System (INIS)

Ullah, J.H.; Ahmad, K.

2010-01-01

Hospital and other health care facilities (HCFs) are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Out of one hundred and fifty health care facilities (HCFs) in Punjab, the largest province of Pakistan, a sample of fifteen (HCFs) was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities. (author)

Atomic density effects on temperature characteristics and thermal transport at grain boundaries through a proper bin size selection

Energy Technology Data Exchange (ETDEWEB)

Vo, Truong Quoc; Kim, BoHung, E-mail: muratbarisik@iyte.edu.tr, E-mail: bohungk@ulsan.ac.kr [School of Mechanical Engineering, University of Ulsan, Daehak-ro 93, Namgu, Ulsan 680-749 (Korea, Republic of); Barisik, Murat, E-mail: muratbarisik@iyte.edu.tr, E-mail: bohungk@ulsan.ac.kr [Department of Mechanical Engineering, Izmir Institute of Technology, Urla, Izmir 35430 (Turkey)

2016-05-21

This study focuses on the proper characterization of temperature profiles across grain boundaries (GBs) in order to calculate the correct interfacial thermal resistance (ITR) and reveal the influence of GB geometries onto thermal transport. The solid-solid interfaces resulting from the orientation difference between the (001), (011), and (111) copper surfaces were investigated. Temperature discontinuities were observed at the boundary of grains due to the phonon mismatch, phonon backscattering, and atomic forces between dissimilar structures at the GBs. We observed that the temperature decreases gradually in the GB area rather than a sharp drop at the interface. As a result, three distinct temperature gradients developed at the GB which were different than the one observed in the bulk solid. This behavior extends a couple molecular diameters into both sides of the interface where we defined a thickness at GB based on the measured temperature profiles for characterization. Results showed dependence on the selection of the bin size used to average the temperature data from the molecular dynamics system. The bin size on the order of the crystal layer spacing was found to present an accurate temperature profile through the GB. We further calculated the GB thickness of various cases by using potential energy (PE) distributions which showed agreement with direct measurements from the temperature profile and validated the proper binning. The variation of grain crystal orientation developed different molecular densities which were characterized by the average atomic surface density (ASD) definition. Our results revealed that the ASD is the primary factor affecting the structural disorders and heat transfer at the solid-solid interfaces. Using a system in which the planes are highly close-packed can enhance the probability of interactions and the degree of overlap between vibrational density of states (VDOS) of atoms forming at interfaces, leading to a reduced ITR. Thus, an

Globular Clusters: Absolute Proper Motions and Galactic Orbits

Science.gov (United States)

Chemel, A. A.; Glushkova, E. V.; Dambis, A. K.; Rastorguev, A. S.; Yalyalieva, L. N.; Klinichev, A. D.

2018-04-01

We cross-match objects from several different astronomical catalogs to determine the absolute proper motions of stars within the 30-arcmin radius fields of 115 Milky-Way globular clusters with the accuracy of 1-2 mas yr-1. The proper motions are based on positional data recovered from the USNO-B1, 2MASS, URAT1, ALLWISE, UCAC5, and Gaia DR1 surveys with up to ten positions spanning an epoch difference of up to about 65 years, and reduced to Gaia DR1 TGAS frame using UCAC5 as the reference catalog. Cluster members are photometrically identified by selecting horizontal- and red-giant branch stars on color-magnitude diagrams, and the mean absolute proper motions of the clusters with a typical formal error of about 0.4 mas yr-1 are computed by averaging the proper motions of selected members. The inferred absolute proper motions of clusters are combined with available radial-velocity data and heliocentric distance estimates to compute the cluster orbits in terms of the Galactic potential models based on Miyamoto and Nagai disk, Hernquist spheroid, and modified isothermal dark-matter halo (axisymmetric model without a bar) and the same model + rotating Ferre's bar (non-axisymmetric). Five distant clusters have higher-than-escape velocities, most likely due to large errors of computed transversal velocities, whereas the computed orbits of all other clusters remain bound to the Galaxy. Unlike previously published results, we find the bar to affect substantially the orbits of most of the clusters, even those at large Galactocentric distances, bringing appreciable chaotization, especially in the portions of the orbits close to the Galactic center, and stretching out the orbits of some of the thick-disk clusters.

Facial skin care products and cosmetics.

Science.gov (United States)

Draelos, Zoe Diana

2014-01-01

Facial skin care products and cosmetics can both aid or incite facial dermatoses. Properly selected skin care can create an environment for barrier repair aiding in the re-establishment of a healing biofilm and diminution of facial redness; however, skin care products that aggressively remove intercellular lipids or cause irritation must be eliminated before the red face will resolve. Cosmetics are an additive variable either aiding or challenging facial skin health. Copyright © 2014 Elsevier Inc. All rights reserved.

KINERJA PENGELOLAAN LIMBAH HOTEL PESERTA PROPER DAN NON PROPER DI KABUPATEN BADUNG, PROVINSI BALI

Directory of Open Access Journals (Sweden)

Putri Nilakandi Perdanawati Pitoyo

2016-07-01

Full Text Available Bali tourism development can lead to positive and negative impacts that threatening environmental sustainability. This research evaluates the hotel performance of the waste management that includes management of waste water, emission, hazardous, and solid waste by hotel that participate at PROPER and non PROPER. Research using qualitative descriptive method. Not all of non PROPER doing test on waste water quality, chimney emissions quality, an inventory of hazardous waste and solid waste sorting. Wastewater discharge of PROPER hotels ranged from 290.9 to 571.8 m3/day and non PROPER ranged from 8.4 to 98.1 m3/day with NH3 parameter values that exceed the quality standards. The quality of chimney emissions were still below the quality standard. The volume of the hazardous waste of PROPER hotels ranged from 66.1 to 181.9 kg/month and non PROPER ranged from 5.003 to 103.42 kg/month. Hazardous waste from the PROPER hotel which has been stored in the TPS hazardous waste. The volume of the solid waste of PROPER hotel ranged from 342.34 to 684.54 kg/day and non PROPER ranged from 4.83 to 181.51 kg/day. The PROPER and non PROPER hotel not sort the solid waste. The hotel performance in term of wastewater management, emission, hazardous, and solid waste is better at the PROPER hotel compared to non PROPER participants.

Research on orbit prediction for solar-based calibration proper satellite

Science.gov (United States)

Chen, Xuan; Qi, Wenwen; Xu, Peng

2018-03-01

Utilizing the mathematical model of the orbit mechanics, the orbit prediction is to forecast the space target's orbit information of a certain time based on the orbit of the initial moment. The proper satellite radiometric calibration and calibration orbit prediction process are introduced briefly. On the basis of the research of the calibration space position design method and the radiative transfer model, an orbit prediction method for proper satellite radiometric calibration is proposed to select the appropriate calibration arc for the remote sensor and to predict the orbit information of the proper satellite and the remote sensor. By analyzing the orbit constraint of the proper satellite calibration, the GF-1solar synchronous orbit is chose as the proper satellite orbit in order to simulate the calibration visible durance for different satellites to be calibrated. The results of simulation and analysis provide the basis for the improvement of the radiometric calibration accuracy of the satellite remote sensor, which lays the foundation for the high precision and high frequency radiometric calibration.

Knowledge of the inhabitants of Lubelskie region on proper eating habits

Directory of Open Access Journals (Sweden)

Dorota Weber

2017-08-01

  Due to the fact that care about health, where proper eating habits are one of its constituents, exerts a strong impact on both social and economic life of a country, it is not just an individual case of each person, but a public matter.  The state of health status is obviously subject to a number of factors. However, the habits and customs with regard to daily habits are of particular importance due to the significance of food for the physical existence of each human body. These habits are formed in childhood and youth, however they undergo modifications throughout the whole life. Quite frequently the possessed knowledge is not a sufficient motivation to make great changes in the manner of eating, thus it does not change the eating habits. The aim of the paper is to determine the level of knowledge of clinic patients, selected at random, on proper eating habits. Materials and methods The research was conducted during the period of January-February 2016 year in a Lublin clinic. The investigation comprised 148 respondents. The method used in the research was a diagnostic survey, and the selected technique was a questionnaire conducted among the respondents, using a birth certificate, an interview and an anthropometric study. The study included 148 persons, who were further divided into two groups: students and workers. The respondents were the inhabitants of Lublin and nearby villages. The survey findings underwent a static programme analysis in Statistica 9.1 software (StatSoft, Poland. Conclusions The identification of nutritional knowledge and dietary behaviours of consumers as well as determination of the level and diversity of their nutritional awareness should become the basis for the preparation of guidelines on the content of broadcasts in order to promote healthy eating habits among consumers of different groups.

Palliative care and end-of-life care for polypathological patients.

Science.gov (United States)

Martinez-Litago, E; Martínez-Velasco, M C; Muniesa-Zaragozano, M P

2017-12-01

Patients with advanced chronic diseases receive fragmented care, which entails high resource consumption and a poor quality of life. Uncertainty in the prognosis and scarce investigation into the importance of symptomatic control in this patient group hinders a proper therapeutic approach. Palliative care teams optimise the use of resources through comprehensive patient care, the optimization of the patient's environment, communication, the preparation of early care plans and the creation of coordinated healthcare circuits, which improve the quality of the patient's care in advanced stages of the disease. In the end-of-life phase, the therapeutic approach is focused on symptomatic control, selecting treatments according to the cause, comorbidities and the patient's wishes. To control refractory symptoms, palliative sedation is considered an indispensable option. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Nuclear Power Plant project site selection geotechnical considerations

International Nuclear Information System (INIS)

Katti, V.J.; Banerjee, D.C.

1997-01-01

During the selection of a site for Nuclear Power Plant (NPP) and Radioactive Waste Plant (RWP), geotechnical investigations play a significant role in deciding merits and demerits of the sites. Any accidents in these units can play havoc on mankind and may leave bitter imprints on generations to come. Hence proper care has to be taken at the early stage for selecting the sites. Site selection procedure is a complicated one, because it involves experts from various disciplines like geology, geophysics, civil, mechanical electrical engineering, health-physics and other fields

Identifying barriers to emergency care services.

Science.gov (United States)

Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

2012-01-01

This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

Science.gov (United States)

Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

2015-01-01

(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis

NARCIS (Netherlands)

Oostdijk, E.A.; Wit, G.A. de; Bakker, M; Smet, A.M. de; Bonten, M.J.; Hoeven, J.G. van der; Pickkers, P.; Sturm, P.D.J.; Voss, A.; et al.,

2013-01-01

OBJECTIVE: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). DESIGN: A post hoc analysis of a

Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients : a cost-effectiveness analysis

NARCIS (Netherlands)

Oostdijk, Evelien A. N.; de Wit, G. A.; Bakker, Marina; de Smet, Anne-Marie; Bonten, M. J. M.

2013-01-01

Objective: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). Design: A post hoc analysis of a

Price elasticity and pharmaceutical selection: the influence of managed care.

Science.gov (United States)

Domino, Marisa Elena; Salkever, David S

2003-07-01

State Medicaid programs are turning increasingly to managed care to control expenditures, although the types of managed care programs in use have changed dramatically. Little is known about the influence of the shifting Medicaid managed care arena on treatment decisions. This paper investigates factors affecting the selection of treatments for depression by providers participating in either of two Medicaid managed care programs. Of particular interest is the influence of medication price on the choice of treatment, since one vehicle through which managed care organizations can reduce total expenditures is by increasing the price sensitivity of participating providers. We take a new approach by phrasing the problem as a discrete choice, using a nested multinomial logit model for the analyses. Contrary to earlier literature, we find some evidence that physicians in both programs do take price into consideration when selecting among treatment options. HMO providers in particular demonstrate increased price sensitivity in the two most commonly prescribed categories of antidepressants. Copyright 2002 John Wiley & Sons, Ltd.

National Survey of Prison Health Care: Selected Findings.

Science.gov (United States)

Maruschak, Laura; Chari, Karishma A; Simon, Alan E; DeFrances, Carol J

2016-07-01

This report presents selected findings on the provision of health care services in U.S. state prisons. Findings on admissions testing for infectious disease, cardiovascular risk factors, and mental health conditions, as well as the location of the provision of care and utilization of telemedicine are all included. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Transcultural nursing in perioperative patient care.

Directory of Open Access Journals (Sweden)

Anna Kostka

2017-06-01

Full Text Available Jehovah's Witnesses is a religious association, who refuses blood transfusions even in life-threatening conditions. There are several alternative methods, implemented for use with patients that religion, whose task is to reduce the risk of bleeding and hemorrhage in the perioperative period. Good cooperation of the therapeutic team, the selection of appropriate treatment, the use of recommended methods of anesthesia, surgical techniques and proper nursing care with careful monitoring of post-operative complications and quick response if they leave, they contribute to the improvement of health.

Feeling-of-knowing for proper names.

Science.gov (United States)

Izaute, Marie; Chambres, Patrick; Larochelle, Serge

2002-12-01

The main objective of the presented study was to study feeling-of-knowing (FOK) in proper name retrieval. Many studies show that FOK can predict performance on a subsequent criterion test. Although feeling-of-knowing studies involve questions about proper names, none make this distinction between proper names and common names. Nevertheless, the specific character of proper names as a unique label referring to a person should allow participants to target precisely the desired verbal label. Our idea here was that the unique character of proper name information should result in more accurate FOK evaluations. In the experiment, participants evaluated feeling-of-knowing for proper and common name descriptions. The study demonstrates that FOK judgments are more accurate for proper names than for common names. The implications of the findings for proper names are briefly discussed in terms of feeling-of-knowing hypotheses.

Assigned value improves memory of proper names.

Science.gov (United States)

Festini, Sara B; Hartley, Alan A; Tauber, Sarah K; Rhodes, Matthew G

2013-01-01

Names are more difficult to remember than other personal information such as occupations. The current research examined the influence of assigned point value on memory and metamemory judgements for names and occupations to determine whether incentive can improve recall of proper names. In Experiment 1 participants studied face-name and face-occupation pairs assigned 1 or 10 points, made judgements of learning, and were given a cued recall test. High-value names were recalled more often than low-value names. However, recall of occupations was not influenced by value. In Experiment 2 meaningless nonwords were used for both names and occupations. The name difficulty disappeared, and value influenced recall of both names and occupations. Thus value similarly influenced names and occupations when meaningfulness was held constant. In Experiment 3 participants were required to use overt rote rehearsal for all items. Value did not boost recall of high-value names, suggesting that differential processing could not be implemented to improve memory. Thus incentives may improve memory for proper names by motivating people to engage in selective rehearsal and effortful elaborative processing.

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

Science.gov (United States)

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

2015-11-01

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

Machine safety: proper safeguarding techniques.

Science.gov (United States)

Martin, K J

1992-06-01

1. OSHA mandates certain safeguarding of machinery to prevent accidents and protect machine operators. OSHA specifies moving parts that must be guarded and sets criteria for the guards. 2. A 1989 OSHA standard for lockout/tagout requires locking the energy source during maintenance, periodically inspecting for power transmission, and training maintenance workers. 3. In an amputation emergency, first aid for cardiopulmonary resuscitation, shock, and bleeding are the first considerations. The amputated part should be wrapped in moist gauze, placed in a sealed plastic bag, and placed in a container of 50% water and 50% ice for transport. 4. The role of the occupational health nurse in machine safety is to conduct worksite analyses to identify proper safeguarding and to communicate deficiencies to appropriate personnel; to train workers in safe work practices and observe compliance in the use of machine guards; to provide care to workers injured by machines; and to reinforce safe work practices among machine operators.

Proper motion survey for solar nearby stars

International Nuclear Information System (INIS)

Goldman, Bertrand

2001-01-01

For its microlensing observations EROS 2 built one of the largest CCD mosaic opera ting since 1996. This instrument allowed us to survey a large area of the sky, to look for faint, cool compact objects in the Solar neighborhood that may contribute to the Dark Matter revealed by flat rotation curves of spiral galaxies and the Milky Way. We imaged over 400 square degrees, at least three times over four years, with a single, stable instrument. The aim of this work is the reduction, the analysis and the detection of high proper motion objects that would look like those expected in a dark halo. We selected and analyzed thousands of images taken in two bands, visible and near-infrared, and obtained a catalogue of several thousand stars with proper motion typically higher than 80 milli-arc-seconds per year. None of these candidates displays the expected properties of the halo objects: very high proper motion and faintness. The second part of our work was to put constraints on the contributions of white dwarfs and brown dwarfs ta the halo. To do that, we simulated our data set and estimated our sensitivity to halo objects. We compared our results about moderately high proper motion stars with existing Galactic models, and confirmed the robustness of these models. We deduced a upper limit ta the contribution of M_v = 17.5 white dwarfs to the standard halo of 10% (at the 95% confidence level), or 5% of a 14 Gyr old halo, and to the contribution of brown dwarfs of 7% (95% C.L.). Finally, among our candidates, several interesting objects, that do not belong to the halo but are among the coolest and faintest known, have been discovered. Systematic search for faint, nearby objects thus lead us to study disk L dwarfs, as well as old white dwarfs of the disk. (author) [fr

Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias?

Science.gov (United States)

Nomaguchi, Kei M; Demaris, Alfred

2013-06-01

Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development ( N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims.

Larmor time and proper time

Energy Technology Data Exchange (ETDEWEB)

Kudaka, Shoju [Department of Physics, University of the Ryukyus, Okinawa 903-0129 (Japan); Matsumoto, Shuichi, E-mail: shuichi@edu.u-ryukyu.ac.jp [Department of Mathematics, University of the Ryukyus, Okinawa 903-0129 (Japan)

2012-10-01

The idea of a Larmor clock is reexamined in the relativistic regime. We propose a concept of proper time for quantum theoretical particles. The Larmor clock can measure, under some relevant conditions, the proper time that passes while the particle stays in a space region. Our approach to Larmor clock is different than those of other researchers in the following two aspects: our concept of Larmor clock does not distinguish whether the particle is transmitted or reflected at the end of its stay, and pointer of our Larmor clock is not the spin but the total angular momentum. -- Highlights: ► The idea of a Larmor clock is reexamined in the relativistic regime. ► We propose a concept of proper time for quantum theoretical particles. ► The Larmor clock measures the passage of this quantum theoretical proper time.

7 CFR 29.112 - Proper light.

Science.gov (United States)

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Proper light. 29.112 Section 29.112 Agriculture... INSPECTION Regulations Inspectors, Samplers, and Weighers § 29.112 Proper light. Tobacco shall not be inspected or sampled for the purposes of the Act except when displayed in proper light for correct...

Selection of a cardiac surgery provider in the managed care era.

Science.gov (United States)

Shahian, D M; Yip, W; Westcott, G; Jacobson, J

2000-11-01

Many health planners promote the use of competition to contain cost and improve quality of care. Using a standard econometric model, we examined the evidence for "value-based" cardiac surgery provider selection in eastern Massachusetts, where there is significant competition and managed care penetration. McFadden's conditional logit model was used to study cardiac surgery provider selection among 6952 patients and eight metropolitan Boston hospitals in 1997. Hospital predictor variables included beds, cardiac surgery case volume, objective clinical and financial performance, reputation (percent out-of-state referrals, cardiac residency program), distance from patient's home to hospital, and historical referral patterns. Subgroup analyses were performed for each major payer category. Distance from patient's home to hospital (odds ratio 0.90; P =.000) and the historical referral pattern from each patient's hometown (z = 45.305; P =.000) were important predictors in all models. A cardiac surgery residency enhanced the probability of selection (odds ratio 5.25; P =.000), as did percent out-of-state referrals (odds ratio 1.10; P =.001). Higher mortality rates were associated with decreased probability of selection (odds ratio 0.51; P =.027), but higher length of stay was paradoxically associated with greater probability (odds ratio 1.72; P =.000). Total hospital costs were irrelevant (odds ratio 1.00; P =.179). When analyzed by payer subgroup, Medicare patients appeared to select hospitals with both low mortality (odds ratio 0.43; P =.176) and short length of stay (odds ratio 0.76; P =.213), although the results did not achieve statistical significance. The commercial managed care subgroup exhibited the least "value-based" behavior. The odds ratio for length of stay was the highest of any group (odds ratio = 2.589; P =.000) and there was a subset of hospitals for which higher mortality was actually associated with greater likelihood of selection. The observable

Proper Acknowledgment?

Science.gov (United States)

East, Julianne

2005-01-01

The concern in Australian universities about the prevalence of plagiarism has led to the development of policies about academic integrity and in turn focused attention on the need to inform students about how to avoid plagiarism and how to properly acknowledge. Teaching students how to avoid plagiarism can appear to be straightforward if based on…

Angiographic manifestation and transcatheter arterial embolization of proper esophageal artery in hemoptysis

International Nuclear Information System (INIS)

Jiang Sen; Zhu Xiaohua; Sun Xiwen; Zhi Wenxiang; Jie Bing; You Zhengqian; Yu Dong; Peng Gang

2008-01-01

Objective: To investigate the angiographic manifestation of the proper esophageal artery (PEA), the high risk factors for the presence of the anomalous PEA in hemoptysis and to evaluate the safety of transcatheter arterial embolization (TAE) of the PEA using gelatin sponge (GS). Methods: Selective esophageal arteriography was performed in forty-three patients with hemoptysis, including 15 cases of pulmonary tuberculosis, 18 cases of bronchiectasis, 7 cases of posttuberculous bronchiectasis and three cases of lung cancer. One case experienced failure of bronchial arterial embolization. The angiographic manifestation of the PEAs was studied. The complications of the procedure and clinical results were observed in the patients who underwent TAE using GS. Results: Thirty-nine PEAs were catheterized selectively in 37 patients (86.0%). Eighteen anomalous PEAs (46.2%) were catheterized selectively in 17 patients (45.9%). The anomalous PEAs showed tortuosity, dilatation, hyperplasia, shunting with pulmonary artery and anastomosis with the bronchial artery. All lesions involved basal segment of inferior pulmonary lobar. Bronchiectasis was the most frequent disease for PEA abnormality. No complications occurred and satisfactory curative effect was achieved with TAE of the anomalous PEAs. Conclusions: It is necessary to perform selective proper esophageal arteriography when the lesion involves basal segment of inferior pulmonary lobar in hemoptysis. Supplemental TAE of the anomalous PEA using GS is safe and valuable in the management of hemoptysis. (authors)

Deriving proper uniform priors for regression coefficients, Parts I, II, and III

NARCIS (Netherlands)

van Erp, H.R.N.; Linger, R.O.; van Gelder, P.H.A.J.M.

2017-01-01

It is a relatively well-known fact that in problems of Bayesian model selection, improper priors should, in general, be avoided. In this paper we will derive and discuss a collection of four proper uniform priors which lie on an ascending scale of informativeness. It will turn out that these

Proper motions and distances of quasars

International Nuclear Information System (INIS)

Varshni, Y.P.

1982-01-01

The author's theory that quasars are stars raises the question of their proper motions. From the evidence presented in a previous paper, it is hypothesised that planetary nuclei and quasars are related objects and that their distributions in the galaxy are not very different. Proper motions of 30 quasars, calculated from existing measurements, are discussed. It is shown that three of these, namely PHL 1033, LB 8956 and LB 8991, have proper motions comparable to the largest proper motion known amongst the planetary nuclei. From this it is estimated that these three quasars lie within a few hundred parsecs from the sun. The evidence presented in a previous paper and the present one clearly supports the theory that quasars are stars. The possibility of using the interstellar K and H lines as distance indicators of quasars is discussed and the available evidence summarised. The desirability of determining more accurate values of the proper motions of quasars is emphasised. (Auth.)

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

NARCIS (Netherlands)

Gribble, P.A.; Delahunt, E.; Bleakley, C.; Caulfield, B.; Docherty, C.; Fourchet, F.; Fong, D.T.; Hertel, J.; Hiller, C.; Kaminski, T.; McKeon, P.; Refshauge, K.; Wees, P.J. van der; Vincenzino, B.; Wikstrom, E.

2014-01-01

While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly.

Resistance exercise-induced rhabdomyolysis: Need for immediate intervention and proper counselling.

Science.gov (United States)

Khalil, Maysaa A; Saab, Basem R

2016-12-01

Rhabdomyolysis results from damage to skeletal muscle. Improper resistance training may result in rhabdomyolysis, which can cause acute kidney injury, serious metabolic abnormalities, compartmental syndrome and even death. Proper counselling for athletes may prevent this condition. We present two patients with unilateral swelling after resistance exercise. The workup revealed rhabdomyolysis. We highlight the importance of counselling to prevent rhabdomyolysis secondary to resistance exercise. Trainers and primary care physicians need to be educated about the main features of rhabdomyolysis and urgently refer trainees suspected of having this condition. Treatment consists mainly of hydration and correction of metabolic abnormalities. Primary care physicians need to counsel patients on ways to prevent rhabdomyolysis. Trainers and primary care physicians should instruct novice trainees who are performing resistance exercise to start low and gradually increase the load. Training with loads of 60-70% of one repetition maximum for 8-12 repetitions and use of one to three sets per exercise is recommended.

Selecting, adapting, and sustaining programs in health care systems

Directory of Open Access Journals (Sweden)

Zullig LL

2015-04-01

Full Text Available Leah L Zullig,1,2 Hayden B Bosworth1–4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3School of Nursing, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Abstract: Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. Keywords: program sustainability, diffusion of innovation, information dissemination, health services research, intervention studies 

A Case of Ruptured Aneurysm of the Proper Esophageal Artery with Symptomatic Mediastinal Hematoma

Energy Technology Data Exchange (ETDEWEB)

Liu, Jiajia; Sato, Yusuke, E-mail: yusuke@doc.med.akita-u.ac.jp [Akita University Graduate School of Medicine, Department of Thoracic Surgery (Japan); Takahashi, Satoshi [Akita University Graduate School of Medicine, Department of Radiology (Japan); Motoyama, Satoru; Yoshino, Kei; Sasaki, Tomohiko; Imai, Kazuhiro; Saito, Hajime; Minamiya, Yoshihiro [Akita University Graduate School of Medicine, Department of Thoracic Surgery (Japan)

2016-08-15

Mediastinal aneurysms are rare but potentially life-threatening. Among these, bronchial artery aneurysms are most frequently reported, whereas up to now aneurysms of the proper esophageal artery had never been reported. A 69-year-old woman was referred to our hospital for treatment of a massive mediastinal hematoma. Enhanced computed tomography and selective proper esophageal arteriography revealed a 5-mm aneurysm in the proper esophageal artery that arises from the thoracic aorta at the Th8 level and has an anastomotic branch with the bronchial artery peripherally. Transcatheter arterial embolization was successfully performed using a mixture of N-butyl cyanoacrylate and lipiodol (1:3 ratio, 0.3 ml). Post-embolization angiography showed no filling into the aneurysm. The patient recovered with no complications and was discharged on the 25th post-procedure day.

Dashboard report on performance on select quality indicators to cancer care providers.

Science.gov (United States)

Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats

2016-01-01

Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

Selective epitaxy of semiconductor nanopyramids for nanophotonics

Energy Technology Data Exchange (ETDEWEB)

Poole, P J; Dalacu, D; Lefebvre, J; Williams, R L, E-mail: philip.poole@nrc-cnrc.gc.ca [Institute for Microstructural Sciences, National Research Council, Ottawa, ON, K1A 0R6 (Canada)

2010-07-23

We present a detailed study of the parameters which affect the geometrical perfection of nanopyramids used for the site-selected nucleation of quantum dots. Through an understanding of crystal facet formation, we demonstrate that undesirable high index planes can be suppressed using carefully optimized lithography together with properly orientated source fluxes in the growth reactor. High quality InP nanopyramids are reported with individual InAs/InP quantum dots positioned with high precision. This represents an important milestone for the fabrication of complex quantum dot based nanophotonic devices.

Compressors selection and sizing

CERN Document Server

Brown, Royce N

2005-01-01

This practical reference provides in-depth information required to understand and properly estimate compressor capabilities and to select the proper designs. Engineers and students will gain a thorough understanding of compression principles, equipment, applications, selection, sizing, installation, and maintenance. The many examples clearly illustrate key aspects to help readers understand the ""real world"" of compressor technology.Compressors: Selection and Sizing, third edition is completely updated with new API standards. Additions requested by readers include a new section on di

Use of selective digestive tract decontamination in European intensive cares

DEFF Research Database (Denmark)

Reis Miranda, D; Citerio, G; Perner, A

2015-01-01

BACKGROUND: Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multi drug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care...

Towards proper name generation : A corpus analysis

NARCIS (Netherlands)

Castro Ferreira, Thiago; Wubben, Sander; Krahmer, Emiel

We introduce a corpus for the study of proper name generation. The corpus consists of proper name references to people in webpages, extracted from the Wikilinks corpus. In our analyses, we aim to identify the different ways, in terms of length and form, in which a proper names are produced

uvby photometry in McCormick proper motion fields

Science.gov (United States)

Degewij, J.

1982-01-01

The Danish 50 cm telescope at the European Southern Observatory was used to obtain high-precision uvby photometry for 50 F2 to G2 stars, with V values in the 9.4-12.3 mag range, which were selected in the southern galactic polar regions of the McCormick proper motion fields and measured on six different nights. The brighter stars are found to systematically exhibit smaller m(1) indices, of about 0.02 mag, upon comparison with the earlier data of Blaauw et al (1976). Single measurements are given for 98 stars in eight McCormick fields at intermediate southern galactic latitudes.

VizieR Online Data Catalog: WD+dMs from the SUPERBLINK proper motion survey (Skinner+, 2017)

Science.gov (United States)

Skinner, J. N.; Morgan, D. P.; West, A. A.; Lepine, S.; Thorstensen, J. R.

2018-06-01

To select for nearby WD+dMs, we used the SUPERBLINK proper motion survey (Lepine et al. 2002, J/AJ/124/1190; Lepine & Shara 2005, Cat. I/298), an ongoing all-sky survey that identifies and characterizes stars with proper motions μ>40 mas/yr. For this study, we used the 2011 July version of SUPERBLINK, which listed 2270481 stars, and was estimated to be >90% complete to V=19.0. We selected WD+dMs based on a combination of V magnitudes derived from the DSS plates (see Lepine & Shara 2005, Cat. I/298), near-UV magnitudes from GALEX, and Ks magnitudes from 2MASS. Using the UV-optical-IR color selection outlined in Skinner et al. (2014AJ....148..115S), we selected targets for spectroscopic follow-up (see bottom panel of Figure 1). We acquired optical spectroscopy of 178 newly identified WD+dM candidates, with the Boller and Chivens CCD spectrograph (CCDS), using both the Hiltner 2.4 m and McGraw-Hill 1.3 m telescopes located at the MDM Observatory. (3 data files).

Anesthesia for day-care surgeries: Current perspectives

Directory of Open Access Journals (Sweden)

Sukhminder Jit Singh Bajwa

2017-01-01

Full Text Available Day-care surgery has become a popular modality of surgical intervention throughout the globe. Numerous factors including the economic and financial issues are driving this therapeutic modality to a widespread acceptance among surgeons and anesthesiologists. Advancements in anesthesia and surgical techniques as well as availability of newer drugs are largely responsible for the progress of day-care surgeries. Numerous challenges are still faced by anesthesiologists and surgeons in carrying out day-care surgeries, especially in spite of these advancements, at resource-limited setups. The first right step in successfully delivering the day-care surgical services includes proper selection of the patients. The preanesthetic evaluation is highly essential in determining the suitability of the patient for day-care anesthesia and surgery as well as the formulation of various anesthetic plans and strategies. The current review is intended to highlight inherent challenges and probable solutions to them for this rapidly progressing anesthesia.

Health care in rural areas.

Science.gov (United States)

Nath, L M

1994-02-01

In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

Management of select bacterial and parasitic conditions of raptors.

Science.gov (United States)

Willette, Michelle; Ponder, Julia; Cruz-Martinez, Luis; Arent, Lori; Bueno Padilla, Irene; de Francisco, Olga Nicolas; Redig, Patrick

2009-09-01

Raptors are susceptible to a broad array of established and emerging bacterial and parasitic diseases, including babesiosis, chlamydiosis, clostridiosis, coccidiosis, cryptosporidiosis, malaria, mycobacteriosis, pasteurellosis, salmonellosis, trichomoniasis, and pododermatitis. Many of these conditions are opportunistic and can be easily managed or averted with proper preventive measures related to captive management, husbandry and diet, and veterinary care. Once infected, treatment must be prompt, appropriate, and judicious. This article examines the significance, diagnosis, management, and prevention of select bacterial and parasitic pathogens of raptors.

Properly colored connectivity of graphs

CERN Document Server

Li, Xueliang; Qin, Zhongmei

2018-01-01

A comprehensive survey of proper connection of graphs is discussed in this book with real world applications in computer science and network security. Beginning with a brief introduction, comprising relevant definitions and preliminary results, this book moves on to consider a variety of properties of graphs that imply bounds on the proper connection number. Detailed proofs of significant advancements toward open problems and conjectures are presented with complete references. Researchers and graduate students with an interest in graph connectivity and colorings will find this book useful as it builds upon fundamental definitions towards modern innovations, strategies, and techniques. The detailed presentation lends to use as an introduction to proper connection of graphs for new and advanced researchers, a solid book for a graduate level topics course, or as a reference for those interested in expanding and further developing research in the area.

Implementation of Provider Perspectives Resulted in Proper Health Care Resource Utilization

National Research Council Canada - National Science Library

Mclean, Hugh

2001-01-01

.... One such system is Provider Perspectives. This study shows that Provider Perspectives significantly decreased Emergency Room utilization and subsequently increased the usage of primary care clinics at Martin Army Community Hospital and Winn...

Contents of polyethylene microplastic in some selected personal care products in Denmark

DEFF Research Database (Denmark)

Strand, Jakob

Some personal care products include primary microplastic particles as particulate material, which may not be efficiently removed in WWTPs and therefore they will probably end up in aquatic environments. Microplastics in personal care products were focus in a prime time program DR Kontant...... on national TV - April 30, 2013. For this program Aarhus University contributed with analyses of microplastic particles (>40 μm) in some selected products and in the field. The results for microplastic contents in the nine analysed personal care products are presented here....

The relationship between organizational commitment and nursing care behavior.

Science.gov (United States)

Naghneh, Mohammad Hossein Khalilzadeh; Tafreshi, Mansoureh Zagheri; Naderi, Manijeh; Shakeri, Nehzat; Bolourchifard, Fariba; Goyaghaj, Naser Sedghi

2017-07-01

Nursing care encompasses physical, emotional, mental and social needs, in order to improve a patient's health and wellbeing. Caring is the central core and the essence of nursing. The important issue of care is access to proper care and increasing patients' satisfaction. Job performance of nurses is affected by many factors including organizational commitment. This study aimed to determine the relationship between organizational commitment and nurses caring behavior. In this cross-sectional study, 322 nurses from selected Hospitals of Shahid Beheshti University of Medical Sciences in Tehran were randomly selected and enrolled in the study in 2015. The self-reported data by nurses were collected through demographic characteristics questionnaire, Meyer & Allen organizational commitment model and Caring Behavior Inventory (CBI). Data were analyzed with SPSS statistical software version 20, using t-test and ANOVA. The majority of nurses (63%) were female. The mean score and standard deviation of organizational commitment and caring behavior of nurses were 74.12±9.61 and 203.1±22.46, respectively. The results showed a significantly positive correlation between organizational commitment and caring behavior (p=0.001). In this study the caring behavior of nurses with higher organizational commitment were significantly better than the others. Managers and nurse leaders should pay more attention to improve organizational commitment of nurses, in order to improve nurses' performance.

Application of group theory to proper vibrations in an electric circuit

OpenAIRE

Hosoya, Masahiko; 細谷, 将彦

2010-01-01

Group-theoretical analysis is first presented to three-dimensional behavior of an electric circuit. All the modes of proper vibration are found and assigned to each irreducible representation of symmetrical group of the circuit without solving its circuit equations. In order that an electromagnetic radiation from the outside may induce each vibration, a selection rule which is similar to that in infrared absorption must be fulfilled. The circuit may be used as a directive antenna.

Dental care - child

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/002213.htm Dental care - child To use the sharing features on ... please enable JavaScript. Proper care of your child's teeth and gums includes brushing and rinsing daily. It ...

Handbook on care, handling and protection of nuclear medicine instruments

International Nuclear Information System (INIS)

2000-11-01

Instruments are fundamental to successful nuclear medicine practice. They must be properly installed in an environment in which they can give accurate and uninterrupted service. They have to be properly and carefully operated and supported throughout their life by regular care and maintenance. If something is wrong with a key instrument all well trained staff members are idle and all purchased radiopharmaceuticals become useless. Overall responsibility for instrumentation rests with the directors of nuclear medicine centres. They should support their electronic engineers, medical physicists, technologists and physicians to plan and implement the care and protection of nuclear medicine instruments, see that they are properly maintained, and kept in optimum working condition by regular checks. Protection should be considered, and provided for, before installing any new instrument. The protective devices are part of the new installation and should be well maintained along with the instrument throughout its life. Thus protection needs careful planning, particularly at the beginning of a new instrumentation programme. It can affect selection, procurement, acceptance testing, and the design of quality control and maintenance routines. These activities should be considered as important in their own right. They should not be mixed in with other functions or left to take care of themselves in the daily rush to get through routine work. Experience suggests that more than half of all failures of electronic equipment are due to damage by external electrical disturbances. Section 2 of this handbook aims to help instrument users in nuclear medicine centres to understand the nature of the various types of disturbance, and to protect against them. Section 3 shows how air conditioning can help to protect instrumentation. Section 4 lists some practical tips to avoid accidental damage due to mishandling. A computer program for use with Personal Computers, ''EPC Expert'' is described

Non-adaptive territory selection by a bird with exceptionally long parental care

Directory of Open Access Journals (Sweden)

Radosław Włodarczyk

2016-03-01

Full Text Available High-quality territories are expected to provide greater fitness return for breeding individuals and, thus, are likely to have higher long-term occupation rate in comparison to low-quality territories. However, if environmental and ecological cues used for territory selection cannot reliably predict true territory quality, a mismatch between preferences and fitness may occur. We suggest that this kind of non-adaptive territory selection is more likely in species with long reproductive cycles, as a long time interval between territory establishment and young fledgling should reduce predictability of conditions during the critical stages of brood care. In this study, we investigated adaptiveness of territory selection in a migratory bird with exceptionally long parental care, the mute swan Cygnus olor, which requires over four months to complete the entire reproductive cycle from egg laying to young fledging. For this purpose, we collected information on the long-term (10–19 years occupancy of 222 swan breeding territories and correlated it with reproductive performance (n = 1,345 breeding attempts and body condition of breeding adults. We found that long-term occupancy positively correlated with the timing of breeding, suggesting that individuals settled earlier in the attractive, frequently occupied territories. By contrast, we found no relationship between territory occupancy and reproductive output (hatching and fledging success or adult body condition. The results indicate that at the time of territory selection swans might not be able to reliably assess territory quality, likely due to: (1 exceptionally long period of parental care, which reduces temporal correlation between the conditions at the time of territory selection and conditions during chick rearing; and (2 unpredictability of human-related activities that had a major impact on reproductive output of swan pairs in our population.

Employer Satisfaction With an Injured Employee's Health Care: How Does It Affect the Selection of an Occupational Health Care Provider?

Science.gov (United States)

Keleher, Myra P; Stanton, Marietta P

2016-01-01

The purpose of this article is to explore the most important factors that an employer utilizes in selecting an occupational health care provider for their employees injured on the job. The primary practice setting is the attending physician's office who is an occupational health care provider. The responding employers deemed "work restrictions given after each office visit" as their most important factor in selecting an occupational health care provider, with a score of 43. This was followed in order in the "very important" category by communication, appointment availability, employee return to work within nationally recognized guidelines, tied were medical provider professionalism and courtesy with diagnostics ordered timely, next was staff professionalism and courtesy, and tied with 20 responses in the "very important" category were wait time and accurate billing by the provider.The selection of an occupational health care provider in the realm of workers' compensation plays a monumental role in the life of a claim for the employer. Safe and timely return to work is in the best interest of the employer and their injured employee. For the employer, it can represent hard dollars saved in indemnity payments and insurance premiums when the employee can return to some form of work. For the injured employee, it can have a positive impact on their attitude of going back to work as they will feel they are a valued asset to their employer. The case managers, who are the "eyes and ears" for the employer in the field of workers' compensation, have a valuable role in a successful outcome of dollars saved and appropriate care rendered for the employees' on the job injury. The employers in the study were looking for case managers who could ensure their employees received quality care but that this care is cost-effective. The case manager can be instrumental in assisting the employer in developing and monitoring a "stay-at-work" program, thereby reducing the financial exposure

Status of hospital infection control measures at seven major tertiary care hospitals of northern Punjab

International Nuclear Information System (INIS)

Ikram, A.; Shah, S.I.H.; Naseem, S.; Absar, S.A.; Safi-Ullah; Ambreen, T.

2010-01-01

To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Study Design: Survey. Place and Duration of Study: National Institute of Science and Technology, Islamabad, from June through August 2008. Methodology: Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Results: Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. Conclusion: The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures. (author)

Determination of proper motions in the Pleiades cluster

Science.gov (United States)

Schilbach, E.

1991-04-01

For 458 stars in the Pleiades field from the catalog of Eichhorn et al. (1970) proper motions were derived on Tautenburg and CERGA Schmidt telescope plates measured with the automated measuring machine MAMA in Paris. The catalog positions were considered as first epoch coordinates with an epoch difference of ca. 33 years to the observations. The results show good coincidence of proper motions derived with both Schmidt telescopes within the error bars. Comparison with proper motions determined by Vasilevskis et al. (1979) displays some significant differences but no systematic effects depending on plate coordinates or magnitudes could be found. An accuracy of 0.3 arcsec/100a for one proper motion component was estimated. According to the criterion of common proper motion 34 new cluster members were identified.

On the Determination of Proper Time

OpenAIRE

Hurl, Bing; Zhang, Zhi-Yong Wang Hai-Dong

1998-01-01

Through the analysis of the definition of the duration of proper time of a particle given by the length of its world line, we show that there is no transitivity of the coordinate time function derived from the definition, so there exists an ambiguity in the determination of the duration of the proper time for the particle. Its physical consequence is illustrated with quantum measurement effect.

Injuries in recreational curling include head injuries and may be prevented by using proper footwear.

Science.gov (United States)

Ting, D K; Brison, R J

2015-04-01

Our study examines a recreational curling population to describe patterns of injury occurrence, estimate risk of injury and to gauge attitudes towards equipment-based prevention strategies. In a retrospective case series, we queried the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national injury surveillance database, for curling injuries entered between 1993 and 2011. Kingston General Hospital and Hotel Dieu Hospital provide the two Kingston, Ontario, sites for emergency department (ED) care and participate in CHIRPP. Each retrieved entry underwent a chart review. A secondary survey was mailed to select individuals who had experienced curling injuries to solicit details on their injury and attitudes towards equipment to prevent injury. We used descriptive statistics for rates and proportions. Over 90% of acute curling injuries resulted from a fall, and 31.7% were head impacts. We found that acute injuries requiring ED presentation occur at a rate of approximately 0.17 per 1000 athlete-exposures (95% CI: 0.12-0.22). The secondary survey was completed by 54% of potential respondents. Of survey respondents, 41.3% attributed their fall to a lack of proper footwear and 73.5% of respondents agreed with mandatory sport-specific footwear as a prevention strategy, but only 8% agreed with mandatory helmet wear. Although curling injuries requiring medical care are not common, head injuries make up a large proportion. Mandated use of appropriate footwear appears to be the most effective prevention strategy, as well as the measure deemed most acceptable by players.

