The Role of the Advanced Practice Nurse in Geriatric Oncology Care.

Science.gov (United States)

Morgan, Brianna; Tarbi, Elise

2016-02-01

To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care. Copyright © 2015 Elsevier Inc. All rights reserved.

Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

OpenAIRE

Carpenter, Christopher R; Griffey, Richard T; Stark, Susan; Coopersmith, Craig M; Gage, Brian F

2011-01-01

Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED) survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of t...

R and D into stand-alone PV systems for export

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-09-01

The current status of photovoltaic (PV) technology is reviewed for systems to provide electricity where mains supplies are unavailable, known as stand-alone PV systems. Typical applications and experiences with installed stand-alone systems are described. Economic issues and barriers to the wide use of PV systems are also examined. (UK)

Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program.

Science.gov (United States)

Kant, Rebecca E; Vejar, Maria; Parnes, Bennett; Mulder, Joy; Daddato, Andrea; Matlock, Daniel D; Lum, Hillary D

2018-05-03

This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016-May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care. Published by Elsevier Inc.

Basic Stand Alone Medicare Inpatient Claims PUF

Data.gov (United States)

U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare...

Basic Stand Alone Carrier Line Items PUF

Data.gov (United States)

U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Carrier Line Items Public Use Files (PUF) with information from Medicare Carrier claims. The CMS BSA Carrier Line...

[Geriatric nursing staff retention. Opportunities, potentials, and strategies].

Science.gov (United States)

Joost, A

2013-08-01

Retaining geriatric nurses in their line of work could be an important strategy to prevent the shortage of skilled staff in the future. A prerequisite for this is detailed knowledge of the length and structure of professional careers. The IWAK ( Institut für Wirtschaft, Arbeit und Kultur) evaluated data from the German Social Insurance and carried out a structural analysis of the professional careers of geriatric nurses. Results showed that the average duration of professional careers is 20 years, of which 11.7 years constitute the period of employment and 7.8 years account for periods of inactivity. According to these findings, there is a considerable potential in extending professional careers and reducing the periods of inactivity to make better use of the existing skilled staff and to reduce staff shortage in this area. Concrete measures could involve improvement of working conditions (with the aim of avoiding long periods of inactivity and illness-related premature career endings as well as of increasing job satisfaction), creating better conditions for a good balance between work and family life, as well as setting up individual strategies to expand weekly working hours. Key players are businesses but also local authorities and politicians.

[Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study].

Science.gov (United States)

Osuna-Pozo, Carmen María; Serra-Rexach, José Antonio; Viña, José; Gómez-Cabrera, María del Carmen; Salvá, Antoni; Ruiz, Domingo; Masanes, Ferrán; Lopez-Soto, Alfonso; Formiga, Francesc; Cuesta, Federico; Cruz-Jentoft, Alfonso

2014-01-01

There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

Clustering excellence to exert transformative change: the Hartford Geriatric Nursing Initiative (HGNI).

Science.gov (United States)

McBride, Angela Barron; Watman, Rachael; Escobedo, Marcus; Beilenson, John

2011-01-01

This paper describes how the John A. Hartford Foundation sought to maximize the influence of its various geriatric nursing projects by organizing and managing them collectively as the Hartford Geriatric Nursing Initiative (HGNI). This initiative aimed to develop a shared identity, encouraged cross-pollination of efforts, convened project leaders to address opportunities and problems, launched across-project collaborations, and created tools and resources to support overall efforts. This paper ends with some reflections on the processes implemented to maximize HGNI effectiveness, particularly the importance of forging a common identity in order to encourage expanded solutions. The HGNI can serve as an example of how intersecting interests can fuel new ideas, thus helping others think more strategically about change efforts in the future. Copyright © 2011 Elsevier Inc. All rights reserved.

Stand-alone wind system with Vanadium Redox Battery energy storage

DEFF Research Database (Denmark)

Teodorescu, Remus; Barote, L.; Weissbach, R.

2008-01-01

Energy storage devices are required for power balance and power quality in stand alone wind energy systems. A Vanadium Redox Flow Battery (VRB) system has many features which make its integration with a stand-alone wind energy system attractive. This paper proposes the integration of a VRB system...... with a typical stand-alone wind energy system during wind speed variation as well as transient performance under variable load. The investigated system consists of a variable speed wind turbine with permanent magnet synchronous generator (PMSG), diode rectifier bridge, buck-boost converter, bidirectional charge...... controller, transformer, inverter, ac loads and VRB (to store a surplus of wind energy and to supply power during a wind power shortage). The main purpose is to supply domestic appliances through a single phase 230V, 50Hz inverter. Simulations are accomplished in order to validate the stability of the supply....

Models for a stand-alone PV system

DEFF Research Database (Denmark)

Hansen, A.D.; Sørensen, Poul Ejnar; Hansen, L.H.