Large proper motions in the Orion nebula

International Nuclear Information System (INIS)

Cudworth, K.M.; Stone, R.C.

1977-01-01

Several nebular features, as well as one faint star, with large proper motions were identified within the Orion nebula. The measured proper motions correspond to tangential velocities of up to approximately 70 km sec -1 . One new probable variable star was also found

Back to basic: bio-burden on hands of health care personnel in tertiary teaching hospital in Malaysia.

Science.gov (United States)

Wong, J L; Siti Azrin, A H; Narizan, M I; Norliah, Y; Noraida, M; Amanina, A; Nabilah, I; Habsah, H; Siti Asma, H

2014-09-01

Hands of Health Care Personnel (HCP) are one of the most common vehicles for the transmission of infection. Microorganisms can survive well on the hands of HCP for a certain duration. Therefore, the purpose of this study is to bring awareness to HCP that their hands can actually be contaminated with many microorganisms. These microbes on the hands of HCP can potentially infect their patients if they do not comply with the proper hand hygiene practice. This cross-sectional study was conducted at a randomly selected Intensive Care Unit (ICU) and general ward in a hospital. Twenty five HCP from each ward were randomly selected and their hands were imprinted on blood culture plates. Microorganism growth were quantified and identified. Data were analyzed and presented as descriptive analysis. One hundred blood agar plates were processed and analyzed. Majority (71%) of the samples had more than 50 colony-forming units (CFU) and only 17% of the samples had less than 25 CFU. Microorganisms identified include Staphylococcus spp., Acinetobacter spp., Enterobacteriaceae, Pseudomonas spp., Moraxella, Delftiaacidovorans and fungi. All isolated microorganisms were antibiotic sensitive strain. This study showed that the hands of HCP were contaminated with many microorganisms. Therefore, it is imperative that HCP must practice proper hand hygiene when taking care of their patients in the wards.

Selective mutism: are primary care physicians missing the silence?

Science.gov (United States)

Schwartz, Richard H; Freedy, Alicia S; Sheridan, Michael J

2006-01-01

To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.

Computation of Asteroid Proper Elements: Recent Advances

Science.gov (United States)

Knežević, Z.

2017-12-01

The recent advances in computation of asteroid proper elements are briefly reviewed. Although not representing real breakthroughs in computation and stability assessment of proper elements, these advances can still be considered as important improvements offering solutions to some practical problems encountered in the past. The problem of getting unrealistic values of perihelion frequency for very low eccentricity orbits is solved by computing frequencies using the frequency-modified Fourier transform. The synthetic resonant proper elements adjusted to a given secular resonance helped to prove the existence of Astraea asteroid family. The preliminary assessment of stability with time of proper elements computed by means of the analytical theory provides a good indication of their poorer performance with respect to their synthetic counterparts, and advocates in favor of ceasing their regular maintenance; the final decision should, however, be taken on the basis of more comprehensive and reliable direct estimate of their individual and sample average deviations from constancy.

Taxonomic and Thematic Organisation of Proper Name Conceptual Knowledge

Directory of Open Access Journals (Sweden)

Sebastian J. Crutch

2011-01-01

Full Text Available We report the investigation of the organisation of proper names in two aphasic patients (NBC and FBI. The performance of both patients on spoken word to written word matching tasks was inconsistent, affected by presentation rate and semantic relatedness of the competing responses, all hallmarks of a refractory semantic access dysphasia. In a series of experiments we explored the semantic relatedness effects within their proper name vocabulary, including brand names and person names. First we demonstrated the interaction between very fine grain organisation and personal experience, with one patient with a special interest in the cinema demonstrating higher error rates when identifying the names of actors working in a similar film genre (e.g. action movies: Arnold Schwarzenegger, Bruce Willis, Sylvester Stallone, Mel Gibson than those working in different genres (e.g. Arnold Schwarzenegger, Gregory Peck, Robin Williams, Gene Kelly. Second we compared directly two potential principles of semantic organisation – taxonomic and thematic. Furthermore we considered these principles of organisation in the context of the individuals' personal knowledge base. We selected topics matching the interests and experience of each patient, namely cinema and literature (NBC and naval history (FBI. The stimulus items were arranged in taxonomic arrays (e.g. Jane Austen, Emily Bronte, Agatha Christie, thematic arrays (e.g. Jane Austen, Pride and Prejudice, Mr Darcy, and unrelated arrays (e.g. Jane Austen, Wuthering Heights, Hercule Poirot. We documented that different patterns of taxonomic and thematic organisation were constrained by whether the individual has limited knowledge, moderate knowledge or detailed knowledge of a particular vocabulary. It is suggested that moderate proper name knowledge is primarily organised by taxonomy whereas extensive experience results in a more detailed knowledge base in which theme is a powerful organising principle.

Taxonomic and thematic organisation of proper name conceptual knowledge.

Science.gov (United States)

Crutch, Sebastian J; Warrington, Elizabeth K

2011-01-01

We report the investigation of the organisation of proper names in two aphasic patients (NBC and FBI). The performance of both patients on spoken word to written word matching tasks was inconsistent, affected by presentation rate and semantic relatedness of the competing responses, all hallmarks of a refractory semantic access dysphasia. In a series of experiments we explored the semantic relatedness effects within their proper name vocabulary, including brand names and person names. First we demonstrated the interaction between very fine grain organisation and personal experience, with one patient with a special interest in the cinema demonstrating higher error rates when identifying the names of actors working in a similar film genre (e.g., action movies: Arnold Schwarzenegger, Bruce Willis, Sylvester Stallone, Mel Gibson) than those working in different genres (e.g., Arnold Schwarzenegger, Gregory Peck, Robin Williams, Gene Kelly). Second we compared directly two potential principles of semantic organisation - taxonomic and thematic. Furthermore we considered these principles of organisation in the context of the individuals' personal knowledge base. We selected topics matching the interests and experience of each patient, namely cinema and literature (NBC) and naval history (FBI). The stimulus items were arranged in taxonomic arrays (e.g., Jane Austen, Emily Bronte, Agatha Christie), thematic arrays (e.g., Jane Austen, Pride and Prejudice, Mr Darcy), and unrelated arrays (e.g., Jane Austen, Wuthering Heights, Hercule Poirot). We documented that different patterns of taxonomic and thematic organisation were constrained by whether the individual has limited knowledge, moderate knowledge or detailed knowledge of a particular vocabulary. It is suggested that moderate proper name knowledge is primarily organised by taxonomy whereas extensive experience results in a more detailed knowledge base in which theme is a powerful organising principle.

Sexual minorities and selection of a primary care physician in a midwestern U.S. city.

Science.gov (United States)

Labig, Chalmer E; Peterson, Tim O

2006-01-01

How and why sexual minorities select a primary care physician is critical to the development of methods for attracting these clients to a physician's practice. Data obtained from a sample of sexual minorities in a mid-size city in our nation's heartland would indicate that these patients are loyal when the primary care physician has a positive attitude toward their sexual orientation. The data also confirms that most sexual minorities select same sex physicians but not necessarily same sexual orientation physicians because of lack of knowledge of physicians' sexual orientation. Family practice physicians and other primary care physicians can reach out to this population by encouraging word of mouth advertising and by displaying literature on health issues for all sexual orientations in their offices.

Knowledge Sharing, Control of Care Quality, and Innovation in Intensive Care Nursing

DEFF Research Database (Denmark)

Paunova, Minna; Li-Ying, Jason; Egerod, Ingrid Eugenie

This study investigates the influence of nurse knowledge sharing behavior on nurse innovation, given different conditions of control of care quality within the intensive care unit (ICU). After conducting a number of interviews and a pilot study, we carried out a multi-source survey study of more...... control of care quality and innovate may be conflicting, unless handled properly....

Injuries in recreational curling include head injuries and may be prevented by using proper footwear

Directory of Open Access Journals (Sweden)

D. K. Ting

2015-04-01

Full Text Available Introduction: Our study examines a recreational curling population to describe patterns of injury occurrence, estimate risk of injury and to gauge attitudes towards equipment-based prevention strategies. Methods: In a retrospective case series, we queried the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP, a national injury surveillance database, for curling injuries entered between 1993 and 2011. Kingston General Hospital and Hotel Dieu Hospital provide the two Kingston, Ontario, sites for emergency department (ED care and participate in CHIRPP. Each retrieved entry underwent a chart review. A secondary survey was mailed to select individuals who had experienced curling injuries to solicit details on their injury and attitudes towards equipment to prevent injury. We used descriptive statistics for rates and proportions. Results: Over 90% of acute curling injuries resulted from a fall, and 31.7% were head impacts. We found that acute injuries requiring ED presentation occur at a rate of approximately 0.17 per 1000 athlete-exposures (95% CI: 0.12–0.22. The secondary survey was completed by 54% of potential respondents. Of survey respondents, 41.3% attributed their fall to a lack of proper footwear and 73.5% of respondents agreed with mandatory sport-specific footwear as a prevention strategy, but only 8% agreed with mandatory helmet wear. Conclusions: Although curling injuries requiring medical care are not common, head injuries make up a large proportion. Mandated use of appropriate footwear appears to be the most effective prevention strategy, as well as the measure deemed most acceptable by players.

Proper time axis of a closed relativistic system

International Nuclear Information System (INIS)

Chernikov, N.A.; Fadeev, N.G.; Shavokhina, N.S.

1997-01-01

The definition of a proper time axis of a closed relativistic system of colliding particles is given. The solution of the proper time axis problem is presented. If the light velocity c equals the imaginary unit i, then in the case of a plane motion of the system the problem about the proper time axis turns out to be equivalent to the known in engineering mechanics problem about the reduction of any system of forces, applied to a rigid body, to the dynamic screw. In the general case, when c=i, the problem about the proper time axis turns out to be equivalent to the problem about the reduction to the dynamic screw of a system of forces, applied to a rigid body in a four-dimensional Euclidean space

Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

NARCIS (Netherlands)

Smet, A.M. de; Kluytmans, J.A.; Blok, H.E.; Mascini, E.M.; Benus, R.F.; Bernards, A.T.; Kuijper, E.J.; Leverstein-van Hall, M.A.; Jansz, A.R.; Jongh, B.M. de; Asselt, G.J. van; Frenay, I.H.; Thijsen, S.F.; Conijn, S.N.; Kaan, J.A.; Arends, J.P.; Sturm, P.D.J.; Bootsma, M.C.; Bonten, M.J.

2011-01-01

BACKGROUND: Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for

[Basic therapeutics : What are the features of modern personal care products to protect and regenerate the skin barrier?

Science.gov (United States)

Daniels, R

2017-11-01

It is international consensus that the daily use of properly selected products for the maintenance therapy is a must in the adjuvant treatment of most chronic skin diseases. In a first step, the selection of an adequate product can be guided by the classical triangle of the dermal vehicles. However, modern skin care products use diverse excipients, e. g. emulsifiers and viscosity enhancers, to improve the galenical and haptic properties of the formulations. It is thus no longer sufficient to simply have knowledge about the oil and water content of a cream in order to make a proper selection. A very positive effect on the skin barrier can be achieved using biomimetic lipids which can be incorporated into the epidermal lipid barrier. The application of such products as a foam cream is the most convenient way especially favorable when inflamed or hardly accessible skin areas have to be treated.

Management of common eye conditions in a primary health care ...

African Journals Online (AJOL)

treated by properly trained middle cadre eye health worker working with simple diagnostic tools in a primary health care setting or by referring to secondary care in a timely ... Personal and environmental hygiene: (regular hand and face washing, proper disposal of garbage, human and animal waste and maintenance of a.

Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units : an open-label, clustered group-randomised, crossover study

NARCIS (Netherlands)

de Smet, Anne Marie G. A.; Kluytmans, Jan A. J. W.; Blok, Hetty E. M.; Mascini, Ellen M.; Benus, Robin F. J.; Bernards, Alexandra T.; Kuijper, Ed J.; Leverstein-van Hall, Maurine A.; Jansz, Arjan R.; de Jongh, Bartelt M.; van Asselt, Gerard J.; Frenay, Ine H. M. E.; Thijsen, Steven F. T.; Conijn, Simon N. M.; Kaan, Jan A.; Arends, Jan P.; Sturm, Patrick D. J.; Bootsma, Martin C. J.; Bonten, Marc J. M.

Background Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for prevention

Comparison of Cardiovascular Risk Screening Methods and Mortality Data among Hungarian Primary Care Population: Preliminary Results of the First Government-Financed Managed Care Program.

Science.gov (United States)

Móczár, Csaba; Rurik, Imre

2015-09-01

Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the characteristics of individual primary care practices and doctors' screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.

FACTORS THAT INFLUENCE THE SELECTION OF LEARNING OPPORTUNITIES FOR STUDENT NURSES IN PRIMARY HEALTH CARE

Directory of Open Access Journals (Sweden)

H. lita

2002-11-01

The study therefore focused on the following objective: To identify the factors that influence the selection of learning opportunities for primary health care in hospital units. A qualitative research design utilising focus group discussions were used. The population consisted of conveniently selected lecturers, student nurses and registered nurses. The same initial question was asked in each focus group to initiate the discussions. The data were analysed according to Tesch's method. The results indicated that there is positive commitment from the lecturers and registered nurses to be involved in selecting appropriate learning opportunities. The student nurses also demonstrated a willingness to learn and to be exposed to learning opportunities in primary health care. There were however certain constraints that emerged as themes, namely: • Managerial constraints • Educational constraints Under the theme "managerial constraints" categories such as workload, nursing staff shortages and communication problems were identified. Under the theme "educational constraints" categories such as a lack of guidance, and the correlation of theory and practice emerged. Recommendations based on this research report include improvement of in-service education on managerial and educational aspects to facilitate the primary health care approach in hospitals.

TOWARDS PROPER CULTURAL RESOURCE MANAGEMENT ...

African Journals Online (AJOL)

GRACE

proper harnessing and management of cultural resources in Nigeria for sustainable development .... and knowledge) to organize the resources available to man with the aim of optimizing their use in the ... needs‖ (World Bank 1992). Thus, as ...

Proper Islamic Consumption

DEFF Research Database (Denmark)

Fischer, Johan

mobile, religiously committed communities to the opportunities and perils presented by modernisation. It also tells us something about the debates concerning the meanings and practices of Islam within an aggressive, globalised, secularised modernity. In Malaysia this is an especially intriguing issue...... spite of a long line of social theory analyzing the spiritual in the economic, and vice versa, very little of the recent increase in scholarship on Islam addresses its relationship with capitalism. Johan Fischer’s book,Proper Islamic Consumption, begins to fill this gap. […] Fischer’s detailed...

Cotranslational protein folding reveals the selective use of ...

Indian Academy of Sciences (India)

to fold properly by decelerating the translation rate at these sites. Thus the cotranslational protein folding is believed to be true for many proteins and is an important selection factor for the selective codon usage to optimize proper gene expres- sion and function (Komar 2009). A web server CS and S has been created by ...

Developing a Strong Direct Care Workforce.

Science.gov (United States)

Stear, Lynda A

The aging population of the United States has led to a need for more direct care workers to provide personal care to older adults and disabled people in their homes. The U.S. Bureau of Labor Statistics predicts employment of paraprofessionals in home care will grow 49% between 2012 and 2022 as the baby boomer generation ages and requires more assistance in activities of daily living. The typical direct care worker is a female aged 25 to 54 years old, a demographic that is projected to remain flat in the coming years. Direct care workers typically are poorly paid for work that is labor-intensive and often work in less than optimal working conditions. It is important that agencies hiring direct care workers understand the challenges these workers face and institute sound hiring practices and provide proper training and ongoing supervision. It is possible to have a quality direct care team. Proper training, role modeling, and supervision will improve employee satisfaction, decrease turnover, and improve care outcomes for patients.

Inviting parents to take part in paediatric palliative care research: a mixed-methods examination of selection bias.

Science.gov (United States)

Crocker, Joanna C; Beecham, Emma; Kelly, Paula; Dinsdale, Andrew P; Hemsley, June; Jones, Louise; Bluebond-Langner, Myra

2015-03-01

Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents' experiences of advance care planning (ACP). We examined differences between eligible families invited and not invited to participate by clinicians using (1) field notes of discussions with clinicians during the invitation phase and (2) anonymised information from the service's clinical database. Families were eligible for the ACP study if their child was receiving care from a UK-based tertiary palliative care service (Group A; N = 519) or had died 6-10 months previously having received care from the service (Group B; N = 73). Rates of non-invitation to the ACP study were high. A total of 28 (5.4%) Group A families and 21 (28.8%) Group B families (p research findings. Non-invitation and selection bias should be considered, assessed and reported in palliative care studies. © The Author(s) 2014.

INTERNAL PROPER MOTIONS IN THE ESKIMO NEBULA

International Nuclear Information System (INIS)

García-Díaz, Ma. T.; Gutiérrez, L.; Steffen, W.; López, J. A.; Beckman, J.

2015-01-01

We present measurements of internal proper motions at more than 500 positions of NGC 2392, the Eskimo Nebula, based on images acquired with WFPC2 on board the Hubble Space Telescope at two epochs separated by 7.695 yr. Comparisons of the two observations clearly show the expansion of the nebula. We measured the amplitude and direction of the motion of local structures in the nebula by determining their relative shift during that interval. In order to assess the potential uncertainties in the determination of proper motions in this object, in general, the measurements were performed using two different methods, used previously in the literature. We compare the results from the two methods, and to perform the scientific analysis of the results we choose one, the cross-correlation method, because it is more reliable. We go on to perform a ''criss-cross'' mapping analysis on the proper motion vectors, which helps in the interpretation of the velocity pattern. By combining our results of the proper motions with radial velocity measurements obtained from high resolution spectroscopic observations, and employing an existing 3D model, we estimate the distance to the nebula to be 1.3 kpc

INTERNAL PROPER MOTIONS IN THE ESKIMO NEBULA

Energy Technology Data Exchange (ETDEWEB)

García-Díaz, Ma. T.; Gutiérrez, L.; Steffen, W.; López, J. A. [Instituto de Astronomía, Universidad Nacional Autónoma de México, Km 103 Carretera Tijuana-Ensenada, 22860 Ensenada, B.C. (Mexico); Beckman, J., E-mail: tere@astro.unam.mx, E-mail: leonel@astro.unam.mx, E-mail: wsteffen@astro.unam.mx, E-mail: jal@astro.unam.mx, E-mail: jeb@iac.es [Instituto de Astrofísica de Canarias, La Laguna, Tenerife (Spain)

2015-01-10

We present measurements of internal proper motions at more than 500 positions of NGC 2392, the Eskimo Nebula, based on images acquired with WFPC2 on board the Hubble Space Telescope at two epochs separated by 7.695 yr. Comparisons of the two observations clearly show the expansion of the nebula. We measured the amplitude and direction of the motion of local structures in the nebula by determining their relative shift during that interval. In order to assess the potential uncertainties in the determination of proper motions in this object, in general, the measurements were performed using two different methods, used previously in the literature. We compare the results from the two methods, and to perform the scientific analysis of the results we choose one, the cross-correlation method, because it is more reliable. We go on to perform a ''criss-cross'' mapping analysis on the proper motion vectors, which helps in the interpretation of the velocity pattern. By combining our results of the proper motions with radial velocity measurements obtained from high resolution spectroscopic observations, and employing an existing 3D model, we estimate the distance to the nebula to be 1.3 kpc.

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities.

Science.gov (United States)

Daneman, Nick; Campitelli, Michael A; Giannakeas, Vasily; Morris, Andrew M; Bell, Chaim M; Maxwell, Colleen J; Jeffs, Lianne; Austin, Peter C; Bronskill, Susan E

2017-06-26

Understanding the extent to which current antibiotic prescribing behaviour is influenced by clinicians' historical patterns of practice will help target interventions to optimize antibiotic use in long-term care. Our objective was to evaluate whether clinicians' historical prescribing behaviours influence the start, prolongation and class selection for treatment with antibiotics in residents of long-term care facilities. We conducted a retrospective cohort study of all physicians who prescribed to residents in long-term care facilities in Ontario between Jan. 1 and Dec. 31, 2014. We examined variability in antibiotic prescribing among physicians for 3 measures: start of treatment with antibiotics, use of prolonged durations exceeding 7 days and selection of fluoroquinolones. Funnel plots with control limits were used to determine the extent of variation and characterize physicians as extreme low, low, average, high and extreme high prescribers for each tendency. Multivariable logistic regression was used to assess whether a clinician's prescribing tendency in the previous year predicted current prescribing patterns, after accounting for residents' demographics, comorbidity, functional status and indwelling devices. Among 1695 long-term care physicians, who prescribed for 93 132 residents, there was wide variability in the start of antibiotic treatment (median 45% of patients, interquartile range [IQR] 32%-55%), use of prolonged treatment durations (median 30% of antibiotic prescriptions, IQR 19%-46%) and selection of fluoroquinolones (median 27% of antibiotic prescriptions, IQR 18%-37%). Prescribing tendencies for antibiotics by physicians in 2014 correlated strongly with tendencies in the previous year. After controlling for individual resident characteristics, prior prescribing tendency was a significant predictor of current practice. Physicians prescribing antibiotics exhibited individual, measurable and historical tendencies toward start of antibiotic treatment

Proper laboratory notebook practices: protecting your intellectual property.

Science.gov (United States)

Nickla, Jason T; Boehm, Matthew B

2011-03-01

A laboratory notebook contains a wealth of knowledge that can be critical for establishing evidence in support of intellectual property rights and for refuting claims of research misconduct. The proper type, organization, use, maintenance, and storage of laboratory notebooks should be a priority for everyone at research institutions. Failure to properly document research activities can lead to serious problems, including the loss of valuable patent rights. Consequences of improper laboratory notebook practices can be harsh; numerous examples are described in court cases and journal articles, indicating a need for research institutions to develop strict policies on the proper use and storage of research documentation.

Comparison of Methods of Teaching Children Proper Lifting ...

African Journals Online (AJOL)

Objective: This study was designed to determine the effects of three teaching methods on children\\'s ability to demonstrate and recall their mastery of proper lifting techniques. Method: Ninety-three primary five and six public school children who had no knowledge of proper lifting technique were assigned into three equal ...

Evaluation of Student Care Process in Urban and Rural Health Care Centers and Health House in Tabriz Using Tracer Methodology

Directory of Open Access Journals (Sweden)

Neda Kabiri

2015-08-01

Full Text Available Background and Objectives : Tracer methodology is a novel evaluation method which its purpose is to provide an accurate assessment of systems and processes for the delivery of care, treatment, and services at a health care organization. This study aimed to assess student care process in Tabriz using Tracer methodology. Material and Methods : This cross-sectional study was conducted in autumn 1391. Population study consisted of all the students who were covered by Tabriz health care center and study sample included an urban health care center, a rural health care center, a health house, and two schools in urban and rural areas which were selected by simple sampling method. Also, all the complicated and problematic processes were chosen to be assessed. Data were collected by interviewing, observing, and surveying documents and were compared with current standards. Results : The results of this study declared the percentage of points that each target group gained from tracer evaluation in student care process was 77% in health house, 90% in rural health care center and 83% in urban health care center. Findings indicated that documentation was the main weak point. Conclusion : According to the results of this study, student care process is sufficient; despite the fact that there are some deficiencies in caring process, as it may be improved through appropriate strategies. Furthermore, tracer methodology seems to be a proper method to evaluate various levels of health care system. ​

Customer Quality during Prenatal Care in Health Care Centers in Tabriz City

Directory of Open Access Journals (Sweden)

Jafar Sadegh Tabrizi

2015-07-01

Full Text Available Background and Objectives :  Customer Quality (CQ refers to customer’s characteristics and is concerned with the knowledge, skills and confidence of health services customers who actively participate with health team in proper decision-making, appropriate activities and changing environment and health related behaviors. The purpose of this study was measuring customer quality of pregnant women during prenatal care. Materials and Methods :  This is a cross- sectional study which was conducted with the participation of 185 pregnant women who received prenatal care from urban health centers in Tabriz city. All participants were selected randomly from 40 health centers. Customer quality was measured based on CQMH-CQ questionnaire.  Questionnaire content validity was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0.714. Spss v.17 was used for data analysis. Results : According to the results, the mean score of customer quality among pregnant women was (11.29± 67.79   and only %14 of the participants reported the highest customer quality score and ability of continuity of care under stressful situations. There was a positive relationship between customer quality score and visiting midwife and a better evaluation of overall quality of care, but there was inverse relationship with early registration at health centers. Conclusion :  The participation of pregnant women in service delivery process and decision-making can promote costumer quality. Furthermore, training health care providers in empowering patients and using their abilities to improve quality of care and paying attention to patient-centered care will be helpful. ​

Decontamination of cephalosporin-resistant Enterobacteriaceae during selective digestive tract decontamination in intensive care units

NARCIS (Netherlands)

Oostdijk, E.A.; Smet, A.M. de; Kesecioglu, J.; Bonten, M.J.; Hoeven, J.G. van der; Pickkers, P.; Sturm, P.D.; Voss, A.; et al.,

2012-01-01

OBJECTIVES: Prevalences of cephalosporin-resistant Enterobacteriaceae are increasing globally, especially in intensive care units (ICUs). The effect of selective digestive tract decontamination (SDD) on the eradication of cephalosporin-resistant Enterobacteriaceae from the intestinal tract is

Comparative Evaluations of Randomly Selected Four Point-of-Care Glucometer Devices in Addis Ababa, Ethiopia.

Science.gov (United States)

Wolde, Mistire; Tarekegn, Getahun; Kebede, Tedla

2018-05-01

Point-of-care glucometer (PoCG) devices play a significant role in self-monitoring of the blood sugar level, particularly in the follow-up of high blood sugar therapeutic response. The aim of this study was to evaluate blood glucose test results performed with four randomly selected glucometers on diabetes and control subjects versus standard wet chemistry (hexokinase) methods in Addis Ababa, Ethiopia. A prospective cross-sectional study was conducted on randomly selected 200 study participants (100 participants with diabetes and 100 healthy controls). Four randomly selected PoCG devices (CareSens N, DIAVUE Prudential, On Call Extra, i-QARE DS-W) were evaluated against hexokinase method and ISO 15197:2003 and ISO 15197:2013 standards. The minimum and maximum blood sugar values were recorded by CareSens N (21 mg/dl) and hexokinase method (498.8 mg/dl), respectively. The mean sugar values of all PoCG devices except On Call Extra showed significant differences compared with the reference hexokinase method. Meanwhile, all four PoCG devices had strong positive relationship (>80%) with the reference method (hexokinase). On the other hand, none of the four PoCG devices fulfilled the minimum accuracy measurement set by ISO 15197:2003 and ISO 15197:2013 standards. In addition, the linear regression analysis revealed that all four selected PoCG overestimated the glucose concentrations. The overall evaluation of the selected four PoCG measurements were poorly correlated with standard reference method. Therefore, before introducing PoCG devices to the market, there should be a standardized evaluation platform for validation. Further similar large-scale studies on other PoCG devices also need to be undertaken.

The secret bread tests: selective primary health care or experimentation on human-beings?

Science.gov (United States)

Kamien, M

1987-01-01

This is a case history which describes an attempt to fortify the bread of Australian Aborigines in an isolated area of New South Wales. The medically successful intervention was accomplished by the publication of scientific enquiry and by attention to the culture of Aborigines. Paradoxically the long-term failure of the project was also due to the power of the written word and the neglect of the culture of the more densely populated and politically dominant white community. The need for doctors to be aware of the different approaches of primary health care and selective primary health care is stressed so that a general practitioner who provides health care for minority groups of the Fourth World can better define his role and relevance.

Decontamination of cephalosporin-resistant Enterobacteriaceae during selective digestive tract decontamination in intensive care units

NARCIS (Netherlands)

Oostdijk, Evelien A. N.; de Smet, Anne Marie G. A.; Kesecioglu, Jozef; Bonten, Marc J. M.

Prevalences of cephalosporin-resistant Enterobacteriaceae are increasing globally, especially in intensive care units (ICUs). The effect of selective digestive tract decontamination (SDD) on the eradication of cephalosporin-resistant Enterobacteriaceae from the intestinal tract is unknown. We

Determination of Proper Motions of Circumpolar Stars by Using Images from Ukrvo Plate Archives

Science.gov (United States)

Protsyuk, Yu.; Andruk, V.; Mazhaev, A.; Kovylianska, O.; Protsyuk, S.; Golovnya, V.

UkrVO plate archives contain informationobtained at different time periods and in different observatories for the same regions of the sky [3, 5, 6, 7, 8]. It allows us to carry out joint processing of plates and to receive new results for interesting objects. To obtain proper motions of stars in circumpolar areas, we selected 34 photographic plates from the RI NAO archive and 161 plates from the archive of the MAO NAS. A mean epoch difference between the plates from these archives is 55 years. Scanning of the plates and data processing were independently carried out by both observatories. A catalog of equatorial positions for 195 thousand stars up to 15m was compiled in the RI NAO (black dots in Fig. 1). A catalog of equatorial positions for 1050 thousand stars up to 16.5m was compiled in MAO (gray dots in Fig. 1). A comparison of positions for common stars contained in these catalogs was conducted. A catalog of proper motions for 30 thousand common stars up to 15m was compiled using these two input catalogs. The obtained result suggests the advisability of processing of all observations to receive proper motions of stars up to 14-15m in the declination zone of 65° to 90°.

Selected problems associated with the treatment and care for patients with colostomy - part 2.

Science.gov (United States)

Muzyczka, Katarzyna; Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

2013-01-01

Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and mastering them in practice is to provide ostomy patients not only with highest-standard care and help but also to prepare them for dealing with problems independently, i.e. for self-care.

Data re-arranging techniques leading to proper variable selections in high energy physics

Science.gov (United States)

Kůs, Václav; Bouř, Petr

2017-12-01

We introduce a new data based approach to homogeneity testing and variable selection carried out in high energy physics experiments, where one of the basic tasks is to test the homogeneity of weighted samples, mainly the Monte Carlo simulations (weighted) and real data measurements (unweighted). This technique is called ’data re-arranging’ and it enables variable selection performed by means of the classical statistical homogeneity tests such as Kolmogorov-Smirnov, Anderson-Darling, or Pearson’s chi-square divergence test. P-values of our variants of homogeneity tests are investigated and the empirical verification through 46 dimensional high energy particle physics data sets is accomplished under newly proposed (equiprobable) quantile binning. Particularly, the procedure of homogeneity testing is applied to re-arranged Monte Carlo samples and real DATA sets measured at the particle accelerator Tevatron in Fermilab at DØ experiment originating from top-antitop quark pair production in two decay channels (electron, muon) with 2, 3, or 4+ jets detected. Finally, the variable selections in the electron and muon channels induced by the re-arranging procedure for homogeneity testing are provided for Tevatron top-antitop quark data sets.

Indwelling catheter care

Science.gov (United States)

Foley catheter ... You will need to make sure your indwelling catheter is working properly. You will also need to ... not get an infection or skin irritation. Make catheter and skin care part of your daily routine. ...

The use of the waiting list in a fair selection of patients for nursing home care

NARCIS (Netherlands)

Meiland, F. J.; Danse, J. A.; Hoos, A. M.; Wendte, J. F.; Gunning-Schepers, L. J.

1996-01-01

When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was

Smarandachely Adjacent-Vertex-Distinguishing Proper Edge Chromatic Number of Cm∨Kn

OpenAIRE

Shunqin Liu

2016-01-01

According to different conditions, researchers have defined a great deal of coloring problems and the corresponding chromatic numbers. Such as, adjacent-vertex-distinguishing total chromatic number, adjacent-vertex-distinguishing proper edge chromatic number, smarandachely-adjacent-vertex-distinguishing proper edge chromatic number, smarandachely-adjacent-vertex-distinguishing proper total chromatic number. And we focus on the smarandachely adjacent-vertex-distinguishing proper edge chromatic...

Taking good care of myself: a qualitative study on self-care behavior among Chinese persons with a permanent colostomy.

Science.gov (United States)

Tao, Hui; Songwathana, Praneed; Isaramalai, Sang-arun; Wang, Qingxi

2014-12-01

In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral obligation of family members, while self-care is only the basis of fulfilling filial piety. This qualitative study aims to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a university hospital in southwest China were analyzed using content analysis. Informants' self-care behavior was characterized by "taking good care of myself," which underlined individuals' efforts to manage colostomy-related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that informants' self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design a culturally appropriate care plan to improve self-care behavior and proper family caregiving. © 2014 Wiley Publishing Asia Pty Ltd.

Chemically Dissected Rotation Curves of the Galactic Bulge from Main-sequence Proper Motions

Science.gov (United States)

Clarkson, William I.; Calamida, Annalisa; Sahu, Kailash C.; Brown, Thomas M.; Gennaro, Mario; Avila, Roberto J.; Valenti, Jeff; Debattista, Victor P.; Rich, R. Michael; Minniti, Dante; Zoccali, Manuela; Aufdemberge, Emily R.

2018-05-01

We report results from an exploratory study implementing a new probe of Galactic evolution using archival Hubble Space Telescope imaging observations. Precise proper motions are combined with photometric relative metallicity and temperature indices, to produce the proper-motion rotation curves of the Galactic bulge separately for metal-poor and metal-rich main-sequence samples. This provides a “pencil-beam” complement to large-scale wide-field surveys, which to date have focused on the more traditional bright giant branch tracers. We find strong evidence that the Galactic bulge rotation curves drawn from “metal-rich” and “metal-poor” samples are indeed discrepant. The “metal-rich” sample shows greater rotation amplitude and a steeper gradient against line-of-sight distance, as well as possibly a stronger central concentration along the line of sight. This may represent a new detection of differing orbital anisotropy between metal-rich and metal-poor bulge objects. We also investigate selection effects that would be implied for the longitudinal proper-motion cut often used to isolate a “pure-bulge” sample. Extensive investigation of synthetic stellar populations suggests that instrumental and observational artifacts are unlikely to account for the observed rotation curve differences. Thus, proper-motion-based rotation curves can be used to probe chemodynamical correlations for main-sequence tracer stars, which are orders of magnitude more numerous in the Galactic bulge than the bright giant branch tracers. We discuss briefly the prospect of using this new tool to constrain detailed models of Galactic formation and evolution. Based on observations made with the NASA/ESA Hubble Space Telescope and obtained from the data archive at the Space Telescope Science Institute. STScI is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555.

Transformation management of primary health care services in two selected local authorities in Gauteng

Directory of Open Access Journals (Sweden)

W Sibaya

2000-09-01

Full Text Available The transformation of health services in South Africa today is governed by the political, policy and legislative frameworks. This article focuses on the transformation of a primary health care service within a local authority in Gauteng. The purpose with this article is to explore and describe the perceptions (expectations and fears of selected managers employed in this primary health care service. The results are utilised to compile a strategy (framework for transformation management and leadership within the primary health care service. A qualitative research design was utilised and the data was collected by means of individual interviews with selected managers in the service, followed by a content analysis. The expectations and fears of managers focus mainly on personnel matters, community participation/satisfaction, salaries and parity, inadequate stocks/supplies and medication, the deterioration of quality service delivery and the need for training and empowerment. These results are divided into structure, process and outcome dimensions and are embodied in the conceptual framework for the transformation and leadership strategy. It is recommended that standards for transformation management be formulated and that the quality of transformation management be evaluated accordingly.

Nurses’ Burnout in Oncology Hospital Critical Care Unit

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Yeliz İrem Tunçel

2014-08-01

Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

The Southern Proper Motion Program. IV. The SPM4 Catalog

Science.gov (United States)

Girard, Terrence M.; van Altena, William F.; Zacharias, Norbert; Vieira, Katherine; Casetti-Dinescu, Dana I.; Castillo, Danilo; Herrera, David; Lee, Young Sun; Beers, Timothy C.; Monet, David G.; López, Carlos E.

2011-07-01

We present the fourth installment of the Yale/San Juan Southern Proper Motion Catalog, SPM4. The SPM4 contains absolute proper motions, celestial coordinates, and B, V photometry for over 103 million stars and galaxies between the south celestial pole and -20° declination. The catalog is roughly complete to V = 17.5 and is based on photographic and CCD observations taken with the Yale Southern Observatory's double astrograph at Cesco Observatory in El Leoncito, Argentina. The proper-motion precision, for well-measured stars, is estimated to be 2-3 mas yr-1, depending on the type of second-epoch material. At the bright end, proper motions are on the International Celestial Reference System by way of Hipparcos Catalog stars, while the faint end is anchored to the inertial system using external galaxies. Systematic uncertainties in the absolute proper motions are on the order of 1 mas yr-1.

Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator

National Research Council Canada - National Science Library

Gallagher, Brian; Cen, Liyi; Hannan, Edward L

2005-01-01

Objective: Evaluate the Agency for Healthcare Research and Quality's Patient Safety Indicator that identifies patients with selected infections that result from medical care during hospital inpatient treatment...

Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

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Soma Hewa

2011-12-01

Full Text Available This paper argues that the health unit program developed in Sri Lanka in the early twentieth century was an earlier model of selective primary health care promoted by the Rockefeller Foundation in the 1980s in opposition to comprehensive primary health care advocated by the Alma-Ata Declaration of the World Health Organization. A key strategy of the health unit program was to identify the most common and serious infectious diseases in each health unit area and control them through improved sanitation, health education, immunization and treatment with the help of local communities. The health unit program was later introduced to other countries in South and Southeast Asia as part of the Rockefeller Foundation's global campaign to promote public health.

What can Gaia proper motions tell us about Milky Way dwarf galaxies?

NARCIS (Netherlands)

Jin, S.; Helmi, A.; Breddels, M.

We present a proper-motion study on models of the dwarf spheroidal galaxy Sculptor, based on the predicted proper-motion accuracy of Gaia measurements. Gaia will measure proper motions of several hundreds of stars for a Sculptor-like system. Even with an uncertainty on the proper motion of order 1.5

Selected problems associated with the treatment and care for patients with colostomy – part 2

Science.gov (United States)

Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

2013-01-01

Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and mastering them in practice is to provide ostomy patients not only with highest-standard care and help but also to prepare them for dealing with problems independently, i.e. for self-care. PMID:24596509

5 CFR 2635.205 - Proper disposition of prohibited gifts.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Proper disposition of prohibited gifts... STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH Gifts From Outside Sources § 2635.205 Proper disposition of prohibited gifts. (a) An employee who has received a gift that cannot be accepted...

The VMC survey. XXX. Stellar proper motions in the central parts of the Small Magellanic Cloud

Science.gov (United States)

Niederhofer, F.; Cioni, M.-R. L.; Rubele, S.; Schmidt, T.; Bekki, K.; Grijs, R. de; Emerson, J.; Ivanov, V. D.; Marconi, M.; Oliveira, J. M.; Petr-Gotzens, M. G.; Ripepi, V.; van Loon, J. Th.; Zaggia, S.

2018-05-01

We present the first spatially resolved map of stellar proper motions within the central ( 3.1 × 2.4 kpc) regions of the Small Magellanic Cloud (SMC). The data used for this study encompasses four tiles from the ongoing near-infrared VISTA survey of the Magellanic Clouds system and covers a total contiguous area on the sky of 6.81 deg2. Proper motions have been calculated independently in two dimensions from the spatial offsets in the Ks filter over time baselines between 22 and 27 months. The reflex motions of approximately 33 000 background galaxies are used to calibrate the stellar motions to an absolute scale. The resulting catalog is composed of more than 690 000 stars which have been selected based on their position in the (J - Ks, Ks) color-magnitude diagram. For the median absolute proper motion of the SMC, we find (μαcos(δ), μδ) = (1.087 ± 0.192 (sys.) ± 0.003 (stat.), -1.187 ± 0.008 (sys.) ± 0.003 (stat.)) mas yr-1, consistent with previous studies. Mapping the proper motions as a function of position within the SMC reveals a nonuniform velocity pattern indicative of a tidal feature behind the main body of the SMC and a flow of stars in the south-east moving predominantly along the line-of-sight. Based on observations made with VISTA at the Paranal Observatory under program ID 179.B-2003.

Thyroid Lobectomy Is Associated with Excellent Clinical Outcomes in Properly Selected Differentiated Thyroid Cancer Patients with Primary Tumors Greater Than 1 cm

Science.gov (United States)

Vaisman, Fernanda; Momesso, Denise; Bulzico, Daniel A.; Pessoa, Cencita H. C. N.; da Cruz, Manuel Domingos Gonçalves; Dias, Fernando; Corbo, Rossana; Vaisman, Mario; Tuttle, R. Michael

2013-01-01

Background and Objective. An individualized risk-based approach to the treatment of thyroid cancer is being extensively discussed in the recent literature. However, controversies about the ideal surgical approach remain an important issue with regard to the impact on prognosis and follow-up strategies. This study was designed to describe clinical outcomes in a cohort of low and intermediate risk thyroid cancer patients treated with thyroid lobectomy. Methods. Retrospective review of 70 patients who underwent lobectomy. Results. After a median follow-up of 11 years, 5 patients (5/70, 7.1%) recurred and 5 had a completion for benign lesions, while 60 patients (86%) continued to be observed without evidence for disease recurrence. Suspicious ultrasound findings were significantly more common in patients that had structural disease recurrence (100% versus 4.3%, P < 0.001). Furthermore, a rising suppressed Tg value over time was also associated with structural disease recurrence (80% versus 21.5%, P = 0.01). After additional therapy, 99% of the patients had no evidence of disease. Conclusions. Properly selected thyroid cancer patients can be treated with lobectomy with excellent clinical outcomes. PMID:24455413

Thyroid Lobectomy Is Associated with Excellent Clinical Outcomes in Properly Selected Differentiated Thyroid Cancer Patients with Primary Tumors Greater Than 1 cm

Directory of Open Access Journals (Sweden)

Fernanda Vaisman

2013-01-01

Full Text Available Background and Objective. An individualized risk-based approach to the treatment of thyroid cancer is being extensively discussed in the recent literature. However, controversies about the ideal surgical approach remain an important issue with regard to the impact on prognosis and follow-up strategies. This study was designed to describe clinical outcomes in a cohort of low and intermediate risk thyroid cancer patients treated with thyroid lobectomy. Methods. Retrospective review of 70 patients who underwent lobectomy. Results. After a median follow-up of 11 years, 5 patients (5/70, 7.1% recurred and 5 had a completion for benign lesions, while 60 patients (86% continued to be observed without evidence for disease recurrence. Suspicious ultrasound findings were significantly more common in patients that had structural disease recurrence (100% versus 4.3%, P<0.001. Furthermore, a rising suppressed Tg value over time was also associated with structural disease recurrence (80% versus 21.5%, P=0.01. After additional therapy, 99% of the patients had no evidence of disease. Conclusions. Properly selected thyroid cancer patients can be treated with lobectomy with excellent clinical outcomes.

Developing Proper Systems for Successful Cloud Computing Implementation Using Fuzzy ARAS Method (Case Study: University of Tehran Faculty of New Science and Technology

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Jalil Heidaryd Dahooie

2017-12-01

Full Text Available Given the increasing requirements of communication and the need for advanced network-based technologies, cloud computing has been suggested as a perfect strategy to achieve these objectives. Yet, despite the development of computing applications and the increased number of alternatives, it is quite a difficult task to select the exact software platform for the implementation of cloud computing arrangements. In this line, the present paper aimed to develop a scientific framework as how to select the proper software for successful cloud computing implantation at the infrastructure level. First through a review on the related literature and using experts’ opinions, the software selection criteria were extracted. Based on the framework proposed here, the interval-valued fuzzy ARAS method was then employed for weighting and prioritizing specified alternatives. This model was applied by the Faculty of New Sciences and Technologies of Tehran University in order to select proper software platforms from among five alternatives. The results revealed that the OpenStack cloud operating system has been selected as the best alternative, most probably because this platform demonstrates significant achievement for its merits such as high level of performance, reliability and security, stability, and usability.

Characterizations of proper actions

Science.gov (United States)

Biller, Harald

2004-03-01

Three kinds of proper actions of increasing strength are defined. We prove that the three definitions specialize to the definitions by Bourbaki, by Palais and by Baum, Connes and Higson in their respective settings. The third of these, which thus turns out to be the strongest, originally only concerns actions of second countable locally compact groups on metrizable spaces. In this situation, it is shown to coincide with the other two definitions if the total space locally has the Lindelöf property and the orbit space is regular.

Asteroid proper elements from an analytical second order theory

International Nuclear Information System (INIS)

Knezevic, Z.; Milani, A.

1989-01-01

The authors have computed by a fully analytical method a new set of proper elements for 3322 numbered main-belt asteroids. They are presented in the following format: asteroid number, proper semimajor axis (AU), proper eccentricity, sine of proper inclination and quality code (see below). This new set is significantly more accurate than all the previous ones at low to moderate eccentricities and inclinations, and especially near the main mean-motion resonances (e.g., the Themis region). This is because the short periodic perturbations are rigorously removed, and the main effects of the second-order (containing the square of the ratio [the mass of Jupiter/mass of the Sun]) are accounted for. Effects arising from the terms in the Hamiltonian of degree up to four in the eccentricity and inclination of both the asteroid and Jupiter are taken into account, and the fundamental frequencies g (for the perihelion) and s(for the node) of the asteroid are computed with a interative algorithm consistent with the basic results of modern dynamics (e.g., Kolmogorov-Arnold-Moser theory)

Standard guidelines of care for vitiligo surgery

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Parsad Davinder

2008-03-01

Full Text Available Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. Physician′s qualifications: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. Facility: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. Indications for vitiligo surgery : Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. Preoperative counseling and Informed consent: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure

Application of theoretical and methodological components of nursing care

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Rosa del Socorro Morales-Aguilar

2016-12-01

Full Text Available Introduction: the theoretical and methodological components are the proper expertise in nursing, and it refers to models, theories, care process, taxonomy of nursing diagnoses, system of nursing intervention classification, and system of outcomes classification, which base nursing care into professional practice. Methodology: research was performed on Google Scholar, reviewing the databases of Scielo, Ciberindex, Index Enfermería, Dialnet, Redalyc, Medline, identifying 70 published articles between 2005-2015, and selecting 52 of them. The keywords used were: nurse care, nursing diagnostic, classification, nursing theory, in spanish and portuguese. Results: training students, receive knowledge in the nursing process, NANDA International, classification of the interventions, nurse results and theoretical components. The Dorothea Orem, Callista Roy, Nola Pender, Virginia Henderson, Florence Nightingale, and Betty Neuman theories are applied. The application of the nursing process is limited and low familiarity with the international taxonomy by nurse professionals in the assistance area is noticed. Conclusions: the challenge of nursing is to continue to solidify the scientific knowledge and to undo the gap between theory and practice.

Proper Sterol Distribution Is Required for Candida albicans Hyphal Formation and Virulence

Science.gov (United States)

McCourt, Paula; Liu, Hsing-Yin; Parker, Josie E.; Gallo-Ebert, Christina; Donigan, Melissa; Bata, Adam; Giordano, Caroline; Kelly, Steven L.; Nickels, Joseph T.

2016-01-01

Candida albicans is an opportunistic fungus responsible for the majority of systemic fungal infections. Multiple factors contribute to C. albicans pathogenicity. C. albicans strains lacking CaArv1 are avirulent. Arv1 has a conserved Arv1 homology domain (AHD) that has a zinc-binding domain containing two cysteine clusters. Here, we explored the role of the CaAHD and zinc-binding motif in CaArv1-dependent virulence. Overall, we found that the CaAHD was necessary but not sufficient for cells to be virulent, whereas the zinc-binding domain was essential, as Caarv1/Caarv1 cells expressing the full-length zinc-binding domain mutants, Caarv1C3S and Caarv1C28S, were avirulent. Phenotypically, we found a direct correlation between the avirulence of Caarv1/Caarv1, Caarrv1AHD, Caarv1C3S, and Caarv1C28S cells and defects in bud site selection, septa formation and localization, and hyphal formation and elongation. Importantly, all avirulent mutant strains lacked the ability to maintain proper sterol distribution. Overall, our results have established the importance of the AHD and zinc-binding domain in fungal invasion, and have correlated an avirulent phenotype with the inability to maintain proper sterol distribution. PMID:27587298

Proper Sterol Distribution Is Required for Candida albicans Hyphal Formation and Virulence

Directory of Open Access Journals (Sweden)

Paula McCourt

2016-11-01

Full Text Available Candida albicans is an opportunistic fungus responsible for the majority of systemic fungal infections. Multiple factors contribute to C. albicans pathogenicity. C. albicans strains lacking CaArv1 are avirulent. Arv1 has a conserved Arv1 homology domain (AHD that has a zinc-binding domain containing two cysteine clusters. Here, we explored the role of the CaAHD and zinc-binding motif in CaArv1-dependent virulence. Overall, we found that the CaAHD was necessary but not sufficient for cells to be virulent, whereas the zinc-binding domain was essential, as Caarv1/Caarv1 cells expressing the full-length zinc-binding domain mutants, Caarv1C3S and Caarv1C28S, were avirulent. Phenotypically, we found a direct correlation between the avirulence of Caarv1/Caarv1, Caarrv1AHD, Caarv1C3S, and Caarv1C28S cells and defects in bud site selection, septa formation and localization, and hyphal formation and elongation. Importantly, all avirulent mutant strains lacked the ability to maintain proper sterol distribution. Overall, our results have established the importance of the AHD and zinc-binding domain in fungal invasion, and have correlated an avirulent phenotype with the inability to maintain proper sterol distribution.

Selective mutism: a consensus based care pathway of good practice.

Science.gov (United States)

Keen, D V; Fonseca, S; Wintgens, A

2008-10-01

Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management. To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway. A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage. Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway. Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was

Selection Behavior in the Market for Private Complementary Long-term Care Insurance in Germany

DEFF Research Database (Denmark)

Bauer, Jan; Schiller, Jörg; Schreckenberger, Christopher

is dominating in this market, with respect to both the decision to buy a CompLTCI policy and the decision about the extent of CompLTCI coverage. We identify occupational status, residential location and the holding of further supplementary health insurance policies as unused observables contributing...... to selection effects in this market. Our results suggest that non-linearitiesin the relationship of potential sources of selection to insurance coverage and risk should be considered. A panel data analysis shows that an increase in health insurance payouts is positively correlated with the uptake of Comp......In this paper, we analyze selection effects in the German market for private complementary longterm care insurance contracts (CompLTCI) within a static and dynamic framework. Using data on more than 98,000 individuals from a German insurance company, we provide evidence that advantageous selection...

Kinematics of Local, High-Velocity K dwarfs in the SUPERBLINK Proper Motion Catalog

Science.gov (United States)

Kim, Bokyoung; Lepine, Sebastien

2018-01-01

We present a study of the kinematics of 345,480 K stars within 2 kpc of the Sun, based on data from the SUPERBLINK catalog of stars with high proper motions (> 40 mas/yr), combined with data from the 2MASS survey and from the first GAIA release, which together yields proper motions accurate to ~2 mas/yr. All K dwarfs were selected based on their G-K colors, and photometric distances were estimated from a re-calibrated color-magnitude relationship for K dwarfs. We plot transverse velocities VT in various directions on the sky, to examine the local distribution of K dwarfs in velocity space. We have also obtained radial velocity information for a subsample of 10,128 stars, from RAVE and SDSS DR12, which we use to construct spatial velocity (U, V, W) plots. About a third (123,350) of the stars are high-velocity K dwarfs, with motions consistent with the local Galactic halo population. Our kinematic analysis suggests that their velocity-space distribution is very uniform, and we find no evidence of substructure that might arise, e.g., from local streams or moving groups.

Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

Science.gov (United States)

Carrasco-Sanz, A; Leiva-Gea, I; Martin-Alvarez, L; Del Torso, S; van Esso, D; Hadjipanayis, A; Kadir, A; Ruiz-Canela, J; Perez-Gonzalez, O; Grossman, Z

2018-03-01

Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children. © 2017 John Wiley & Sons Ltd.

[An Integrative Review of Home Care Service for Pregnant Women, Mothers, Infants, and Toddlers in Vulnerable Group].

Science.gov (United States)

Kim, Dasom; Lee, Insook

2017-10-01

This study was intended to integrate the evidence of home care service intervention for mothers and children in vulnerable groups through an integrative literature review. We searched the MEDLINE (PubMED), EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, DBpia databases. The quality of the articles was assessed by one doctoral researcher and verified by one professor of community health nursing who had participated in the systematic review of literature. A framework was developed to identify the intervention patterns in the selected papers and categorize various elements. The extracted intervention elements were grouped into potential themes, which were verified by assessors on whether they clearly reflected the interventions in the papers. Among 878 searched papers, we selected 16 papers after excluding literature that does not satisfy the selection criteria and quality evaluation. The intervention elements of 16 selected papers were categorized into six themes. The extracted intervention elements were divided into the themes of Patient-specific/Situation-specific care planning and intervention, Emphasis on self care competency, Intense home visit by developmental milestone, Reinforcing and modeling mother-child attachment, Communication and interaction across the intervention, Linkage with community resource and multidisciplinary approach. As a result of the analysis of proper interventions of home care services for mothers and children in vulnerable groups, it was found that it is necessary to consider indispensable intervention elements that can standardize the quality of home care services, and conduct studies on developing intervention programs based on the elements. © 2017 Korean Society of Nursing Science

Thallium-201 myocardial imaging as a selection method for the coronary care unit

International Nuclear Information System (INIS)

Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Samson, G.; Schoot, J.B. van der

1980-01-01

In many patients admitted to the coronary care unit, the diagnosis of acute myocardial infarction is evident at the time of arrival at the hospital. Nevertheless, a substantial group of patients still remains in whom initial evaluation provides a questionable history and a nondiagnostic electrocardiogram. Results suggested that 201 Tl scintigraphy may have potential value to serve as an appropriate means of selecting patients for admission to the coronary care unit. In order to evaluate this possibility, the authors performed a prospective study from September 1975 to September 1976. During this period 1861 patients were refered to the coronary care unit because of presumed acute myocardial infarction. The study concludes that for patients in whom the history and the electrocardiogram are of little help in decision making, thallium-201 scintigraphy can be viewed as an additional and important diagnostic method, which improves efficient management of patients with potential coronary artery disease syndrome. (Auth.)

Social Media as a Platform for Information About Diabetes Foot Care: A Study of Facebook Groups.

Science.gov (United States)

Abedin, Tasnima; Al Mamun, Mohammad; Lasker, Mohammad A A; Ahmed, Syed Walid; Shommu, Nusrat; Rumana, Nahid; Turin, Tanvir C

2017-02-01

Diabetes is one of the most challenging chronic health conditions in the current era. Diabetes-related foot problems need proper patient education, and social media could a play role to disseminate proper information. A systematic search was performed on Facebook groups using the key words "diabetes foot care", "diabetes foot", "diabetes foot management" and "podiatric care". The search resulted in 57 groups and detailed activity information was collected from those groups. Usefulness of each relevant post was determined. Regression analysis was performed to explore the factors associated with the level of usefulness of diabetes foot care-related Facebook groups. Our search resulted in a total of 16 eligible diabetes foot care-related Facebook groups with a total of 103 eligible posts. The average number of group members for the selected groups were 265.75 with an interquartile range of 3.5-107.75. Of the total 103 timeline posts, 45.6% posts were categorized as useful, while the remaining posts were not useful. Top mentioned diabetes foot care practice was "Checking feet daily". Multivariable logistic regression analysis showed that the level of usefulness of diabetes foot care-related Facebook groups were significantly associated with the type of posts and no association was found with presence of "likes" and presence of comment. Facebook being a widely used social networking system, patient welfare organizations, doctors, nurses and podiatrists could use this platform to provide support to educating diabetes patients and their caregivers by disseminating useful and authentic knowledge and information related to diabetes foot care. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Dynamical systems of proper characteristic 0

International Nuclear Information System (INIS)

Ahmad, K.H.; Hamoui, A.

1991-07-01

Flows with orbits of proper characteristics 0 exhibit recurrent behaviour, a feature of basic importance in the description of their dynamics. Here, we analyze flows with such orbits relating them with recurrent flows and with flows that exhibit orbital, Poisson or Lagrange stability. (author). 11 refs

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers.

Science.gov (United States)

Mosca, Ilaria; van der Wees, Philip J; Mot, Esther S; Wammes, Joost J G; Jeurissen, Patrick P T

2016-08-17

The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU's European Semester. This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC

Selective digestive decontamination in patients in intensive care. The Dutch Working Group on Antibiotic Policy

NARCIS (Netherlands)

Bonten, M. J.; Kullberg, B. J.; van Dalen, R.; Girbes, A. R.; Hoepelman, I. M.; Hustinx, W.; van der Meer, J. W.; Speelman, P.; Stobberingh, E. E.; Verbrugh, H. A.; Verhoef, J.; Zwaveling, J. H.

2000-01-01

Selective digestive decontamination (SDD) is the most extensively studied method for the prevention of infection in patients in intensive care units (ICUs). Despite 27 prospective randomized studies and six meta-analyses, routine use of SDD is still controversial. In this review, we summarize the

Proper Antibiotic Use in a Home-Based Primary Care Population Treated for Urinary Tract Infections.

Science.gov (United States)

Gee, Megan E; Ford, James; Conway, Erin L; Ott, Michael C; Sellick, John A; Mergenhagen, Kari A

2018-02-01

To evaluate the trends associated with diagnosis and treatment of urinary tract infections (UTI) in a home-based primary care population of Veterans Health System patients from 2006 to 2015. Retrospective cohort study. Veterans Healthcare System. Home-based primary care patients treated for UTI from 2006 to 2015. None. Appropriate therapy was determined based on the McGeer criteria. Multivariate logistic regression was used to determine factors leading to appropriate UTI treatment. Of 366 available patients, 68 (18.6%) were tested for a UTI. Appropriate therapy occurred in 26% of patients. Allergy to any antibiotic increased the odds of appropriate treatment (odds ratio [OR] = 5.6, 95% confidence interval [CI] 1.5-23.2). Flank pain and increased urinary frequency also increased the likelihood of being treated appropriately (OR = 25.9, 95% CI 2.9-584.0 and OR = 4.49, 95% CI 0.99-21.2, respectively). Antibiotics were overused for treating UTIs in the homebound population. Patients with flank pain, increased urinary frequency, and antibiotic allergy were more likely to receive appropriate treatment. Pharmacists, therefore, have a viable opportunity to increase appropriate antibiotic prescribing in the home-based primary care population.

Critical Care Organizations: Building and Integrating Academic Programs.

Science.gov (United States)

Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir

2018-04-01

Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical

Investigating differences between proper and common nouns using novel word learning

Directory of Open Access Journals (Sweden)

Anastasiya Romanova

2014-04-01

Full Text Available Empirical studies have shown higher rates of tip-of-the-tongue states for proper nouns, in comparison to common nouns, in non-brain-damaged speakers (e.g., Valentine & Moore, 1995, and higher retrieval failure rates for proper nouns relative to common nouns in people with aphasia (e.g., Semenza, 2009. Some authors suggest the source of these differences lies in logical properties (e.g., Semenza, 2009. That is, common nouns refer to a category of beings or objects that share certain semantic properties, while proper nouns designate specific individual beings or objects with unique features. Other authors attribute the distinction in processing to a number of statistical properties that differ across common and proper nouns (Kay, Hanley, & Miles, 2001. The aims of the present study were: 1 to dissociate the effects of logical and statistical properties by using novel words with equal statistical properties; 2 to determine whether people with aphasia show disproportionate impairments in learning proper nouns relative to common nouns, compared to aged-matched subjects. Methods We tested young (n=16 and elderly (n=14 adult non-brain-damaged participants and people with aphasia (n=2. Items-to-be-learnt were given as representatives of an unknown species (n=10 in the common noun condition, or as individual creatures (n=10 in the proper noun condition. The experiment consisted of 5 sessions. Each session included a learning phase and a test phase with naming and word-picture verification tasks. Results and Discussion Preliminary analysis showed learning of both common and proper nouns for both younger (F(4=140.68, p<.01 and elderly (F(4=34.87, p<.01 non-brain-damaged participants, with learning being significantly better for the younger group (F(4=6.5, p<.01. Contrary to expectations, performance on proper nouns was better than that for common nouns for both young and elderly subjects (F(1=6.47, p=.02 and F(1=9.75, p<.01, respectively, possibly due to

Computation of Asteroid Proper Elements on the Grid

Science.gov (United States)

Novakovic, B.; Balaz, A.; Knezevic, Z.; Potocnik, M.

2009-12-01

A procedure of gridification of the computation of asteroid proper orbital elements is described. The need to speed up the time consuming computations and make them more efficient is justified by the large increase of observational data expected from the next generation all sky surveys. We give the basic notion of proper elements and of the contemporary theories and methods used to compute them for different populations of objects. Proper elements for nearly 70,000 asteroids are derived since the beginning of use of the Grid infrastructure for the purpose. The average time for the catalogs update is significantly shortened with respect to the time needed with stand-alone workstations. We also present basics of the Grid computing, the concepts of Grid middleware and its Workload management system. The practical steps we undertook to efficiently gridify our application are described in full detail. We present the results of a comprehensive testing of the performance of different Grid sites, and offer some practical conclusions based on the benchmark results and on our experience. Finally, we propose some possibilities for the future work.

Proper Names in Dialectal Idioms: Stages of Idiomatization

Directory of Open Access Journals (Sweden)

Ekaterina S. Kogan

2014-06-01

Full Text Available The article deals with the functioning of proper names (both personal and place names and their derivatives in dialectal idioms. Based upon the criteria of the establishing of the idiomatic status of word combinations, traditionally used in contemporary lexicology, the author marks out four stages of the entry of units containing proper names and their derivatives into a regional idiomatic inventory: 1 word combinations with figurative meanings and transparent motivation easily decoded by every member of the local community (e. g., naryaditsa kak Anisya Klimovskaya ‘to be slovenly dressed’; 2 word combinations with a proper name localizing a nationally known idiom (e. g., zhelninsky telyonok ‘screaming person’; 3 word combinations including a name with a general meaning (e. g., Masha s Yashey ‘two inseparable persons’; 4 idioms with non-transparent motivation (e. g., tutursky pop ‘cuckoo male’. The analyzed data are retrieved from dialect dictionaries (including those of idioms and notes made by the Ural Federal University Toponymic Expeditions in Kostroma Region in 2011–2013.

Fast algorithms for finding proper strategies in game trees

DEFF Research Database (Denmark)

Miltersen, Peter Bro; Sørensen, Troels Bjerre

2008-01-01

We show how to find a normal form proper equilibrium in behavior strategies of a given two-player zero-sum extensive form game with imperfect information but perfect recall. Our algorithm solves a finite sequence of linear programs and runs in polynomial time. For the case of a perfect information...... game, we show how to find a normal form proper equilibrium in linear time by a simple backwards induction procedure....

LocZ Is a New Cell Division Protein Involved in Proper Septum Placement in Streptococcus pneumoniae

Science.gov (United States)

Holečková, Nela; Molle, Virginie; Buriánková, Karolína; Benada, Oldřich; Kofroňová, Olga; Ulrych, Aleš; Branny, Pavel

2014-01-01

ABSTRACT How bacteria control proper septum placement at midcell, to guarantee the generation of identical daughter cells, is still largely unknown. Although different systems involved in the selection of the division site have been described in selected species, these do not appear to be widely conserved. Here, we report that LocZ (Spr0334), a newly identified cell division protein, is involved in proper septum placement in Streptococcus pneumoniae. We show that locZ is not essential but that its deletion results in cell division defects and shape deformation, causing cells to divide asymmetrically and generate unequally sized, occasionally anucleated, daughter cells. LocZ has a unique localization profile. It arrives early at midcell, before FtsZ and FtsA, and leaves the septum early, apparently moving along with the equatorial rings that mark the future division sites. Consistently, cells lacking LocZ also show misplacement of the Z-ring, suggesting that it could act as a positive regulator to determine septum placement. LocZ was identified as a substrate of the Ser/Thr protein kinase StkP, which regulates cell division in S. pneumoniae. Interestingly, homologues of LocZ are found only in streptococci, lactococci, and enterococci, indicating that this close phylogenetically related group of bacteria evolved a specific solution to spatially regulate cell division. PMID:25550321

Inviting parents to take part in paediatric palliative care research: A mixed-methods examination of selection bias

OpenAIRE

Crocker, Joanna C; Beecham, Emma; Kelly, Paula; Dinsdale, Andrew P; Hemsley, June; Jones, Louise; Bluebond-Langner, Myra

2015-01-01

Background: Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. Aim: To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents? experiences of advance care planning (ACP). Design: We examined differences between eligible families invited and not invited to participate by clinicians us...

Quality Improvement in Critical Care: Selection and Development of Quality Indicators

Science.gov (United States)

Martin, Claudio M.; Project, The Quality Improvement in Critical Care

2016-01-01

Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

Preventative foot care in people with diabetes: Quality patient ...

African Journals Online (AJOL)

Keywords: preventative foot care; diabetes; risk stratification: self care. Introduction ... diabetes is considered to be a key indicator of the quality of foot ... loss of protective sensation, the importance of foot monitoring on a daily basis, the proper ...

[Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].

Science.gov (United States)

Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María

2016-01-01

To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Multi-criteria decision analysis to select the optimum position and proper field of view of a photosensor

International Nuclear Information System (INIS)

Doulos, L.; Tsangrassoulis, A.; Topalis, F.V.

2014-01-01

Highlights: • A new methodology for the determination of proper FOV and position of a photosensor is proposed. • Model takes into account illuminance ratio, energy savings and lighting adequacy. • A multiple criteria decision method (ELECTRE) is used to estimate best solution. • A number of simulations were performed in order to clarify the calculation procedure. • An experimental procedure was performed in order to verify the simulation procedure. - Abstract: The lack of knowledge concerning the commissioning of a daylight responsive system constitutes a serious impediment to their widespread use. Furthermore, installation details and tools regarding their photosensor position and field of view (FOV) are insufficient. This paper presents a decision making method capable to estimate the best position of a photosensor on the ceiling and its proper FOV based on multiple criteria analysis. The criteria used are (a) the correlation of the lighting levels between the working plane and the ceiling, (b) the corresponding energy savings and (c) the lighting adequacy which is defined as the percentage for occupied time with total illuminance exceeding design illuminance (i.e 500 lux EN 12464-1, 2011) and is strongly affected by the control algorithm. A number of simulations with variable FOV and position of photosensors were performed in order to clarify the calculation procedure of the proposed methodology. Three different typical room geometries have been used with variable window sizes and orientation. Furthermore a prototype photosensor with variable FOV through the use of a telescopic cylinder was constructed and placed in a scale room (1:10) in order to verify the results of simulations. The verification was based on a set of experimental procedures concerning measurements of the spatial response of the prototype photosensor (for various FOVs) and measurements of ceiling/workplane illuminance inside the scaled room for various combinations of position and

The selection of disposition of precast concrete industrial building

Directory of Open Access Journals (Sweden)

Goleš Danica

2014-01-01

Full Text Available Design of precast concrete industrial building is a complex iterative procedure by which, from a set of known possible solutions, is found the one, that in optimal way meets the set requirements and limitations. By proper selection of the disposition of the building, number of possible solutions is reduced at an early stage of design. This paper presents the main requirements and limitations faced by the structure of precast concrete industrial building, as well as parameters that can be defined in dispositional solution: dimensions, orientation and position of the object, materials, structural system, geometric characteristics, foundation system, the way of decomposition of the structure to prefabricated elements, their bearings and connections, and others. Special emphasis is given to the proper selection of the parameters of disposition in function of set requirements and constraints. The work is intended for graduates and young engineers, to help them to properly systematize and apply the knowledge gained during education, and select the optimal dispositional solution the exact way.

The Importance Of Proper Evaluation Of The Geological Conditions For The Design Of Industrial Floor Subbase

Directory of Open Access Journals (Sweden)

Drusa Marián

2015-06-01

Full Text Available Nowadays many problems concerning industrial floors or floors in shopping centres occurred when local geological characterization is not adequately considered by structural designers, material selection is not evaluated properly and in time for future stability, or consolidation of soft organic subsoil laid in active zone is not taken into account during design evaluation. Similar problems occur when flooding effects on subbase layers cause a new settlement of the upper floor structure. Generally speaking, majority of these symptoms of floor damage have their origin in underestimation of the geotechnical risk. At some locations, the selection of support structure and material type is not adequate due to lack of experience and in order to offer the lowest price as a contractor.

Lived Experiences of the Caregivers of Infants about Family-Centered Care in the Neonatal Intensive Care Unit: A Phenomenological Study

Directory of Open Access Journals (Sweden)

Zahra Hadian Shirazi

2018-03-01

Conclusion: According the results, FCC is a dynamic care intervention, which is established through purposeful interactions between heterogeneous group members (professional and familial caregivers in order to achieve care goals and create balance in all caregivers. Moreover, the approach enables familial caregivers to play their role efficiently. Application of this comprehensive care requires the attention of healthcare policymakers and managers to provide the proper context for optimal care provision in the NICU.

20 CFR 658.415 - Transferring complaints to proper JS office.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Transferring complaints to proper JS office... Agency Js Complaint System § 658.415 Transferring complaints to proper JS office. (a) Where a JS-related... local office serving the area in which the employer is located. Where a JS-related complaint deals with...

The proper name as starting point for basic reading skills

NARCIS (Netherlands)

Both-De Vries, Anna C.; Bus, Adriana G

Does alphabetic-phonetic writing start with the proper name and how does the name affect reading and writing skills? Sixty 4- to 5(1/2)-year-old children from middle SES families with Dutch as their first language wrote their proper name and named letters. For each child we created unique sets of

Opening a Pandora's Box: Proper Names in English Phraseology

Directory of Open Access Journals (Sweden)

Pierini, Patrizia

2008-01-01

Full Text Available This article explores the linguistic-cultural aspects and usage of phraseological units involving personal and place names in English. The introductory sections outline the linguistic features of proper names and phraseological units. The qualitative part of this study provides a list of units belonging to four phraseological types (idioms, stereotyped similes, binomials, formulae, drawn from idiom dictionaries. An investigation of the sources of names shows that the personal and place names involved are historically, socially or culturally prominent in British culture. Here is noted a predominance of personal over place names, and within the former, a predominance of male over female names, and first names over family names, with a number of hypocorisms. The quantitative part of the study consists of a corpus search of the selected units in the British National Corpus in order to find their frequency and distribution across registers. The search reveals that they have very low levels of occurrence, and are more commonly used in written registers, in particular, in fiction, journalism and miscellaneous texts.

Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

Science.gov (United States)

Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

2018-01-01

Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

Directory of Open Access Journals (Sweden)

Tina M. Slusher

2018-03-01

Full Text Available Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

Child Care Practices and Its Effects to School Performance

Directory of Open Access Journals (Sweden)

Alfred Raymund C. Panopio

2017-05-01

Full Text Available This scholarly work aimed to determine the child care practices that have the potential in honing a child with good school performance. The result of the study led to the formulation of a model that typifies the good child care practices. Since children are on the accepting side, it is the way parents raise a nd rear them that will influence what they will be in the near future. The participants were selected as they are included in the top performing public schools in Batangas City , Philippines . The parents and teachers of the said child were the respondents to assess the ability of the child. A total of 215 students from grades 4 to 6 were selected as the target sample. Descriptive correlational design was utilized to determine the relationship between the child care practices and school performance. A self - made questionnaire was formulated and used face validity and content reliability to come up with the most appropriate instrument. Frequency distribution, weighted mean and chi square were th e statistical tests utilized to aid the analysis of data. Based on the result of the study, breastfeeding, proper hygiene, allowing the child to participate in family conversation and providing monetary allowance were among the practices that lead to child ren’s good school performance. Having knowledge on these practices will guide parents in giving their child a better and assured future, and eventually benefit their children as they become parents themselves.

HARMONIC DRIVE SELECTION

Directory of Open Access Journals (Sweden)

Piotr FOLĘGA

2014-03-01

Full Text Available The variety of types and sizes currently in production harmonic drive is a problem in their rational choice. Properly selected harmonic drive must meet certain requirements during operation, and achieve the anticipated service life. The paper discusses the problems associated with the selection of the harmonic drive. It also presents the algorithm correct choice of harmonic drive. The main objective of this study was to develop a computer program that allows the correct choice of harmonic drive by developed algorithm.

Computation of asteroid proper elements on the Grid

Directory of Open Access Journals (Sweden)

Novaković B.

2009-01-01

Full Text Available A procedure of gridification of the computation of asteroid proper orbital elements is described. The need to speed up the time consuming computations and make them more efficient is justified by the large increase of observational data expected from the next generation all sky surveys. We give the basic notion of proper elements and of the contemporary theories and methods used to compute them for different populations of objects. Proper elements for nearly 70,000 asteroids are derived since the beginning of use of the Grid infrastructure for the purpose. The average time for the catalogs update is significantly shortened with respect to the time needed with stand-alone workstations. We also present basics of the Grid computing, the concepts of Grid middleware and its Workload management system. The practical steps we undertook to efficiently gridify our application are described in full detail. We present the results of a comprehensive testing of the performance of different Grid sites, and offer some practical conclusions based on the benchmark results and on our experience. Finally, we propose some possibilities for the future work.

Computation of Asteroid Proper Elements on the Grid

Directory of Open Access Journals (Sweden)

Novaković, B.

2009-12-01

Full Text Available A procedure of gridification of the computation of asteroid proper orbital elements is described. The need to speed up the time consuming computations and make them more efficient is justified by the large increase of observational data expected from the next generation all sky surveys. We give the basic notion of proper elements and of the contemporary theories and methods used to compute them for different populations of objects. Proper elements for nearly 70,000 asteroids are derived since the beginning of use of the Grid infrastructure for the purpose. The average time for the catalogs update is significantly shortened with respect to the time needed with stand-alone workstations. We also present basics of the Grid computing, the concepts of Grid middleware and its Workload management system. The practical steps we undertook to efficiently gridify our application are described in full detail. We present the results of a comprehensive testing of the performance of different Grid sites, and offer some practical conclusions based on the benchmark results and on our experience. Finally, we propose some possibilities for the future work.

Secular Extragalactic Parallax and Geometric Distances with Gaia Proper Motions

Science.gov (United States)

Paine, Jennie; Darling, Jeremiah K.

2018-06-01

The motion of the Solar System with respect to the cosmic microwave background (CMB) rest frame creates a well measured dipole in the CMB, which corresponds to a linear solar velocity of about 78 AU/yr. This motion causes relatively nearby extragalactic objects to appear to move compared to more distant objects, an effect that can be measured in the proper motions of nearby galaxies. An object at 1 Mpc and perpendicular to the CMB apex will exhibit a secular parallax, observed as a proper motion, of 78 µas/yr. The relatively large peculiar motions of galaxies make the detection of secular parallax challenging for individual objects. Instead, a statistical parallax measurement can be made for a sample of objects with proper motions, where the global parallax signal is modeled as an E-mode dipole that diminishes linearly with distance. We present preliminary results of applying this model to a sample of nearby galaxies with Gaia proper motions to detect the statistical secular parallax signal. The statistical measurement can be used to calibrate the canonical cosmological “distance ladder.”

Boltzmann babies in the proper time measure

Energy Technology Data Exchange (ETDEWEB)

Bousso, Raphael; Bousso, Raphael; Freivogel, Ben; Yang, I-Sheng

2007-12-20

After commenting briefly on the role of the typicality assumption in science, we advocate a phenomenological approach to the cosmological measure problem. Like any other theory, a measure should be simple, general, well defined, and consistent with observation. This allows us to proceed by elimination. As an example, we consider the proper time cutoff on a geodesic congruence. It predicts that typical observers are quantum fluctuations in the early universe, or Boltzmann babies. We sharpen this well-known youngness problem by taking into account the expansion and open spatial geometry of pocket universes. Moreover, we relate the youngness problem directly to the probability distribution for observables, such as the temperature of the cosmic background radiation. We consider a number of modifications of the proper time measure, but find none that would make it compatible with observation.

Computing more proper covariances of energy dependent nuclear data

International Nuclear Information System (INIS)

Vanhanen, R.

2016-01-01

Highlights: • We present conditions for covariances of energy dependent nuclear data to be proper. • We provide methods to detect non-positive and inconsistent covariances in ENDF-6 format. • We propose methods to find nearby more proper covariances. • The methods can be used as a part of a quality assurance program. - Abstract: We present conditions for covariances of energy dependent nuclear data to be proper in the sense that the covariances are positive, i.e., its eigenvalues are non-negative, and consistent with respect to the sum rules of nuclear data. For the ENDF-6 format covariances we present methods to detect non-positive and inconsistent covariances. These methods would be useful as a part of a quality assurance program. We also propose methods that can be used to find nearby more proper energy dependent covariances. These methods can be used to remove unphysical components, while preserving most of the physical components. We consider several different senses in which the nearness can be measured. These methods could be useful if a re-evaluation of improper covariances is not feasible. Two practical examples are processed and analyzed. These demonstrate some of the properties of the methods. We also demonstrate that the ENDF-6 format covariances of linearly dependent nuclear data should usually be encoded with the derivation rules.

Assessment of selected quality fields of nursing care in neurosurgical wards: a prospective study of 530 people – multicenter studies

Directory of Open Access Journals (Sweden)

Ślusarz R

2014-08-01

Full Text Available Robert Ślusarz,1 Monika Biercewicz,2 Ewa Barczykowska,3 Beata Haor,4 Mariola Głowacka5 1Neurological and Neurosurgical Nursing Department, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 2Clinic of Geriatrics, 3Nursing Department, Collegium Medicum, Nicolaus Copernicus University, Torun, 4Faculty of Health Science, University of Humanities and Economics in Wloclawek, Wloclawek, 5Institute of Health Sciences, State School of Higher Professional Education in Plock, Plock, Poland Background: One of the elements influencing the assessment of nursing care quality is the assessment of the nurse’s functions that determine the nurse’s particular tasks. The aim of this work was to assess selected tasks involved in the nurse’s caring function, which influence nursing care quality on neurosurgical wards, on the basis of patients’ and nursing staff’s opinions.Materials and methods: The research was carried out on neurosurgical wards in Poland on a group of 455 patients and 75 nurses. In order to assess nursing care quality, an author’s original questionnaire (Questionnaire – Patient Satisfaction was used.Results: Statistically significant differences concerned particular groups (both patients and nurses in the assessment of selected issues: providing information about performed activities and operations (P=0.000 and P=0.040, respecting personal dignity and assuring discretion during the operations (P=0.000 and P=0.001, speed of response to patient’s requests (P=0.000 and P=0.000, time availability of nurses for the patient (P=0.000 and P=0.000, providing information about further self-care at home (P=0.032, P=0.008, and nurses’ attitude (kindness, courtesy, tenderness, care to patients (patient’s assessment only P=0.000.Conclusion: Selected tasks in the field of the caring function of nurses were assessed differently by particular groups. There were no statistically significant differences in the assessment of particular

The Requirement of Being a "Fit and Proper" Person for the Legal ...

African Journals Online (AJOL)

An important requirement for admission as an attorney or advocate is to be a "fit and proper" person. Lawyers are also struck from the respective rolls of advocates or attorneys if they cease to be "fit and proper". This requirement of being a "fit and proper" person is not defined or described in legislation. It is left to the ...

Collaborative efforts are needed to ensure proper knowledge dissemination of telemedicine projects.

Science.gov (United States)

Jakobsen, Neel Kolthoff; Jensen, Lena Sundby; Kayser, Lars

2014-09-01

Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were documented and disseminated. Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted and information about project results and dissemination were obtained. More than half of all projects were disseminated to professionals as well as to the public and used two-way communication. However, it was generally difficult to obtain an overview of the projects due to dynamic changes in names and scopes. We propose that the funding authorities require designs comprising proper evaluation models that will subsequently allow the investigators to publish their findings. Furthermore, a dissemination plan comprising both peers and other professions should be made mandatory. The investigators should ensure proper documentation and dissemination of changes both during and after the projects in order to ensure transparency, and national or international organisations should establish a database with relevant data fields. not relevant. not relevant.

Taking Care After A Concussion

Centers for Disease Control (CDC) Podcasts

2010-03-17

This podcast describes how to take care of yourself after a concussion, including proper recognition and response recommendations.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis.

Science.gov (United States)

Oostdijk, Evelien A N; de Wit, G A; Bakker, Marina; de Smet, Anne Marie G A; Bonten, M J M

2013-03-05

To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). A post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20). 13 Dutch ICUs. Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990). SDD or SOD. Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation. Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving. SDD and SOD were both effective and cost-saving in Dutch ICUs.

The proper contributions of social workers in health practice.

Science.gov (United States)

Huntington, J

1986-01-01

of the clinician. Provision of social work services to the health system has become a questionable priority and raises the issue of whether much of what is now termed "health care' could more appropriately be termed "social care' and provided in a primary social work setting to which medicine and nursing would make their "proper contributions'.

The Essentials of Proper Wine Service.

Science.gov (United States)

Manago, Gary H.

This instructional unit was designed to assist the food services instructor and/or the restaurant manager in training students and/or staff in the proper procedure for serving wines to guests. The lesson plans included in this unit focus on: (1) the different types of wine glasses and their uses; (2) the parts of a wine glass; (3) the proper…

Perspectives on barriers and facilitators to self-care in Lebanese cardiac patients: A qualitative descriptive study.

Science.gov (United States)

Dumit, Nuhad Yazbik; Noureddine, Samar Nayef; Magilvy, Joan Kathy

2016-08-01

Cardiovascular disease is the leading cause of mortality worldwide. Cardiac self-care practices are essential for managing cardiac illness and improving quality of life. However, these practices may be affected by factors that may hinder or facilitate self-care especially in countries that experience political and economic instabilities. The purpose of this study was to explore self-care practices among Lebanese cardiac patients. Another aim was to reveal factors that might influence these self-care practices. This is a qualitative descriptive study. Participants were recruited from a referral medical center in Beirut, Lebanon and interviews took place in their homes. Purposive sample of 15 adult participants, seven females and eight males, diagnosed with coronary artery disease at least a year ago and not in critical condition recruited from the cardiology clinics of the medical center. Data were collected through semi-structured audio-recorded interviews that took place in their places of residents. Three themes emerged from the data: I. The behaviors of cardiac patients demonstrated selected self-care practices; II. Patients identified barriers to self-care reflective of the Lebanese political and socio-economic situation; and, III. Patients described facilitators to self-care consistent with the Lebanese socio-cultural values and norms. The most common self-care practices included taking medications and eating properly. Participants emphasized avoiding stress and being upset as a self-protective measure for cardiac health. Health care costs, family responsibilities, psychological factors and the country's political situation impeded self-care practices whereas family support facilitated them. Lebanese patients reported select self-care practices in dealing with their cardiac illness. Barriers and facilitators to their self-care behaviors reflected the Lebanese context and culture. Thus health care providers must assess their patients' practices within their

Proper generalized decompositions an introduction to computer implementation with Matlab

CERN Document Server

Cueto, Elías; Alfaro, Icíar

2016-01-01

This book is intended to help researchers overcome the entrance barrier to Proper Generalized Decomposition (PGD), by providing a valuable tool to begin the programming task. Detailed Matlab Codes are included for every chapter in the book, in which the theory previously described is translated into practice. Examples include parametric problems, non-linear model order reduction and real-time simulation, among others. Proper Generalized Decomposition (PGD) is a method for numerical simulation in many fields of applied science and engineering. As a generalization of Proper Orthogonal Decomposition or Principal Component Analysis to an arbitrary number of dimensions, PGD is able to provide the analyst with very accurate solutions for problems defined in high dimensional spaces, parametric problems and even real-time simulation. .

Depression, self-esteem, diabetes care and self-care behaviors among middle-aged and older Mexicans.

Science.gov (United States)

Rivera-Hernandez, Maricruz

2014-07-01

Examine the associations of depression and self-esteem on self-care activities and care received among Mexicans with diabetes. Using data from the Mexican Nutrition and Health Survey 2012, logistic regression models were fit to test the associations between each self-care activity and diabetes care, and self-esteem and depression. People with low self-esteem were less likely to follow a diet, but no other associations were found. Contrary to what was expected, there were no relationships between depression and quality of care received or self-care behaviors. Current findings support the importance of looking at mental health and emotional state among older adults with diabetes. Future studies should explore the relationship between different psychological barriers to proper diabetes management. Published by Elsevier Ireland Ltd.

Depression, self-esteem, diabetes care and self-care behaviors among middle-aged and older Mexicans☆

Science.gov (United States)

Rivera-Hernandez, Maricruz

2016-01-01

Aims Examine the associations of depression and self-esteem on self-care activities and care received among Mexicans with diabetes. Methods Using data from the Mexican Nutrition and Health Survey 2012, logistic regression models were fit to test the associations between each self-care activity and diabetes care, and self-esteem and depression. Results People with low self-esteem were less likely to follow a diet, but no other associations were found. Contrary to what was expected, there were no relationships between depression and quality of care received or self-care behaviors. Conclusion Current findings support the importance of looking at mental health and emotional state among older adults with diabetes. Future studies should explore the relationship between different psychological barriers to proper diabetes management. PMID:24846446

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.

Clinical care of adult Turner syndrome--new aspects.