2001-01-01

are based on the model descriptions found in the literature. The battery model is developed at UMASS and is known as the Kinetic Battery Model(KiBaM). The other component models in the PV system are based on simple electrical knowledge. The implementation is done using Matlab/Simulink, a simulation program......This report presents a number of models for modelling and simulation of a stand-alone photovoltaic (PV) system with a battery bank verified against a system installed at Risø National Laboratory. The work has been supported by the Danish Ministry ofEnergy, as a part of the activities in the Solar...... Energy Centre Denmark. The study is carried out at Risø National Laboratory with the main purpose to establish a library of simple mathematical models for each individual element of a stand-alone PVsystem, namely solar cells, battery, controller, inverter and load. The models for PV module and battery...

Basic Stand Alone Medicare DME Line Items PUF

Data.gov (United States)

U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Durable Medical Equipment (DME) Line Items Public Use Files (PUF) with information from Medicare DME claims. The...

Medications Associated with Geriatric Syndromes (MAGS) and their Prevalence in Older Hospitalized Adults Discharged to Skilled Nursing Facilities

Science.gov (United States)

Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.

2016-01-01

Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830

Models for a stand-alone PV system[Photovoltaic

Energy Technology Data Exchange (ETDEWEB)

Hansen, A.D.; Soerensen, P.; Hansen, L.H.; Bindner, H.

2000-12-01

This report presents a number of models for modelling and simulation of a stand-alone photovoltaic (PV) system with a battery bank verified against a system installed at Risoe National Laboratory. The work has been supported by the Danish Ministry of Energy, as a part of the activities in the Solar Energy Centre Denmark. The study is carried out at Risoe National Laboratory with the main purpose to establish a library of simple mathematical models for each individual element of a stand-alone PV system, namely solar cells, battery, controller, inverter and load. The models for PV module and battery are based on the model descriptions found in the literature. The battery model is developed at UMASS and is known as the Kinetic Battery Model (KiBaM). The other component models in the PV system are based on simple electrical knowledge. The implementation is done using Matlab/Simulink, a simulation program that provides a graphical interface for building models as modular block diagrams. The non-linear behaviour of the battery, observed in the measurements, is investigated and compared to the KiBaM model's performance. A set of linear Black box models are estimated based on the battery measurements. The performance of the best linear Black box model is compared to the KiBaM model. A validation of each of the implemented mathematical model is performed by an interactive analysis and comparison between simulation results and measurements, acquired from the stand-alone PV system at Risoe. (au)

Procedures for Determining the Performance of Stand-Alone Photovoltaic Systems; TOPICAL

International Nuclear Information System (INIS)

DeBlasio, R.; Durand, S.; Hansen, R.; Hutchinson, P.; Kroposki, B.; McNutt, P.; Rosenthal, A.; Thomas, M.

1999-01-01

This document provides the procedures for determining the performance of stand-alone PV systems. The procedures in this document provide a common approach for evaluating whether a given PV system is suitable to perform the function for which it was designed and manufactured to accomplish, and whether it will provide adequate power to run the load. These procedures cover small stand-alone PV systems. They cover complete outdoor system testing. Test results are valid only for the system that is tested

Stand-alone photovoltaic systems in the Netherlands. Evaluation of the market introduction

International Nuclear Information System (INIS)

Cloin, J.; Van Dijk, A.L.; Westra, C.A.

1999-08-01

The policy followed for stand-alone PV systems in the Netherlands is evaluated for the period 1997-1998. The world-wide powerful growth of the PV industry is not being followed by the increase in volume of implemented stand-alone PV systems in the Netherlands. This leads to the question whether the Dutch policy to stimulate stand-alone PV systems is effective. Recommendations on the use of communication as a strategic instrument are given, including the drawing up of a marketing plan. Other recommendations include increased transparency in the application for subsidies and a pro-active role of the Netherlands Agency for Energy and the Environment (Novem) in the contact with relevant market parties. The increased focus on product development aimed at the environmental benefits and general reliability of PV systems is recommended. 38 refs

Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities

Science.gov (United States)

Bell, Susan P.; Vasilevskis, Eduard E.; Saraf, Avantika A.; Jacobsen, J. Mary Lou; Kripalani, Sunil; Mixon, Amanda S.; Schnelle, John F.; Simmons, Sandra F.

2016-01-01

Background Geriatric syndromes are common in older adults and associated with adverse outcomes. The prevalence, recognition, co-occurrence and recent onset of geriatric syndromes in patients transferred from hospital to skilled nursing facilities (SNFs) are largely unknown. Design Quality improvement project. Setting Acute care academic medical center and 23 regional partner SNFs. Participants 686 Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs. Measurements Nine geriatric syndromes were measured by project staff -- weight loss, decreased appetite, incontinence and pain (standardized interview), depression (Geriatric Depression Scale), delirium (Brief-Confusion Assessment Method), cognitive impairment (Brief Interview for Mental Status), falls and pressure ulcers (hospital medical record utilizing hospital-implemented screening tools). Estimated prevalence, new-onset prevalence and common coexisting clusters were determined. The extent that syndromes were commonly recognized by treating physicians and communicated to SNFs in hospital discharge documentation was evaluated. Results Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for 3 or more co-existing syndromes. Overall the most prevalent syndromes were falls (39%), incontinence (39%), decreased appetite (37%) and weight loss (33%). Of individuals that met criteria for 3 or more syndromes, the most common triad clusters included nutritional syndromes (weight loss, loss of appetite), incontinence and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33–95% of syndromes present as assessed by research personnel. Conclusion Geriatric syndromes in hospitalized older adults transferred to SNF are prevalent and commonly co-exist with the most frequent clusters including nutritional syndromes, depression and incontinence. Despite

Stand-alone induction generators for small water power schemes

Energy Technology Data Exchange (ETDEWEB)

Harvey, Adam [Intermediate Technology Development Group, Rugby (United Kingdom); Smith, Nigel [Smith Associates, Nottingham (United Kingdom)

1996-04-01

Conventional technology for isolated power generation is the synchronous generator. Using stand-alone induction generators has proved to have tremendous advantages in remote regions of developing countries, where electricity has significant social benefits. (author)

Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease

DEFF Research Database (Denmark)

Udby, Peter M.; Bech-Azeddine, Rachid

2015-01-01

The objective of the article was to: a) present results from a case cohort pilot study comparing stand-alone ALIF and TLIF and, b) review the literature on studies comparing the clinical outcome of stand-alone ALIF with posterior instrumentation including TLIF or PLIF, in patients with disabling...... low back pain resulting from degenerative disc disease. ALIF surgery has previously been linked with certain high risk complications and unfavorable long term fusion results. Newer studies suggest that stand-alone ALIF can possibly be advantageous compared to other types of posterior instrumented...

Advancing nursing home practice: the International Association of Geriatrics and Gerontology Recommendations.

Science.gov (United States)

Tolson, Debbie; Morley, John E; Rolland, Yves; Vellas, Bruno

2011-01-01

Recognition of the urgent need to improve the provision of long-term care, as well as the known variations in standards of nursing home care around the world, prompted the International Association of Geriatrics and Gerontology (IAGG), in association with the World Health Organization (WHO), to form a task force. This task force was charged with the identification of the key concerns, research priorities, and actions that would enhance the care provided to older people in nursing homes. Nurses are equipped with the knowledge to take a leadership role in the IAGG/WHO initiative, and the task force eagerly seeks their input. Copyright © 2011 Mosby, Inc. All rights reserved.

Cooperative learning strategies to teach nutrition to geriatric nursing staff.

Science.gov (United States)

Arroyo, Marta; Rocandio, Ana Ma; Ansotegui, Laura; Pascual, Estíbaliz; Martínez de la Pera, Concepción

2008-03-01

The objective of this study was to test the hypothesis that cooperative learning strategies will help to increase nutrition knowledge of nurses and nursing assistants caring for the elderly in different institutional communities of the Basque Country, Spain. The target population was a sample of volunteers, 16 nurses and 28 nursing assistants. Training consisted of 12 nutrition education sessions using cooperative strategies conducted over a period of 3 consecutive weeks. The assessment instruments included two pretest and two posttest questionnaires with questions selected in multiple-choice format. The first questionnaire was about general knowledge of applied nutrition (0-88 point scale) and the second one on geriatric nutrition knowledge (0-18 point scale). Data were analyzed using SPSS vs. 11.0. The outcomes indicated a significant increase in general nutrition knowledge (difference between the pre- and post-test mean score: 14.5+/-10.1; Pcooperative learning strategies could improve the nutrition knowledge of nursing staff. Additionally, the results of this study provide direction to continuing nutrition education program planners regarding appropriate content and methodology for programs.

Stand-alone solutions, computer networks and extern communications

International Nuclear Information System (INIS)

Tarschisch, H.

1988-01-01

The advantages of local networks over stand-alone solutions are presented. Of the local networks (LAN), two are presently at the center of attention: the bus and the ring. ETHERNET and the IBM-Token-Ring are described as typical examples. Access to public networks, especially TELEPAC and ISDN, is discussed. 12 figs

Use of a mobile device by nursing home residents for long-term care comprehensive geriatric self-assessment: a feasibility study.