Science.gov (United States)

Trolle, Christian; Mortensen, Kristian Havmand; Hjerrild, Britta E; Cleemann, Line; Gravholt, Claus H

2012-05-01

Turner syndrome (TS) is characterized by numerous medical challenges during adolescence and adulthood. Puberty has to be induced in most cases, and female sex hormone replacement therapy (HRT) should continue during adult years. These issues are normally dealt with by the paediatrician, but once a TS female enters adulthood it is less clear who should be the primary care giver. Morbidity and mortality is increased, especially due to the risk of dissection of the aorta and other cardiovascular diseases, as well as the risk of type 2 diabetes, hypertension, osteoporosis, thyroid disease and other diseases. The proper dose of HRT with female sex steroids has not been established, and, likewise, benefits and/or drawbacks from HRT have not been thoroughly evaluated. The transition period from paediatric to adult care seems to be especially vulnerable and the proper framework for transition has not yet been established. Likewise, no framework is in place for continuous follow-up during adult years in many countries. Today, most treatment recommendations are based on expert opinion and are unfortunately not evidence based, although more areas, such as growth hormone and oxandrolone treatment for increasing height, are becoming well founded. Osteoporosis, diabetes, both type 1 and 2, hypothyroidism, obesity and a host of other endocrine diseases and conditions are seen more frequently in TS. Prevention, intervention and proper treatment is only just being recognized. Hypertension is frequent and can be a forerunner of cardiovascular disease. The description of adult life with TS has been broadened and medical, social and psychological aspects are being added at a compelling pace. Proper care during adulthood should be studied and a framework for care should be in place, since most morbidity potentially is amenable to intervention. In summary, TS is a condition associated with a number of diseases and conditions which need the attention of a multi-disciplinary team during

Regional differences in the validity of self-reported use of health care in Belgium: selection versus reporting bias

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J. Van der Heyden

2016-08-01

Full Text Available Abstract Background The Health Care Module of the European Health Interview Survey (EHIS is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. In this study we assessed the validity of self-reported information on the use of health care, collected through this instrument, in the Belgian Health Interview Survey (BHIS, and explored the impact of selection and reporting bias on the validity of regional differences in health care use observed in the BHIS. Methods To assess reporting bias, self-reported BHIS 2008 data were linked with register-based data from the Belgian compulsory health insurance (BCHI. The latter were compared with similar estimates from a random sample of the BCHI to investigate the selection bias. Outcome indicators included the prevalence of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The validity of the estimates and the regional differences were explored through measures of agreement and logistic regression analyses. Results Validity of self-reported health care use varies by type of health service and is more affected by reporting than by selection bias. Compared to health insurance estimates, self-reported results underestimate the percentage of people with a specialist contact in the past year (50.5 % versus 65.0 % and a day patient hospitalisation (7.8 % versus 13.9 %. Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3 % versus 48.6 %. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75. Survey data overestimate the higher prevalence of a contact with a specialist [OR 1.51 (95 % CI 1.33–1.72 for self-report and 1.08 (95 % CI 1.05–1.15 for register] and underestimate the lower prevalence of a contact with a GP [ORs 0.59 (95 % CI 0.51–0.70 and 0.41 (95 % CI 0.39–0.42 respectively] in

THE PROPER MOTION OF PALOMAR 5

Energy Technology Data Exchange (ETDEWEB)

Fritz, T. K.; Kallivayalil, N., E-mail: tkf4w@astro.virginia.edu [Department of Astronomy, University of Virginia, Charlottesville, 3530 McCormick Road, VA 22904-4325 (United States)

2015-10-01

Palomar 5 (Pal 5) is a faint halo globular cluster associated with narrow tidal tails. It is a useful system to understand the process of tidal dissolution, as well as to constrain the potential of the Milky Way. A well-determined orbit for Pal 5 would enable detailed study of these open questions. We present here the first CCD-based proper motion measurement of Pal 5 obtained using SDSS as a first epoch and new Large Binocular Telescope/Large Binocular Camera (LBC) images as a second, giving a baseline of 15 years. We perform relative astrometry, using SDSS as a distortion-free reference, and images of the cluster and also of the Pal 5 stream for the derivation of the distortion correction for LBC. The reference frame is made up of background galaxies. We correct for differential chromatic refraction using relations obtained from SDSS colors as well as from flux-calibrated spectra, finding that the correction relations for stars and for galaxies are different. We obtain μ{sub α} = −2.296 ± 0.186 mas yr{sup −1} and μ{sub δ} = −2.257 ± 0.181 mas yr{sup −1} for the proper motion of Pal 5. We use this motion, and the publicly available code galpy, to model the disruption of Pal 5 in different Milky Way models consisting of a bulge, a disk, and a spherical dark matter halo. Our fits to the observed stream properties (streak and radial velocity gradient) result in a preference for a relatively large Pal 5 distance of around 24 kpc. A slightly larger absolute proper motion than what we measure also results in better matches but the best solutions need a change in distance. We find that a spherical Milky Way model, with V{sub 0} = 220 km s{sup −1} and V{sub 20} {sub kpc}, i.e., approximately at the apocenter of Pal 5, of 218 km s{sup −1}, can match the data well, at least for our choice of disk and bulge parametrization.

Invert emulsion: Method of preparation and application as proper formulation of entomopathogenic fungi.

Science.gov (United States)

Batta, Yacoub A

2016-01-01

The present article describes the technique used for preparing the invert emulsion (water-in-oil type) then, selecting the most proper formulation of invert emulsion for being used as a carrier formulation of entomopathogenic fungi. It also describes the method used for testing the efficacy of the formulated fungi as biocontrol agents of targeted insects. Detailed examples demonstrating the efficacy of formulated strains of entomopathogenic fungi against certain species of insect pests were included in the present article. The techniques and methods described in this article are reproducible and helpful in enhancing the effectiveness of formulated fungi against wide range of targeted insects in comparison with the unformulated form of these fungi. Also, these techniques and methods can be used effectively in crop protection and in the integrated pest management programs. Finally, it is important to indicate that the ingredients used for preparation of the invert emulsion have no environmental side-effects or health risks since these ingredients are safe to use and can be used in manufacturing of cosmetics or as food additives.•Description of method used for preparation of invert emulsion (water-in-oil type) and selecting the most stable and non-viscous emulsion.•Description of technique used for introducing the entomopathogenic fungi into the selected stable and non-viscous invert emulsion.•Description of method for testing the efficacy of introduced entomopathogenic fungus into the selected invert emulsion against targeted insects with detailed examples on the efficacy testing.

Multicrack Localization in Rotors Based on Proper Orthogonal Decomposition Using Fractal Dimension and Gapped Smoothing Method

Directory of Open Access Journals (Sweden)

Zhiwen Lu

2016-01-01

Full Text Available Multicrack localization in operating rotor systems is still a challenge today. Focusing on this challenge, a new approach based on proper orthogonal decomposition (POD is proposed for multicrack localization in rotors. A two-disc rotor-bearing system with breathing cracks is established by the finite element method and simulated sensors are distributed along the rotor to obtain the steady-state transverse responses required by POD. Based on the discontinuities introduced in the proper orthogonal modes (POMs at the locations of cracks, the characteristic POM (CPOM, which is sensitive to crack locations and robust to noise, is selected for cracks localization. Instead of using the CPOM directly, due to its difficulty to localize incipient cracks, damage indexes using fractal dimension (FD and gapped smoothing method (GSM are adopted, in order to extract the locations more efficiently. The method proposed in this work is validated to be effective for multicrack localization in rotors by numerical experiments on rotors in different crack configuration cases considering the effects of noise. In addition, the feasibility of using fewer sensors is also investigated.

Prenatal Care: First Trimester Visits

Science.gov (United States)

... care provider will discuss the importance of proper nutrition and prenatal vitamins. Your first prenatal visit is a good time to discuss exercise, sex during pregnancy and other lifestyle issues. You might also discuss your work environment and the use of medications during pregnancy. If ...

Broad-scale recombination patterns underlying proper disjunction in humans.

Directory of Open Access Journals (Sweden)

Adi Fledel-Alon

2009-09-01

Full Text Available Although recombination is essential to the successful completion of human meiosis, it remains unclear how tightly the process is regulated and over what scale. To assess the nature and stringency of constraints on human recombination, we examined crossover patterns in transmissions to viable, non-trisomic offspring, using dense genotyping data collected in a large set of pedigrees. Our analysis supports a requirement for one chiasma per chromosome rather than per arm to ensure proper disjunction, with additional chiasmata occurring in proportion to physical length. The requirement is not absolute, however, as chromosome 21 seems to be frequently transmitted properly in the absence of a chiasma in females, a finding that raises the possibility of a back-up mechanism aiding in its correct segregation. We also found a set of double crossovers in surprisingly close proximity, as expected from a second pathway that is not subject to crossover interference. These findings point to multiple mechanisms that shape the distribution of crossovers, influencing proper disjunction in humans.

Improved Industrial Development In Nigeria Through Proper ...

African Journals Online (AJOL)

The paper noted that most industrial development strategies in Nigeria did not give attention to technology education. And that technology education as recognized by few of the strategies were not only properly articulated for the tertiary institutions, but also poorly implemented. Therefore, to put technology and thus ...

Selection of detailed items for periodic safety review on PWR radwaste management system

Energy Technology Data Exchange (ETDEWEB)

Sung, K. B.; Ahn, Y. S.; Park, Y. S.; Kim, S. H.; Kim, J. T. [Korea Hydric and Nuclear Power Company, Taejon (Korea, Republic of)

2003-10-01

Selection of detailed-items for Periodic Safety Review on PWR radwaste management system, the main component could be faithfully clarified according to the purpose of establishment on each system and basic purpose. It is proper to select detailed-items those of radioactivities in the reactor coolant activity levels and the released volume of liquid and gaseous radioactive material on safety performance. It's also proper to select solid radwaste production quantities as detailed-item that it would be predict the next ten years trends after PSR.

Research into care quality criteria for long-term care institutions.

Science.gov (United States)

Wang, Wen-Liang; Chang, Hong-Jer; Liu, An-Chi; Chen, Yu-Wen

2007-12-01

The purpose of this paper was to determine the criteria that reflect the quality of care provided by long-term care institutions. Research was conducted using a two-step procedure that first utilized the SERVQUAL model with Fuzzy Delphi Method to establish the proper criteria by which service quality could be measured. A total of 200 questionnaires were mailed to expert respondents, of which 89 were returned and 77 deemed valid for use in this study. We then applied the Multi-Criteria Decision Making Process to determine the degree of importance of each criterion to long-term care institution service quality planning work. Secondly, 200 questionnaires were distributed and 74 valid responses were returned. Based on the 5 SERVQUAL model constructs, this study found 17 of the 28 criteria, to be pertinent to nursing care quality, with those in the Responsiveness and Empathy domains being the ones most critical.

Computing Proper Equilibria of Zero-Sum Games

DEFF Research Database (Denmark)

Miltersen, Peter Bro; Sørensen, Troels Bjerre

2007-01-01

We show that a proper equilibrium of a matrix game can be found in polynomial time by solving a linear (in the number of pure strategies of the two players) number of linear programs of roughly the same dimensions as the standard linear programs describing the Nash equilibria of the game....

45 CFR 170.423 - Principles of proper conduct for ONC-ATCBs.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Principles of proper conduct for ONC-ATCBs. 170... § 170.423 Principles of proper conduct for ONC-ATCBs. An ONC-ATCB shall: (a) Operate its certification... EHR Module developer conspicuously include the following text on its Web site and in all marketing...

25 CFR 87.12 - Insuring the proper performance of approved plans.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Insuring the proper performance of approved plans. 87.12... DISTRIBUTION OF INDIAN JUDGMENT FUNDS § 87.12 Insuring the proper performance of approved plans. A timetable... regarding the maintenance of the timetable, a full accounting of any per capita distribution, and the...

32 CFR 725.7 - Contents of a proper request or demand.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Contents of a proper request or demand. 725.7 Section 725.7 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL RELEASE... § 725.7 Contents of a proper request or demand. (a) Routine requests. If official information is sought...

Dimension invariants for groups admitting a cocompact model for proper actions

DEFF Research Database (Denmark)

Degrijse, Dieter Dries; Martínez-Pérez, Conchita

2016-01-01

Let G be a group that admits a cocompact classifying space for proper actions X. We derive a formula for the Bredon cohomological dimension for proper actions of G in terms of the relative cohomology with compact support of certain pairs of subcomplexes of X. We use this formula to compute the Br...

Determining proper strategies for health, safety, security and environmental (HSSE) management system.

Science.gov (United States)

Zaeimdar, Mojgan; Nasiri, Parvin; Taghdisi, Mohammadhoseyn; Abbaspour, Majid; Arjmandi, Reza; Kalatipor, Omid

2013-01-01

Today, managing an organization is concerned with many problems. Adopting proper strategies can promote an organization's survival. This study aimed at developing an appropriate HSSE Strategy for regional operation associated companies of Iran National Gas Company (INGS) using SWOT analysis. The analysis of the strengths, weaknesses, opportunities, and threats of HSSE was carried out and according to the results suitable strategies were recommended. In this regard, senior and junior managers, supervisors, and experts active in regional operation associated companies of Iran National Gas Company participated in SWOT analysis from HSSE angle. Then, they selected the most applicable SWOT factors pertaining to the organization. In the next step, these factors were weighted and scored. Based on the results four categories of strategies were developed including SO, WO, ST, and WT. Further examination showed that SO Strategies were the most applicable for the organization.

Effects of selective decontamination of digestive tract on mortality and antibiotic resistance in the intensive-care unit

NARCIS (Netherlands)

de Jonge, Evert

2005-01-01

Purpose of review Since its introduction in 1984 several small trials have studied the infection prevention regimen of selective decontamination of the digestive tract (SDD) in intensive care patients. Although meta-analyses of these studies suggested that SDD could reduce mortality, it continued to

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

Science.gov (United States)

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of

Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care

Directory of Open Access Journals (Sweden)

Lene Juel Kjeldsen

2017-05-01

Full Text Available The objective was to investigate type, frequency and result of clinical outcomes used in studies to assess the effect of clinical pharmacy interventions in inpatient care. The literature search using Pubmed.gov was performed for the period up to 2013 using the search phrases: “Intervention(s” and “pharmacist(s” and “controlled” and “outcome(s” or “effect(s”. Primary research studies in English of controlled, clinical pharmacy intervention studies, including outcome evaluation, were selected. Titles, abstracts and full-text papers were assessed individually by two reviewers, and inclusion was determined by consensus. In total, 37 publications were included in the review. The publications presented similar intervention elements but differed in study design. A large variety of outcome measures (135 had been used to evaluate the effect of the interventions; most frequently clinical measures/assessments by physician and health care service use. No apparent pattern was established among primary outcome measures with significant effect in favour of the intervention, but positive effect was most frequently related to studies that included power calculations and sufficient inclusion of patients (73% vs. 25%. This review emphasizes the importance of considering the relevance of outcomes selected to assess clinical pharmacy interventions and the importance of conducting a proper power calculation.

A community based interventional approach to intranatal And neonatal health care

Directory of Open Access Journals (Sweden)

Bhupendra Tripathi

2003-12-01

Full Text Available Objective : To assess the contribution of the interventions through the local change agent (Bal Parivar Mitra towards achievement of health awareness among rural women regarding maternal child health through improvement and change in health practices. Study design: Stratified multistage random sampling technique. Study unit : Within the selected households lactating mothers were selected as study units. Study area : The study was conducted in Jasra and Saidabad blocks of Allahabad district wherein MCHN Project is going on since July 2000. Study variable : Maternal care. Intervention, Impact. Statistical analysis : Ztesl for testing significance of differences between two proportions (Z - test. Results: Deliveries assisted by trained persons increased from 22.4%to 36.7%. Follow-up of'5-cleans’ during pregnancy was among 43.3%. Birth registration increased from 19.2% in baseline to 35%. feeding of colostrum from 27,4% to 40.0%. Breastfeeding within half an hour after birth was among 23.3% followed by 16.7% within 1/2-12 hours. Proper warmth was given to 68.3% newborns and 58.3% babies were bathed after one day of birth. Conclusions : The suggested intervention package through BPM seems to be a sustainable effort and several parameters of intranatal and neonatal health care arc expected to be attained as long-term achievements.

Impact of Training on Improving Proper Handwashing Practices among Elementary School Students

Directory of Open Access Journals (Sweden)

Theruna Huthamaputiran

2017-06-01

Full Text Available Background: Hand washing is among the most effective ways to prevent diseases. In Indonesia, only a quarter of the entire population practice proper handwashing techniques. Of these, children are the most vulnerable group for contracting diseases. Nevertheless, they also are crucial agent for behavior transformation as they are keen and open to new ideas. Therefore, this study was conducted to determine if training would have an improvement on a proper hand washing practices among elementary school students. Methods:An observational descriptive study design using random sampling was conducted from September to November 2013 in Jatinangor Subdistrict, West Java, Indonesia using primary data of one hundred elementary school students from four elementary schools. Questionnaires were given after informed consent. A demonstration on hand washing techniques and education on proper hand washing practices was then given. Two weeks later, the same questionnaire was given to measure the influence of the training. The collected data were presented using frequency tabulation. Results: Before the training on proper hand washing practices was conducted, only 86.9% students were practicing it properly. After the training was given, 90.7% of the students were doing it properly. For the hand washing technique, only 66.8% of students knew the correct steps before the intervention was given and 78.7% students did them correctly after the intervention. Conclusions:The training shows an overall improvement on the students’ hand washing practices.   DOI: 10.15850/amj.v4n2.1073

Selected aspects of nursing care for an elderly patient with chronic obstructive pulmonary disease

OpenAIRE

Budnik, Marta; Galikowska, Anna; Marzec, Izabela; Balcerak, Dominika; Kobus, Edyta; Posieczek, Zuzanna

2017-01-01

Budnik Marta, Galikowska Anna, Marzec Izabela, Balcerak Dominika, Kobus Edyta, Posieczek Zuzanna. Selected aspects of nursing care for an elderly patient with chronic obstructive pulmonary disease. Journal of Education, Health and Sport. 2017;7(6):34-44. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.802926 http://ojs.ukw.edu.pl/index.php/johs/article/view/4501 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation...

Chiropractic physicians: toward a select conceptual understanding of bureaucratic structures and functions in the health care institution

Science.gov (United States)

Fredericks, Marcel; Kondellas, Bill; Hang, Lam; Fredericks, Janet; Ross, Michael WV

2011-01-01

Objective The purpose of this article is to present select concepts and theories of bureaucratic structures and functions so that chiropractic physicians and other health care professionals can use them in their respective practices. The society-culture-personality model can be applied as an organizational instrument for assisting chiropractors in the diagnosis and treatment of their patients irrespective of locality. Discussion Society-culture-personality and social meaningful interaction are examined in relationship to the structural and functional aspects of bureaucracy within the health care institution of a society. Implicit in the examination of the health care bureaucratic structures and functions of a society is the focus that chiropractic physicians and chiropractic students learn how to integrate, synthesize, and actualize values and virtues such as empathy, integrity, excellence, diversity, compassion, caring, and understanding with a deep commitment to self-reflection. Conclusion It is essential that future and current chiropractic physicians be aware of the structural and functional aspects of an organization so that chiropractic and other health care professionals are able to deliver care that involves the ingredients of quality, affordability, availability, accessibility, and continuity for their patients. PMID:22693481

Chiropractic physicians: toward a select conceptual understanding of bureaucratic structures and functions in the health care institution.

Science.gov (United States)

Fredericks, Marcel; Kondellas, Bill; Hang, Lam; Fredericks, Janet; Ross, Michael Wv

2011-12-01

The purpose of this article is to present select concepts and theories of bureaucratic structures and functions so that chiropractic physicians and other health care professionals can use them in their respective practices. The society-culture-personality model can be applied as an organizational instrument for assisting chiropractors in the diagnosis and treatment of their patients irrespective of locality. Society-culture-personality and social meaningful interaction are examined in relationship to the structural and functional aspects of bureaucracy within the health care institution of a society. Implicit in the examination of the health care bureaucratic structures and functions of a society is the focus that chiropractic physicians and chiropractic students learn how to integrate, synthesize, and actualize values and virtues such as empathy, integrity, excellence, diversity, compassion, caring, and understanding with a deep commitment to self-reflection. It is essential that future and current chiropractic physicians be aware of the structural and functional aspects of an organization so that chiropractic and other health care professionals are able to deliver care that involves the ingredients of quality, affordability, availability, accessibility, and continuity for their patients.

The VMC survey. XXVIII. Improved measurements of the proper motion of the Galactic globular cluster 47 Tucanae

Science.gov (United States)

Niederhofer, Florian; Cioni, Maria-Rosa L.; Rubele, Stefano; Schmidt, Thomas; Bekki, Kenji; de Grijs, Richard; Emerson, Jim; Ivanov, Valentin D.; Oliveira, Joana M.; Petr-Gotzens, Monika G.; Ripepi, Vincenzo; Sun, Ning-Chen; van Loon, Jacco Th.

2018-05-01

We use deep multi-epoch point-spread function (PSF) photometry taken with the Visible and Infrared Survey Telescope for Astronomy (VISTA) to measure and analyze the proper motions of stars within the Galactic globular cluster 47 Tucanae (47 Tuc, NGC 104). The observations are part of the ongoing near-infrared VISTA survey of the Magellanic Cloud system (VMC). The data analyzed in this study correspond to one VMC tile, which covers a total sky area of 1.77 deg2. Absolute proper motions with respect to 9070 background galaxies are calculated from a linear regression model applied to the positions of stars in 11 epochs in the Ks filter. The data extend over a total time baseline of about 17 months. We found an overall median proper motion of the stars within 47 Tuc of (μαcos(δ), μδ) = (+5.89 ± 0.02 (statistical) ± 0.13 (systematic), -2.14 ± 0.02 (statistical) ± 0.08 (systematic)) mas yr-1, based on the measurements of 35 000 individual sources between 5' and 42' from the cluster center. We compared our result to the proper motions from the newest US Naval Observatory CCD Astrograph Catalog (UCAC5), which includes data from the Gaia data release 1. Selecting cluster members ( 2700 stars), we found a median proper motion of (μαcos(δ), μδ) = (+5.30 ± 0.03 (statistical) ± 0.70 (systematic), -2.70 ± 0.03 (statistical) ± 0.70 (systematic)) mas yr-1. Comparing the results with measurements in the literature, we found that the values derived from the VMC data are consistent with the UCAC5 result, and are close to measurements obtained using the Hubble Space Telescope. We combined our proper motion results with radial velocity measurements from the literature and reconstructed the orbit of 47 Tuc, finding that the cluster is on an orbit with a low ellipticity and is confined within the inner 7.5 kpc of the Galaxy. We show that the use of an increased time baseline in combination with PSF-determined stellar centroids in crowded regions significantly improves

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

25 CFR 11.1111 - Minor-in-need-of-care dispositional hearing.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Minor-in-need-of-care dispositional hearing. 11.1111... INDIAN OFFENSES AND LAW AND ORDER CODE Minor-in-Need-of-Care Procedure § 11.1111 Minor-in-need-of-care... take place to hear evidence on the question of proper disposition. (b) All the rights listed in § 11...

Day care monopolar transurethral resection of prostate: Is it feasible?

Directory of Open Access Journals (Sweden)

Altaf Khan

2014-01-01

Full Text Available Introduction: Benign prostatic hyperplasia is a common disease accounting for 30% of our OPD cases and about 25% of our surgery cases. Various treatment options are now available for more efficient care and early return to work. We wanted to determine the safety and feasibility of day care monopolar transurethral resection of prostate (m-TURP, by admitting the patients on the day of surgery and discharging the patient without catheter on the same day. We also compared the morbidity associated with conventional TURP where in the catheter is removed after 24-48 h of surgery and day care TURP where in the catheter is removed on the day of surgery. Materials and Methods: A total of 120 patients who fulfilled the criteria were included in the study which was conducted between November 2008 and December 2010. A total of 60 patients were assigned for day care and 60 for conventional monopolar TURP. There was no significant difference in age, prostatic volume or IPSS score. Day care patients were admitted on day of surgery and discharged the same day after the removal of catheter. Results: Both the groups were comparable in outcome. Stricture rate was less with day care TURP. Mean catheterization time was similar to laser TURP. Conclusion: Monopolar TURP is still the gold standard of care for BPH. If cases are selected properly and surgery performed diligently it remains the option of choice for small and medium sized glands and patients can be back to routine work early.

Comparison the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit

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Shahriari M

2015-05-01

Full Text Available Background and Objective: Proper nutritional support is one of the important caring aspects in patients who were hospitalized in Intensive Care Unit. Although the several studies have been done concerning the selection of proper nutrition method for patients, but there is no agreement on this issue. The aim of current study was the compare the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit.  Materials and Method: The current clinical trial was conducted on patients who were hospitalized in intensive care unit in Alzahra hospital in Isfahan, 2013. Fifty patients were selected through convenient sampling and were randomly assigned into two groups of 25 people of intervention and control. Nutrition was done through infusion pump in intervention group and by bolus in control group. Gastric residual volume and diarrhea was assessed each four hours for four days. Data were gathered through checklist and were analyzed by SPSS18 using descriptive and inferential statistics including independent T-test, Fisher's exact test and repeated measures ANOVA.  Results: The results showed that the mean of gastric residual volume in control group was more than the intervention group on the third day (p=0.04. Also, the mean of gastric residual volume did not show significant difference at different times in intervention group, but the mean of gastric residual volume was significantly increased in control group at different times (p=0.04. Fisher's exact test showed no significant difference between two groups concerning the diarrhea frequency.  Conclusion: In nutritional support with continuous infusion method, gastric residual volume was not increased and gastric emptying rate was not diminished. Therefore, this method can be used as an appropriate nutritional support in intensive care unit.

Ocean Models and Proper Orthogonal Decomposition

Science.gov (United States)

Salas-de-Leon, D. A.

2007-05-01

The increasing computational developments and the better understanding of mathematical and physical systems resulted in an increasing number of ocean models. Long time ago, modelers were like a secret organization and recognize each other by using secret codes and languages that only a select group of people was able to recognize and understand. The access to computational systems was reduced, on one hand equipment and the using time of computers were expensive and restricted, and on the other hand, they required an advance computational languages that not everybody wanted to learn. Now a days most college freshman own a personal computer (PC or laptop), and/or have access to more sophisticated computational systems than those available for research in the early 80's. The resource availability resulted in a mayor access to all kind models. Today computer speed and time and the algorithms does not seem to be a problem, even though some models take days to run in small computational systems. Almost every oceanographic institution has their own model, what is more, in the same institution from one office to the next there are different models for the same phenomena, developed by different research member, the results does not differ substantially since the equations are the same, and the solving algorithms are similar. The algorithms and the grids, constructed with algorithms, can be found in text books and/or over the internet. Every year more sophisticated models are constructed. The Proper Orthogonal Decomposition is a technique that allows the reduction of the number of variables to solve keeping the model properties, for which it can be a very useful tool in diminishing the processes that have to be solved using "small" computational systems, making sophisticated models available for a greater community.

Preserving community in health care.

Science.gov (United States)

Emanuel, E J; Emanuel, L L

1997-02-01

There are two prominent trends in health care today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine health care as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm health care as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in

Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects.

NARCIS (Netherlands)

Buelow, Elena; Bello González, Teresita D J; Fuentes, Susana; de Steenhuijsen Piters, Wouter A A; Lahti, Leo; Bayjanov, Jumamurat R; Majoor, Eline A M; Braat, Johanna C; van Mourik, Maaike S M; Oostdijk, Evelien A N; Willems, Rob J L; Bonten, Marc J M; van Passel, Mark W J; Smidt, Hauke; van Schaik, Willem

2017-01-01

The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed "selective

The Informal Caregivers’ Viewpoint About Care Inhibitors for Community-Dwelling Elderly in an Iranian Context: A Qualitative Study

Directory of Open Access Journals (Sweden)

Samaneh Pourhadi

2016-09-01

Discussion: The inhibitors affect a proper caregiving and based on their own nature, cause discomfort to the caregiver and care receiver. Many of these cases are deemed as rectifiable hindrances that can lead us to optimal care for community-dwelling elderly if the cases are taken into consideration and proper strategies are designed and implemented in small and large scale planning.

The impact of the Brazilian family health strategy on selected primary care sensitive conditions: A systematic review.

Directory of Open Access Journals (Sweden)

Mayara Lisboa Bastos

Full Text Available Brazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. The Family Health Strategy (FHS is the main primary care model, but there is no consensus on its impact on health outcomes. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC.We searched Medline, Web of Science and Lilacs in May 2016 using key words in Portuguese and English, without language restriction. We included studies if intervention was the FHS; comparison was either different levels of FHS coverage or other primary health care service models; outcomes were the selected PCSC; and results were adjusted for relevant sanitary and socioeconomic variables, including the national conditional cash transfer program (Bolsa Familia. Due to differences in methods and outcomes reported, pooling of results was not possible.Of 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies. Twenty-one employed longitudinal quasi-experimental methods, 27 compared different levels the FHS coverage, whilst four compared the FHS versus other models of primary care. Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no clear pattern of association was found. In four studies, there was no effect on child and elderly vaccination or low-birth weight. No included studies addressed breast-feeding, dengue, HIV/AIDS and other neglected infectious diseases.Among these ecological studies with limited quality evidence, increasing coverage by the FHS was consistently associated with improvements in child mortality. Scarce evidence on other health outcomes, hospitalization and synergies with cash transfer was found.

Meeting the challenge of managed care - Part II: Designing a radiation oncology department and setting up a clinical practice program

International Nuclear Information System (INIS)

Halman, Marc A.; Szerlag, Chester

1997-01-01

Objective: Identify the business practices necessary to develop a successful radiation oncology department in the current health care environment. Course content will be of interest to new practitioners establishing first time programs or joining existing groups as well as experienced radiation oncologists who are challenged with redesigning programs to be competitive. Course Content: During this session, the following topics will be discussed: 1) Space planning and equipment selection 2) Personnel; creating efficiencies while promoting productivity 3) Professional and Technical Billing; establishing proper fee structures and coding procedures 4) Utilizing benchmarking as a tool to improve operations 5) Information technology in radiation oncology 6) Current and Future Trends: a) Oncology networks b) Reimbursement: managed care and capitation c) Downsizing d) Relative Value Units

Game Theoretic Approach for Systematic Feature Selection; Application in False Alarm Detection in Intensive Care Units

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Fatemeh Afghah

2018-03-01

Full Text Available Intensive Care Units (ICUs are equipped with many sophisticated sensors and monitoring devices to provide the highest quality of care for critically ill patients. However, these devices might generate false alarms that reduce standard of care and result in desensitization of caregivers to alarms. Therefore, reducing the number of false alarms is of great importance. Many approaches such as signal processing and machine learning, and designing more accurate sensors have been developed for this purpose. However, the significant intrinsic correlation among the extracted features from different sensors has been mostly overlooked. A majority of current data mining techniques fail to capture such correlation among the collected signals from different sensors that limits their alarm recognition capabilities. Here, we propose a novel information-theoretic predictive modeling technique based on the idea of coalition game theory to enhance the accuracy of false alarm detection in ICUs by accounting for the synergistic power of signal attributes in the feature selection stage. This approach brings together techniques from information theory and game theory to account for inter-features mutual information in determining the most correlated predictors with respect to false alarm by calculating Banzhaf power of each feature. The numerical results show that the proposed method can enhance classification accuracy and improve the area under the ROC (receiver operating characteristic curve compared to other feature selection techniques, when integrated in classifiers such as Bayes-Net that consider inter-features dependencies.

Challenging nurse student selection policy: Using a lifeworld approach to explore the link between care experience and student values.

Science.gov (United States)

Scammell, Janet; Tait, Desiree; White, Sara; Tait, Michael

2017-10-01

This study uses a lifeworld perspective to explore beginning students' values about nursing. Internationally, increasing care demand, a focus on targets and evidence of dehumanized care cultures have resulted in scrutiny of practitioner values. In England, selection policy dictates that prospective nursing students demonstrate person-centred values and care work experience. However, there is limited recent evidence exploring values at programme commencement or the effect of care experience on values. Mixed method study. A total of 161 undergraduate nursing students were recruited in 2013 from one English university. Thematic content analysis and frequency distribution to reveal descriptive statistics were used. Statistical analysis indicated that most of the values identified in student responses were not significantly affected by paid care experience. Five themes were identified: How I want care to be; Making a difference; The value of learning; Perceived characteristics of a nurse; and Respecting our humanity. Students readily drew on their experience of living to identify person-centred values about nursing.

The relation between maturity and sophistication shall be properly dealt with in nuclear power development

International Nuclear Information System (INIS)

Li Yongjiang

2009-01-01

The paper analyses the advantages and disadvantages of the second generation improved technologies and third generation technologies mainly developed in China in terms of safety and economy. The paper also discusses the maturity of the second generation improved technologies and the sophistication of the third generation technologies respectively. Meanwhile, the paper proposes that the advantage and disadvantage of second generation improved technologies and third generation technologies should be carefully taken into consideration and the relationship between the maturity and sophistication should be properly dealt with in the current stage. A two-step strategy shall be taken as a solution to solve the problem of insufficient capacity of nuclear power, trace and develop the third generation technologies, so as to ensure the sound and fast development of nuclear power. (authors)

On proper Shapley values for monotone TU-games

NARCIS (Netherlands)

van den Brink, J.R.; Levinsky, R.; Zeleny, M.

2015-01-01

The Shapley value of a cooperative transferable utility game distributes the dividend of each coalition in the game equally among its members. Given exogenous weights for all players, the corresponding weighted Shapley value distributes the dividends proportionally to their weights. A proper Shapley

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

Science.gov (United States)

Bosch-Capblanch, Xavier; Marceau, Claudine

2014-12-01

To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence

Science.gov (United States)

Bosch–Capblanch, Xavier; Marceau, Claudine

2014-01-01

Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong

Combining service marketing and strategic alliances in health care.

Science.gov (United States)

Lazarus, I R

1993-11-01

With or without federal health care reform to impact the delivery of health care services in the U.S., hospitals must commit to service marketing and strategic alliances as a fundamental business strategy. Service marketing not only differentiates the provider, but with the proper programs in place, it may actually facilitate the formation of strategic alliances. The combination of these strategies will be particularly effective in preparing for any health care policy change.

Health-Care Waste Treatment Technology Selection Using the Interval 2-Tuple Induced TOPSIS Method

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Chao Lu

2016-06-01

Full Text Available Health-care waste (HCW management is a major challenge for municipalities, particularly in the cities of developing nations. Selecting the best treatment technology for HCW can be regarded as a complex multi-criteria decision making (MCDM issue involving a number of alternatives and multiple evaluation criteria. In addition, decision makers tend to express their personal assessments via multi-granularity linguistic term sets because of different backgrounds and knowledge, some of which may be imprecise, uncertain and incomplete. Therefore, the main objective of this study is to propose a new hybrid decision making approach combining interval 2-tuple induced distance operators with the technique for order preference by similarity to an ideal solution (TOPSIS for tackling HCW treatment technology selection problems with linguistic information. The proposed interval 2-tuple induced TOPSIS (ITI-TOPSIS can not only model the uncertainty and diversity of the assessment information given by decision makers, but also reflect the complex attitudinal characters of decision makers and provide much more complete information for the selection of the optimum disposal alternative. Finally, an empirical example in Shanghai, China is provided to illustrate the proposed decision making method, and results show that the ITI-TOPSIS proposed in this paper can solve the problem of HCW treatment technology selection effectively.

Healthy Contact Lens Wear and Care

Centers for Disease Control (CDC) Podcasts

2014-02-04

In this podcast, CDC’s Dr. Jennifer Cope explains some basic steps for proper wear and care of soft contact lenses.  Created: 2/4/2014 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 2/4/2014.

The Nordic Maintenance Care Program – An interview study on the use of maintenance care in a selected group of Danish chiropractors

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Leboeuf-Yde Charlotte

2009-06-01

Full Text Available Abstract Background Although maintenance care appears to be relatively commonly used among chiropractors, the indications for its use are incompletely understood. A questionnaire survey was recently carried out among Swedish chiropractors in order to identify their choice of various management strategies, including maintenance care. That study revealed a common pattern of choice of strategies. However, it would be necessary to verify these findings in another study population and to obtain some additional information best collected through an interview. Objectives The main aim of the present study was to attempt to reproduce the findings in the Swedish study and to obtain more information on the use of maintenance care. Method A group of 11 chiropractors were selected because they used maintenance care. They were interviewed using the questionnaire from the previous Swedish survey. The questionnaire consisted of a simple description of a hypothetical patient with low back pain and nine possible ways in which the case could develop ("scenarios". They could choose between six different management strategies for each scenario. In addition, the chiropractors were encouraged to provide their own definition of maintenance care in an open-ended question. Interviews were taped, transcribed and analyzed. For the open-ended question, statements were identified relating to six pre hoc defined topics on the inclusion criteria/rationale for maintenance care, the frequency of treatments, and the duration of the maintenance care program. Results The open-ended question revealed that in patients with low back pain, maintenance care appears to be offered to prevent new events. The rationale was to obtain optimal spinal function. There appears to be no common convention on the frequency of treatments and duration of the treatment program was not mentioned by any of the interviewees. Conclusion The results from the questionnaire in the Danish survey showed that

Staff perception on biomedical or health care waste management: a qualitative study in a rural tertiary care hospital in India.

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Sudhir Chandra Joshi

Full Text Available Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management.A qualitative study was conducted using 10 focus group discussions (FGDs, with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i role of Health Care Waste Management (HCWM in prevention of health care associated infections, (ii awareness of and views about HCWM-related guidelines/legislation, (iii current HCWM practices, (iv perception and preparedness related to improvements of the current practices, and (v proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi and analysed using content analysis.Two themes were identified: Theme (A, 'Challenges in integration of HCWM in organizational practice,' with the categories (I Awareness and views about HCWM, (II Organizational practices regarding HCWM, and (III Challenges in Implementation of HCWM; and Theme (B, 'Interventions to improve HCWM,' with three categories, (I Educational and motivational interventions, (II Organizational culture change, and (III Policy-related interventions.A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings.

Prostate cancer as a chronic disease: cost-effectiveness and proper follow-up

International Nuclear Information System (INIS)

Guttilla, A.; Bortolami, A.; Evangelista, L.

2015-01-01

In western countries, prostate cancer (PCa) is the most common non-dermatological malignant disease in men. Bone metastases more often develop in patients with advanced PCa; the associated complications present a substantial disease and economic burden. Although the introduction of new therapeutic strategies have provided some advantages in terms of overall survival and quality of life in patients with metastatic PCa, the skeletal related events and side effects due to the therapies are associated with an important impact on the health care costs. In particular, the number of hospital admission, clinical consultation and the introduction of new expensive diagnostic modalities have changed the management of metastatic patients. However, the National and International guidelines suggest to follow patients with metastatic PCa by using clinical assessment, biochemical evaluation and, when necessary, diagnostic imaging. The aims of the present review were: 1) to summarize the information regarding the clinical and economic burden of metastasis; 2) to evaluate the quality of life; and 3) to suggest a proper follow-up in advanced PCa patients.

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA.

Science.gov (United States)

Goli, Srinivas; Nawal, Dipty; Rammohan, Anu; Sekher, T V; Singh, Deepshikha

2017-10-30

The gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010-11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of -0.1147, -0.1146, -0.2859 and -0.0638 for inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

Impact of Generalist Physician Initiatives on Residency Selection

Directory of Open Access Journals (Sweden)

Michael H. Malloy

2001-10-01

Full Text Available Objective:To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies. Background:In the fall of 1994 a first year Community Continuity Experience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education. Design/Methods:We examined the residency selections of cohorts of graduating medical students before (1992-1996 and after (1997-1999 the implementation of the primary care courses. Survey information on career preferences at matriculation and in the fourth year of medical school were available for students graduating after the programs began. We compared the career preferences and characteristics of those students who selected a primary care residency to those who did not. Results:Prior to the implementation of the programs, 45%(425/950 of students graduating selected primary care residencies compared to 45% (210/465 of students participating in the programs (p=0.88. At matriculation, 45% of students had listed a primary care discipline as their first career choice. Among the students who had indicated this degree of primary care interest 61% ended up matching in a primary care discipline. At year 4, 31% of students indicated a primary care discipline as their first career choice and 92% of these students matched to a primary care residency. By univariate analysis, minority students (53% were more likely to select a primary care residency than non-minority students (40%; students in the two lowest grade point average quartiles (55% and 50% selected primary care residencies compared to 37% and 38% of students in the top 2

Protection against malevolent use of vehicles at Nuclear Power Plants. Vehicle barrier system selection guidance

International Nuclear Information System (INIS)

Nebuda, D.T.

1994-08-01

This manual provides a simplified procedure for selecting land vehicle barriers that will stop the design basis vehicle threat adopted by the U.S. Nuclear Regulatory Commission. Proper selection and construction of vehicle barriers should prevent intrusion of the design basis vehicle. In addition, vital safety related equipment should survive a design basis vehicle bomb attack when vehicle barriers are properly selected, sited, and constructed. This manual addresses passive vehicle barriers, active vehicle barriers, and site design features that can be used to reduce vehicle impact velocity

Selected problems associated with the treatment and care for patients with colostomy – part 2

OpenAIRE

Muzyczka, Katarzyna; Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

2013-01-01

Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and maste...

Systemic tobramycin concentrations during selective decontamination of the digestive tract in intensive care unit patients on continuous venovenous hemofiltration

NARCIS (Netherlands)

Mol, Meriel; van Kan, H. J. M.; Schultz, Marcus J.; de Jonge, Evert

2008-01-01

OBJECTIVE: To study whether selective decontamination of the digestive tract (SDD) results in detectable serum tobramycin concentrations in intensive care unit (ICU) patients with acute renal failure treated with continuous venovenous hemofiltration (CVVH). DESIGN AND SETTING: Prospective,

Not proper ROC curves as new tool for the analysis of differentially expressed genes in microarray experiments

Directory of Open Access Journals (Sweden)

Pistoia Vito

2008-10-01

Full Text Available Abstract Background Most microarray experiments are carried out with the purpose of identifying genes whose expression varies in relation with specific conditions or in response to environmental stimuli. In such studies, genes showing similar mean expression values between two or more groups are considered as not differentially expressed, even if hidden subclasses with different expression values may exist. In this paper we propose a new method for identifying differentially expressed genes, based on the area between the ROC curve and the rising diagonal (ABCR. ABCR represents a more general approach than the standard area under the ROC curve (AUC, because it can identify both proper (i.e., concave and not proper ROC curves (NPRC. In particular, NPRC may correspond to those genes that tend to escape standard selection methods. Results We assessed the performance of our method using data from a publicly available database of 4026 genes, including 14 normal B cell samples (NBC and 20 heterogeneous lymphomas (namely: 9 follicular lymphomas and 11 chronic lymphocytic leukemias. Moreover, NBC also included two sub-classes, i.e., 6 heavily stimulated and 8 slightly or not stimulated samples. We identified 1607 differentially expressed genes with an estimated False Discovery Rate of 15%. Among them, 16 corresponded to NPRC and all escaped standard selection procedures based on AUC and t statistics. Moreover, a simple inspection to the shape of such plots allowed to identify the two subclasses in either one class in 13 cases (81%. Conclusion NPRC represent a new useful tool for the analysis of microarray data.

The Requirement of Being a "Fit and Proper" Person for the Legal Profession

Directory of Open Access Journals (Sweden)

M Slabbert

2011-07-01

Full Text Available An important requirement for admission as an attorney or advocate is to be a "fit and proper" person. Lawyers are also struck from the respective rolls of advocates or attorneys if they cease to be "fit and proper". This requirement of being a "fit and proper" person is not defined or described in legislation. It is left to the subjective interpretation of and application by seniors in the profession and ultimately the court. In the apartheid years this requirement was applied arbitrarily but today the question may be asked why some lawyers who have been found to be "fit and proper" do not act as such. The pre-admission character screening of lawyers seems not to be effective any more. Post- admission moral development is imperative.

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...

Proper-time quantum-mechanics and the Klein paradox

International Nuclear Information System (INIS)

Thaller, B.

1981-01-01

Scattering at high potential-steps is treated in the framework of relativistic proper-time theory. No paradox arises in contrast to Dirac's wavemechanics (''Klein's paradox''); pair creation may happen with a certain probability and may be described as a scattering process with ordinary quantum-mechanical methods. (author)

Positions and proper motions of dwarf carbon stars

Science.gov (United States)

Deutsch, Eric W.

1994-01-01

Recent-epochs positions and proper motions of nine dwarf carbon star candidates are presented along with finding charts for each object. Measurements are obtained from digitized Palomar Observatory Sky Survey (POSS) and Quik V plate archives at the Space Telescope Science Institute, and from recent CCD images.