Science.gov (United States)

Huang, Fanpin; Chang, Polun; Hou, I-Ching; Tu, Ming-Hsiang; Lan, Chung-Fu

2015-01-01

Long-term-care comprehensive geriatric assessments, such as the Minimum Data Set 3.0, are used to evaluate the clinical, psychological, and personal status of residents in long-term-care nursing facilities. Nursing staff conducts assessment interviews, thereby increasing the workload of nurses and the cost of patient care. This study explored the ability of nursing home residents to use two different mobile devices for a geriatric self-assessment. Study participants were residents of long-term-care nursing homes. A modified Minimum Data Set 3.0 was converted to a format for use with a 6-inch mobile pad and a 3.7-inch mobile smartphone. The survey completion rate and the response time were measured. A Technology Assessment Model questionnaire analyzed the participants' experience. All participants were able to use a 6-inch pad, with an average completion rate of 92.9% and an average time for completion of 21 minutes. Only 20% of the participants could complete the assessment with the 3.7-inch smartphone. The participants found the 6-inch pad easier to use than the 3.7-inch smartphone. This exploratory study suggests that nursing home residents are able to use a mobile device to perform a geriatric self-assessment and delineates the importance of the ergonomics of the device.

Connecting embedded and stand-alone peer mentoring models to enhance student engagement

Directory of Open Access Journals (Sweden)

Rhys Cooper

2018-03-01

Full Text Available This paper outlines the Trident Student Mentoring Program that runs in the College of Engineering at Victoria University, Melbourne, Australia. The program offers both embedded and stand-alone models of peer mentoring services to the same cohort of first-year students. It shows that by forming strong links between these two types of peer mentoring models, the inherent challenges of both, such as low attendance rates in stand-alone models and short periods of peer to peer time in embedded models, are mitigated.

Sensorless direct voltage control of the stand-alone brushless doubly-fed generator

DEFF Research Database (Denmark)

Liu, Yi; Xu, Wei; Xiong, Fei

2017-01-01

The conventional stand-alone brushless doubly-fed generator (BDFG) control strategies need the feedback from the rotor position or speed sensors, which can reduce system reliability and increase the cost and axial volume of the machine. In this paper, a sensorless direct voltage control (DVC) str......) strategy is presented for the stand-alone BDFG. The satisfactory dynamic performance is verified by experimental results under four kinds of typical operation conditions. Besides, the proposed control strategy is robust due to no generator parameters being required....

The stand-alone test and decreasing serial cost sharing

DEFF Research Database (Denmark)

Hougaard, Jens Leth; Thorlund-Petersen, Lars

2000-01-01

The rule of decreasing serial cost sharing defined in de Frutos [1] over the class of concave cost functions may violate the important stand-alone test. Sufficient conditions for the test to be satisfied are given, in terms of individual rationality as well as coalitional stability...

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

Science.gov (United States)

Rolland, Yves; Resnick, Barbara; Katz, Paul R; Little, Milta O; Ouslander, Joseph G; Bonner, Alice; Geary, Carol R; Schumacher, Karen L; Thompson, Sarah; Martin, Finbarr C; Wilbers, Joachim; Zúñiga, Franziska; Ausserhofer, D; Schwendimann, R; Schüssler, S; Dassen, Theo; Lohrmann, Christa; Levy, Cari; Whitfield, Emily; de Souto Barreto, Philipe; Etherton-Beer, Christopher; Dilles, Tinne; Azermai, Majda; Bourgeois, Jolyce; Orrell, Martin; Grossberg, George T; Kergoat, Hélène; Thomas, David R; Visschedijk, Jan; Taylor, Stephanie J C; Handajani, Yvonne S; Widjaja, Nelly T; Turana, Yuda; Rantz, Marilyn J; Skubic, Marjorie; Morley, John E

2014-05-01

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Diagnosis and management of geriatric insomnia: a guide for nurse practitioners.

Science.gov (United States)

Krishnan, Preetha; Hawranik, Pamela

2008-12-01

To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers. Extensive literature review of the published research articles and textbooks. Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults. Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management.

Geriatric workforce capacity: a pending crisis for nursing home residents.

Science.gov (United States)

Lee, Wei-Chen; Sumaya, Ciro V

2013-07-29

The nursing home (NH) population in the US has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification) indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

Science.gov (United States)

Kocyigit, Burhan Fatih; Berk, Ejder

2018-01-01

Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

[Geriatric rehabilitation care: Doing the right things right].

Science.gov (United States)

de Vos, A J B M; van Balen, R; Gobbens, R J J; Bakker, T J E M

2018-02-01

Geriatric rehabilitation concerns short-term integrated multidisciplinary care aimed at functional recovery and social participation for relatively frail elderly. Given the geriatric clients' complex care issues, nurses should possess sufficient and appropriate competencies in order to identify and assess the relevant symptoms and intervene effectively. Yet, nurses experience a certain apprehensiveness to perform their tasks and express difficulties in multidisciplinary communication and collaboration in a constructive manner. In addition to the client's and informal care giver's perception of their input in the geriatric rehabilitation process, this study provides an in-depth understanding of the way nurses perceive their role in geriatric rehabilitation. This descriptive study entails a quantitative and a qualitative component. The quantitative component concerns questionnaires for clients, informal care givers, nurses, and team leaders. The qualitative component aims to obtain in-depth information (i. e. opinions, meanings, and reflections) with regard to the decision making process and the performance of the rehabilitation care by means of open-ended questions (in the questionnaire) and semi-structured interviews. Clients and informal care givers rate specific themes in geriatric rehabilitation in a more negative light than nurses and team leaders do. These themes concern the provision of information in the hospital (prior to admission in the rehabilitation facility), involvement in the draw-up of the treatment plan and rehabilitation goals, geriatric rehabilitation as a 24/7 activity, and taking into account the client's other life events. The latter three findings in particular, are caused by nurses' apprehensiveness to perform their tasks adequately. Nurses working in geriatric rehabilitation, experience apprehensiveness to perform their tasks adequately. Uncertainty about the client's reaction or fear of damaging the relationship of trust, results

Availability model of stand-alone photovoltaic system

Science.gov (United States)

Mazurek, G.

2017-08-01

In this paper we present a simple, empirical model of stand-alone photovoltaic power system availability. The model is a final result of five-year long studies and ground measurements of solar irradiation carried out in Central Europe. The obtained results facilitate sizing of PV modules that have to be installed with taking into account system's availability level in each month of a year. The model can be extended to different geographical locations, with help of local meteorological data or solar irradiation datasets derived from satellite measurements.

Input of biomass in stand-alone small-scale installations for power generation. Calculation of the financial gap

International Nuclear Information System (INIS)

Van Tilburg, X.; De Vries, H.J.; Pfeiffer, A.E.; Beekes, M.; Cleijne, J.W.

2005-09-01

A number of new initiatives in which bio-oil is used in stand-alone plants for power generation has been reviewed. The question to be answered is whether the reference case for stand alone biomass projects based on burning of wood chips can still be considered representative for the costs and benefits in this category. ECN, in cooperation with KEMA, have determined the financial gap between the costs and benefits of projects in which bio-oil is used in stand alone plants for power generation. The ranges and reference case for bio-oil in stand alone applications show that these projects have a substantially lower financial gap than the current reference case based on wood chips [nl

Environmental/Climatic Effect on Stand-Alone Solar Energy Supply ...

African Journals Online (AJOL)

This paper investigates the climatic eects and environmental variations on the performance of a stand-alone photovoltaic system. The eects of partial shading with dierent climate conditions and load resistance variations were examined. A survey of some of the work done in this eld of environmental eect on solar panel was ...

Modelling of fluid-solid interaction using two stand-alone codes

CSIR Research Space (South Africa)

Grobler, Jan H

2010-01-01

Full Text Available A method is proposed for the modelling of fluid-solid interaction in applications where fluid forces dominate. Data are transferred between two stand-alone codes: a dedicated computational fluid dynamics (CFD) code capable of free surface modelling...

Twitter discussions about the predicaments of robots in geriatric nursing: forecast of nursing robotics in aged care.

Science.gov (United States)

Eriksson, Henrik; Salzmann-Erikson, Martin

2018-02-01

People use social media to express perceptions, attitudes and a wide range of concerns regarding human life. This study aims at analysing the ongoing discussions on the internet microblog Twitter and offers some coming predicaments regarding developments in geriatric nursing regarding nursing robots. Data were retrospectively collected from Twitter. 1322 mentions were included in the final analyses, where principles of interpreting data by using netnography were utilized. Many ideas are presented expressing functional, psychological and social aspects of robots in nursing care. Most postings come from metropolitan cities around the globe. The discussion focuses on market-driven, science fiction solutions for aged care. Twitter users overall seem to be positive using various nursing robots in aged care. These discussions offer a window into the attitudes and ideas of this group of users. We suggest that monitoring Twitter discussions on social media can provide valuable insights into current attitudes as well as forecast coming trends.

Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients

NARCIS (Netherlands)

Jongenelis, K; Eisses, AMH; Gerritsen, DL; Beekman, ATF; Kluiter, H; Ribbe, MW

2005-01-01

Objective To determine the diagnostic accuracy of the 30-item and shortened versions of the Geriatric Depression Scale (GDS) in diagnosing depression in older nursing home patients. Method Three hundred and thirty-three older nursing home patients participated in a prospective cross-sectional study

Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients

NARCIS (Netherlands)

Jongenelis, K; Eisses, AMH; Gerritsen, DL; Beekman, ATF; Kluiter, H; Ribbe, MW

Objective To determine the diagnostic accuracy of the 30-item and shortened versions of the Geriatric Depression Scale (GDS) in diagnosing depression in older nursing home patients. Method Three hundred and thirty-three older nursing home patients participated in a prospective cross-sectional study

Analysis and controller design for stand-alone VSIs in synchronous reference frame

DEFF Research Database (Denmark)

Ramezani, Malek; Li, Shuhui; Golestan, Saeed

2017-01-01

-by-step graphical analysis and design approach for a three-phase stand-alone VSI system in the dq reference frame, which provides a clear systematic decoupling process to design the inner- and outer-loop current and voltage controllers, respectively. The closed-loop d- and q-axis output impedances of the stand......-alone VSI system by considering the coupling effects between axes are also formulated, modelled, and evaluated. The study investigates how the decoupling and compensating terms added in the current and voltage controllers affect the dynamic performance and output dq impedances of the VSI system. Simulation...... and hardware results verify the effectiveness of the graphic design and analysis strategy....