Selective decline of neurotrophin and neurotrophin receptor genes within CA1 pyramidal neurons and hippocampus proper: Correlation with cognitive performance and neuropathology in mild cognitive impairment and Alzheimer's disease.

Science.gov (United States)

Ginsberg, Stephen D; Malek-Ahmadi, Michael H; Alldred, Melissa J; Che, Shaoli; Elarova, Irina; Chen, Yinghua; Jeanneteau, Freddy; Kranz, Thorsten M; Chao, Moses V; Counts, Scott E; Mufson, Elliott J

2017-09-09

Hippocampal CA1 pyramidal neurons, a major component of the medial temporal lobe memory circuit, are selectively vulnerable during the progression of Alzheimer's disease (AD). The cellular mechanism(s) underlying degeneration of these neurons and the relationship to cognitive performance remains largely undefined. Here, we profiled neurotrophin and neurotrophin receptor gene expression within microdissected CA1 neurons along with regional hippocampal dissections from subjects who died with a clinical diagnosis of no cognitive impairment (NCI), mild cognitive impairment (MCI), or AD using laser capture microdissection (LCM), custom-designed microarray analysis, and qPCR of CA1 subregional dissections. Gene expression levels were correlated with cognitive test scores and AD neuropathology criteria. We found a significant downregulation of several neurotrophin genes (e.g., Gdnf, Ngfb, and Ntf4) in CA1 pyramidal neurons in MCI compared to NCI and AD subjects. In addition, the neurotrophin receptor transcripts TrkB and TrkC were decreased in MCI and AD compared to NCI. Regional hippocampal dissections also revealed select neurotrophic gene dysfunction providing evidence for vulnerability within the hippocampus proper during the progression of dementia. Downregulation of several neurotrophins of the NGF family and cognate neurotrophin receptor (TrkA, TrkB, and TrkC) genes correlated with antemortem cognitive measures including the Mini-Mental State Exam (MMSE), a composite global cognitive score (GCS), and Episodic, Semantic, and Working Memory, Perceptual Speed, and Visuospatial domains. Significant correlations were found between select neurotrophic expression downregulation and neuritic plaques (NPs) and neurofibrillary tangles (NFTs), but not diffuse plaques (DPs). These data suggest that dysfunction of neurotrophin signaling complexes have profound negative sequelae within vulnerable hippocampal cell types, which play a role in mnemonic and executive dysfunction

How to get properly rid of confidential data?

CERN Multimedia

Computer Security Team

2012-01-01

Have you ever bought a used laptop on ebay? Try it and you might not only get (hopefully) functional hardware, but also a bunch of personal files, intriguing photos, sensitive documents, etc. Not everybody worries enough to clean the local hard disks properly before selling their equipment or giving it away. So the next owner of the hard disk can comfortably crawl through the remaining data, and use it at his or her convenience...   In fact, properly cleaning a hard disk is difficult! Deleting local files or formatting the hard disk usually just purges the files from being listed in the folder, but the actual data remains intact on the hard disk. Freely available tools can easily reconstruct those files and, thus, expose it. It is better practice to get rid of your files by running tools like “shred” on the Linux platform (try “shred –fuvzn1 [FILENAME]” or check “man shred” for details), or “File Shredder&rdqu...

Proper Use of Audio-Visual Aids: Essential for Educators.

Science.gov (United States)

Dejardin, Conrad

1989-01-01

Criticizes educators as the worst users of audio-visual aids and among the worst public speakers. Offers guidelines for the proper use of an overhead projector and the development of transparencies. (DMM)

Multi-scale habitat selection modeling: A review and outlook

Science.gov (United States)

Kevin McGarigal; Ho Yi Wan; Kathy A. Zeller; Brad C. Timm; Samuel A. Cushman

2016-01-01

Scale is the lens that focuses ecological relationships. Organisms select habitat at multiple hierarchical levels and at different spatial and/or temporal scales within each level. Failure to properly address scale dependence can result in incorrect inferences in multi-scale habitat selection modeling studies.

The Defense Logistics Agency Properly Awarded Power Purchase Agreements and the Army Obtained Fair Market Value for Leases Supporting Power Purchase Agreements

Science.gov (United States)

2016-09-28

response to an allegation reported to the Defense Hotline. The allegation stated that the Army and Navy leased land to utility companies to produce...awarded the two power purchase agreements at Fort Hood and Fort Detrick, using full and open competition, in accordance with Federal and DoD guidance...Specifically, the contracting officials properly issued requests for proposals, developed source selection plans, and evaluated proposals in

Using aspen for artist stretcher frames: adding value through quality service, direct marketing, and careful material selection

Science.gov (United States)

Chris Polson

2001-01-01

Aspen wood, when carefully selected and kiln dried, makes excellent stock for artist stretcher frames. Direct marketing techniques including the Internet and word of mouth give access to national markets, providing a more diverse and stable customer base for operations from a rural area. High-quality service, as shown by product performance and rapid order fulfillment...

Partograph utilization and associated factors among obstetric care ...

African Journals Online (AJOL)

% of maternal deaths which can be reduced by proper utilization of partograph during labor. Methods: An Institution based cross-sectional study was conducted in June, 2013 on 403 obstetric care providers. A pre-test- ed and structured ...

Proper Elements and Secular Resonances for Irregular Satellites

Science.gov (United States)

Beaugé, C.; Nesvorný, D.

2007-06-01

We present results of an analytical study of proper elements and secular resonances for the irregular satellites of the outer planets. In the case of the Jovian system we identify three satellite families, two of them previously known (Carme and Ananke), plus a new agglomeration of four bodies that includes Pasiphae as its largest member. While the distribution of proper elements for Saturn's moons seems to be more random, a small cluster was found for the direct moons formed by Albiorix, Erriapo, and 2004 S1, slightly different from the so-called Gaulish cluster. No significant families are detected in the present study for the Uranian or Neptunian satellite systems. For each satellite system we determine the location of several secular resonances in the proper element space. Apart from the well-known resonance locks of Pasiphae, Sinope, and Siarnaq, a comparison between the resonance locations and proper elements shows that Saturn's satellite Narvi also exhibits temporary librations in the ϖ-ϖsolar resonance. However, unlike the resonant Jovian moons that are located in the same configuration, Narvi's critical argument librates alternately around values near 90° and 270°. Neither the Uranian nor Neptunian systems seem to have resonant moons. The resonant dynamics of the real satellites in the vicinity of ϖ˙-ϖ˙solar=0 is studied with a simple model for secular resonances based on the restricted three-body problem. Depending on the initial conditions, we show the existence of one or two modes of libration that can occur at different values of the critical angle, showing a good correspondence with the observed behavior of all the resonant moons. Finally, we discuss the global distribution of the real satellites with respect to the secular resonances, as compared with synthetic populations of bodies drawn solely from stability conditions. For Saturn, we find that the present satellite population appears compatible with simple random distributions. Although

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China.

Science.gov (United States)

Wang, Hong; Zhang, Licheng; Yip, Winnie; Hsiao, William

2006-09-01

This study examines adverse selection in a subsidized voluntary health insurance scheme, the Rural Mutual Health Care (RMHC) scheme, in a poor rural area of China. The study was made possible by a unique longitudinal data set: the total sample includes 3492 rural residents from 1020 households. Logistic regression was employed for the data analysis. The results show that although this subsidized scheme achieved a considerable high enrollment rate of 71% of rural residents, adverse selection still exists. In general, individuals with worse health status are more likely to enroll in RMHC than individuals with better health status. Although the household is set as the enrollment unit for the RMHC for the purpose of reducing adverse selection, nearly 1/3 of enrolled households are actually only partially enrolled. Furthermore, we found that adverse selection mainly occurs in partially enrolled households. The non-enrolled individuals in partially enrolled households have the best health status, while the enrolled individuals in partially enrolled households have the worst health status. Pre-RMHC, medical expenditure for enrolled individuals in partially enrolled households was 206.6 yuan per capita per year, which is 1.7 times as much as the pre-RMHC medical expenditure for non-enrolled individuals in partially enrolled households. The study also reveals that the pre-enrolled medical expenditure per capita per year of enrolled individuals was 9.6% higher than the pre-enrolled medical expenditure of all residents, including both enrolled and non-enrolled individuals. In conclusion, although the subsidized RMHC scheme reached a very high enrollment rate and the household is set as the enrollment unit for the purpose of reducing adverse selection, adverse selection still exists, especially within partially enrolled households. Voluntary RMHC will not be financially sustainable if the adverse selection is not fully taken into account.

Proper comparison among methods using a confusion matrix

CSIR Research Space (South Africa)

Salmon

2015-07-01

Full Text Available -1 IGARSS 2015, Milan, Italy, 26-31 July 2015 Proper comparison among methods using a confusion matrix 1,2 B.P. Salmon, 2,3 W. Kleynhans, 2,3 C.P. Schwegmann and 1J.C. Olivier 1School of Engineering and ICT, University of Tasmania, Australia 2...

Community Health Centers: Providers, Patients, and Content of Care

Science.gov (United States)

... can be more easily delivered than specialty and inpatient care, and if properly distributed could be effective ... services : Include education about asthma, diet and nutrition, exercise, growth and development, injury prevention, stress management, tobacco ...

System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

Science.gov (United States)

Thoburn, E; Norris, P; Flores, R; Goode, S; Rodriguez, E; Adams, V; Campbell, S; Albrink, M; Rosemurgy, A

1993-01-01

A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

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

Directory of Open Access Journals (Sweden)

Elisabeth eJonas

2015-02-01

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

Modelling Seasonal GWR of Daily PM2.5 with Proper Auxiliary Variables for the Yangtze River Delta

Directory of Open Access Journals (Sweden)

Man Jiang

2017-04-01

Full Text Available Over the past decades, regional haze episodes have frequently occurred in eastern China, especially in the Yangtze River Delta (YRD. Satellite derived Aerosol Optical Depth (AOD has been used to retrieve the spatial coverage of PM2.5 concentrations. To improve the retrieval accuracy of the daily AOD-PM2.5 model, various auxiliary variables like meteorological or geographical factors have been adopted into the Geographically Weighted Regression (GWR model. However, these variables are always arbitrarily selected without deep consideration of their potentially varying temporal or spatial contributions in the model performance. In this manuscript, we put forward an automatic procedure to select proper auxiliary variables from meteorological and geographical factors and obtain their optimal combinations to construct four seasonal GWR models. We employ two different schemes to comprehensively test the performance of our proposed GWR models: (1 comparison with other regular GWR models by varying the number of auxiliary variables; and (2 comparison with observed ground-level PM2.5 concentrations. The result shows that our GWR models of “AOD + 3” with three common meteorological variables generally perform better than all the other GWR models involved. Our models also show powerful prediction capabilities in PM2.5 concentrations with only slight overfitting. The determination coefficients R2 of our seasonal models are 0.8259 in spring, 0.7818 in summer, 0.8407 in autumn, and 0.7689 in winter. Also, the seasonal models in summer and autumn behave better than those in spring and winter. The comparison between seasonal and yearly models further validates the specific seasonal pattern of auxiliary variables of the GWR model in the YRD. We also stress the importance of key variables and propose a selection process in the AOD-PM2.5 model. Our work validates the significance of proper auxiliary variables in modelling the AOD-PM2.5 relationships and

Statistical HR diagrams for one hundred and fifteen thousand proper-motion stars

International Nuclear Information System (INIS)

Luyten, W.J.

1978-01-01

Since regular HR diagrams require apparent magnitudes, colors or spectra, and parallaxes, and such complete data are available for relatively few stars, there may be some advantage in making up diagrams which utilize proper motions instead of parallaxes, and are thus statistically similar to an HR diagram. The reduced proper motion, first used by Hertzsprung, is defined as H=m+5+5log μ, but may also be written as H=M+5log T, where T is the tangential velocity, and is expressed in astronomical units per year. A diagram plotting H against color will thus contain the considerable dispersion in tangential velocity which is a serious disadvantage. However, this is outweighed by two practical advantages. First, the one and the same person who does the proper motion survey can, and does also determine the other two quantities needed. Second, when using data obtained from such a proper motion survey one deals, statistically, with all the stars within a given distance and the results, therefore, are much more representative of the real situation in space than many HR diagrams which often contain an unrealistic preponderance of giants. (Auth.)

Application of theoretical and methodological components of nursing care

OpenAIRE

Rosa del Socorro Morales-Aguilar; Gloria Elena Lastre-Amell; Alba Cecilia Pardo-Vásquez

2016-01-01

Introduction: the theoretical and methodological components are the proper expertise in nursing, and it refers to models, theories, care process, taxonomy of nursing diagnoses, system of nursing intervention classification, and system of outcomes classification, which base nursing care into professional practice. Methodology: research was performed on Google Scholar, reviewing the databases of Scielo, Ciberindex, Index Enfermería, Dialnet, Redalyc, Medline, identifying 70 published articles b...

THE TEACHERS ROLE IN FORMING PROPER BODY POSTURE

Directory of Open Access Journals (Sweden)

Zoran Bogdanović

2007-05-01

Full Text Available Being acquainted and well aware of the presence of physical deformation in school population, this study is based on the research of postural deformity of the pupils of the 5th grade of elementary school and determination of dependance of deformations appearance in relation to frequency of remonstration and indication to correct sitting position from proffesors’ perspective. The complete program content is conducted in the territory of the city of Kragujevac in several elementary schools comprising 299 students of the 5th grade. The object was to determine the number of students with kyphotic and lordotic deformity, to determine the presence of deformation in depandance of gender and to determine the presence of kyphotic and lordotic deformity in depandance of the frequency of proffesors indication to improper sitting. We can notice higher presence of kyphotic deformity at the probationers of male population that it is the case with female population while the higher presence of lordotic deformity is at female population.The highest number of probationers have reported that none of the proffesors warn them about proper sitting. The measures inside the groups sorted by gender qualifi cation, indicate on high percentage of both boys and girls who are not warned on proper sitting. Also, inside the groups of improper body holders, we can notice the most signifi cant kyphotic and lordotic deformity in the category of students who are never warned to sit properly. These indicators report us that is necessary to invest much more work on the education of parents and children as well as school stuff at the preschool and school institutions which would result in reducing the appearence and development of postural deformity at the population who is more liable to transformations of such kind.

A generalised Green-Julg theorem for proper groupoids and Banach algebras

OpenAIRE

Paravicini, Walther

2009-01-01

The Green-Julg theorem states that K_0^G(B) is isomorphic to K_0(L^1(G,B)) for every compact group G and every G-C*-algebra B. We formulate a generalisation of this result to proper groupoids and Banach algebras and deduce that the Bost assembly map is surjective for proper Banach algebras. On the way, we show that the spectral radius of an element in a C_0(X)-Banach algebra can be calculated from the spectral radius in the fibres.

Care of the abandoned child.

Science.gov (United States)

Raghunath, M

1991-01-01

Care of abandoned children in India is discussed in terms of reasons for abandonment, the physical condition of the children, and legal categories. The options available currently are the cottage system, sponsorship programs, foster care, or adoption. Child-care and rehabilitation that may be necessary is specified as is the importance of maintaining records. The gaps in child-care are exposed. The role of nongovernmental organization (NGOs) and new legislation in closing the gaps is presented. Abandonment is usually a direct result of poverty, but it can also be caused by mental or physical handicaps or illegitimacy. The numbers of abandoned children may reach 2 million. 40-60% of abandoned infants die during monsoons and summers. The legal categories are privately abandoned, children on remand, or court-committed children. The cottage system emphasizes deinstitutionalization, but there remains a great demand for care. Sponsorship aims to strengthen the family unit to prevent abandonment. Foster care provides an alternative family substitute, but is known only theoretically. Childcare may involve instant hospitalization, care is an institution, or foster care with a suitable family. Nursery care requires discipline in hygiene, sanitation, maintenance of individual medical records, and a general cheerful atmosphere. Records are important for the child in later life and for adoption. Rehabilitation is a sociolegal process which must be done properly or it can jeopardize a child's future security. Despite the Supreme Court guidelines of 1984, there is no uniform system of adoption practices, and the child's interests are overlooked when adoptions are promoted. NGOs play an important role in making social welfare programs work. However their efforts are of limited help without government support and legislation. There is a lack of proper legislation which is outside the control of political and religious interests; e.g., Hindu law only permits adoption of one child of

Handling medical negligence: necessity of a proper system

Directory of Open Access Journals (Sweden)

Nuwadatta Subedi

2017-12-01

field by the councils framed to settle the cases of medical negligence, especially the consumer protection council, Nepal Medical Council, etc.It is a high time for the government to play role to address to this sensitive and quai-legal issue. If this trend is not ended, the trust of patients towards the doctors may nullify. The doctors also cannot work effectively when there is no safe working environment and may begin to have tendency to abandon handling critical cases with a fear of vulnerability to defamation if not physical assault in worst case. The situation is ultimately disastrous to the entire health care system. The very sensitive issue of health care delivery cannot be compared to any other commercial issues. The proper mechanism of addressing the issue of medical negligence should be practiced alongside encouragement from governmental urge to come up with better medicolegal systems in this regard. This is highly essential for balancing expectations of the patients and performance of medical professionals.

HIV-positive patients’ perceptions of care received at a selected antiretroviral therapy clinic in Vhembe district, South Africa

Directory of Open Access Journals (Sweden)

Tshifhiwa V. Ndou

2016-04-01

Full Text Available Background: Patients’ experiences are a reflection of what has happened during the care process and, therefore, provide information about the performance of health care professional workers. They refer to the process of care provision at the antiretroviral therapy (ART sites. Aim and setting: This article explored the perceptions of HIV-positive patients of care received at the Gateway Clinic of the regional hospital that provides antiretroviral treatment in the Vhembe district. Methods: A qualitative, explorative and descriptive design was used. A non-probability, convenient sampling method was used to select 20 HIV-positive patients who were above 18 years of age. In-depth individual interviews were used to collect data. Data were analysed through Tech’s open coding method. Results: One theme and two sub-themes emerged, namely positive experiences related to the environment and attitudes of health professionals, and negative experiences concerning the practices by health care providers. Conclusion: Patients’ perceptions of quality of, and satisfaction with, health care may affect health outcomes. Recommendations are made to consider, practice and strengthen the protocols, the standard operating procedures and the principles of infection control in the health facilities. Keywords: Human Immunodeficiecy Virus, Antiretroviral Treatment, HIV positive, Limpopo

Ethics and end of life care: the Liverpool Care Pathway and the Neuberger Review.

Science.gov (United States)

Wrigley, Anthony

2015-08-01

The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication and ethical decision-making, without the added demand to end the Liverpool Care Pathway, would have resulted in a genuine advance in end of life care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Treatment of Proper Name Retrieval Deficits in an Individual with Temporal Lobe Epilepsy

Science.gov (United States)

Minkina, Irene; Ojemann, Jeffrey G.; Grabowski, Thomas J.; Silkes, JoAnn P.; Phatak, Vaishali; Kendall, Diane L.

2013-01-01

Purpose: Studies investigating language deficits in individuals with left temporal-lobe epilepsy have consistently demonstrated impairments in proper name retrieval. The aim of this Phase I rehabilitation study was to investigate the effects of a linguistically distributed word retrieval treatment on proper name retrieval in an individual with…

“On the Margins and Not the Mainstream:” Case Selection for the Implementation of Community based Primary Health Care in Canada and New Zealand

Directory of Open Access Journals (Sweden)

Kerry Kuluski

2017-06-01

Full Text Available Healthcare system reforms are pushing beyond primary care to more holistic, integrated models of community based primary health care (CBPHC to better meet the needs of the population. Across the world CBPHC is at varying stages of development and few standard models exist. In order to scale up and spread successful models of care it is important to study what works and why. The first step is to select ‘appropriate’ cases to study. In this commentary we reflect on our journey in the selection of CBPHC models for older adults, revealing the limited utility of sourcing the empirical literature; the difficulty in identifying “successful” models to study when outcomes of importance differ across stakeholders; the value of drawing on clinical and organisational networks and experts; and the association between policy context and ease of case selection. Such insights have important implications for case study methodology in health services and policy research.

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

Science.gov (United States)

Jonas, Elisabeth; de Koning, Dirk-Jan

2015-01-01

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

CMS MDS 3.0 Section M Skin Conditions in Long-term Care: Pressure Ulcers, Skin Tears, and Moisture-Associated Skin Damage Data Update.

Science.gov (United States)

Ayello, Elizabeth A

2017-09-01

The purpose of this learning activity is to provide information about the updates to the Centers for Medicare & Medicaid Services (CMS) MDS 3.0 Section M, Skin Conditions documentation in long-term care. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Explain the use of the CMS MDS 3.0 tool for documenting skin problems in long-term care.2. Demonstrate examples of proper documentation for specific skin problems. This manuscript reviews some of the key parts of the October 2016 revised Long-term Care Resident Assessment Instrument manual for Minimum Data Set (MDS) 3.0 Section M Skin Conditions. It also reports the Centers for Medicare & Medicaid's publicly reported frequency data in long-term care for selected items on the MDS 3.0 Section M Skin Conditions. Percentages and trends of pressure ulcers/injuries, skin tears, and moisture-associated skin damage are assessed.

Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries

Directory of Open Access Journals (Sweden)

Joyce E Thompson

2015-05-01

Full Text Available OBJECTIVE: To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC to 1 better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2 determine the need for more rigorous study of the issues. METHODS: A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. RESULTS: Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. CONCLUSIONS: The findings suggest that 1 the quality of maternal and newborn care and 2 the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

Leptospermum Honey for Wound Care in an Extremely Premature Infant.

Science.gov (United States)

Esser, Media

2017-02-01

Neonatal wound care is challenging due to the fragility and vulnerable skin structure. Neonates are often left susceptible to the forces of their environment, leaving them open to infection when skin injury occurs. Leptospermum honey has been used successfully in adult patients, with evidence lacking in the neonatal population. This case demonstrates the management of a difficult-to-heal wound in a 23-week gestation infant. Selecting the proper treatment and products for wound healing is challenging, with little evidence-based research available for the treatment of neonatal wounds. Leptospermum honey and other adult-driven dressings have been used for neonatal wound care as well as other adult-driven dressings. This case demonstrates the benefits of Leptospermum honey as an option for neonatal wounds. This case presents the treatment and healing of an extensive wound of a 23-week gestation neonate using a hydrogel product initially and then transitioning to a Leptospermum honey dressing due to suboptimal healing. Results of this treatment included quick healing time, little to no scarring, and no loss of movement or function to the affected extremities. The incorporation of Leptospermum honey for wound care has the potential to promote faster wound healing, with less scarring in the neonatal population. Adult wound care principles have been applied in the face of a weak evidence base relating to neonatal-specific cases. There is a need for continued research related to moist wound healing in the neonatal population, with resulting product and practice recommendations.

77 FR 70484 - Preoperational Testing of Onsite Electric Power Systems To Verify Proper Load Group Assignments...

Science.gov (United States)

2012-11-26

...-1294, ``Preoperational Testing of On-Site Electric Power Systems to Verify Proper Load Group... entitled ``Preoperational Testing of On- Site Electric Power Systems to Verify Proper Load Group... Electric Power Systems to Verify Proper Load Group Assignments, Electrical Separation, and Redundancy...

UCAC3 PROPER MOTION SURVEY. II. DISCOVERY OF NEW PROPER MOTION STARS IN UCAC3 WITH 0.''40 yr–1 > μ ≥ 0.''18 yr–1 BETWEEN DECLINATIONS –47° and 00°

International Nuclear Information System (INIS)

Finch, Charlie T.; Zacharias, Norbert; Boyd, Mark R.; Henry, Todd J.; Hambly, Nigel C.

2012-01-01

We present 474 new proper motion stellar systems in the southern sky having no previously known components, with 0.''40 yr –1 >μ ≥ 0.''18 yr –1 between declinations –47° and 0°. In this second paper utilizing the U.S. Naval Observatory third CCD Astrograph Catalog (UCAC3) we complete our sweep of the southern sky for objects in the proper motion range targeted by this survey with R magnitudes ranging from 9.80 to 19.61. The new systems contribute a ∼16% increase in the number of new stellar systems for the same region of sky reported in previous SuperCOSMOS Research Consortium On Nearby Stars (RECONS) surveys. Among the newly discovered stellar systems are 16 multiples, plus an additional ten components that are new common proper motion companions to previously known objects. A comparison of UCAC3 proper motions to those from Hipparcos, Tycho-2, Southern Proper Motion, and SuperCOSMOS indicates that all proper motions are consistent to ∼10 mas yr –1 , with the exception of SuperCOSMOS. Distance estimates are derived for all stellar systems having SuperCOSMOS Sky Survey B J , R 59F , and I IVN plate magnitudes and Two Micron All Sky Survey (2MASS) infrared photometry. We find five new red dwarf systems estimated to be within 25 pc. These discoveries support results from previous proper motion surveys suggesting that more nearby stellar systems are to be found, particularly in the fainter, slower moving samples. In this second paper utilizing the UCAC3 we complete our sweep of the southern sky for objects in the proper motion range targeted by this survey with R magnitudes ranging from 9.80 to 19.61.

Practice innovation: the need for nimble data platforms to implement precision oncology care.

Science.gov (United States)

Elfiky, Aymen; Zhang, Dongyang; Krishnan Nair, Hari K

2015-01-01

Given the drive toward personalized, value-based, and coordinated cancer care delivery, modern knowledge-based practice is being shaped within the context of an increasingly technology-driven healthcare landscape. The ultimate promise of 'precision medicine' is predicated on taking advantage of the range of new capabilities for integrating disease- and individual-specific data to define new taxonomies as part of a systems-based knowledge network. Specifically, with cancer being a constantly evolving complex disease process, proper care of an individual will require the ability to seamlessly integrate multi-dimensional 'omic' and clinical data. Importantly, however, the challenges of curating knowledge from multiple dynamic data sources and translating to practice at the point-of-care highlight parallel needs. As patients, caregivers, and their environments become more proactive in clinical care and management, practical success of precision medicine is equally dependent on the development of proper infrastructures for evolving data integration, platforms for knowledge representation in a clinically-relevant context, and implementation within a provider's work-life and workflow.

Perceptions of point-of-care infectious disease testing among European medical personnel, point-of-care test kit manufacturers, and the general public

NARCIS (Netherlands)

W.E. Kaman (Wendy); E-R. Andrinopoulou (Eleni-Rosalina); J.P. Hays (John)

2013-01-01

textabstractBackground: The proper development and implementation of point-of-care (POC) diagnostics requires knowledge of the perceived requirements and barriers to their implementation. To determine the current requirements and perceived barriers to the introduction of POC diagnostics in the field

What is the proper evaluation method: Some basic considerations

International Nuclear Information System (INIS)

Leeb, Helmut; Schnabel, Georg; Srdinko, Thomas

2014-01-01

Recent developments and applications demand for an extension of the energy range and the inclusion of reliable uncertainty information in nuclear data libraries. Due to the scarcity of neutron-induced reaction data beyond 20 MeV the extension of the energy range up to at least 150 MeV is not trivial because the corresponding nuclear data evaluations depend heavily on nuclear models and proper evaluation methods are still under discussion. Restricting to evaluation techniques based on Bayesian statistics the influence of the a priori knowledge on the final result of the evaluation is considered. The study clearly indicates the need to account properly for the deficiencies of the nuclear model. Concerning the covariance matrices it is argued that they depend not only on the model, but also on the method of generation and an additional consent is required for the comparison of different evaluations of the same data sets. (authors)

Quantitative measures of sexual selection reveal no evidence for sex-role reversal in a sea spider with prolonged paternal care

OpenAIRE

Barreto, Felipe S.; Avise, John C.

2010-01-01

Taxa in which males alone invest in postzygotic care of offspring are often considered good models for investigating the proffered relationships between sexual selection and mating systems. In the pycnogonid sea spider Pycnogonum stearnsi, males carry large egg masses on their bodies for several weeks, so this species is a plausible candidate for sex-role reversal (greater intensity of sexual selection on females than on males). Here, we couple a microsatellite-based assessment of the mating ...

[Optimizing antibiotics policy in the Netherlands. VI. SWAB advice: no selective decontamination of intensive care patients on mechanical ventilation

NARCIS (Netherlands)

Bonten, M.J.; Kullberg, B.J.; Filius, P.M.

2001-01-01

The Working Party on Antibiotic Policy (Dutch acronym is SWAB) has issued a guideline in which the pro and cons of the routine use of selective decontamination (SD) in patients in intensive care (IC) on mechanical ventilation are compared in order to decide whether SD is indicated. The effectiveness

Radial velocities for the HIPPARCOS-Gaia Hundred-Thousand-Proper-Motion project

Science.gov (United States)

de Bruijne, J. H. J.; Eilers, A.-C.

2012-10-01

Context. The Hundred-Thousand-Proper-Motion (HTPM) project will determine the proper motions of ~113 500 stars using a ~23-year baseline. The proper motions will be based on space-based measurements exclusively, with the Hipparcos data, with epoch 1991.25, as first epoch and with the first intermediate-release Gaia astrometry, with epoch ~2014.5, as second epoch. The expected HTPM proper-motion standard errors are 30-190 μas yr-1, depending on stellar magnitude. Aims: Depending on the astrometric characteristics of an object, in particular its distance and velocity, its radial velocity can have a significant impact on the determination of its proper motion. The impact of this perspective acceleration is largest for fast-moving, nearby stars. Our goal is to determine, for each star in the Hipparcos catalogue, the radial-velocity standard error that is required to guarantee a negligible contribution of perspective acceleration to the HTPM proper-motion precision. Methods: We employ two evaluation criteria, both based on Monte-Carlo simulations, with which we determine which stars need to be spectroscopically (re-)measured. Both criteria take the Hipparcos measurement errors into account. The first criterion, the Gaussian criterion, is applicable to nearby stars. For distant stars, this criterion works but returns overly pessimistic results. We therefore use a second criterion, the robust criterion, which is equivalent to the Gaussian criterion for nearby stars but avoids biases for distant stars and/or objects without literature radial velocity. The robust criterion is hence our prefered choice for all stars, regardless of distance. Results: For each star in the Hipparcos catalogue, we determine the confidence level with which the available radial velocity and its standard error, taken from the XHIP compilation catalogue, are acceptable. We find that for 97 stars, the radial velocities available in the literature are insufficiently precise for a 68.27% confidence

Twisted equivariant K-theory, groupoids and proper actions

OpenAIRE

Cantarero, Jose

2009-01-01

In this paper we define twisted equivariant K-theory for actions of Lie groupoids. For a Bredon-compatible Lie groupoid, this defines a periodic cohomology theory on the category of finite CW-complexes with equivariant stable projective bundles. A classification of these bundles is shown. We also obtain a completion theorem and apply these results to proper actions of groups.

Ethics of Care: A Panacea to the Niger-Delta Crises. | Eribo | Lwati ...

African Journals Online (AJOL)

This paper examines the relevance of 'ethics of care' in the furtherance of a harmonious relationship between the Federal government, multi-national oil companies with the indigenous communities in the Niger-Delta region of Nigeria. The paper is of the view that when the 'ethics of care' is properly applied to the ...

Optimizing chain life in bucket elevators through proper design and elongation measurement

Energy Technology Data Exchange (ETDEWEB)

Luglio, J.J. [Rexnord, Inc., Milwaukee, WI (United States)

2001-04-01

Since down time in the bulk solids handling industry is so expensive, bucket elevators must operate with extreme reliability, and, of course, the cost per ton of material conveyed must be minimized. This means balancing initial costs, operating and maintenance costs as well as minimizing the inventory of parts required in order to insure reliability. The elevator must be designed properly for each application. It must also be operated and maintained properly. (orig.)

'What is not written does not exist': the importance of proper documentation of medication use history.

Science.gov (United States)

Silvestre, Carina Carvalho; Santos, Lincoln Marques Cavalcante; de Oliveira-Filho, Alfredo Dias; de Lyra, Divaldo Pereira

2017-10-01

Medications are perceived as health risk factors, because they might cause damage if used improperly. In this context, an adequate assessment of medication use history should be encouraged, especially in transitions of care to avoid unintended medication discrepancies (UMDs). In a case-controlled study, we investigated potential risk factors for UMDs at hospital admission and found that 150 (42%) of the 358 patients evaluated had one or more UMDs. We were surprised to find that there was no record of a patient and/or relative interview on previous use of medication in 117 medical charts of adult patients (44.8%). Similarly, in the medical charts of 52 (53.6%) paediatric patients, there was no record of parents and/or relatives interviews about prior use of medications. One hundred thirty-seven medical charts of adult patients (52.4%) and seventy-two medical charts of paediatric patients (74.2%) had no record about medication allergies and intolerances. In other words, there was a lack of basic documentation regarding the patient's medication use history. As patients move between settings in care, there is insufficient tracking of verbal and written information related to medication changes, which results in a progressive and cumulative loss of information, as evidenced by problems associated with clinical transfers and medication orders. Proper documentation of medication information during transfer is a key step in the procedure; hence, it should be rightly performed. It remains unclear whether interviews, and other investigations about medication use history have been performed but have not been recorded as health-care data. Therefore, it is crucial to the improvement of medication use safety that documentation of all drug-related information-even if not directly related to the actual event-become routine practice in health-care organizations, since 'what is not written does not exist'.

Corrections to the Hipparcos proper motions in declination for 807 stars

Directory of Open Access Journals (Sweden)

Damljanović G.

2008-01-01

Full Text Available We used the data on latitude variations obtained from observations with 10 classical photographic zenith tubes (PZT in order to improve the Hipparcos proper motions in declinations µδ for 807 stars. Part of observing programmes, carried out during the last century for the purpose of studying the Earth's rotation, were realized by using PZT instruments. These observations were performed within in the intervals (tens of years much longer than that of the Hipparcos mission (less than 4 years. In addition, the annual number of observations for every PZT programme star is several hundreds on the average. Though the accuracy of the star coordinates in the Hipparcos Catalogue is by two orders of magnitude better than that of the star coordinates from the PZT observations, the large number of observations performed a much longer time interval makes it possible to correct the Hipparcos proper motions and to improve their accuracy with respect to the accuracy given in the Hipparcos Catalogue. Long term examinations of latitude and time variations were used to form the Earth Orientation Catalogue (EOC-2, aimed at a more accurate determination of positions and proper motions for the stars included. Our method of calculating the corrections of the proper motions in declination from the latitude variations is different from the method used in obtaining the EOC-2 Catalogue. Comparing the results we have established a good agreement between our µδ and the EOC-2 ones for the star sample used in the present paper.

Corrections to the Hipparcos Proper Motions in Declination for 807 Stars

Directory of Open Access Journals (Sweden)

Damljanović, G.

2008-12-01

Full Text Available We used the data on latitude variations obtained from observations with 10 classical photographic zenith tubes (PZT in order to improve the Hipparcos proper motions in declinations $mu_{delta} $ for 807 stars. Part of observing programmes, carried out during the last century for the purpose of studying the Earth's rotation, were realized by using PZT instruments. These observations were performed within in the intervals (tens of years much longer than that of the Hipparcos mission (less than 4 years. In addition, the annual number of observations for every PZT-programme star is several hundreds on the average. Though the accuracy of the star coordinates in the Hipparcos Catalogue is by two orders of magnitude better than that of the star coordinates from the PZT observations, the large number of observations performed a much longer time interval makes it possible to correct the Hipparcos proper motions and to improve their accuracy with respect to the accuracy given in the Hipparcos Catalogue. Long term examinations of latitude and time variations were used to form the Earth Orientation Catalogue (EOC-2, aimed at a more accurate determination of positions and proper motions for the stars included. Our method of calculating the corrections of the proper motions in declination from the latitude variations is different from the method used in obtaining the EOC-2 Catalogue. Comparing the results we have established a good agreement between our $mu_ {delta} $ and the EOC-2 ones for the star sample used in the present paper.

MEASURING THE UNDETECTABLE: PROPER MOTIONS AND PARALLAXES OF VERY FAINT SOURCES

International Nuclear Information System (INIS)

Lang, Dustin; Hogg, David W.; Jester, Sebastian; Rix, Hans-Walter

2009-01-01

The near future of astrophysics involves many large solid-angle, multi-epoch, multiband imaging surveys. These surveys will, at their faint limits, have data on a large number of sources that are too faint to be detected at any individual epoch. Here, we show that it is possible to measure in multi-epoch data not only the fluxes and positions, but also the parallaxes and proper motions of sources that are too faint to be detected at any individual epoch. The method involves fitting a model of a moving point source simultaneously to all imaging, taking account of the noise and point-spread function (PSF) in each image. By this method it is possible to measure the proper motion of a point source with an uncertainty close to the minimum possible uncertainty given the information in the data, which is limited by the PSF, the distribution of observation times (epochs), and the total signal-to-noise in the combined data. We demonstrate our technique on multi-epoch Sloan Digital Sky Survey (SDSS) imaging of the SDSS Southern Stripe (SDSSSS). We show that with our new technique we can use proper motions to distinguish very red brown dwarfs from very high-redshift quasars in these SDSS data, for objects that are inaccessible to traditional techniques, and with better fidelity than by multiband imaging alone. We rediscover all 10 known brown dwarfs in our sample and present nine new candidate brown dwarfs, identified on the basis of significant proper motion.

Possible Relativistic Definitions of Parallax, Proper Motion and Radial Velocity

National Research Council Canada - National Science Library

Klioner, S

2000-01-01

.... In this paper, the authors briefly describe a relativistic model of space-based optical positional observations valid at a high level of accuracy, and suggest definitions of parallax, proper motion...

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Dental Care Utilization for Examination and Regional Deprivation

Science.gov (United States)

Kim, Cheol-Sin; Han, Sun-Young; Lee, Seung Eun; Kang, Jeong-Hee; Kim, Chul-Woung

2015-01-01

Objectives: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. Methods: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). Results: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (pdental care utilization for other reasons in the final model. Conclusions: This study’s findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination. PMID:26265665

Intelligent Decisional Assistant that Facilitate the Choice of a Proper Computer System Applied in Busines

Directory of Open Access Journals (Sweden)

Nicolae MARGINEAN

2009-01-01

Full Text Available The choice of a proper computer system is not an easy task for a decider. One reason could be the present market development of computer systems applied in business. The big number of the Romanian market players determines a big number of computerized products, with a multitude of various properties. Our proposal tries to optimize and facilitate this decisional process within an e-shop where are sold IT packets applied in business, building an online decisional assistant, a special component conceived to facilitate the decision making needed for the selection of the pertinent IT package that fits the requirements of one certain business, described by the decider. The user interacts with the system as an online buyer that visit an e-shop where are sold IT package applied in economy.

HOME CARE NURSES’ ROLES IN ENHANCING QUALITY OF NURSING CARE FOR PATIENTS AT HOME: A PHENOMENOLOGICAL STUDY

Directory of Open Access Journals (Sweden)

Titan Ligita

2017-08-01

Full Text Available Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

Space Projects: Improvements Needed in Selecting Future Projects for Private Financing

Science.gov (United States)

1990-01-01

The Office of Management and Budget (OMB) and NASA jointly selected seven projects for commercialization to reduce NASA's fiscal year 1990 budget request and to help achieve the goal of increasing private sector involvement in space. However, the efforts to privately finance these seven projects did not increase the commercial sector's involvement in space to the extent desired. The General Accounting Office (GAO) determined that the projects selected were not a fair test of the potential of increasing commercial investment in space at an acceptable cost to the government, primarily because the projects were not properly screened. That is, neither their suitability for commercialization nor the economic consequences of seeking private financing for them were adequately evaluated before selection. Evaluations and market tests done after selection showed that most of the projects were not viable candidates for private financing. GAO concluded that projects should not be removed from NASA's budget for commercial development until after careful screening has been done to determine whether adequate commercial demand exists, development risks are commercially acceptable and private financing is found or judged to be highly likely, and the cost effectiveness of such a decision is acceptable. Premature removal of projects from NASA's budget ultimately can cause project delays and increased costs when unsuccessful commercialization candidates must be returned to the budget. NASA also needs to ensure appropriate comparisons of government and private financing options for future commercialization projects.

Proper Motion and Secular Variations of Keplerian Orbital Elements

Directory of Open Access Journals (Sweden)

Alexey G. Butkevich

2018-05-01

Full Text Available High-precision observations require accurate modeling of secular changes in the orbital elements in order to extrapolate measurements over long time intervals, and to detect deviation from pure Keplerian motion caused, for example, by other bodies or relativistic effects. We consider the evolution of the Keplerian elements resulting from the gradual change of the apparent orbit orientation due to proper motion. We present rigorous formulae for the transformation of the orbit inclination, longitude of the ascending node and argument of the pericenter from one epoch to another, assuming uniform stellar motion and taking radial velocity into account. An approximate treatment, accurate to the second-order terms in time, is also given. The proper motion effects may be significant for long-period transiting planets. These theoretical results are applicable to the modeling of planetary transits and precise Doppler measurements as well as analysis of pulsar and eclipsing binary timing observations.

Precedent Proper Names in Informal Oikonymy

Directory of Open Access Journals (Sweden)

Maria V. Akhmetova

2013-06-01

Full Text Available The paper deals with the Russian language informal city names (oikonyms motivated by other toponyms (with reference to Russia and the CIS. The author shows that the motivating proper name can replace the city name (e. g. Глазго < Glasgow ‘Glazov’ or contaminate with it (e. g. Экибостон < Ekibastuz + Boston, the “alien” onym being attracted to construct an informal oikonym due to its phonetic similarity or, on occasion, due to an affinity, either real or imaginary, between the two settlements. The author argues that the phonetic motivation is more characteristic for the modern urban tradition, than for popular dialects.

A properly adjusted forage harvester can save time and money

Science.gov (United States)

A properly adjusted forage harvester can save fuel and increase the realizable milk per ton of your silage. This article details the adjustments necessary to minimize energy while maximizing productivity and forage quality....

An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care.

Science.gov (United States)

Yap, Tracey L; Kennerly, Susan M; Bergstrom, Nancy; Hudak, Sandra L; Horn, Susan D

2016-01-01

Pressure ulcers have consistently resisted prevention efforts in long-term care facilities nationwide. Recent research has described cueing innovations that-when selected according to the assumptions and resources of particular facilities-support best practices of pressure ulcer prevention. This article synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a pressure ulcer prevention program.

32 CFR 842.63 - Who are not proper claimants.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Who are not proper claimants. 842.63 Section 842.63 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND... accompanying US military and US national civilian employees. (c) Foreign military personnel suffering property...

Accounting outsourcing and some problems of selected software for accounting

OpenAIRE

Turková, Lenka

2009-01-01

Diploma thesis on Accounting outsourcing and key problems of selected software for accounting deals with the accounting outsourcing. Work focuses here on the question of the proper selection of an accounting firm and on the conditions of cooperation with it. In this work the reader is also acquainted with some software for accounting and with their advantages and disadvantages.

Adults with Disabilities and Proper Dental Care

Science.gov (United States)

Waldman, H. Barry; Perlman, Steven P.; Cinotti, Debra A.

2009-01-01

Repeated studies of graduating dental students indicate limited preparation to provide services for individuals with special healthcare needs. By the end of the 1990s and into the present decade, more than half of the U.S. dental schools provided less than five hours of class room presentations and about three quarters of the schools provided 0-5…

Metabonomics and Intensive Care

OpenAIRE

Antcliffe, D; Gordon, AC

2016-01-01

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Locale-Specific Categorization of IT Projects for Proper Project Management

Directory of Open Access Journals (Sweden)

Muhammad Nasir

2015-12-01

Full Text Available In this paper we aim to show that not only are the project management techniques important for small-scale projects, but following proper project management techniques is one of the most important requirements. However, there come slight variations in implementing project management techniques in small projects as compared with larger projects. Therefore, proper categorization of projects holds the key to success in many situations. Our paper will show that categorization of a project as small-scale or large-scale should always be locale specific. In this regards, we develop a criteria and evaluate how the projects are categorized as small-scale and large-scale in different parts of the world with focus on IT projects. This research concludes that some methods cannot be used for projects of different scales.

Nursing Care of HIV-Positive Women

DEFF Research Database (Denmark)

Nielsen, Ben; Martinsen, Bente

2015-01-01

to improve quality of life after being diagnosed with HIV, a sharp distinction between HIV and AIDS and a religious and spiritually coping. Identifying the emotional challenges women living with HIV face in their daily lives may help nurses obtain a clearer understanding and greater knowledge of how...... to provide HIV-positive women with effective care that empower and support these women in managing their chronic disease. However to ensure that nurses have the proper tools for effective care for women living with HIV European studies are essentials in relation to what emotional challenges these women...

Target Selection for the SDSS-III MARVELS Survey

Science.gov (United States)

Paegert, Martin; Stassun, Keivan G.; De Lee, Nathan; Pepper, Joshua; Fleming, Scott W.; Sivarani, Thirupathi; Mahadevan, Suvrath; Mack, Claude E., III; Dhital, Saurav; Hebb, Leslie; Ge, Jian

2015-06-01

We present the target selection process for the Multi-object APO Radial Velocity Exoplanets Large-area Survey (MARVELS), which is part of the Sloan Digital Sky Survey (SDSS) III. MARVELS is a medium-resolution (R ∼ 11,000) multi-fiber spectrograph capable of obtaining radial velocities for 60 objects at a time in order to find brown dwarfs and giant planets. The survey was configured to target dwarf stars with effective temperatures approximately between 4500 and 6250 K. For the first 2 years MARVELS relied on low-resolution spectroscopic pre-observations to estimate the effective temperature and log (g) for candidate stars and then selected suitable dwarf stars from this pool. Ultimately, the pre-observation spectra proved ineffective at filtering out giant stars; many giants were incorrectly classified as dwarfs, resulting in a giant contamination rate of ∼30% for the first phase of the MARVELS survey. Thereafter, the survey instead applied a reduced proper motion cut to eliminate giants and used the Infrared Flux Method to estimate effective temperatures, using only extant photmetric and proper-motion catalog information. The target selection method introduced here may be useful for other surveys that need to rely on extant catalog data for selection of specific stellar populations.

Demographic factors and retrieval of object and proper names after age 70.

Directory of Open Access Journals (Sweden)

Gitit Kavé

Full Text Available This research aimed to investigate whether demographic factors are similarly related to retrieval of object and proper names.The sample included 5,907 individuals above age 70 who participated in the Health and Retirement Study between 2004 and 2012. Participants were asked to name two objects as well as the US President and Vice President. Latent growth curve models examined the associations of age, education, and self-rated health with baseline levels and change trajectories in retrieval.Age and education were more strongly related to retrieval of proper names than to retrieval of object names, both for baseline scores and for change trajectory. Similar effects of self-rated health emerged for both types of stimuli.The results show that examining object names and proper names together as indication of cognitive status in the HRS might overlook important differences between the two types of stimuli, in both baseline performance and longitudinal change.

Audit of primary care electrocardiograms sent as emergency to a telehealth service - the Telehealth Network of Minas Gerais, Brazil.

Science.gov (United States)

Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M

2015-01-01

The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.

Modal analysis of fluid flows using variants of proper orthogonal decomposition

Science.gov (United States)

Rowley, Clarence; Dawson, Scott

2017-11-01

This talk gives an overview of several methods for analyzing fluid flows, based on variants of proper orthogonal decomposition. These methods may be used to determine simplified, approximate models that capture the essential features of these flows, in order to better understand the dominant physical mechanisms, and potentially to develop appropriate strategies for model-based flow control. We discuss balanced proper orthogonal decomposition as an approximation of balanced truncation, and explain connections with system identification methods such as the eigensystem realization algorithm. We demonstrate the methods on several canonical examples, including a linearized channel flow and the flow past a circular cylinder. Supported by AFOSR, Grant FA9550-14-1-0289.

Fast algorithms for finding proper strategies in game trees

DEFF Research Database (Denmark)

Miltersen, Peter Bro; Sørensen, Troels Bjerre

2008-01-01

We show how to find a normal form proper equilibrium in behavior strategies of a given two-player zero-sum extensive form game with imperfect information but perfect recall. Our algorithm solves a finite sequence of linear programs and runs in polynomial time. For the case of a perfect informatio...

Improved proper name recall in aging after electrical stimulation of the anterior temporal lobes

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Lars A Ross

2011-10-01

Full Text Available Evidence from neuroimaging and neuropsychology suggests that portions of the anterior temporal lobes play a critical role in proper name retrieval. We previously found that anodal transcranial direct current stimulation (tDCS to the anterior temporal lobes improved retrieval of proper names in young adult. Here we extend that finding to older adults who tend to experience greater proper-naming deficits than young adults. The task was to look at pictures of famous faces or landmarks and verbally recall the associated proper name. Our results show a numerical improvement in face naming after left or right anterior temporal lobe stimulation, but a statistically significant effect only after left-lateralized stimulation. The magnitude of the enhancing effect was similar in older and younger adults but the lateralization of the effect differed depending on age. These results provide evidence that tDCS may be a useful tool for the neurorehabilitation of cognitive function in healthy and pathological cognitive decline.

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.

Science.gov (United States)

Gribble, Phillip A; Delahunt, Eamonn; Bleakley, Chris; Caulfield, Brian; Docherty, Carrie; Fourchet, François; Fong, Daniel Tik-Pui; Hertel, Jay; Hiller, Claire; Kaminski, Thomas; McKeon, Patrick; Refshauge, Kathryn; van der Wees, Philip; Vincenzino, Bill; Wikstrom, Erik

2014-07-01

While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalise this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI with justifications using the best available evidence. The International Ankle Consortium provides this position paper to present and discuss an endorsed set of selection criteria for patients with CAI based on the best available evidence to be used in future research and study designs. These recommendations will enhance the validity of research conducted in this clinical population with the end goal of bringing the research evidence to the clinician and patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Occurrence of transmitted HIV-1 drug resistance among Drug-naïve pregnant women in selected HIV-care centres in Ghana.

Science.gov (United States)

Martin-Odoom, Alexander; Adiku, Theophilus; Delgado, Elena; Lartey, Margaret; Ampofo, William K

2017-03-01

Access to antiretroviral therapy in Ghana has been scaled up across the country over the last decade. This study sought to determine the occurrence of transmitted HIV-1 drug resistance in pregnant HIV-1 positive women yet to initiate antiretroviral therapy at selected HIV Care Centres in Ghana. Plasma specimens from twenty-six (26) HIV seropositive pregnant women who were less than 28weeks pregnant with their first pregnancy and ART naïve were collected from selected HIV care centres in three (3) regions in Ghana. Genotypic testing was done for the reverse transcriptase gene and the sequences generated were analyzed for HIV-1 drug resistance mutations using the Stanford University HIV Drug Resistance Database. Resistance mutations associated with the reverse transcriptase gene were detected in 4 (15.4%) of the participants. At least one major drug resistance mutation in the reverse transcriptase gene was found in 3 (11.5%) of the women. The detection of transmitted HIV-1 drug resistance in this drug-naïve group in two regional HIV care sites is an indication of the need for renewed action in monitoring the emergence of transmitted HIV-1 drug resistance in Ghana. None declared.

Towards the Proper Integration of Extra-Functional Requirements

OpenAIRE

Elke Hochmuller

1999-01-01

In spite of the many achievements in software engineering, proper treatment of extra-functional requirements (also known as non-functional requirements) within the software development process is still a challenge to our discipline. The application of functionality-biased software development methodologies can lead to major contradictions in the joint modelling of functional and extra-functional requirements. Based on a thorough discussion on the nature of extra-functional requirements as wel...

IDENTIFICATION AND SELECTION OF SIX SIGMA PROJECTS

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Abdalhkeim FA. Flifel

2017-04-01

Full Text Available Six Sigma is a well-structured and proven methodology for improving organizational performance. It helps achieving the goals of the organization through the use of project-driven approach. The implementation of Six sigma approach depends on proper identification and selection of projects, moreover, the selection of right Six sigma projects is one of the critical success factors of six sigma efforts. The paper provides the sources for the identification of potential projects, top down and bottom up approaches, the process of selection of projects, guidelines that assist the selection of appropriate projects, selection criteria which must be precisely chosen in accordance with the objectives, needs and capabilities of the organization as well as sophisticated techniques and tools recommended in the literature for the selection of projects.

Improving water, sanitation and hygiene in health-care facilities, Liberia.

Science.gov (United States)

Abrampah, Nana Mensah; Montgomery, Maggie; Baller, April; Ndivo, Francis; Gasasira, Alex; Cooper, Catherine; Frescas, Ruben; Gordon, Bruce; Syed, Shamsuzzoha Babar

2017-07-01

The lack of proper water and sanitation infrastructures and poor hygiene practices in health-care facilities reduces facilities' preparedness and response to disease outbreaks and decreases the communities' trust in the health services provided. To improve water and sanitation infrastructures and hygiene practices, the Liberian health ministry held multistakeholder meetings to develop a national water, sanitation and hygiene and environmental health package. A national train-the-trainer course was held for county environmental health technicians, which included infection prevention and control focal persons; the focal persons acted as change agents. In Liberia, only 45% of 701 surveyed health-care facilities had an improved water source in 2015, and only 27% of these health-care facilities had proper disposal for infectious waste. Local ownership, through engagement of local health workers, was introduced to ensure development and refinement of the package. In-county collaborations between health-care facilities, along with multisectoral collaboration, informed national level direction, which led to increased focus on water and sanitation infrastructures and uptake of hygiene practices to improve the overall quality of service delivery. National level leadership was important to identify a vision and create an enabling environment for changing the perception of water, sanitation and hygiene in health-care provision. The involvement of health workers was central to address basic infrastructure and hygiene practices in health-care facilities and they also worked as stimulators for sustainable change. Further, developing a long-term implementation plan for national level initiatives is important to ensure sustainability.

Students' Assessment Of Farm Practical Programme In Selected ...

African Journals Online (AJOL)

Students' Assessment Of Farm Practical Programme In Selected Universities Of Southwestern, Nigeria. ... Journal of Agriculture, Forestry and the Social Sciences ... Students reported that lack of planning, improper implementation of activities lined up for the programme, lack of fund to properly finance the programme and ...

NICA: Natural Interaction with a Caring Agent

Science.gov (United States)

de Carolis, Berardina; Mazzotta, Irene; Novielli, Nicole

Ambient Intelligence solutions may provide a great opportunity for elderly people to live longer at home. Assistance and care are delegated to the intelligence embedded in the environment. However, besides considering service-oriented response to the user needs, the assistance has to take into account the establishment of social relations. We propose the use of a robot NICA (as the name of the project Natural Interaction with a Caring Agent) acting as a caring assistant that provides a social interface with the smart home services. In this paper, we introduce the general architecture of the robot's "mind" and then we focus on the need to properly react to affective and socially oriented situations.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

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Ilaria Mosca

2017-04-01

Full Text Available Background The sustainability of long-term care (LTC is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1 public- and private funding; (2 informal care and externalities; and (3 the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion The analysis shows why it is difficult for EU Member State

PROPER MOTIONS OF THE HH 110/270 SYSTEM

International Nuclear Information System (INIS)

Kajdič, P.; Reipurth, B.; Walawender, J.; Raga, A. C.; Bally, J.

2012-01-01

We present a study of the HH 110/270 system based on three sets of optical images obtained with the ESO New Technology Telescope, the Subaru Telescope, and the Hubble Space Telescope (HST). The ground-based observations are made in the Hα and [S II] emission lines and the HST observations are made in the Hα line only. Ground-based observations reveal the existence of nine knots, which have not been previously discussed and offer some important insight into the HH 110/270 history. We perform a kinematic study of the HH 110/270 system and an analysis of its emission properties. We measure proper motions of all the knots in the system. Four of the newly identified knots belong to the HH 270 jet. Their positions indicate that the jet's axis changed its direction in the past. We speculate that similar changes may have occurred many times in the past and this could be part of the reason for the unusual structure of the HH 110 jet. The HST observations allow us to resolve individual knots into their substructures and to measure their proper motions. These measurements show that the knots are highly turbulent structures. Finally, we report the discovery of four new Herbig-Haro (HH) objects located near the HH 110/270 system.

An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long Term Care

Science.gov (United States)

Yap, Tracey L.; Kennerly, Susan M.; Bergstrom, Nancy; Hudak, Sandra L.; Horn, Susan D.

2015-01-01

Pressure ulcers (PrUs) have consistently resisted prevention efforts in long term care (LTC) facilities nationwide. Recent research has described cueing innovations that – when selected according to the assumptions and resources of particular facilities – support best practices of PrU prevention. This paper synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a PrU prevention program. PMID:26066791

Factors associated with late antenatal care attendance in selected ...

African Journals Online (AJOL)

Background: Despite antenatal care services being provided free of charge or sometimes at a minimal cost in Zambia, only 19% of women attend antenatal care by their fourth month of pregnancy, as recommended by World Health Organization (WHO). An estimated 21% of pregnant women in urban and 18% in rural ...

Characterization of the selection of medicines for the Brazilian primary health care

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Margô Gomes de Oliveira Karnikowski

2017-11-01

Full Text Available ABSTRACT OBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015, a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS (n = 506, professionals responsible for the dispensing of medicines (n = 1,139, and physicians (n = 1,558. To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC (12.5%. They claimed to have an updated (80.4% list of Essential Medicines (85.3% and being active participants of this process (88.2%. However, in the perception of respondents, the list only partially (70.1% meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%, the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%. For 13.0% of them, the list meets the health demands. CONCLUSIONS As this is the first national survey of

Dexterity test data contribute to proper glovebox over-glove use

International Nuclear Information System (INIS)

Cournoyer, Michael E.; Lawton, Cindy M.; Castro, Armanda M.; Costigan, Stephen A.; Apel, D.M.; Neal, G.E.; Castro, J.M.; Michelotti, R.A.

2010-01-01

Programmatic operations at the Los Alamos National Laboratory Plutonium Facility (TA-55) involve working with various amounts of plutonium and other highly toxic, alpha-emitting materials. The spread of radiological contamination on surfaces, airborne contamination, and excursions of contaminants into the operator's breathing zone are prevented through the use of a variety of gloveboxes (the glovebox, coupled with an adequate negative pressure gradient, provides primary confinement). The glovebox gloves are the weakest part of this engineering control. The Glovebox Glove Integrity Program, which controls glovebox gloves from procurement to disposal at TA-55, manages this vulnerability. A key element of this program is to consider measures that lower the overall risk of glovebox operations. Proper selection of over-gloves is one of these measures. Line management owning glovebox processes have the responsibility to approve the appropriate personal protective equipment/glovebox glove/over-glove combination. As low as reasonably achievable (ALARA) considerations to prevent unplanned glovebox glove openings must be balanced with glove durability and worker dexterity, both of which affect the final overall risk to the worker. In this study, the causes of unplanned glovebox glove openings, the benefits of over-glove features, the effect of over-gloves on task performance using standard dexterity tests, the pollution prevention benefits, and the recommended over-gloves for a task are presented.

41 CFR 128-50.100 - Storage and care.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Storage and care. 128-50.100 Section 128-50.100 Public Contracts and Property Management Federal Property Management... subject to pilferage and properly store them; and (5) Shut all windows and lock all doors and compartments...

PRIMARY HEALTH CARE, SELECTIVE OR COMPREHENSIVE ...

African Journals Online (AJOL)

hi-tech

2003-01-01

Jan 1, 2003 ... and basic sanitation, health education in prevention and control of prevailing health ... to support introduction of a selective version of PHC in ... Governments and collaborating donor organizations could concentrate the ...

THE PROBLEM OF PROPER CARGO SECURING IN ROAD TRANSPORT – CASE STUDY

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Maria CIEŚLA

2013-12-01

Full Text Available This paper presents the problem of improper security of cargo in trucks as the cause of about 25% of the accidents that takes place in road transport. Attention was drawn to aspects of legal liability for errors resulting from incorrect load securing according to polish law. Article was enriched with practical examples illustrating the effects of improper cargo securing on transport unit and shows how it had to be prepared properly. When planning the proper transport protection of metal sheets rolled both calculation methods and computer applications were used.

NATIONAL EXPERIENCES REGARDING CORPORATE GOVERNANCE PROPER PRACTICE CODES

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Durgheu Liliana

2010-12-01

Full Text Available This paper is about the principles of proper governance codes, which even tough have blossomed in all parts of the world for more than a decade, the degree in which companies adopt the codes vary in different countries, and the decision to adopt a certain code does not automatically guarranty efficient corporate governance. The paper trys to identify the mechanisms needed for implementing the codes and that will lead to higher efficiency.

Managing care.

Science.gov (United States)

Sandifer, Q D

1997-09-01

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

Increasing patient knowledge on the proper usage of a PCA machine with the use of a post-operative instructional card.

Science.gov (United States)

Shovel, Louisa; Max, Bryan; Correll, Darin J

2016-01-01

The purpose of this study was to see if an instructional card, attached to the PCA machine following total hip arthroplasty describing proper use of the device, would positively affect subjects' understanding of device usage, pain scores, pain medication consumption and satisfaction. Eighty adults undergoing total hip replacements who had been prescribed PCA were randomized into two study groups. Forty participants received the standard post-operative instruction on PCA device usage at our institution. The other 40 participants received the standard of care in addition to being given a typed instructional card immediately post-operatively, describing proper PCA device use. This card was attached to the PCA device during their recovery period. On post-operative day one, each patient completed a questionnaire on PCA usage, pain scores and satisfaction scores. The pain scores in the Instructional Card group were significantly lower than the Control group (p = 0.024). Subjects' understanding of PCA usage was also improved in the Instructional Card group for six of the seven questions asked. The findings from this study strongly support that postoperative patient information on proper PCA use by means of an instructional card improves pain control and hence the overall recovery for patients undergoing surgery. In addition, through improved understanding it adds an important safety feature in that patients and potentially their family members and/or friends may refrain from PCA-by-proxy. This article demonstrates that the simple intervention of adding an instructional card to a PCA machine is an effective method to improve patients' knowledge as well as pain control and potentially increase the safety of the device use.

The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal

Science.gov (United States)

Gaspar, Heloisa Amaral; Morhy, Samira Saady

2015-01-01

Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged. PMID:26605333

Difficult relationships--interactions between family members and staff in long-term care.

Science.gov (United States)

Norris, S

2000-01-01

Staff of long-term care facilities and family members have a common responsibility to ensure the best course of treatment and everyday care for residents who often cannot speak for themselves. Understanding the difference between instrumental and preservative care, and who the proper agent is to provide care in each category will not only improve staff/family interactions, but residential care in general. The Resident Enrichment and Activity Program improves the family/staff relationship obliquely by involving family in social activities; the Family Involvement in Care program, and the Patterns in Caregiving program directly target the relationship and involve the facility's administration to effect policy change.

Tuberculosis infection control practices and associated factors among health care workers in health centers of West Gojjam zone, Northwest Ethiopia: a cross-sectional study.

Science.gov (United States)

Tamir, Kassahun; Wasie, Belaynew; Azage, Muluken

2016-08-08

Tuberculosis (TB) remains a major global health problem. The emerging epidemic of multi- and extensively drug-resistant (M/XDR) TB further imperils health workers, patients and public health. Health facilities with inadequate infection control are risky environments for the emergence and transmission of TB. There was no study that presented data on infection control practices of health care workers. This study aimed to assess tuberculosis infection control practices and associated factors among health care workers in West Gojjam Zone, Northwest Ethiopia. Institution based quantitative cross-sectional study triangulated with qualitative observation and key informant interview was conducted. Six hundred sixty two health care workers were selected by multistage random sampling method. Self-administered structured questionnaire was used to collect quantitative data. Observation checklists and key informant interview guides were used to collect qualitative data. Quantitative data were entered in to Epi Info version 3.5.3 and analyzed using SPSS version 20. Odds ratio with 95 % confidence interval was used to identify factors associated with TB infection control practice of health care workers. Qualitative data were translated, transcribed, analyzed and triangulated with the quantitative findings. The proportion of proper TB infection control (TBIC) practices was 38 %. Qualitative data showed that administrative, environmental and personal respiratory protection control measures were not practiced well. Knowledge on the presence of TBIC plan [AOR = 4.25, 95 % CI: 2.46 - 7.35], knowledge on the presence of national guideline [AOR = 8.95, 95 % CI: 4.35 - 18.40] and working department of the health care workers were independent predictors of TBIC practices. The proportion of proper TBIC practices of health care workers was low. TBIC practices were determined by knowing the presence of TBIC plan and national guideline and working department. Hence, supportive

PROPER MOTIONS OF YOUNG STELLAR OUTFLOWS IN THE MID-INFRARED WITH SPITZER (IRAC). I. THE NGC 1333 REGION

International Nuclear Information System (INIS)

Raga, A. C.; Noriega-Crespo, A.; Carey, S. J.; Arce, H. G.

2013-01-01

We use two 4.5 μm Spitzer (IRAC) maps of the NGC 1333 region taken over a ∼7 yr interval to determine proper motions of its associated outflows. This is a first successful attempt at obtaining proper motions of stellars' outflow from Spitzer observations. For the outflow formed by the Herbig-Haro objects HH7, 8, and 10, we find proper motions of ∼9-13 km s –1 , which are consistent with previously determined optical proper motions of these objects. We determine proper motions for a total of eight outflows, ranging from ∼10 to 100 km s –1 . The derived proper motions show that out of these eight outflows, three have tangential velocities ≤20 km s –1 . This result shows that a large fraction of the observed outflows have low intrinsic velocities and that the low proper motions are not merely a projection effect.

THE SOLAR NEIGHBORHOOD. XXV. DISCOVERY OF NEW PROPER MOTION STARS WITH 0.''40 yr-1 > μ ≥ 0.''18 yr-1 BETWEEN DECLINATIONS -470 AND 000

International Nuclear Information System (INIS)

Boyd, Mark R.; Winters, Jennifer G.; Henry, Todd J.; Jao, Wei-Chun; Finch, Charlie T.; Subasavage, John P.; Hambly, Nigel C.

2011-01-01

We present 2817 new southern proper motion systems with 0.''40 yr -1 > μ ≥ 0.''18 yr -1 and declination between -47 0 and 00 0 . This is a continuation of the SuperCOSMOS-RECONS (SCR) proper motion searches of the southern sky. We use the same photometric relations as previous searches to provide distance estimates based on the assumption that the objects are single main-sequence stars. We find 79 new red dwarf systems predicted to be within 25 pc, including a few new components of previously known systems. Two systems-SCR 1731-2452 at 9.5 pc and SCR 1746-3214 at 9.9 pc-are anticipated to be within 10 pc. We also find 23 new white dwarf (WD) candidates with distance estimates of 15-66 pc, as well as 360 new red subdwarf candidates. With this search, we complete the SCR sweep of the southern sky for stars with μ ≥ 0.''18 yr -1 and R 59F ≤ 16.5, resulting in a total of 5042 objects in 4724 previously unreported proper motion systems. Here we provide selected comprehensive lists from our SCR proper motion search to date, including 152 red dwarf systems estimated to be within 25 pc (9 within 10 pc), 46 WDs (10 within 25 pc), and 598 subdwarf candidates. The results of this search suggest that there are more nearby systems to be found at fainter magnitudes and lower proper motion limits than those probed so far.

Predicting Factors of Worker Behavior for Proper Working Posture Based on Planed Behavior Theory

Directory of Open Access Journals (Sweden)

E Mohammadi Zeydi

2008-12-01

Introduction & Objective: Injuries resulting from ignoring proper working posture especially in employees who sitting at workplace for more than of working hours are costly, and create significant pain and discomfort. Decreasing of these injuries is most effectively accomplished through the application of ergonomic design principles. Sometimes, however, barriers (technical and economic preclude ergonomic improvement and, consequently, some organizations rely on the use of proper sitting techniques and maintaining proper working posture as a major control strategy during workday. The problem, however, is that these process performing is inconsistent and managers have a difficult time motivating use of these techniques. The main aim of this study was to understand the factors driving proper working posture among employees. Materials & Methods: This study used the theory of planned behavior to predict upright working posture maintenance among 222 of assembling, machinery and printing line’s employees at a Qazvin Alborz industrial town manufacturing organization. Structural equation modeling, explanatory and confirmatory factor analysis were employed to analyze relationships among constructs. Results: Results revealed that attitude (p< 0.05, β= 0.53 and intention (p< 0.05, β= 0.46 were the strongest predictors of proper working posture maintenance behavior. Perceived behavior control, to a lesser degree, were also important influences on intention (p< 0.05, β= 0.34 and behavior (p< 0.05, β= 0.28. Subjective norms did not surface as effective direct predictors of upright working posture maintenance, but did affect behavior and intent via mediating factors (attitudes subjective norms and perceived behavioral control. Finally, the TPB was supported as an effective model explaining upright working posture maintenance, and had potential application for many other safety-related behaviors. Conclusion: results of this study emphasis on considering factors such as

The quality of care in occupational therapy: an assessment of selected Michigan hospitals.

Science.gov (United States)

Kirchman, M M

1979-07-01

In this study, a methodology was developed and tested for assessing the quality of care in occupational therapy between educational and noneducational clinical settings, as measured by process and outcome. An instrument was constructed for an external audit of the hospital record. Standards drafted by the investigator were established as normative by a panel of experts for use in judging the programs. Hospital records of 84 patients with residual hemiparesis or hemiplegia in three noneducational settings and of 100 patients with similar diagnoses in two educational clinical settings from selected Michigan facilities were chosen by proportionate stratified random sampling. The process study showed that occupational therapy was of significantly higher quality in the educational settings. The outcome study did not show significant differences between types of settings. Implications for education and practice are discussed.

[A project to reduce the incidence of intubation care errors among foreign health aides].

Science.gov (United States)

Chen, Mei-Ju; Lu, Yu-Hua; Chen, Chiu-Chun; Li, Ai-Cheng

2014-08-01

Foreign health aides are the main providers of care for the elderly and the physically disabled in Taiwan. Correct care skills improve patient safety. In 2010, the incidence of mistakes among foreign health aides in our hospital unit was 58% for nasogastric tube care and 57% for tracheostomy tube care. A survey of foreign health aides and nurses in the unit identified the main causes of these mistakes as: communication difficulties, inaccurate instructions given to patients, and a lack of standard operating procedures given to the foreign health aides. This project was designed to reduce the rates of improper nasogastric tube care and improper tracheostomy tube care to 20%, respectively. This project implemented several appropriate measures. We produced patient instruction hand-outs in Bahasa Indonesia, established a dedicated file holder for Bahasa Indonesian tube care reference information, produced Bahasa Indonesian tube-care-related posters, produced a short film about tube care in Bahasa Indonesian, and established a standardized operating procedure for tube care in our unit. Between December 15th and 31st, 2011, we audited the performance of a total of 32 foreign health aides for proper execution of nasogastric tube care (21 aides) and of proper execution of tracheostomy tube care (11 aides). Patients with concurrent nasogastric and tracheostomy tubes were inspected separately for each care group. The incidence of improper care decreased from 58% to 18% nasogastric intubation and 57% to 18% for tracheostomy intubation. This project decreased significantly the incidence of improper tube care by the foreign health aides in our unit. Furthermore, the foreign health aides improved their tube nursing care skills. Therefore, this project improved the quality of patient care.

Buruli ulcer: wound care and rehabilitation

Directory of Open Access Journals (Sweden)

Frimpong M

2016-06-01

Full Text Available Michael Frimpong,1 Fred Stephen Sarfo,2 Mabel Sarpong Duah,1 Mark Wansbrough-Jones,3 Richard O Phillips2 1Kumasi Centre for Collaborative Research in Tropical Medicine, 2Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 3Institute for Infection and Immunity, St George’s University of London, London, UK Abstract: Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive ulceration involving predominantly the upper and lower limbs of patients. The disease is common in rural tropical communities in West and Central Africa, where access to proper health care is limited. Pathogenesis of the characteristic painless ulcers is linked to the elaboration by M. ulcerans of a lipid toxin called mycolactone that has potent cytopathic, immunosuppressive, and analgesic effects on a host of cells in cutaneous tissues. Mycolactone is known to profoundly inhibit secretion of a plethora of proteins that are essential for wound healing. Even though a combination antibacterial therapy of streptomycin and rifampicin for 8 weeks is effective for treatment, it relies on good and appropriate wound management to prevent secondary bacterial infections and improve healing. Evidence-based interventions for wound care in Buruli ulcer disease are often lacking and have relied on expert advice and recommendations. Surgical interventions are limited to debridement of necrotic tissue and grafting of extensive ulcers, usually after antibiotic therapy. Patients’ rehabilitation is an important component of care to reduce disabilities associated with the disease and proper integration into the community after treatment. Keywords: Buruli ulcer, Mycobacterium ulcerans disease, Mycobacterium ulcerans, wound care, rehabilitation, disability

Rationale, design features, and baseline characteristics: The Heart Institute of Japan-PRoper level of lipid lOwering with Pitavastatin and Ezetimibe in acute coRonary syndrome (HIJ-PROPER).

Science.gov (United States)

Kawada-Watanabe, Erisa; Ogawa, Hiroshi; Koyanagi, Ryo; Arashi, Hiroyuki; Yamaguchi, Junichi; Matsui, Kunihiko; Hagiwara, Nobuhisa

2017-03-01

In contrast to current guidelines in Western countries, moderate reduction of low-density lipoprotein cholesterol (LDL-C) is recommended for Japanese patients with atherosclerotic cardiovascular disease and dyslipidemia even in secondary prevention. HIJ-PROPER (Heart Institute of Japan-PRoper level of lipid lOwering with Pitavastatin and Ezetimibe in acute coRonary syndrome) is a prospective, randomized, open-label, blinded endpoint multicenter trial designed to assess whether closely controlled LDL-C lowering with a standard statin dose plus ezetimibe, targeting LDL-C of acute coronary syndrome (ACS) and dyslipidemia. We recruited patients with ACS and dyslipidemia who had undergone coronary angiography. Participants are randomly allocated to either intensive LDL-C lowering treatment (target LDL-C of acute MI in 61.5%. This study is expected to report its findings in August 2016. HIJ-PROPER will determine whether targeting LDL-C of <70mg/dL with pitavastatin plus ezetimibe can improve cardiovascular outcomes in Japanese patients with ACS and dyslipidemia in comparison to targeting LDL-C of 90-100mg/dL with standard pitavastatin monotherapy. UMIN000002742. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

National Health-Care Reform

Science.gov (United States)

2009-03-24

and pre/ post partum care during delivery. America should select measures that reflect the health-care goals of the nation. As an example, the Healthy...accidents (8) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression ...reflect the cumulative efforts of different types of individual care. For example, infant mortality is a reflection of pre-natal care, post - natal care

PROPER MOTIONS OF THE HH 110/270 SYSTEM

Energy Technology Data Exchange (ETDEWEB)

Kajdic, P. [Instituto de Astronomia, UNAM, Mexico D.F. (Mexico); Reipurth, B.; Walawender, J. [Institute for Astronomy, University of Hawaii at Manoa, 640 N. A' ohoku Place, Hilo, HI 96720 (United States); Raga, A. C. [Instituto de Ciencias Nucleares, UNAM, Mexico D.F. (Mexico); Bally, J., E-mail: primoz@geofisica.unam.mx, E-mail: reipurth@IfA.Hawaii.Edu, E-mail: raga@nucleares.unam.mx, E-mail: John.Bally@casa.colorado.edu, E-mail: joshw@ifa.hawaii.edu [CASA, University of Colorado, 389 UCB, Boulder, CO 80309-0389 (United States)

2012-05-15

We present a study of the HH 110/270 system based on three sets of optical images obtained with the ESO New Technology Telescope, the Subaru Telescope, and the Hubble Space Telescope (HST). The ground-based observations are made in the H{alpha} and [S II] emission lines and the HST observations are made in the H{alpha} line only. Ground-based observations reveal the existence of nine knots, which have not been previously discussed and offer some important insight into the HH 110/270 history. We perform a kinematic study of the HH 110/270 system and an analysis of its emission properties. We measure proper motions of all the knots in the system. Four of the newly identified knots belong to the HH 270 jet. Their positions indicate that the jet's axis changed its direction in the past. We speculate that similar changes may have occurred many times in the past and this could be part of the reason for the unusual structure of the HH 110 jet. The HST observations allow us to resolve individual knots into their substructures and to measure their proper motions. These measurements show that the knots are highly turbulent structures. Finally, we report the discovery of four new Herbig-Haro (HH) objects located near the HH 110/270 system.

UCAC3 Proper Motion Survey. I. Discovery of New Proper Motion Stars in UCAC3 With 0.40/yr mu 0.18/yr Between Declinations -90 deg and -47 deg

Science.gov (United States)

2010-09-01

overlooked during previous SCR and other searches. The Two-Micron All Sky Survey ( 2MASS ) was used to probe for and reduce systematic errors in UCAC CCD...of 50–200 mas, when compared to 2MASS data. For a detailed description of the derived UCAC3 proper motions see Zacharias et al. (2010). An effort was...meeting the declination and proper motion survey limits, all stars (1) must be in the 2MASS catalog with an e2mpho ( 2MASS photometry error) less than

Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

Science.gov (United States)

Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

2018-02-02

Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

Selective Compensation of Voltage Harmonics in a Grid-Connected Microgrid

DEFF Research Database (Denmark)

Savaghebi, M.; Guerrero, Josep M.; Jalilian, A.

2011-01-01

In this paper, a method for selective voltage harmonic compensation in a grid-connected microgrid is presented. Harmonic compensation is done through proper control of distributed generators (DGs) interface converters. In order to achieve proper sharing of compensation effort among the DGs, a power...... named “Harmonic Distortion Power (HDP)” is defined. In the proposed method, active and reactive power control loops are considered to control the powers injected by the DGs. Also, a virtual impedance loop and voltage and current proportional-resonant controllers are included. Simulation results show...

An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

Directory of Open Access Journals (Sweden)

Hoque Dewan ME

2012-12-01

Full Text Available Abstract Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. Methods Using adapted World Health Organization (WHO hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6 and sub-district (n=12 hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. Results Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. Conclusion Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

Pen of Health Care Worker as Vector of Infection

Directory of Open Access Journals (Sweden)

Prashant Patil

2010-10-01

Full Text Available Nosocomial infections are the major concern in tertiary hospitals. Health care workers and their belonging are known to act as vector in transmission of infections. In present study, the writing pen of health care workers was worked out for carrying infection. The swab from writing pen of health care workers were cultured for any growth of microorganism and compared with swab from pen of the non health care workers. It was found that the rate of growth of microorganism were more in pen of health care workers. Similarly the organism attributed to the nosocomial infection was grown from the pens of health care workers. These organisms might be transmitted from the hands of health care workers. The writing pen which health care worker are using became the vectors of transmission of infection. So to prevent it, the most important way is to wash the hands and pen properly after examining the patients.

The Assessment of Social Support and Self-Care Requisites for Preventing Diabetic Foot Ulcer in Diabetic Foot Patients

Directory of Open Access Journals (Sweden)

Mohammad Taher

2016-03-01

Full Text Available Background and Objectives: Diabetic foot as one of the most common complications of diabetes is involved in more than %25 of diabetic patients’ lives, and if not treated properly can lead to amputation up to %20. The lack of self-care is the underlying cause of mortality, morbidity and chronic complications of diabetes. Identification and rectifying of diabetic foot care needs of patients can additionally reduce readmission; also, %85 of diabetic foot problems can be prevented. Materials and Methods: In this descriptive study, 130patients with diabetic foot from Shahid Modarres hospital were selected using census method. Data in forms of demographic questionnaire, self-care requisites assessment tool for preventing diabetic foot ulcer, and Social Support Behavior Scale were completed by patients and then were collected. Data were analyzed by SPSS version 16. Results: In this study, a significant relationship was found between self-care and social support (P<0.05. This means that people with better social support reported better self-care than those with weaker social support. A significant relationship in level of education and monthly income with self-care was seen, as well as in level of education, monthly income and marital status with social support (P<0.001. Conclusions: The results showed that social support can be considered as an effective factor in individual self-care behaviors, and with regard to this factor in educational, treatment and care programs of patients, can improve their self-care, in addition to decreasing economic costs, and improve their qualities of lives as well.

Investigation on proper materials of a liner system for trench type disposal facilities of radioactive wastes from research, industrial and medical facilities

International Nuclear Information System (INIS)

Nakata, Hisakazu; Amazawa, Hiroya; Sakai, Akihiro; Arikawa, Masanobu; Sakamoto, Yoshiaki

2011-08-01

The Low-level Radioactive Waste Disposal Project Center of Japan Atomic Energy Agency will settle on near surface disposal facilities with and without engineered barriers for radioactive wastes from research, industrial and medical facilities. Both of them are so called 'concrete pit type' and 'trench type', respectively. The technical standard of constructing and operating a disposal facility based on 'Law for the Regulations of Nuclear Source Material, Nuclear Fuel Material and Reactors' have been regulated partly by referring to that of 'Waste Management and Public Cleansing Law'. This means that the concrete pit type and the trench type disposal facility resemble an isolated type for specified industrial wastes and a non leachate controlled type final disposal site for stable industrial wastes, respectively. On the other, We plan to design a disposal facility with a liner system corresponding to a leachate controlled type final disposal site on a crucial assumption that radioactive wastes other than stable industrial wastes to be disposed into the trench type disposal facility is generated. By current nuclear related regulations in Japan, There are no technical standard of constructing the disposal facility with the liner system referring to that of 'Waste Management and Public Cleansing Law'. We investigate the function of the liner system in order to design a proper liner system for the trench type disposal facility. In this report, We investigated liner materials currently in use by actual leachate controlled type final disposal sites in Japan. Thereby important items such as tensile strength, durability from a view point of selecting proper liner materials were studied. The items were classified into three categories according to importance. We ranked proper liner materials for the trench type disposal facility by evaluating the important items per material. As a result, high density polyethylene(HDPE) of high elasticity type polymetric sheet was selected

Parent Experiences with State Child Care Subsidy Systems and Their Perceptions of Choice and Quality in Care Selected

Science.gov (United States)

Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn

2012-01-01

Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…

Partnering for optimal respiratory home care: physicians working with respiratory therapists to optimally meet respiratory home care needs.

Science.gov (United States)

Spratt, G; Petty, T L

2001-05-01

The need for respiratory care services continues to increase, reimbursement for those services has decreased, and cost-containment measures have increased the frequency of home health care. Respiratory therapists are well qualified to provide home respiratory care, reduce misallocation of respiratory services, assess patient respiratory status, identify problems and needs, evaluate the effect of the home setting, educate the patient on proper equipment use, monitor patient response to and complications of therapy, monitor equipment functioning, monitor for appropriate infection control procedures, make recommendations for changes to therapy regimen, and adjust therapy under the direction of the physician. Teamwork benefits all parties and offers cost and time savings, improved data collection and communication, higher job satisfaction, and better patient monitoring, education, and quality of life. Respiratory therapists are positioned to optimize treatment efficacy, maximize patient compliance, and minimize hospitalizations among patients receiving respiratory home care.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Mass estimates from stellar proper motions: the mass of ω Centauri

Science.gov (United States)

D'Souza, Richard; Rix, Hans-Walter

2013-03-01

We lay out and apply methods to use proper motions of individual kinematic tracers for estimating the dynamical mass of star clusters. We first describe a simple projected mass estimator and then develop an approach that evaluates directly the likelihood of the discrete kinematic data given the model predictions. Those predictions may come from any dynamical modelling approach, and we implement an analytic King model, a spherical isotropic Jeans equation model and an axisymmetric, anisotropic Jeans equation model. This maximum likelihood modelling (MLM) provides a framework for a model-data comparison, and a resulting mass estimate, which accounts explicitly for the discrete nature of the data for individual stars, the varying error bars for proper motions of differing signal-to-noise ratio, and for data incompleteness. Both of these two methods are evaluated for their practicality and are shown to provide an unbiased and robust estimate of the cluster mass. We apply these approaches to the enigmatic globular cluster ω Centauri, combining the proper motion from van Leeuwen et al. with improved photometric cluster membership probabilities. We show that all mass estimates based on spherical isotropic models yield (4.55 ± 0.1) × 106 M⊙[D/5.5 ± 0.2 kpc]3, where our modelling allows us to show how the statistical precision of this estimate improves as more proper motion data of lower signal-to-noise ratio are included. MLM predictions, based on an anisotropic axisymmetric Jeans model, indicate for ω Cen that the inclusion of anisotropies is not important for the mass estimates, but that accounting for the flattening is: flattened models imply (4.05 ± 0.1) × 106 M⊙[D/5.5 ± 0.2 kpc]3, 10 per cent lower than when restricting the analysis to a spherical model. The best current distance estimates imply an additional uncertainty in the mass estimate of 12 per cent.

Proper Installation of Replacement Windows | Efficient Windows

Science.gov (United States)

Collaborative Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring

Outcomes in the ultrasound follow-up of the Essure micro-insert: complications and proper placement.

Science.gov (United States)

Thiel, John; Suchet, Ian; Tyson, Nerissa; Price, Pamela

2011-02-01

To review the use of three-dimensional ultrasound follow-up of the Essure micro-insert placement at three months for the identification of misplaced coils and complications. We conducted a retrospective cohort study of reproductive age women requesting permanent sterilization in a tertiary care ambulatory women's clinic. Women who underwent placement of the Essure micro-insert were assessed for appropriate positioning of the Essure micro-insert coil using three-dimensional ultrasound as well as hysterosalpingography when indicated. A total of 610 women who had undergone the Essure procedure with ultrasound follow-up at three months were retrospectively reviewed and in 524 (86%) the location and shape were both normal. The remaining 86 (15%) required hysterosalpingography to confirm proper placement, 34 because of a non-diagnostic ultrasound and the remaining 52 for a complication noted on ultrasound, including perforation, proximal or distal migration of the device, or device expulsion. Ultrasound can be used at three months after Essure placement to identify normal placement as well as misplaced and perforated devices.

A cross-sectional survey of parental care-seeking behavior for ...

African Journals Online (AJOL)

Background: Infections are a common cause of childhood morbidity and mortality in developing countries. Proper management of these conditions in appropriate health facilities provides the best opportunity for survival and reducing disability. Aims: To evaluate the care-seeking behavior by parents of under-five children ...

Materials selection for cutting tools

International Nuclear Information System (INIS)

Burkhis, Adel M.

2008-01-01

The selection of proper tool steel for a given application is a difficult task. So; the most important selection factors in choosing cutting tool materials are based on their tool material requirements, cutting tool design and service conditions which is mainly considered as functional requirements. The processability requirements concerns in heat treat ability of the material tool. The classification of these tool materials were discussed with their properties requirement and percent of alloying element which is added to give best properties with a little increase in cost that highly appear in comparison of the selection. The cutting tool materials were evaluated based on two cases; The first was in case of rough surface; the high speed steels is the best material and the other was the ceramic material is the highest performance in cutting of soft or high rate of metal removal. (author)

Statistical learning and selective inference.