Improving efficiency of a regional stand alone bone bank.

Science.gov (United States)

Warnock, Jonathan M; Rowan, Clare H; Davidson, Helen; Millar, Ciara; McAlinden, M Gavan

2016-03-01

The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £ 610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective.

Geriatric Workforce Capacity: A Pending Crisis for Nursing Home Residents

Directory of Open Access Journals (Sweden)

Wei Chen eLee

2013-07-01

Full Text Available Introduction: The nursing home (NH population in the U.S. has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. Methods: This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. Results: English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Conclusion: Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

Fall prediction according to nurses' clinical judgment: differences between medical, surgical, and geriatric wards.

Science.gov (United States)

Milisen, Koen; Coussement, Joke; Flamaing, Johan; Vlaeyen, Ellen; Schwendimann, René; Dejaeger, Eddy; Surmont, Kurt; Boonen, Steven

2012-06-01

To assess the value of nurses' clinical judgment (NCJ) in predicting hospital inpatient falls. Prospective multicenter study. Six Belgian hospitals. Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours. Within 24 hours after admission, nurses gave their judgment on the question "Do you think your patient is at high risk for falling?" Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form. During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75. This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Ampere hour method of sizing a stand alone photovoltaic system ...

African Journals Online (AJOL)

Stand-alone photovoltaic power systems are natural options for application in electrification of remote areas which are not served by the grid electricity supply system. An ampere-hour ... Sizing of the balance-of-system were carefully handled to avoid undersizing or oversizing and subsequent variation in supply reliability.

Hybrid Configuration of Darrieus and Savonius Rotors for Stand-alone Power Systems

Science.gov (United States)

Wakui, Tetsuya; Tanzawa, Yoshiaki; Hashizume, Takumi; Nagao, Toshio

The suitable hybrid configuration of Darrieus lift-type and Savonius drag-type rotors for stand-alone wind turbine-generator systems is discussed using our dynamic simulation model. Two types of hybrid configurations are taken up: Type-A installs the Savonius rotor inside the Darrieus rotor and Type-B installs the Savonius rotor outside the Darrieus rotor. The computed results of the output characteristics and the dynamic behaviors of the system operated at the maximum power coefficient points show that Type-A, which has fine operating behavior to wind speed changes and can be compactly designed because of a shorter rotational shaft, is an effective way for self-controlled stand-alone small-scale systems.

A formative evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic.

Science.gov (United States)

Hansen, Kevin T; McDonald, Cheryl; O'Hara, Sue; Post, Leslie; Silcox, Susan; Gutmanis, Iris A

2017-07-01

The number of older adults with multiple complex comorbidities and frailty is expected to increase dramatically in the coming decades, which will necessitate a concomitant increase in the need for skilled clinicians who are able to manage complex geriatric needs. Many physicians, however, lack the required formal training, often leading to long wait-lists for specialist clinics. Yet, clinics led by non-physician professionals specialising in geriatric care could decrease these delays. This article describes the development and evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic (Inter-D Clinic). A combination of semi-structured clinician interviews, post-clinic follow-up phone calls, satisfaction surveys, and information from the hospital workload management system served as data sources for this formative programme evaluation. Between January 2013 and December 2014, 293 patients were seen in the clinic with the majority being referred for either memory issues (49%) or functional decline (35%). The clinic assessment frequently uncovered other issues, which led to guidance around falls prevention, improved nutrition, medication management, and referrals to available community supports. Both patients and referring physicians were very satisfied with this model of care, which is likely transferable to other locations provided the needed clinical expertise and community support services are available.

The Stand-alone Heliostat

International Nuclear Information System (INIS)

Garcia Navajas, G. I.; Egea Gea, A.