Science.gov (United States)

Taylor, Jonathan; Tibshirani, Robert J

2015-06-23

We describe the problem of "selective inference." This addresses the following challenge: Having mined a set of data to find potential associations, how do we properly assess the strength of these associations? The fact that we have "cherry-picked"--searched for the strongest associations--means that we must set a higher bar for declaring significant the associations that we see. This challenge becomes more important in the era of big data and complex statistical modeling. The cherry tree (dataset) can be very large and the tools for cherry picking (statistical learning methods) are now very sophisticated. We describe some recent new developments in selective inference and illustrate their use in forward stepwise regression, the lasso, and principal components analysis.

Sexual selection: Another Darwinian process.

Science.gov (United States)

Gayon, Jean

2010-02-01

the Darwin-Wallace controversy was that most Darwinian biologists avoided the subject of sexual selection until at least the 1950s, Ronald Fisher being a major exception. This controversy still deserves attention from modern evolutionary biologists, because the modern approach inherits from both Darwin and Wallace. The modern approach tends to present sexual selection as a special aspect of the theory of natural selection, although it also recognizes the big difficulties resulting from the inevitable interaction between these two natural processes of selection. And contra Wallace, it considers mate choice as a major process that deserves a proper evolutionary treatment. The paper's conclusion explains why sexual selection can be taken as a test case for a proper assessment of "Darwinism" as a scientific tradition. Darwin's and Wallace's attitudes towards sexual selection reveal two different interpretations of the principle of natural selection: Wallace's had an environmentalist conception of natural selection, whereas Darwin was primarily sensitive to the element of competition involved in the intimate mechanism of any natural process of selection. Sexual selection, which can lack adaptive significance, reveals this exemplarily. 2010 Académie des sciences. Published by Elsevier SAS. All rights reserved.

The resurgence of selective contracting restrictions.

Science.gov (United States)

Marsteller, J A; Bovbjerg, R R; Nichols, L M; Verrilli, D K

1997-10-01

As managed care has spread, so has legislation to force plans to contract with any willing provider (AWP) and give patients freedom of choice (FOC). Managed care organizations' selective networks and provider integration reduce patient access to providers, along with provider access to paying patients, so many providers have lobbied for AWP-FOC laws. In opposition are managed care organizations (MCOs), which want full freedom to contract selectively to control prices and utilization. This article comprehensively describes laws in all fifty-one jurisdictions, classifies their relative strength, and assesses the implications of the laws. Most are relatively weak forms and all are limited in application by ERISA and the federal HMO Act. The article also uses an associative multivariate analysis to relate the selective contracting environments to HMO penetration rates, rural population, physician density, and other variables. States with weak laws also have higher HMO penetration and higher physician density, but smaller rural populations. We conclude that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, not restricting selective contracting could diminish long-term competition and patient access to care. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option expands patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plans' ability to control core providers.

Proper body mechanics from an engineering perspective.

Science.gov (United States)

Mohr, Edward G

2010-04-01

The economic viability of the manual therapy practitioner depends on the number of massages/treatments that can be given in a day or week. Fatigue or injuries can have a major impact on the income potential and could ultimately reach the point which causes the practitioner to quit the profession, and seek other, less physically demanding, employment. Manual therapy practitioners in general, and massage therapists in particular, can utilize a large variety of body postures while giving treatment to a client. The hypothesis of this paper is that there is an optimal method for applying force to the client, which maximizes the benefit to the client, and at the same time minimizes the strain and effort required by the practitioner. Two methods were used to quantifiably determine the effect of using "poor" body mechanics (Improper method) and "best" body mechanics (Proper/correct method). The first approach uses computer modeling to compare the two methods. Both postures were modeled, such that the biomechanical effects on the practitioner's elbow, shoulder, hip, knee and ankle joints could be calculated. The force applied to the client, along with the height and angle of application of the force, was held constant for the comparison. The second approach was a field study of massage practitioners (n=18) to determine their maximal force capability, again comparing methods using "Improper and Proper body mechanics". Five application methods were tested at three different application heights, using a digital palm force gauge. Results showed that there was a definite difference between the two methods, and that the use of correct body mechanics can have a large impact on the health and well being of the massage practitioner over both the short and long term. Copyright 2009 Elsevier Ltd. All rights reserved.

Duty periods for establishing eligibility for health care. Final rule.

Science.gov (United States)

2013-12-26

The Department of Veterans Affairs (VA) is amending its medical regulations concerning eligibility for health care to re-establish the definitions of "active military, naval, or air service,'' "active duty,'' and "active duty for training.'' These definitions were deleted in 1996; however, we believe that all duty periods should be defined in part 17 of the Code of Federal Regulations (CFR) to ensure proper determination of eligibility for VA health care. We are also providing a more complete definition of "inactive duty training.''

Proper Living - Exploring Domestic Ideals in Medieval Denmark

DEFF Research Database (Denmark)

Kristiansen, Mette Svart

2014-01-01

Houses frame homes, households, and daily life, and it is reasonable to suggest that ideas of domestic space in medieval society, and ideas of how to live in an orderly and acceptable manner in the eyes of one’s peers and oneself are reflected in domestic architecture, its layout, fittings......, and ornaments. This paper addresses ideas of proper living in affluent rural and urban milieus in medieval Denmark, particularly as they are expressed through houses, inventories, and murals, and it also addresses current challenges in understanding the materialized ideas based on excavations and analysis...

Selection of nuclear power information database management system

International Nuclear Information System (INIS)

Zhang Shuxin; Wu Jianlei

1996-01-01

In the condition of the present database technology, in order to build the Chinese nuclear power information database (NPIDB) in the nuclear industry system efficiently at a high starting point, an important task is to select a proper database management system (DBMS), which is the hinge of the matter to build the database successfully. Therefore, this article explains how to build a practical information database about nuclear power, the functions of different database management systems, the reason of selecting relation database management system (RDBMS), the principles of selecting RDBMS, the recommendation of ORACLE management system as the software to build database and so on

The Solar Neighborhood. XXV. Discovery of New Proper Motion Stars with 0.40 sec/yr > mu > or = 0.18 sec/yr Between Declinations -47 deg and 00 deg

Science.gov (United States)

Boyd, Mark R.; Winters, Jennifer G.; Henry, Todd J.; Jao, Wei-Chun; Finch, Charlie T.; Subasavage, John P.; Hambly, Nigel C.

2011-01-01

We present 2817 new southern proper motion systems with 0.40 sec/yr > mu > or = 0.18 sec/yr and declination between 47 deg and 00 deg. This is a continuation of the SuperCOSMOS-RECONS (SCR) proper motion searches of the southern sky. We use the same photometric relations as previous searches to provide distance estimates based on the assumption that the objects are single main-sequence stars. We find 79 new red dwarf systems predicted to be within 25 pc, including a few new components of previously known systems. Two systems--SCR 1731-2452 at 9.5 pc and SCR 1746-3214 at 9.9 pc--are anticipated to be within 10 pc. We also find 23 new white dwarf (WD) candidates with distance estimates of 15-66 pc, as well as 360 new red subdwarf candidates. With this search, we complete the SCR sweep of the southern sky for stars with mu > or = 0.18 sec/yr and R(sub 59F) < or = 16.5, resulting in a total of 5042 objects in 4724 previously unreported proper motion systems. Here we provide selected comprehensive lists from our SCR proper motion search to date, including 152 red dwarf systems estimated to be within 25 pc (9 within 10 pc), 46 WDs (10 within 25 pc), and 598 subdwarf candidates. The results of this search suggest that there are more nearby systems to be found at fainter magnitudes and lower proper motion limits than those probed so far.

A turbulent jet in crossflow analysed with proper orthogonal decomposition

DEFF Research Database (Denmark)

Meyer, Knud Erik; Pedersen, Jakob Martin; Özcan, Oktay

2007-01-01

and pipe diameter was 2400 and the jet to crossflow velocity ratios were R = 3.3 and R = 1.3. The experimental data have been analysed by proper orthogonal decomposition (POD). For R = 3.3, the results in several different planes indicate that the wake vortices are the dominant dynamic flow structures...

Eclampsia: Feto-Maternal Outcomes in A Tertiary Care Centre in Eastern Nepal

Directory of Open Access Journals (Sweden)

Sita Ghimire

2016-03-01

Conclusions: Although the obstetric care facilities are improving with time, the feto-maternal outcomes are still poor in our country. Therefore early recognition and proper management are vital to tackle this challenge. Keywords: eclampsia; fetomaternal outcomes; retrospective analysis. | PubMed

Parity for mental health and substance abuse care under managed care.

Science.gov (United States)

Frank, Richard G.; McGuire, Thomas G.

1998-12-01

BACKGROUND: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. AIMS: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. METHOD: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. RESULTS: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less

VizieR Online Data Catalog: Proper motions in M 11 (Su+ 1998)

Science.gov (United States)

Su, C.-G.; Zhao, J.-L.; Tian, K.-P.

1997-07-01

Relative proper motions of 872 stars in the open cluster M 11 region are reduced using 10 plate pairs taken over time baselines of 16~70 years with the double astrograph telescope of Shanghai Observatory. The scale is 30"/mm. The plates were measured with the PDS machines in the Purple Mountain Observatory in Nanjing and the Institute of Technology and Communication in Luoyang, China. The average proper motion accuracy is about 1.1mas/yr with 85% of the data better than 1mas/yr. Membership probabilities of 785 stars within 25' centred on M 11 are determined based on their proper motions. The method used is suggested by Su et al. (1995AcApS..15..217S) with some improvements of Zhao & He (1990A&A...237...54Z), in which the space distribution and magnitude dependencies for cluster stars are taken into account. The results are significantly good. The total integrated membership probabilities for all these stars is 547 and the number of stars with probabilities higher than 0.7 is 541. It can be found after the membership determination that there exists mass segregation in M 11. Some comparisons and discussion are also given. (1 data file).

Definition of supportive care: does the semantic matter?

Science.gov (United States)

Hui, David

2014-07-01

'Supportive care' is a commonly used term in oncology; however, no consensus definition exists. This represents a barrier to communication in both the clinical and research settings. In this review, we propose a unifying conceptual framework for supportive care and discuss the proper use of this term in the clinical and research settings. A recent systematic review revealed several themes for supportive care: a focus on symptom management and improvement of quality of life, and care for patients on treatments and those with advanced stage disease. These findings are consistent with a broad definition for supportive care: 'the provision of the necessary services for those living with or affected by cancer to meet their informational, emotional, spiritual, social, or physical needs during their diagnostic, treatment, or follow-up phases encompassing issues of health promotion and prevention, survivorship, palliation, and bereavement.' Supportive care can be classified as primary, secondary, and tertiary based on the level of specialization. For example, palliative care teams provide secondary supportive care for patients with advanced cancer. Until a consensus definition is available for supportive care, this term should be clearly defined or cited whenever it is used.

Radiating c metric: an example of a proper Ricci Collineation

International Nuclear Information System (INIS)

Aulestia, L.; Nunez, L.; Patino, A.; Rago, H.; Herrera, L.

1984-01-01

A generalization of the charged c metric to the nonstationary case is given. The possibility of associating the energy-momentum tensor with the electromagnetic or neutrino field is discussed. It is shown that, for a specific choice of the time-dependent parameters, the metric admits at least a two-parameter group of proper Ricci collineations

Application of interval 2-tuple linguistic MULTIMOORA method for health-care waste treatment technology evaluation and selection.

Science.gov (United States)

Liu, Hu-Chen; You, Jian-Xin; Lu, Chao; Shan, Meng-Meng

2014-11-01

The management of health-care waste (HCW) is a major challenge for municipalities, particularly in the cities of developing countries. Selection of the best treatment technology for HCW can be viewed as a complicated multi-criteria decision making (MCDM) problem which requires consideration of a number of alternatives and conflicting evaluation criteria. Additionally, decision makers often use different linguistic term sets to express their assessments because of their different backgrounds and preferences, some of which may be imprecise, uncertain and incomplete. In response, this paper proposes a modified MULTIMOORA method based on interval 2-tuple linguistic variables (named ITL-MULTIMOORA) for evaluating and selecting HCW treatment technologies. In particular, both subjective and objective importance coefficients of criteria are taken into consideration in the developed approach in order to conduct a more effective analysis. Finally, an empirical case study in Shanghai, the most crowded metropolis of China, is presented to demonstrate the proposed method, and results show that the proposed ITL-MULTIMOORA can solve the HCW treatment technology selection problem effectively under uncertain and incomplete information environment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patients’ perception of care during special radiological examinations

Directory of Open Access Journals (Sweden)

Anthony C. Ugwu

2009-08-01

Method: A total of 200 self-completion questionnaires were delivered to four radiology departments within the north-eastern states of Nigeria (50 to each centre. The questionnaires included questions on patient demographics as well as ordinal scales for patients to rate their care on various indices and a 10 visual analogue scale to rate their overall satisfaction, while an open-ended question was used to assess patients’ expectation of radiology staff. 142 questionnaires (71% were returned. Both descriptive and inferential statistics were done. Tests were two-tailed with p smaller than 0.05 indicating statistical significance. Results: Patients’ perception of care correlated significantly with patients’ satisfaction. Conclusion: Good staff-patient interaction and proper organisational behaviour could improve patients’ perception of care.

Mechanism of action and application of virocids in health care-associated viral infections

Directory of Open Access Journals (Sweden)

Babak Shahbaz

2016-03-01

Full Text Available Viruses are important causes of acute and chronic diseases in humans. Newer viruses are still being discovered. Apart from frequently causing infections in the general community, many types of viruses are significant nosocomial pathogens that with emerging viruses has become a real issue in medical field. There are specific treatments, vaccine and physical barrier to fight some of these infections. Health care-associated viral infections are an important source of patient’s morbidity and mortality. The method of sterilization or disinfection depends on the intended use of the medical devices (comprising critical, semicritical and noncritical items and failure to perform proper sterilization or disinfection of these items may leads to introduction of viruses, resulting in infection. Disinfection is an essential way in reducing or disruption of transmission of viruses by environmental surfaces, instruments and hands which achieves by chemical disinfectants and antiseptics, respectively. This review discusses about chemical agents with virocids properties (e.g. alcohols, chlorine compounds, formaldehyde, phenolic compounds, glutaraldehyde, ortho-phthaldehyde, hydrogen peroxide, peracetic acid, iodophor, ammonium compounds quaternary, bigunides and so on., mechanisms of action and their applications in health care-associated viral infection control. As well as, we described an overview for hierarchy of viruses in challenge with disinfantans, effective agents on viral inactivation, i.e.targect viruses, viral stability or survival duration time in enviromental surfaces and hands. We explained disinfection of surfaces, challenges in emerging viral pathogens inactivation, viral resistance to chemical disinfectants and antiseptics. Because, there are laboratory studies and clinical evidences for some viruses which viral resistance to biocide or failure to perform proper disinfection can lead to infection outbreaks. Also, we described virucidal

Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi.

Science.gov (United States)

Bhagawati, G; Nandwani, S; Singhal, S

2015-01-01

Health care institutions are generating large amount of Bio-Medical Waste (BMW), which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM) and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%), intermediate (50-80%) and unsatisfactory (less than 50%). Some major areas of deficit found were about knowledge regarding number of BMW categories (17%), mercury waste disposal (37.56%) and definition of BMW (47%).

Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi

Directory of Open Access Journals (Sweden)

G Bhagawati

2015-01-01

Full Text Available Health care institutions are generating large amount of Bio-Medical Waste (BMW, which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%, intermediate (50–80% and unsatisfactory (less than 50%. Some major areas of deficit found were about knowledge regarding number of BMW categories (17%, mercury waste disposal (37.56% and definition of BMW (47%.

Cost escalation in health - care technology possible solutions | Járos ...

African Journals Online (AJOL)

Solutions to cost escalation due to health-care technology are proposed. It is argued that proper systems analysis, technology assessment, and planning would result in net savings and itnproved cost-benefits. Identification of needs early in the technological life cycle can positively influence the final form of the chosen ...

Comparison of differences in knowledge about skin care bettwen young women and man

Directory of Open Access Journals (Sweden)

Katarzyna Bojarczuk

2017-08-01

Full Text Available Introduction: The skin of modern people is exposed daily to a number of irritants like stress, consequences of inadequate diet, exposure to chemicals and plastics. Those factors can pose a challenge not only for delicate skin of a child, or a woman, but also for more resistant skin of men. Every type of complexion requires individual care, adjusted to different conditions and life circumstances. The choice of proper skin care products should be based on basic skin type and also one's gender. Objectives: Evaluation of differences in students' knowledge about skin care in relation to their gender. Material and methods: Evaluation of students' knowledge concerning proper skin care guidelines was conducted among 210 students (150 women and 60 men using anonymous survey. Results: Majority of male respondents determined their skin type as a normal one (56.6%, majority of female respondents as a combination type (51.3%. Men in contrast to women are more often unable to evaluate the type of their own skin (16.7% vs 4.0%.  Acne was the most common skin condition students of both sexes complained about. Daily skin care activities are performed by 96.6% interviewed women and 63.3% men. The regular use of face skin care products was reported by 87.3% of women and 31.6% of men. Conclusions: 1. Majority of women evaluate their basic skin type as combination one, most men regarded their skin type as normal . 2. Women more often than men take care of their skin and use adequate skin care products. 3. Facial moisturizing lotion is the most frequently chosen skin care product by both women and men.

Motivation and Evaluation of Employees in a Selected Company

OpenAIRE

ŠVIHÁLKOVÁ, Klára

2015-01-01

This work is focused on an analysis and evaluation of the real state in the sphere of motivation and evaluation of employees in a selected company. The aim of the research was to determine whether the company uses a proper employee evaluation system and if it can motivate their employees effectively.

Workers' opinions on the effect of contact with health care providers on sickness absence duration.

Science.gov (United States)

Steenbeek, Romy

2014-01-01

Because of the aging working population and the increasing age of retirement the number of workers with chronic illnesses and disabilities is growing. It is important that workers with health complaints receive efficient health care in order to remain fully or at least partly productive. To explore workers' opinions about the effectiveness of contact with health care providers in shortening sickness absence duration. Data come from a four-wave study from 2005 to 2008 among Dutch workers (n=1,424). Data were obtained on visits to health care providers, sickness absence and workers' opinions on whether and how their absence could have been shortened. A third of the workers were of the opinion that the health care provider (most often the general practitioner, GP) had played a role in preventing sickness absence and 35% were of the opinion that the health care provider had limited their absence. Most often the physical therapist (71%) and mental health therapist (61%) shortened sickness absence duration, in contrast to the occupational physician (OP, 25%) and GP (32%). The effectiveness of the health care providers' treatment was associated with the cause of sickness absence. Approximately 15% of the workers reported that their sickness absence could have been shortened if health care providers had provided the proper treatment and if waiting times had been reduced. Health care providers differ in their potential to shorten sickness absence duration. Health care providers can further reduce sickness absence and health care costs by providing the proper treatment and by reducing waiting times.

An Empirical Study of Wrappers for Feature Subset Selection based on a Parallel Genetic Algorithm: The Multi-Wrapper Model

KAUST Repository

Soufan, Othman

2012-09-01

Feature selection is the first task of any learning approach that is applied in major fields of biomedical, bioinformatics, robotics, natural language processing and social networking. In feature subset selection problem, a search methodology with a proper criterion seeks to find the best subset of features describing data (relevance) and achieving better performance (optimality). Wrapper approaches are feature selection methods which are wrapped around a classification algorithm and use a performance measure to select the best subset of features. We analyze the proper design of the objective function for the wrapper approach and highlight an objective based on several classification algorithms. We compare the wrapper approaches to different feature selection methods based on distance and information based criteria. Significant improvement in performance, computational time, and selection of minimally sized feature subsets is achieved by combining different objectives for the wrapper model. In addition, considering various classification methods in the feature selection process could lead to a global solution of desirable characteristics.

Patient Satisfaction with Virtual Obstetric Care.

Science.gov (United States)

Pflugeisen, Bethann Mangel; Mou, Jin

2017-07-01

Introduction The importance of patient satisfaction in US healthcare is increasing, in tandem with the advent of new patient care modalities, including virtual care. The purpose of this study was to compare the satisfaction of obstetric patients who received one-third of their antenatal visits in videoconference ("Virtual-care") compared to those who received 12-14 face-to-face visits in-clinic with their physician/midwife ("Traditional-care"). Methods We developed a four-domain satisfaction questionnaire; Virtual-care patients were asked additional questions about technology. Using a modified Dillman method, satisfaction surveys were sent to Virtual-care (N = 378) and Traditional-care (N = 795) patients who received obstetric services at our institution between January 2013 and June 2015. Chi-squared tests of association, t-tests, logistic regression, and ANOVA models were used to evaluate differences in satisfaction and self-reported demographics between respondents. Results Overall satisfaction was significantly higher in the Virtual-care cohort (4.76 ± 0.44 vs. 4.47 ± 0.59; p Virtual-care selection (OR = 2.4, 95% CI: 1.5-3.8; p Virtual-care respondents was not significantly impacted by the incorporation of videoconferencing, Doppler, and blood pressure monitoring technology into their care. The questionnaire demonstrated high internal consistency as measured by domain-based correlations and Cronbach's alpha. Discussion Respondents from both models were highly satisfied with care, but those who had selected the Virtual-care model reported significantly higher mean satisfaction scores. The Virtual-care model was selected by significantly more women who already have children than those experiencing pregnancy for the first time. This model of care may be a reasonable alternative to traditional care.

Compliance to Hand Hygiene Guidelines in Hospital Care: A stepwise behavioural approach

NARCIS (Netherlands)

V. Erasmus (Vicky)

2012-01-01

textabstractHealthcare associated infections (HAI) are a threat to the health of people requiring acute or chronic care. Since HAI can often be avoided by taking preventative measures, including proper application of hand hygiene principles, the prevention of these infections has received growing

"We are supposed to take care of it": a qualitative examination of care and repair behaviour of long-lasting, insecticide-treated nets in Nasarawa State, Nigeria.

Science.gov (United States)

Hunter, Gabrielle C; Scandurra, Leah; Acosta, Angela; Koenker, Hannah; Obi, Emmanuel; Weber, Rachel

2014-08-14

The longevity of long-lasting insecticidal nets (LLIN) under field conditions has important implications for malaria vector control. The behaviour of bed net users, including net care and repair, may protect or damage bed nets and impact the physical integrity of nets. However, this behaviour, and the motivating and inhibiting factors, is not well understood. Qualitative research methods were used to examine behaviour, attitudes and norms around damage, care and repair of LLINs. Eighteen in-depth interviews (IDI) and six focus group discussions (FGD) were conducted with LLIN users in two local government areas of Nasarawa State, Nigeria. A brief background questionnaire with the 73 participants prior to IDIs or FGDs collected additional data on demographics, net use, and care and repair behaviour. Respondents cited that the major causes of damage to bed nets are primarily children, followed by rodents, everyday handling that is not gentle, and characteristics of sleeping spaces. Caring for nets was perceived as both preventing damage by careful handling and keeping the net clean, which may lead to over-washing of LLINs. Repairing a damaged net was considered something that net users should do and the responsibility of adults in the household. Despite this, reported frequency of net repair was low (18%). Motivations for taking care of and repairing nets centred around caring for one's family, avoiding mosquito bites, saving money, and maintaining the positive opinion of others by keeping a clean and intact net. Barriers to net care and repair related to time availability and low perceived value of bed nets or of one's health. This study provides novel and valuable insights on the perceptions and attitudes of LLIN users in Nasarawa, Nigeria on the durability of bed nets, how to care for and repair nets, and for what reasons. Communication around net care should stress proper daily storage of nets, regular net inspections, prompt repairs, and clarify misconceptions

The care connection: The World Bank and women's unpaid care work in select sub-Saharan African countries

OpenAIRE

Bibler, Sarah; Zuckerman, Elaine

2013-01-01

With the aim of reducing women's greater unpaid care work than men&'s and increasing women's paid employment, this paper examines the extent to which World Bank investments address unpaid care work. The paper conducts an in-depth gender analysis of 36 World Bank employment-related projects in Malawi, Mali, Niger, and Rwanda. It concludes that the vast majority (92 per cent) of reviewed projects fail to account for unpaid care work. Exceptionally, Malawi's Shire River Basin Management Program ...

Health care law versus constitutional law.

Science.gov (United States)

Hall, Mark A

2013-04-01

National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care

Directory of Open Access Journals (Sweden)

Francesco Chiumeo

2015-12-01

Full Text Available The treatment of chronic obstructive pulmonary disease (COPD and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners. The objectives were to identify: i prevalence of COPD in patients (65-98 years in the province of Trento; ii presence and incidence of heart failure (HF in COPD patients; iii early detection of other chronic diseases; and iv improving electronic medical records (EMR as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years, suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of sentinel therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the sentinel drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation.

Proper survey methods for research of aquatic plant ecology and management

Science.gov (United States)

Proper survey methods are essential for objective, quantitative assessment of the distribution and abundance of aquatic plants as part of research and demonstration efforts. For research, the use of the appropriate method is an essential part of the scientific method, to ensure that the experimenta...

Identifications and limited spectroscopy for Luyten common proper motion stars with probable white dwarf components. I - Pair brighter than 17th magnitude

Science.gov (United States)

Oswalt, Terry D.; Hintzen, Paul M.; Luyten, Willem J.

1988-01-01

Identifications are provided for 103 bright Luyten common proper motion (CPM) stellar systems with m(pg) less than 17.0 mag containing likely white dwarf (WD) components. New spectral types are presented for 55 components, and spectral types for 51 more are available in the literature. With the CPM systems previously published by Giclas et al. (1978), the Luyten stars provide a uniform sample of nearly 200 pairs or multiples brighter than 17h magnitude. Selection effects biasing the combined samples are discussed; in particular, evidence is presented that fewer than 1 percent of wide WD binaries have been detected.

Impact of quasar proper motions on the alignment between the International Celestial Reference Frame and the Gaia reference frame

Science.gov (United States)

Liu, J.-C.; Malkin, Z.; Zhu, Z.

2018-03-01

The International Celestial Reference Frame (ICRF) is currently realized by the very long baseline interferometry (VLBI) observations of extragalactic sources with the zero proper motion assumption, while Gaia will observe proper motions of these distant and faint objects to an accuracy of tens of microarcseconds per year. This paper investigates the difference between VLBI and Gaia quasar proper motions and it aims to understand the impact of quasar proper motions on the alignment of the ICRF and Gaia reference frame. We use the latest time series data of source coordinates from the International VLBI Service analysis centres operated at Goddard Space Flight Center (GSF2017) and Paris observatory (OPA2017), as well as the Gaia auxiliary quasar solution containing 2191 high-probability optical counterparts of the ICRF2 sources. The linear proper motions in right ascension and declination of VLBI sources are derived by least-squares fits while the proper motions for Gaia sources are simulated taking into account the acceleration of the Solar system barycentre and realistic uncertainties depending on the source brightness. The individual and global features of source proper motions in GSF2017 and OPA2017 VLBI data are found to be inconsistent, which may result from differences in VLBI observations, data reduction and analysis. A comparison of the VLBI and Gaia proper motions shows that the accuracies of the components of rotation and glide between the two systems are 2-4 μas yr- 1 based on about 600 common sources. For the future alignment of the ICRF and Gaia reference frames at different wavelengths, the proper motions of quasars must necessarily be considered.

Criteria for clinical audit of women friendly care and providers' perception in Malawi

Directory of Open Access Journals (Sweden)

van den Broek Nynke

2008-07-01

Full Text Available Abstract Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a establish standards for women friendly care and (b explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i reception, (ii attitudes towards women, (iii respect for culture, (iv respect for women, (v waiting time, (vi enabling environment, (vii provision of information, (viii individualised care, (ix provision of skilled attendance at birth and emergency obstetric care, (x confidentiality, and (xi proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54 agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%, and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%. Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

Just health care (II): Is equality too much?

Science.gov (United States)

Fleck, L M

1989-12-01

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a 'non-ideal' mode, a framework in which philosophers have done little.

Demand management: another marketing tool or a way to quality care?

Science.gov (United States)

Mohler, M J; Harris, J M

1998-05-01

Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care.

Analysis of Criteria Influencing Contractor Selection Using TOPSIS Method

Science.gov (United States)

Alptekin, Orkun; Alptekin, Nesrin

2017-10-01

Selection of the most suitable contractor is an important process in public construction projects. This process is a major decision which may influence the progress and success of a construction project. Improper selection of contractors may lead to problems such as bad quality of work and delay in project duration. Especially in the construction projects of public buildings, the proper choice of contractor is beneficial to the public institution. Public procurement processes have different characteristics in respect to dissimilarities in political, social and economic features of every country. In Turkey, Turkish Public Procurement Law PPL 4734 is the main regulatory law for the procurement of the public buildings. According to the PPL 4734, public construction administrators have to contract with the lowest bidder who has the minimum requirements according to the criteria in prequalification process. Public administrators are not sufficient for selection of the proper contractor because of the restrictive provisions of the PPL 4734. The lowest bid method does not enable public construction administrators to select the most qualified contractor and they have realised the fact that the selection of a contractor based on lowest bid alone is inadequate and may lead to the failure of the project in terms of time delay Eand poor quality standards. In order to evaluate the overall efficiency of a project, it is necessary to identify selection criteria. This study aims to focus on identify importance of other criteria besides lowest bid criterion in contractor selection process of PPL 4734. In this study, a survey was conducted to staff of Department of Construction Works of Eskisehir Osmangazi University. According to TOPSIS (Technique for Order Preference by Similarity to the Ideal Solution) for analysis results, termination of construction work in previous tenders is the most important criterion of 12 determined criteria. The lowest bid criterion is ranked in rank 5.

When Things Don’t Look Right: What Appear to be Proper Motion Discrepancies in the WDS

Science.gov (United States)

Harshaw, Richard

2017-10-01

Proper motion data for double stars are included for most of the records in the Washington Double Star Catalog (WDS). In many cases, the proper motion data agree well with the observed changes in the system over time. But in other cases, the proper motion data do not align well with the observations. It is therefore incumbent on the double star researcher to treat any research based on proper motions with caution to be sure that wrong conclusions are not drawn. Possible reasons for such discrepancies are explored.

Nursing care for patients carrying indwelling catheter in target vessel for continuous chemotherapy

International Nuclear Information System (INIS)

Wen Lihong

2009-01-01

Objective: To reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. Methods: (1)To enhance the propaganda,education and guidance to patients. (2) To standardize the nursing care operations. (3) To establish the reasonable care rules and procedures. (4) The nurses should take the daily nursing care,observations and recording work seriously. Results: Through the analysis of a variety of problems occurred in patients with indwelling catheter during the course of continuous chemotherapy the nursing care experience was summed up. Conclusion: Proper and effective care can reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. (authors)

The transverse index theorem for proper cocompact actions of Lie groupoids

NARCIS (Netherlands)

Pflaum, M.J.; Posthuma, H.; Tang, X.

2015-01-01

Given a proper, cocompact action of a Lie groupoid, we define a higher index pairing between invariant elliptic differential operators and smooth groupoid cohomology classes. We prove a cohomological index formula for this pairing by applying the van Est map and algebraic index theory. Finally we

Proper Wound Care: How to Minimize a Scar

Science.gov (United States)

... Registration General information Housing & travel Education Exhibit hall Mobile app 2019 Annual Meeting Derm Exam Prep Course ... SkinPAC State societies Scope of practice Truth in advertising NP/PA laws Action center Public and patients ...

[Transparency and replicability of nursing intervention studies in long-term care: A selective literature review].

Science.gov (United States)

Gspörer, Irene; Schrems, Berta M

2018-05-01

The development and evaluation of interventions in long-term care is time-consuming and expensive due to their complexity. To ensure reproducibility and successful implementation, these interventions must be described and published in a comprehensible and qualitative manner. The aim of this study is to analyze intervention studies from the inpatient long-term care setting with regard to their completeness, reporting quality, transparency and thus reproducibility. The completeness and the reporting quality of the interventions described in the publications were examined in the context of a selective literature review by means of intervention studies from the long-term care setting (n=22). To this end, the Template for Intervention Description and Replication (TIDieR) checklist and the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare 2 (CReDECI2-DE) list were used. Transparency criteria included study registration and access to study protocols. The TIDieR checklist examination revealed that only three studies contained all the information necessary; the CReDECI2 test provided a complete description for only one study. Frequent shortcomings were observed concerning the information on modifications and titrations for the study participants and the location. Protocols were available for eight studies, 14 studies were registered. In terms of science, this means that the reproducibility of scientific findings is limited, which is why they cannot provide secure knowledge. As a result, the practical benefit to be derived from published studies that are accessible to decision-makers is limited as well. As far as publishers are concerned they should pay more attention to the completeness, registration and availability of materials. Copyright © 2018. Published by Elsevier GmbH.

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

Science.gov (United States)

Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

2017-01-01

Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

Properly quantized history-dependent Parrondo games, Markov processes, and multiplexing circuits

Energy Technology Data Exchange (ETDEWEB)

Bleiler, Steven A. [Fariborz Maseeh Department of Mathematics and Statistics, Portland State University, PO Box 751, Portland, OR 97207 (United States); Khan, Faisal Shah, E-mail: faisal.khan@kustar.ac.a [Khalifa University of Science, Technology and Research, PO Box 127788, Abu Dhabi (United Arab Emirates)

2011-05-09

Highlights: History-dependent Parrondo games are viewed as Markov processes. Quantum mechanical analogues of these Markov processes are constructed. These quantum analogues restrict to the original process on measurement. Relationship between these analogues and a quantum circuits is exhibited. - Abstract: In the context of quantum information theory, 'quantization' of various mathematical and computational constructions is said to occur upon the replacement, at various points in the construction, of the classical randomization notion of probability distribution with higher order randomization notions from quantum mechanics such as quantum superposition with measurement. For this to be done 'properly', a faithful copy of the original construction is required to exist within the new quantum one, just as is required when a function is extended to a larger domain. Here procedures for extending history-dependent Parrondo games, Markov processes and multiplexing circuits to their quantum versions are analyzed from a game theoretic viewpoint, and from this viewpoint, proper quantizations developed.

Prehepatocholedochal proper hepatic artery. Rare anatomical variant. Surgical considerations. Case report.

Science.gov (United States)

Ardeleanu, V; Chicoş, S; Tutunaru, D; Georgescu, C

2014-01-01

In classical anatomic variants, the proper hepatic artery (PHA)continues the common hepatic artery (CHA) after the gastroduodenal artery (GDA) detaches itself and divides into the right hepatic artery (RHA) and left hepatic artery (LHA), the proper hepatic artery being located to the left of the hepatocholedochal duct (HCD). This paper presents an abnormal positioning of the PHA placed before the HCD with an increased diameter of about 5-7 mm, which could be confused with the HCD. We present the case of a 57 year-old woman diagnosed with acute lithiasic cholecystitis, associated with hypersplenism and hypertension. The literature mentions manifold anatomical variants of arterial liver vascularization,including PHA. For this reason, this paper presents an overview of similar cases that can be found in medical literature. The aforementioned case is a rare topographic anatomy for the PHA that can easily pass for HCD especially during celioscopy, therefore it is crucial for this to be acknowledged by all surgeons. Celsius.

Sample Selection for Training Cascade Detectors.

Science.gov (United States)

Vállez, Noelia; Deniz, Oscar; Bueno, Gloria

2015-01-01

Automatic detection systems usually require large and representative training datasets in order to obtain good detection and false positive rates. Training datasets are such that the positive set has few samples and/or the negative set should represent anything except the object of interest. In this respect, the negative set typically contains orders of magnitude more images than the positive set. However, imbalanced training databases lead to biased classifiers. In this paper, we focus our attention on a negative sample selection method to properly balance the training data for cascade detectors. The method is based on the selection of the most informative false positive samples generated in one stage to feed the next stage. The results show that the proposed cascade detector with sample selection obtains on average better partial AUC and smaller standard deviation than the other compared cascade detectors.

Patient Care Planning: An Interdisciplinary Approach

OpenAIRE

Prophet, Colleen M.

1989-01-01

The INFORMM Patient Care Planning System provides interdepartmental communication and individualized patient care plans based upon current standards of care. This interdisciplinary system facilitates the identification of patient problems and nursing diagnoses as well as patient care orders. The selected nurses' and physicians' orders are integrated and organized by care plan categories in printouts. As a system by-product, Patient Care Planning automatically generates and calculates patient ...

THE COMMON AND PROPER NOUNS BETWEEN ALBANIAN AND ENGLISH

OpenAIRE

Shkelqim Millaku

2017-01-01

The noun in Albanian language classified as common and proper. The common nouns in turn divide into countable and uncountable. Collective nouns and substance nouns are subclasses of the other classes. The structure of noun formation between Albanian and English on the general aspect of morphology and syntax still didn’t study in the way of comparative, contrast and generative. Those fields are our object of study. In Albanian and English we find some concepts of studies for noun for exam...

[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

Changing the focus of care: from curative to palliative care

Directory of Open Access Journals (Sweden)

Silvia Soffritti

2014-06-01

Full Text Available The improvements in the obstetrical and neonatal diagnosis and therapies have resulted into an increase in the survival rate of infants previously considered as non-viable. Debate is focusing on professionals’ behaviour about withdrawal or withholding of life sustaining treatment (LST and administration of palliative care for newborns whose conditions are incompatible with a prolonged life. Decisions about treatment should be made jointly by the professionals’ team and the family, placing the interest of the baby at the very heart of the decision process. It is very important that the environment in which the family has to make the decision is characterized by openness, dialogue and frankness. A proper and effective communication with parents is always necessary and can resolve any conflict caused by disagreement. Furthermore, parents need time in the decision making process. Other supports, which could help the family in the final decision are the possibility to ask for a specialist’s second opinion and the involvement of religious leaders and of an indipendent clinical ethics committee. Withholding or withdrawal of LST does not mean cessation of care for the baby, it means to change the focus of care from curative to palliative care. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou 

34 CFR 472.22 - What selection criteria does the Secretary use?

Science.gov (United States)

2010-07-01

... the business or industry partners or labor organizations. (Approved by the Office of Management and... extent to which the plan of management is effective and ensures proper and efficient administration of... are otherwise eligible to participate, are selected without regard to race, color, national origin...

Success/Failure Prediction of Noninvasive Mechanical Ventilation in Intensive Care Units. Using Multiclassifiers and Feature Selection Methods.

Science.gov (United States)

Martín-González, Félix; González-Robledo, Javier; Sánchez-Hernández, Fernando; Moreno-García, María N

2016-05-17

This paper addresses the problem of decision-making in relation to the administration of noninvasive mechanical ventilation (NIMV) in intensive care units. Data mining methods were employed to find out the factors influencing the success/failure of NIMV and to predict its results in future patients. These artificial intelligence-based methods have not been applied in this field in spite of the good results obtained in other medical areas. Feature selection methods provided the most influential variables in the success/failure of NIMV, such as NIMV hours, PaCO2 at the start, PaO2 / FiO2 ratio at the start, hematocrit at the start or PaO2 / FiO2 ratio after two hours. These methods were also used in the preprocessing step with the aim of improving the results of the classifiers. The algorithms provided the best results when the dataset used as input was the one containing the attributes selected with the CFS method. Data mining methods can be successfully applied to determine the most influential factors in the success/failure of NIMV and also to predict NIMV results in future patients. The results provided by classifiers can be improved by preprocessing the data with feature selection techniques.

Radar Measurements of Ocean Surface Waves using Proper Orthogonal Decomposition

Science.gov (United States)

2017-03-30

Golinval, 2002, Physical interpretation of the proper orthogonal modes using the singular value decomposition, Journal of Sound and Vibration, 249...complex and contain contributions from the environment (e.g., wind, waves, currents) as well as artifacts associated with electromagnetic (EM) (wave...Although there is no physical basis/ interpretation inherent to the method because it is purely a mathematical tool, there has been an increasing

Parallaxes and Proper Motions From the MCCormick Observatory: List 47

Science.gov (United States)

Ianna, Philip A.; Patterson, Richard J.; Swain, Melanie A.

1996-01-01

Trigonometric parallaxes and proper motions are presented for 32 late-type stars observed photographically with the Leander McCormick 67 cm refractor. Eighteen of the stars have no previously published parallaxes. Twenty one of the stars are K and M dwarfs identified by Vyssotsky and his collaborators. The list includes several x-ray luminous M dwarfs, a rapidly rotating spotted flare star, and two astrometric binaries.

Integrating rheumatology care in the community: can shared care work?

Science.gov (United States)

Lim, Anita Yn; Tan, Chuen Seng; Low, Bernadette Pl; Lau, Tang Ching; Tan, Tze Lee; Goh, Lee Gan; Teng, Gim Gee

2015-01-01

Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, "right siting" aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients) and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

Public reporting in health care: how do consumers use quality-of-care information? A systematic review.

NARCIS (Netherlands)

Faber, M.J.; Bosch, M.C.; Wollersheim, H.C.H.; Leatherman, S.; Grol, R.P.T.M.

2009-01-01

BACKGROUND: One of the underlying goals of public reporting is to encourage the consumer to select health care providers or health plans that offer comparatively better quality-of-care. OBJECTIVE: To review the weight consumers give to quality-of-care information in the process of choice, to

Predictors of Self-care among the Elderly with Diabetes Type 2: Using Social Cognitive Theory.

Science.gov (United States)

Borhaninejad, Vahidreza; Iranpour, Abedin; Shati, Mohsen; Tahami, Ahmad Naghibzadeh; Yousefzadeh, Gholamrezan; Fadayevatan, Reza

Diabetes is one of the most common chronic diseases among the elderly and is also a very serious health problem. Adopting theory-based self-care behaviors is an effective means in managing such diseases. This study aimed to determine the predictors of diabetes self-care in the elderly in Kerman based on a social cognitive theory. In this cross-sectional study, 384 elderly diabetic patients who had referred to health screening centers in Kerman were chosen via cluster sampling. To collect information about self-care and its predictors, Toobert Glasgow's diabetes self-efficacy scale as well as a questionnaire was used which was based on social cognitive theory constructs. The validity and reliability of the questionnaire was confirmed. The data were analyzed using Pearson correlation and linear regression analysis in SPSS software 17. Among the subjects, 67.37% (252) had poor self-care ability; 29.14% (109) had average ability, and 3.40% (13) enjoyed a proper level of self- care ability. There was a significant relationship between the constructs of the social cognitive theory (knowledge, self- efficacy, social support, outcome expectations, outcome expectancy and self-regulation) and the self-care score. Furthermore, the mentioned constructs could predict 0.47% of the variance of the self-care behaviors. self-care behaviors in this study were poor. Therefore, it is necessary to develop an educational intervention based on cognitive theory constructs with the goal of properly managing diabetes in the elderly patients. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

How to Use Rectal Suppositories Properly

Science.gov (United States)

... Follow directions carefully Do not miss doses Store suppositories in a cool place and avoid melting; refrigerate them if so labeled Store medications out of reach of children Copyright 2013, American Society of Health-System Pharmacists. ...