2000-01-01

The first Autonomous Heliostat has been developed by CIEMAT at PSA facilities in Almeria. This heliostat is an innovative approach to reducing the civil engineering work costs in heliostat fields of central tower plants. Channels, cables and other electric elements have been eliminated in the new heliostat. Thus, one 70-nr, classical T glass/metal heliostat has been adapted to include all the new stand-alone concept components. A PV system is able to drive two sun-tracking DC motors between 5 and 24Vdc, 0 and 15A. The heliostat communicates with the control room 400-m away by using a radio-modem working at 9600 baud. An anemometer, a wind switcher, light and ambient temperature sensors have been installed on the heliostat for self-protection decision-making. A PV panel integrated into the heliostat reflecting surface, eliminates cabling and other elements required for a conventional power supply. Communication lines between master control and local control have been replaced by radio-modem. Testing has validated the technical feasibility of the prototype and quantified the real consumption and efficiencies of new elements. The extra costs produced.by the autonomous concepts are compared with the cost of civil work in conventional heliostat field. (Author) 8 refs

National Database of Geriatrics

DEFF Research Database (Denmark)

Kannegaard, Pia Nimann; Vinding, Kirsten L; Hare-Bruun, Helle

2016-01-01

AIM OF DATABASE: The aim of the National Database of Geriatrics is to monitor the quality of interdisciplinary diagnostics and treatment of patients admitted to a geriatric hospital unit. STUDY POPULATION: The database population consists of patients who were admitted to a geriatric hospital unit....... Geriatric patients cannot be defined by specific diagnoses. A geriatric patient is typically a frail multimorbid elderly patient with decreasing functional ability and social challenges. The database includes 14-15,000 admissions per year, and the database completeness has been stable at 90% during the past......, percentage of discharges with a rehabilitation plan, and the part of cases where an interdisciplinary conference has taken place. Data are recorded by doctors, nurses, and therapists in a database and linked to the Danish National Patient Register. DESCRIPTIVE DATA: Descriptive patient-related data include...

Size-Prediction Analysis for Stand-Alone Photovoltaic System

International Nuclear Information System (INIS)

Erusiafe, N. E.; Chendo, M. A. C.

2002-01-01

The cost - effectiveness of photovoltaic (PV) generator depends, among others, on its ability to satisfy energy demand and the cost of achieving this. In this work a step - by - step procedure for predicting the size of the main components of a stand - alone PV system (array and storage) is presented. The results yield an expression which can he used lo determine the size of both components at optimum cost and desired reliability. The result from this work compare favourably with some earlier works in that, the system sizes shows some degree of agreement

Optimal sizing method for stand-alone photovoltaic power systems

Energy Technology Data Exchange (ETDEWEB)

Groumpos, P P; Papageorgiou, G

1987-01-01

The total life-cycle cost of stand-alone photovoltaic (SAPV) power systems is mathematically formulated. A new optimal sizing algorithm for the solar array and battery capacity is developed. The optimum value of a balancing parameter, M, for the optimal sizing of SAPV system components is derived. The proposed optimal sizing algorithm is used in an illustrative example, where a more economical life-cycle cost has bene obtained. The question of cost versus reliability is briefly discussed.

Integral type small PWR with stand-alone safety

International Nuclear Information System (INIS)

Makihara, Yoshiaki

2001-01-01

A feasibility study is achieved on an integral type small PWR with stand-alone safety. It is designed to have the following features. (1) The coolant does not leak out at any accidental condition. (2) The fuel failure does never occur while it is supposed on the large scale PWR at the design base accident. (3) At any accidental condition the safety is secured without any support from the outside (stand-alone safety secure). (4) It has self-regulating characteristics and easy controllability. The above features can be satisfied by integrate the steam generator and CRDM in the reactor vessel while the pipe line break has to be considered on the conventional PWR. Several counter measures are planned to satisfy the above features. The economy feature is also attained by several simplifications such as (1) elimination of main coolant piping and pressurizer by the integration of primary cooling system and self-pressurizing, (2) elimination of RCP by application of natural circulating system, (3) elimination of ECCS and accumulator by application of static safety system, (4) large scale volume reduction of the container vessel by application of integrated primary cooling system, (5) elimination of boric acid treatment by deletion of chemical shim. The long operation period such as 10 years can be attained by the application of Gd fuel in one batch refueling. The construction period can be shortened by the standardizing the design and the introduction of modular component system. Furthermore the applicability of the reduced modulation core is also considered. (K. Tsuchihashi)

A maximum power point tracking scheme for a 1kw stand-alone ...

African Journals Online (AJOL)

A maximum power point tracking scheme for a 1kw stand-alone solar energy based power supply. ... Nigerian Journal of Technology ... A method for efficiently maximizing the output power of a solar panel supplying a load or battery bus under ...

Minimum cost solution of wind–photovoltaic based stand-alone power systems for remote consumers

International Nuclear Information System (INIS)

Kaldellis, J.K.; Zafirakis, D.; Kavadias, K.