Proper Installation of New Windows | Efficient Windows Collaborative

Science.gov (United States)

Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

Nest site selection and nutritional provision through excreta: a form of parental care in a tropical endogeic earthworm

Directory of Open Access Journals (Sweden)

Angel I. Ortiz-Ceballos

2016-05-01

Full Text Available Nest construction is a common form of parental care in soil organisms. However, it is unknown whether the tropical earthworm Pontoscolex corethrurus produces nests in soils with low nutritional quality habitats. Here we studied the reproductive behaviour and nest site selection of P. corethrurus, and tested the hypothesis whether P. corethrurus produces more cocoons in habitats with low nutritional quality. In bidimensional terrariums we evaluated the combined effect of the nutritional quality of habitat: (Poor Quality Habitat = PQH, Medium Quality Habitat = MQH, High Quality Habitat = HQH and soil depth (Shallow, Intermediate, Deep in a factorial 32 design. The number and biomass of cocoons, progeny and the production of internal and external excreta were evaluated. The quality habitat and depth of soil and their interaction had a significant effect on nest site construction and the deposition of internal excreta. Pontoscolex corethrurus built a higher amount of nests in the PQH-Intermediate and MQH-Intermediate treatments while more internal excreta were found in the HQH-Intermediate treatment. Offspring biomass was positively associated with internal excreta in the PQH (soil only and MQH (soil + grass treatments, suggesting that this could be a form of parental care. Since P. corethrurus produces more cocoons in low and medium quality habitats, while produces more internal excreta at high quality habitats, there does not seem to be an association between number of offspring and parental care. We suggest P. corethrurus could have two reproductive strategies that act as diversified bet-hedging (do not put all cocoons in one basket behavior in unpredictable environment, and thus build a higher amount of nests in low and medium quality habitats; and another where they produce more internal excreta as a form of parental care in high quality habitats. Parental care in the form of internal excreta may be particularly important in poor and medium

Proposed system for the use of evaluation factors in the source selection of service contractors

OpenAIRE

Pingel, Richard Douglas

1981-01-01

Approved for public release; distribution is unlimited Technical personnel are increasingly being required to perform vital functions as proposal evaluators in the source selection process for which they have not been properly trained. This research effort provides a comprehensive system for source selection using price and other factors in a form aimed at the technical professionals that support field acquisition activities. All examples selected are from the general acquisition area of...

Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems.

Science.gov (United States)

Oladipo, Jimoh Ayanda

2014-06-01

Disparities in use of healthcare services between rural and urban areas have been empirically attributed to several factors. This study explores the existence of this disparity and its implication for planning and managing healthcare delivery systems. The objectives determine the relative importance of the various predisposing, enabling, need and health services factors on utilization of health services; similarity between rural and urban areas; and major explanatory variables for utilization. A four-stage model of service utilization was constructed with 31 variables under appropriate model components. Data is collected using cross-sectional sample survey of 1086 potential health services consumers in selected health facilities and resident milieu via questionnaire. Data is analyzed using factor analysis and cross tabulation. The 4-stage model is validated for the aggregate data and data for the rural areas with 3-stage model for urban areas. The order of importance of the factors is need, enabling, predisposing and health services. 11 variables are found to be powerful predictors of utilization. Planning of different categories of health care facilities in different locations should be based on utilization rates while proper management of established facilities should aim to improve health seeking behavior of people.

The Factors Influencing Economic Efficiency of the Hospital Bed Care in Terms of the Regional Allowance Organizations

Directory of Open Access Journals (Sweden)

Vaňková Ivana

2014-09-01

Full Text Available This paper aims to provide an efficiency evaluation of selected hospital bed care providers during years 2010 -2012 with respect to selected factors: The size of the hospital establishment according to number of beds, number of hospitalized patients, the average length of stay per a patient in care, total staff cost calculated per bed, total revenues calculated per bed, and total costs calculated per bed. For this purpose, hospitals providing primarily acute bed care were chosen. From the legal point of view, they are allowance organizations of a particular region. The evaluation concerns both allocative efficiency and technical efficiency. The allocative efficiency is treated from the proper algorithm point of view and it compares total costs calculated per bed with total revenues calculated per bed. A method denominated Data Envelopment Analysis was applied for the calculation of the technical efficiency of units. To be more specific, it was input-oriented model with constant returns to scale (CCR. The input parameters involve the number of beds, the average length of stay and costs per day of stay. Output parameters were as follows: Bed occupancy in days and the number of hospitalized patients. The data published by the Institute of Health Information and Statistic of the Czech Republic and by ÚFIS system (the Data Base of Ministry of Finance of the Czech Republic were used as the source of data. The evaluation implies that only three hospitals were economically-effective: Silesian Hospital in Opava, Hospital Jihlava, and TGM Hospital Hodonín. The most significant factor influencing the efficiency was determined - the average length of stay.

Stoicism, the physician, and care of medical outliers

Directory of Open Access Journals (Sweden)

Papadimos Thomas J

2004-12-01

Full Text Available Abstract Background Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. Discussion The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. Summary Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

Sample Selection for Training Cascade Detectors.

Directory of Open Access Journals (Sweden)

Noelia Vállez

Full Text Available Automatic detection systems usually require large and representative training datasets in order to obtain good detection and false positive rates. Training datasets are such that the positive set has few samples and/or the negative set should represent anything except the object of interest. In this respect, the negative set typically contains orders of magnitude more images than the positive set. However, imbalanced training databases lead to biased classifiers. In this paper, we focus our attention on a negative sample selection method to properly balance the training data for cascade detectors. The method is based on the selection of the most informative false positive samples generated in one stage to feed the next stage. The results show that the proposed cascade detector with sample selection obtains on average better partial AUC and smaller standard deviation than the other compared cascade detectors.

The status of IT service management in health care - ITIL® in selected European countries.

Science.gov (United States)

Hoerbst, Alexander; Hackl, Werner O; Blomer, Roland; Ammenwerth, Elske

2011-12-21

Due to the strained financial situation in the healthcare sector, hospitals and other healthcare providers are facing an increasing pressure to improve their efficiency and to reduce costs. These trends challenge health care organizations to introduce innovative information technology (IT) based supportive processes. To guarantee that IT supports the clinical processes perfectly, IT must be managed proactively. However, until now, there is only very few research on IT service management especially on ITIL® implementations in the health care context. The current study aims at exploring knowledge about and acceptance of IT service management (especially ITIL®) in hospitals in Austria and its neighboring regions Bavaria (Germany), Slovakia, South Tyrol (Italy) and Switzerland. Therefore highly standardized interviews with the respective head of information technology (CIO, IT manager) were conducted for selected hospitals from the different regions. In total 75 hospitals were interviewed. Data gathered was analyzed using descriptive statistics and where necessary methods of qualitative content analysis. In most regions, two-thirds or more of the participating IT managers claim to be familiar with the concepts of IT service management and of ITIL®. IT managers expect from ITIL® mostly better IT services, followed by an increased productivity and a reduction of IT cost. But only five hospitals said to have implemented at least parts of ITIL®, and eight hospitals stated to be planning to do this in the next two years. When it comes to ITIL®, Switzerland and Bavaria seem to be ahead of the other countries. There, the highest levels of knowledge, the highest number of implementations or plans of an implementation as well as the highest number of ITIL® certified staff members were observed. The results collected through this study indicate that the idea of IT services and IT service management is still not widely recognized in hospitals in the countries and regions

The c-index is not proper for the evaluation of $t$-year predicted risks.

Science.gov (United States)

Blanche, Paul; Kattan, Michael W; Gerds, Thomas A

2018-02-16

We show that the widely used concordance index for time to event outcome is not proper when interest is in predicting a $t$-year risk of an event, for example 10-year mortality. In the situation with a fixed prediction horizon, the concordance index can be higher for a misspecified model than for a correctly specified model. Impropriety happens because the concordance index assesses the order of the event times and not the order of the event status at the prediction horizon. The time-dependent area under the receiver operating characteristic curve does not have this problem and is proper in this context.

Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

Science.gov (United States)

Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk

2018-05-09

In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

Towards the Proper Integration of Extra-Functional Requirements

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Elke Hochmuller

1999-05-01

Full Text Available In spite of the many achievements in software engineering, proper treatment of extra-functional requirements (also known as non-functional requirements within the software development process is still a challenge to our discipline. The application of functionality-biased software development methodologies can lead to major contradictions in the joint modelling of functional and extra-functional requirements. Based on a thorough discussion on the nature of extra-functional requirements as well as on open issues in coping with them, this paper emphasizes the role of extra-functional requirements in the software development process. Particularly, a framework supporting the explicit integration of extra functional requirements into a conventional phase-driven process model is proposed and outlined.

Standard of care of erectile dysfunction in U.S. Air Force aircrew and active duty not on flying status.

Science.gov (United States)

Nast, Justin B

2014-11-01

In 2011, over 3,000 active duty U.S. Air Force (USAF) members were prescribed a phosphodiesterase inhibitor (PDEI). PDEIs are first-line therapy for treating erectile dysfunction and can have significant side effects that could impact aircrew performance. In total, 200 eligible subject records were randomly sampled from the active duty USAF population of those males filling a prescription for a PDEI in June 2011; 100 of those records were from aviators. The electronic records were reviewed and scored to determine if USAF aeromedical standards for prescribing PDEIs were followed, with a minimum score of 0 for no standards met and a maximum of 3 for all standards met. The average score for both groups was 1, with no significant difference between the group scores. A proper aeromedical disposition was documented in 67% of the aviator records. Although there was no significant difference in standard of care for aviators and nonaviators, the overall documented standard of care was poor. Lack of documentation was the primary reason for the low scores and the low percentage of properly rendered aeromedical dispositions. Proper medical record documentation is important for evaluating quality of care and ensuring compliance with regulations in an Air Force aviator population. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

STUDY CONCERNING THE ELABORATION OF CERTAIN ORIENTATION MODELS AND THE INITIAL SELECTION FOR SPEED SKATING

Directory of Open Access Journals (Sweden)

Vaida Marius

2009-12-01

Full Text Available In realizing this study I started from the premise that, by elaborating certain orientation models and initial selection for the speed skating and their application will appear superior results, necessary results, taking into account the actual evolution of the high performance sport in general and of the speed skating, in special.The target of this study has been the identification of an orientation model and a complete initial selection that should be based on the favorable aptitudes of the speed skating. On the basis of the made researched orientation models and initial selection has been made, things that have been demonstrated experimental that are not viable, the study starting from the data of the 120 copies, the complete experiment being made by 32 subjects separated in two groups, one using the proposed model and the other formed fromsubjects randomly selected.These models can serve as common working instruments both for the orientation process and for the initial selection one, being able to integrate in the proper practical activity, these being used easily both by coaches that are in charge with the proper selection of the athletes but also by the physical education teachers orschool teachers that are in contact with children of an early age.

Exploring the development of a cultural care framework for European caring science.

Science.gov (United States)

Albarran, John; Rosser, Elizabeth; Bach, Shirley; Uhrenfeldt, Lisbeth; Lundberg, Pranee; Law, Kate

2011-01-01

The aim of this paper is to discuss the development of a cultural care framework that seeks to inform and embrace the philosophical ideals of caring science. Following a review of the literature that identified a lack of evidence of an explicit relationship between caring science and cultural care, a number of well-established transcultural care frameworks were reviewed. Our purpose was to select one that would resonate with underpinning philosophical values of caring science and that drew on criteria generated by the European Academy of Caring Science members. A modified framework based on the work of Giger and Davidhizar was developed as it embraced many of the values such as humanism that are core to caring science practice. The proposed caring science framework integrates determinants of cultural lifeworld-led care and seeks to provide clear directions for humanizing the care of individuals. The framework is offered to open up debate and act as a platform for further academic enquiry.

Selecting a risk-based tool to aid in decision making

Energy Technology Data Exchange (ETDEWEB)

Bendure, A.O.

1995-03-01

Selecting a risk-based tool to aid in decision making is as much of a challenge as properly using the tool once it has been selected. Failure to consider customer and stakeholder requirements and the technical bases and differences in risk-based decision making tools will produce confounding and/or politically unacceptable results when the tool is used. Selecting a risk-based decisionmaking tool must therefore be undertaken with the same, if not greater, rigor than the use of the tool once it is selected. This paper presents a process for selecting a risk-based tool appropriate to a set of prioritization or resource allocation tasks, discusses the results of applying the process to four risk-based decision-making tools, and identifies the ``musts`` for successful selection and implementation of a risk-based tool to aid in decision making.

[PHARMACOLOGICAL TREATMENT IN PALLIATIVE CARE. DRUG ADMINISTRATION ROUTE, CONTINUOUS SUBCUTANEOUS INFUSION, ADVERSE SIDE EFFECTS, SYMPTOM MANAGEMENT].

Science.gov (United States)

Dominguez Álvarez, Rocío; Calderón Carrasco, Justo; García Colchero, Francisco; Postigo Mota, Salvador; Alburquerque Medina, Eulalia

2015-01-01

To achieve well-being in patients in Palliative Care is required to know which are the most common symptoms, which are the drugs used for relief, which are the routes of administration of drugs that are suitable, how effective the drugs are and what incompatibilities, interactions and adverse effects occur. The aim of this article is to review the relevant issues in the management of the drugs commonly used by nursing in Palliative Care and presenting recommendations to clinical practice. Management interventions drugs for nurses in Palliative Care recommended by the scientific literature after a search of Scopus, CINAHL, Medline, PubMed, UpToDate and Google Scholar are selected. The oral route is the choice for patients in palliative situation and subcutaneous route when the first is not available. The symptoms, complex, intense and moody, should be systematically reevaluated by the nurse, to predict when a possible decompensation of it needing extra dose of medication. Nurses must be able to recognize the imbalance of well-being and act quickly and effectively, to get relief to some unpleasant situations for the patient as the pain symptoms, dyspnea or delirium. For the proper administration of rescue medication, the nurse should know the methods of symptomatic evaluation, pharmacokinetics and pharmacodynamics of drugs, the time intervals to elapse between different rescues and nccocc rocnnnco t thocm

Integrating rheumatology care in the community: can shared care work?

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Anita YN Lim

2015-08-01

Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

Integrating rheumatology care in the community: can shared care work?

Directory of Open Access Journals (Sweden)

Anita YN Lim

2015-08-01

Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow.Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care.Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care.Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

Broadband photonic crystal fiber coupler with polarization selection of coupling ratio

Science.gov (United States)

Jaroszewicz, Leszek R.; Stasiewicz, Karol A.; Marć, Paweł; Szymański, Michał

2010-09-01

In the paper a new broadband photonic crystal fiber coupler is presented. The proper application of the biconical taper technology has been used for manufacturing the coupler without air holes collapse in LMA10 fiber (NKT Photonics Crystal). This coupler, operates in the weakly coupling condition, protects coupling operation in range from 900 nm to 1700 nm. The coupling ratio between output arms is depending on wavelength and can be tuning by selection the proper input state of polarization. It gives opportunity to use the broadband crystal fiber coupler in many applications in which it is necessary to tune a coupling between output arms during the measurement.

Reduced verbal fluency for proper names in nondemented patients with Parkinson's disease: a quantitative and qualitative analysis.

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Fine, Eric M; Delis, Dean C; Paul, Brianna M; Filoteo, J Vincent

2011-02-01

There has been an increasing interest within neuropsychology in comparing verbal fluency for different grammatical classes (e.g., verb generation vs. noun generation) in neurological populations, including Parkinson's disease (PD). However, to our knowledge, few studies have compared verbal fluency for common nouns and proper names in PD. Common nouns and proper names differ in terms of their semantic characteristics, as categories of common nouns are organized hierarchically based on semantics, while categories of proper nouns lack a well-defined semantic organization. In addition, there is accumulating evidence that the retrieval of these distinct grammatical classes are subserved by somewhat distinct neural systems. Given that verbal fluency deficits are among the first impairments to emerge in PD, and that such deficits are predictors of future cognitive decline, it is important to examine all aspects of verbal fluency in this population. For the current study, we compared the performance of a group of 32 nondemented PD patients with 32 healthy participants (HP) on verbal fluency tasks for common nouns (animals) and proper names (boys' first names). A significant interaction between verbal fluency task and diagnostic status emerged, as the PD group performed significantly worse on only the proper name fluency task. This finding may reflect the absence of well-defined semantic organization that structures the verbal search for first names, thus placing a greater onus on strategic or "executive" verbal retrieval processes.

THE PROPER MOTIONS OF THE DOUBLE RADIO SOURCE n IN THE ORION BN/KL REGION

International Nuclear Information System (INIS)

Rodríguez, Luis F.; Loinard, Laurent; Zapata, Luis; Lizano, Susana; Dzib, Sergio A.; Menten, Karl M.; Gómez, Laura

2017-01-01

We have extended the time baseline for observations of the proper motions of radio sources in the Orion BN/KL region from 14.7 to 22.5 years. We present improved determinations for the sources BN and I. In addition, we address the proper motions of the double radio source n, that have been questioned in the literature. We confirm that all three sources are moving away at transverse velocities of tens of kilometers per second from a region in-between them, where they were located about 500 years ago. Source n exhibits a new component that we interpret as due to a one-sided ejection of free–free emitting plasma that took place after 2006.36. We used the highly accurate relative proper motions between sources BN and I to determine that their closest separation took place in the year 1475 ± 6, when they were within ∼100 au or less from each other in the plane of the sky.

THE PROPER MOTIONS OF THE DOUBLE RADIO SOURCE n IN THE ORION BN/KL REGION

Energy Technology Data Exchange (ETDEWEB)

Rodríguez, Luis F.; Loinard, Laurent; Zapata, Luis; Lizano, Susana [Instituto de Radioastronomía y Astrofísica, UNAM, Apdo. Postal 3-72 (Xangari), 58089 Morelia, Michoacán, México (Mexico); Dzib, Sergio A.; Menten, Karl M. [Max Planck Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn (Germany); Gómez, Laura, E-mail: l.rodriguez@crya.unam.mx [Joint ALMA Observatory, Alonso de Córdoba 3107, Vitacura, Santiago (Chile)

2017-01-10

We have extended the time baseline for observations of the proper motions of radio sources in the Orion BN/KL region from 14.7 to 22.5 years. We present improved determinations for the sources BN and I. In addition, we address the proper motions of the double radio source n, that have been questioned in the literature. We confirm that all three sources are moving away at transverse velocities of tens of kilometers per second from a region in-between them, where they were located about 500 years ago. Source n exhibits a new component that we interpret as due to a one-sided ejection of free–free emitting plasma that took place after 2006.36. We used the highly accurate relative proper motions between sources BN and I to determine that their closest separation took place in the year 1475 ± 6, when they were within ∼100 au or less from each other in the plane of the sky.

Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts.

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van Riet Paap, Jasper; Vernooij-Dassen, Myrra; Dröes, Rose-Marie; Radbruch, Lukas; Vissers, Kris; Engels, Yvonne

2014-09-17

Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators (QIs) have been developed to monitor and improve the organisation of palliative care for patients with cancer and those with dementia in various settings in different European countries. A multidisciplinary, international panel of professionals participated in a modified RAND Delphi procedure to compose a set of palliative care QIs based on existing sets of QIs on the organisation of palliative care. Panellists participated in three written rounds, one feedback round and one meeting. The panel's median votes were used to identify the final set of QIs. The Delphi procedure resulted in 23 useful QIs. These QIs represent key elements of the organisation of good clinical practice, such as the availability of palliative care teams, the availability of special facilities to provide palliative care for patients and their relatives, and the presence of educational interventions for professionals. The final set also includes QIs that are related to the process of palliative care, such as documentation of pain and other symptoms, communication with patients in need of palliative care and their relatives, and end-of-life decisions. International experts selected a set of 23 QIs for the organisation of palliative care. Although we particularly focused on the organisation of cancer and dementia palliative care, most QIs are generic and are applicable for other types of diseases as well.

Safe injection practice among health-care workers in Gharbiya Governorate, Egypt.

Science.gov (United States)

Ismail, N A; Aboul Ftouh, A M; El-Shoubary, W H; Mahaba, H

2007-01-01

We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study

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Miteku Andualem Limenih

2016-01-01

Full Text Available Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34, place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79, outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19, delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54, and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28 were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study.

Science.gov (United States)

Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa

2016-01-01

Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

Laminoplasty Does not Lead to Worsening Axial Neck Pain in the Properly Selected Patient With Cervical Myelopathy: A Comparison With Laminectomy and Fusion.

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Stephens, Byron F; Rhee, John M; Neustein, Thomas M; Arceo, Rafael

2017-12-15

Retrospective cohort study of prospectively collected data. To determine if laminoplasty (LP) is associated with worsening axial neck pain in patients with multilevel cervical myelopathy, and to compare neck pain, clinical outcomes, and radiographic measures in a group undergoing laminectomy and fusion (LF). Postoperative new or worsening axial neck pain is commonly cited as a major disadvantage of laminoplasty. However, there remains a paucity of corroborative data from large series. Following institutional review board approval, we reviewed the medical records, radiographs, and prospective clinical outcomes database of 85 patients undergoing LP and 52 patients undergoing LF for cervical myelopathy with minimum 1-year radiographic follow-up and average clinical follow-up of 18.5 months. LP was performed in those with neutral to lordotic C2-7 alignment and who did not complain of diffuse axial pain. Otherwise, LF was performed. Clinical outcomes included visual analogue score (VAS)-neck pain, VAS-total pain, neck disability index (NDI), short form 36, modified Japanese Orthopaedic Association (mJOA), and several radiographic parameters. VAS-neck did not worsen in LP (-0.2, P = 0.54) and did improve in LF (-2.0, P = 0.0013). VAS-total improved significantly in both groups (LF -1.04 ± 0.52, P = 0.05; LP -1.4 ± 0.51, P = 0.008). NDI improved in both groups, but was significant in only LP (LP decreased 6.79 ± 2.25, P = 0.0032; LF decreased 4.01 ± 3.05, P = 0.19). mJOA scores improved significantly in both groups (LP improved 2.89 ± 0.27, P cervical lordosis in both groups that was significant in LP (LP 2.92° loss, P = 0.0181; LF 1.25° loss, P = 0.53). In a carefully selected group of myelopathic patients without significant diffuse axial pain preoperatively and appropriate sagittal alignment, laminoplasty did not lead to worsening axial neck pain, and it was associated with significant improvements in other

Risk Attitudes, Sample Selection and Attrition in a Longitudinal Field Experiment

DEFF Research Database (Denmark)

Harrison, Glenn W.; Lau, Morten Igel

with respect to risk attitudes. Our design builds in explicit randomization on the incentives for participation. We show that there are significant sample selection effects on inferences about the extent of risk aversion, but that the effects of subsequent sample attrition are minimal. Ignoring sample...... selection leads to inferences that subjects in the population are more risk averse than they actually are. Correcting for sample selection and attrition affects utility curvature, but does not affect inferences about probability weighting. Properly accounting for sample selection and attrition effects leads...... to findings of temporal stability in overall risk aversion. However, that stability is around different levels of risk aversion than one might naively infer without the controls for sample selection and attrition we are able to implement. This evidence of “randomization bias” from sample selection...

Chiasmata promote monopolar attachment of sister chromatids and their co-segregation toward the proper pole during meiosis I.

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Yukinobu Hirose

2011-03-01

Full Text Available The chiasma is a structure that forms between a pair of homologous chromosomes by crossover recombination and physically links the homologous chromosomes during meiosis. Chiasmata are essential for the attachment of the homologous chromosomes to opposite spindle poles (bipolar attachment and their subsequent segregation to the opposite poles during meiosis I. However, the overall function of chiasmata during meiosis is not fully understood. Here, we show that chiasmata also play a crucial role in the attachment of sister chromatids to the same spindle pole and in their co-segregation during meiosis I in fission yeast. Analysis of cells lacking chiasmata and the cohesin protector Sgo1 showed that loss of chiasmata causes frequent bipolar attachment of sister chromatids during anaphase. Furthermore, high time-resolution analysis of centromere dynamics in various types of chiasmate and achiasmate cells, including those lacking the DNA replication checkpoint factor Mrc1 or the meiotic centromere protein Moa1, showed the following three outcomes: (i during the pre-anaphase stage, the bipolar attachment of sister chromatids occurs irrespective of chiasma formation; (ii the chiasma contributes to the elimination of the pre-anaphase bipolar attachment; and (iii when the bipolar attachment remains during anaphase, the chiasmata generate a bias toward the proper pole during poleward chromosome pulling that results in appropriate chromosome segregation. Based on these results, we propose that chiasmata play a pivotal role in the selection of proper attachments and provide a backup mechanism that promotes correct chromosome segregation when improper attachments remain during anaphase I.

Through the client's eyes: using narratives to explore experiences of care transfers during pregnancy, childbirth, and the neonatal period.

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van Stenus, Cherelle M V; Gotink, Mark; Boere-Boonekamp, Magda M; Sools, Anneke; Need, Ariana

2017-06-12

The client experience is an important outcome in the evaluation and development of perinatal healthcare. But because clients meet different professionals, measuring such experiences poses a challenge. This is especially the case in the Netherlands, where pregnant women are often transferred between professionals due to the nation's approach to risk selection. This paper explores questions around how clients experience transfers of care during pregnancy, childbirth, and the neonatal period, as well as how these experiences compare to the established quality of care aspects the Dutch Patient Federation developed. Narratives from 17 Dutch women who had given birth about their experiences with transfers were collected in the Netherlands. The narratives, for which informed consent was obtained, were collected on paper and online. Storyline analysis was used to identify story types. Story types portray patterns that indicate how clients experience transfers between healthcare providers. A comparative analysis was performed to identify differences and similarities between existing quality criteria and those clients mentioned. Four story types were identified: 1) Disconnected transfers of care lead to uncertainties; 2) Seamless transfers of care due to proper collaboration lead to positive experiences; 3) Transfers of care lead to disruption of patient-provider connectedness; 4) Transfer of care is initiated by the client to make pregnancy and childbirth dreams come true. Most of the quality aspects derived from these story types were identified as being similar or complementary to the Dutch Patient Federation list. A 'new' aspect identified in the clients' stories was the influencing role of prior experiences with transfers of care on current expectations, fears, and wishes. Transfers of care affect clients greatly and influence their experiences. Good communication, seamless transfers, and maintaining autonomy contribute to more positive experiences. The stories also

Animals′ Role in Proper Behaviour: Cheŵa Women′s Instructions in South-Central Africa

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Leslie F Zubieta

2016-01-01

Full Text Available The most common role of animals in the Cheŵa culture of south-central Africa is twofold: they are regarded as an important source of food, and they also provide raw materials for the creation of traditional medicines. Animals, however, also have a nuanced symbolic role that impacts the way people behave with each other by embodying cultural protocols of proper — and not so proper — behaviour. They appear repeatedly in storytelling and proverbs to reference qualities that people need to avoid or pursue and learn from the moral of the story in which animals interplay with each other, just as humans do. For example, someone who wants to prevent the consequences of greed is often advised to heed hyena stories and proverbs. My contribution elaborates on Brian Morris's instrumental work in south-central Africa, which has permitted us to elucidate the symbolism of certain animals and the perception of landscape for Indigenous populations in this region. I discuss some of the ways in which animals have been employed to teach and learn proper behaviour in a particular sacred ceremony of the Cheŵa people which takes place in celebration of womanhood: Chinamwali.

FIRST RESULTS FROM Pan-STARRS1: FAINT, HIGH PROPER MOTION WHITE DWARFS IN THE MEDIUM-DEEP FIELDS

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Tonry, J. L.; Flewelling, H. A.; Deacon, N. R.; Burgett, W. S.; Chambers, K. C.; Kaiser, N.; Kudritzki, R.-P.; Hodapp, K. W.; Magnier, E. A.; Morgan, J. S.; Wainscoat, R. J. [Institute for Astronomy, University of Hawaii, 2680 Woodlawn Drive, Honolulu, HI 96822 (United States); Stubbs, C. W.; Kilic, M.; Chornock, R.; Berger, E. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Price, P. A. [Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544 (United States)

2012-01-20

The Pan-STARRS1 survey has obtained multi-epoch imaging in five bands (Pan-STARRS1 g{sub P1}, r{sub P1}, i{sub P1}, z{sub P1}, and y{sub P1}) on 12 'Medium-Deep fields', each of which spans a 3.{sup 0}3 circle. For the period between 2009 April and 2011 April these fields were observed 50-200 times. Using a reduced proper motion diagram, we have extracted a list of 47 white dwarf (WD) candidates whose Pan-STARRS1 astrometry indicates a non-zero proper motion at the 6{sigma} level, with a typical 1{sigma} proper motion uncertainty of 10 mas yr{sup -1}. We also used astrometry from the Sloan Digital Sky Survey (when available) and USNO-B to assess our proper motion fits. None of the WD candidates exhibits evidence of statistically significant parallaxes, with a typical 1{sigma} uncertainty of 8 mas. Twelve of these candidates are known WDs, including the high proper motion (1.''7 yr{sup -1}) WD LHS 291. We confirm seven more objects as WDs through optical spectroscopy. Based on the Pan-STARRS1 colors, ten of the stars are likely to be cool WDs with 4170 K proper motion WDs that are part of the old thick disk and halo.

Editorial: The proper place for knowledge

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Yngve Nordkvelle

2009-11-01

Full Text Available Knowledge is an interesting word, which never goes out of fashion. In the political context, knowledge is something everyone hails and cherishes. An example is that the Socialist Government in Norway renamed its "Ministry of Education and Research" to the "Ministry of Knowledge". It would probably be politically wrong to defy the word "knowledge". The word "knowledge" stirs, however, different sentiments in people. In modern education, the word signifies something notable, discernable, visual or at least possible to distinguish from what it is not. In learning in higher education, knowledge is most often considered as the raw material for learning, with the little extra that distinguishes it from "information". Knowledge is information with a direction, a purpose and meaning, but without the implied cultivation of a teaching and learning process. Given knowledge is used for educational purposes, the processing of knowledge from its basic concepts to embodied and reflected knowledge, properly understood and reconceptualised by the learner, transforms not only the learner, but also the knowledge. In a peripatetic tradition, one likes to think of knowledge as foundation elements for constructions of ethical wisdom as its highest reflective level. Probably we will never see a "Ministry of Wisdom" established, because what is "wisdom" is probably so much more politically charged than "Knowledge". One can only wonder why anyone would degrade a ministry for education to something less. In Europe a rewriting of university curricula is underway all over the continent, because "knowledge" is a key concept in the writing of "learning outcomes". It appears every college is absorbed in sorting out what knowledge is and how knowledge can be classified in categories and levels, and then composed to readable descriptions of syllabi, course descriptions and schemes. Let us hope they are more able than what has been the case. Professor Ronald Barnett of the

Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

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Yvonne Ying Ru Ng

2014-01-01

Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

Estimating nonlinear selection gradients using quadratic regression coefficients: double or nothing?

Science.gov (United States)

Stinchcombe, John R; Agrawal, Aneil F; Hohenlohe, Paul A; Arnold, Stevan J; Blows, Mark W

2008-09-01

The use of regression analysis has been instrumental in allowing evolutionary biologists to estimate the strength and mode of natural selection. Although directional and correlational selection gradients are equal to their corresponding regression coefficients, quadratic regression coefficients must be doubled to estimate stabilizing/disruptive selection gradients. Based on a sample of 33 papers published in Evolution between 2002 and 2007, at least 78% of papers have not doubled quadratic regression coefficients, leading to an appreciable underestimate of the strength of stabilizing and disruptive selection. Proper treatment of quadratic regression coefficients is necessary for estimation of fitness surfaces and contour plots, canonical analysis of the gamma matrix, and modeling the evolution of populations on an adaptive landscape.

The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias.

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Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; Macleod, Mary Joan

2015-03-01

Randomised trials indicate that stroke unit care reduces morbidity and mortality after stroke. Similar results have been seen in observational studies but many have not corrected for selection bias or independent predictors of outcome. We evaluated the effect of stroke unit compared with general ward care on outcomes after stroke in Scotland, adjusting for case mix by incorporating the six simple variables (SSV) model, also taking into account selection bias and stroke subtype. We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days. There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care. In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Selection to outsmart the germs: The evolution of disease recognition and social cognition.

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Kessler, Sharon E; Bonnell, Tyler R; Byrne, Richard W; Chapman, Colin A

2017-07-01

The emergence of providing care to diseased conspecifics must have been a turning point during the evolution of hominin sociality. On a population level, care may have minimized the costs of socially transmitted diseases at a time of increasing social complexity, although individual care-givers probably incurred increased transmission risks. We propose that care-giving likely originated within kin networks, where the costs may have been balanced by fitness increases obtained through caring for ill kin. We test a novel hypothesis of hominin cognitive evolution in which disease may have selected for the cognitive ability to recognize when a conspecific is infected. Because diseases may produce symptoms that are likely detectable via the perceptual-cognitive pathways integral to social cognition, we suggest that disease recognition and social cognition may have evolved together. Using agent-based modeling, we test 1) under what conditions disease can select for increasing disease recognition and care-giving among kin, 2) whether providing care produces greater selection for cognition than an avoidance strategy, and 3) whether care-giving alters the progression of the disease through the population. The greatest selection was produced by diseases with lower risks to the care-giver and prevalences low enough not to disrupt the kin networks. When care-giving and avoidance strategies were compared, only care-giving reduced the severity of the disease outbreaks and subsequent population crashes. The greatest selection for increased cognitive abilities occurred early in the model runs when the outbreaks and population crashes were most severe. Therefore, over the course of human evolution, repeated introductions of novel diseases into naïve populations could have produced sustained selection for increased disease recognition and care-giving behavior, leading to the evolution of increased cognition, social complexity, and, eventually, medical care in humans. Finally, we lay

Localizing obstructive sites with dynamic MRI and consequentially proper therapy selection for obstructive sleep apnea/hypopnea syndrome

International Nuclear Information System (INIS)

Oda, Makoto

2004-01-01

At present, selection of therapies for obstructive sleep apnea/hypopnea syndrome (OSAHS) relies on the localizing the obstructive sites and determination of its severity by polysomnography (PSG). Many methods have been applied to localize the obstructive sites. We attempted to evaluate the morphology of upper airway during sleep with dynamic MRI, and assessed the severity of OSAHS and results of therapies in groups classified by the patterns of obstructive sites. A categorizing system was set up, by which the obstructive sites were reviewed on axial and sagittal sections and accordingly classified into four patterns: front-to-back pattern, left-to-right pattern, circular pattern and epiglottis pattern. Comparison of apnea/hypopnea index (AHI), lowest SpO2 and BMI was performed between the different patterns. The results showed that the left-to-right pattern and circular pattern had a higher AHI and lower lowest SpO2, and more cases of obesity with higher BMI were found in these two groups. We also evaluated the results of different therapies for different obstructive site patterns. Radiofrequency coblation of soft palate was found to be effective for the front-to-back pattern. Improvement was found in 67% of all the cases that received uvulopalatopharyngoplasty (UPPP), while a significant postoperative improvement of AHI was confirmed in left-to-right pattern and circular pattern groups. No significant difference in the results was found between different obstructive sites or patterns when nasal continuous positive airway pressure (n-CPAP) was applied alone. Being completely free from CPAP (completed treatment with improvement of symptoms) was achieved in 71.4% of all the cases and 85.7% in the left-to-right pattern group who received UPPP. We conclude that an optimal treatment results could be achieved by selecting the therapies based on the severity of OSAHS and result of localizing the obstructive sites by dynamic MRI. (author)

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

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Orlando, Rocco; Haytaian, Marcia

2012-08-01

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

Auditing of Monitoring and Respiratory Support Equipment in a Level III-C Neonatal Intensive Care Unit

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Elena Bergon-Sendin

2015-01-01

Full Text Available Background. Random safety audits (RSAs are a safety tool but have not been widely used in hospitals. Objectives. To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used. Methods. A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device. Results. A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12–3.06, p=0.01, and during the late shift (3 pm to 10 pm, OR 1.59 (1.03–2.4, p=0.03. Conclusions. Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.

Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria.

Science.gov (United States)

Abhulimhen-Iyoha, B I; Ibadin, M O

2012-01-01

. Proper hygiene including proper hand washing techniques while caring for newborns along with vaccination of infants and their mothers will help prevent infections including tetanus while prompt health-seeking behavior is advised to improve outcome should such infections occur.

Acceptance of selective contracting: the role of trust in the health insurer.

Science.gov (United States)

Bes, Romy E; Wendel, Sonja; Curfs, Emile C; Groenewegen, Peter P; de Jong, Judith D

2013-10-02

In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees' trust in the health insurer on their acceptance of selective contracting. An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. This study provides insight into factors that influence people's acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.

Acceptance of selective contracting: the role of trust in the health insurer

Science.gov (United States)

2013-01-01

Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting. Methods An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Results Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. Conclusion This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop. PMID:24083663

Quality of Health Care Activity in Educational Institutions: Conceptual Aspect

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N. V. Tretyakova

2013-01-01

Full Text Available The paper deals with one of the priority tasks of Russian educational system – developing the health responsibility. The recent health deterioration trend among children and adolescents calls for the complex health care measures, equally affecting the learning outcomes. The authors argue that there is a need for proper definition and specification of the key term of health care quality. However, the analysis of the available scientific and documentary recourses demonstrates the absence of such unified definition. The authors describe the existing approaches to defining the health care quality, and examine structural components of the health care activity, their interrelations and interdependence. In authors’ opinion, the synthesis of the available research materials provides the basis for further studies in the theory and practice of quality management activities regarding the health protection of children, adolescents and young adults in educational institutions. 

Duty of care is underpinned by a range of obligations.

Science.gov (United States)

Griffith, Richard

The courts have long established that nurses are in a duty situation and owe a duty of care to their patients (Kent v Griffiths [2001]). Traditionally, the profession set the standard of care and nurses were required to act in accordance with a practice accepted by a responsible body of their peers (Bolam v Friern HMC [1957]).The introduction of the Human Rights Act 1998 gave rise to a positive obligation on government to ensure that laws, policies and procedures are in place to protect violations of human rights. Nurses must now inform their practice with relevant statute law, common law and professional standards in order to properly discharge their duty of care. Richard Griffith considers the law that now underpins a nurse's duty of care and uses a recent report from the Health Service Ombudsman for England to illustrate the obligations that underpin the nurse-patient relationship.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada

OpenAIRE

Romain, Sandra J.

2013-01-01

Background. Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requ...

ORTHOGONAL REPRESENTATION OF THE PROPER TRANSFORMATION OF A PERSYMMETRIC MATRIX BASED ON ROTATION OPERATORS

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V. M. Demko

2018-01-01

Full Text Available The mathematical substantiation of the algorithm for synthesis of the proper transformation and finding the eigenvalue formulae of a persymmetric matrix of dimension N = 2 k ( k =1, 4 based on orthogonal rotation operators is given. The proposed algorithm made it possible to improve the author's approach to calculating eigenvalues based on numerical examples for the maximal dimension of matrices 64×64, resulting the possibility to obtain analytical relations for calculating the eigenvalues of the persymmetric matrix. It is shown that the proper transformation has a factorized structure in the form of a product of rotation operators, each of which is a direct sum of elementary Givens and Jacobian rotation matrices. 

Consumer Demand on Halal Cosmetics and Personal Care Products in Indonesia

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Muniaty Aisyah

2016-12-01

Full Text Available This research aims to analyze the influential factors involved in Moslem consumers’ decision to purchase halal cosmetics and personal care products in Indonesia by using the Theory of Planned Behavior. 100 questionnaires were analyzed using Structural Equation Modeling, collected from respondents of female consumers who purchased Wardah cosmetics and personal care products in South Jakarta and South Tangerang. The findings show that attitude, subjective norm, perceived behavioral control and purchase intention are positively related to the consumers’ decision to purchase halal cosmetics and personal care products. By addressing the consumers’ traits that can predict halal cosmetics and personal care products necessity, marketers could generate proper marketing strategies to validate consumers’ demand which in turn will stimulate the growth of halal products industry in Indonesia.DOI: 10.15408/aiq.v9i1.1867

Cross border reproductive care in six European countries

DEFF Research Database (Denmark)

de Mouzon, J; Pennings, G; Ferraretti, A P

2010-01-01

The quantity and the reasons for seeking cross border reproductive care are unknown. The present article provides a picture of this activity in six selected European countries receiving patients.......The quantity and the reasons for seeking cross border reproductive care are unknown. The present article provides a picture of this activity in six selected European countries receiving patients....

Vantage Theory and the Use of English Demonstrative Determiners with Proper Nouns

Science.gov (United States)

Riddle, Elizabeth M.

2010-01-01

This article discusses some apparently paradoxical behavior of the English demonstratives "this/these" and "that/those" as determiners of proper nouns and as metaphorical signals of epistemic and affective stance within the proximal-distal opposition. It is argued that the apparent paradoxes are actually cases of shifting perspectives or points of…

MERLIN observations of water maser proper motions in VY Canis Majoris

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Richards, A. M. S.; Yates, J. A.; Cohen, R. J.

1998-09-01

MERLIN observations of the 22-GHz water masers in the circumstellar envelope of the supergiant VY CMa show an ellipsoidal distribution with a maximum extent of 700 mas east-west and 400 mas north-south. Comparison with observations made nine years earlier shows that the majority of maser features have survived and show proper motions throughout the region. The mean change in position is 28 mas and the proper motions are generally directed away from the assumed stellar position, and tend to be larger for features at greater projected distances. If the H_2O maser region is modelled as a partially filled thick spherical shell, and VY CMa is at a distance of 1.5 kpc, then the proper motion velocities in the direction of expansion are between 8kms^-1 at a distance of 75 mas from the assumed stellar position and 32kms^-1 at 360 mas. These velocities are consistent with the H_2O maser spectral line velocities which correspond to a maximum expansion velocity of 36kms^-1 at 400 mas from the assumed stellar position. These observations are consistent with radiation pressure on dust providing the force to accelerate the stellar wind as it passes through the H_2O maser shell. The H_2O maser region is elongated in the same direction as the dusty nebula around VY CMa. The water masers illuminate the small-scale dynamics and clumpiness which show the role of dust in driving the outflow. The overall ellipsoidal shape may be due to properties of the dust, such as its behaviour in the stellar magnetic field, or to interaction between the wind and circumstellar material. Maser monitoring also shows the difference between changes on the time-scale of stellar variability (a few years) and possible stages in the evolution of VY CMa to its likely fate as a supernova.

VizieR Online Data Catalog: The VLBA Extragalactic Proper Motion Catalog (Truebenbach+, 2017)

Science.gov (United States)

Truebenbach, A. E.; Darling, J.

2017-11-01

We created our catalog of extragalactic radio proper motions using the 2017a Goddard VLBI global solution. The 2017a solution is computed from more than 30 years of dual-band VLBI observations --1979 August 3 to 2017 March 27. We also observed 28 objects with either no redshift or a "questionable" Optical Characteristic of Astrometric Radio Sources (OCARS; Malkin 2016ARep...60..996M) redshift at the Apache Point Observatory (APO) 3.5m telescope and/or at Gemini North. We conducted observations on the 3.5m telescope at Apache Point Observatory with the Dual Imaging Spectrograph (DIS) from 2015 April 18 to 2016 June 30. We chose two objects for additional observations with the Gemini Multi-Object Spectrograph-North (GMOS-N) at Gemini North Observatory. 2021+317 was observed on 2016 June 26 and 28, while 0420+417 was observed on 2016 November 8 and 26. We also observed 42 radio sources with the Very Long Baseline Array (VLBA) in the X-band (3.6cm/8.3GHz). Our targets had all been previously observed by VLBI. Our VLBA observations were conducted in two campaigns from 2015 September to 2016 January and 2016 October to November. The final extragalactic proper motion catalog (created primarily from archival Goddard VLBI data, with redshifts obtained from OCARS) contains 713 proper motions with average uncertainties of 24μas/yr. (5 data files).