2012-01-01

Renewable energy sources (RES) based stand-alone systems employing either wind or solar power and energy storage comprise a reliable energy alternative, on top of conventional diesel-electric generator sets, commonly used by remote consumers. However, such systems usually imply the need for oversizing and considerable energy storage requirements leading to relatively high costs. On the other hand, hybrid configurations that may exploit both wind and solar potential of a given area may considerably reduce energy storage capacity and improve the economic performance of the system. In this context, an integrated techno-economic methodology for the evaluation of hybrid wind–photovoltaic stand-alone power systems is currently developed, aiming at the designation of optimum configurations for a typical remote consumer, using economic performance criteria. For the problem investigation, the developed evaluation model is applied to four representative areas of the Greek territory with different wind potential characteristics in order to obtain optimum configurations on the basis of minimum initial investment, 10-year and 20-year total cost. According to the results obtained, the proposed solution is favorably compared with all other stand-alone energy alternatives, reflecting the ability of hybrid systems to adjust even in areas where the local RES potential is not necessarily of high quality. - Highlights: ► Wind- and PV-stand alone systems often imply use of extreme battery capacity. ► Hybrid wind–PV systems may reduce energy storage requirements and associated costs. ► An optimization methodology is developed, based on economic performance criteria. ► Methodology is applied to four Greek regions of different wind potential. ► Results obtained reflect the hybrid solution's advantages over other alternatives.

A Three-Port Topology Comparison for a Low Power Stand-Alone Photovoltaic System

DEFF Research Database (Denmark)

Mira Albert, Maria del Carmen; Knott, Arnold; Andersen, Michael A. E.

2014-01-01

Three-port converter (TPC) topologies for renewable energy systems aim to provide higher efficiency and power density than conventional cascaded structures. This work proposes an analytical comparison of different TPC topologies for a photovoltaic LED lamp stand-alone system. A comparison using c...... component stress factor (CSF) is performed, which gives a quantitative measure of the performance of the converter. The candidate topologies are compared to each other according to a defined LED lighting strategy and a solar irradiation profile.......Three-port converter (TPC) topologies for renewable energy systems aim to provide higher efficiency and power density than conventional cascaded structures. This work proposes an analytical comparison of different TPC topologies for a photovoltaic LED lamp stand-alone system. A comparison using...

[Contribution of psychoanalysis to geriatric care for institutionalized patients].

Science.gov (United States)

Charazac, Pierre-Marie

2014-06-01

The contribution of psychoanalysis to geriatric care in nursing home is discussed in three directions: its conception of care, specially on its negative sides; its implication in geriatric units, in their conception and in the analysis of their management of care; the holding of care-givers and nurses by making clear what we call transference and conter-transference and their reflection on their function.

Modeling, Design and Simulation of Stand-Alone Photovoltaic Power Systems with Battery Storage

Directory of Open Access Journals (Sweden)

Abd Essalam BADOUD

2013-06-01

Full Text Available Stand alone renewable energy based on photovoltaic systems accompanied with battery storage system are beginning to play an important role over the world to supply power to remote areas. The objective of the study reported in this paper is to elaborate and design a bond graphs model for sizing stand-alone domestic solar photovoltaic electricity systems and simulating the performance of the systems in a tropical climate. The systems modelled consist of an array of PV modules, a lead-acid battery, and a number of direct current appliances. This paper proposes the combination of lead acid battery system with a typical stand alone photovoltaic energy system under variable loads. The main activities of this work purpose to establish library graphical models for each individual component of standalone photovoltaic system. Control strategy has been considered to achieve permanent power supply to the load via photovoltaic/battery based on the power available from the sun. The complete model was simulated under two testing including sunny and cloudy conditions. Simulation of the system using Symbols software was performed and the results of simulation show the superior stable control system and high efficiency. These results have been contrasted with real measured data from a measurement campaign plant carried on electrical engineering laboratory of Grenoble using various interconnection schemes are presented.

Magnetic field measurements near stand-alone transformer stations.

Science.gov (United States)

Kandel, Shaiela; Hareuveny, Ronen; Yitzhak, Nir-Mordechay; Ruppin, Raphael

2013-12-01

Extremely low-frequency (ELF) magnetic field (MF) measurements around and above three stand-alone 22/0.4-kV transformer stations have been performed. The low-voltage (LV) cables between the transformer and the LV switchgear were found to be the major source of strong ELF MFs of limited spatial extent. The strong fields measured above the transformer stations support the assessment method, to be used in future epidemiological studies, of classifying apartments located right above the transformer stations as highly exposed to MFs. The results of the MF measurements above the ground around the transformer stations provide a basis for the assessment of the option of implementing precautionary procedures.

Learnt and perceived professional roles of a new type of nurse specialized in Gerontology and Geriatrics, a qualitative study.

Science.gov (United States)

Huizenga, Petra; Finnema, Evelyn; Roodbol, Petrie

2016-07-01

To gain insight into a new type of nurse specialized in gerontology and geriatrics, how they find meaning in the care of older persons and how this relates to the seven professional roles derived from the CanMEDS theoretical framework. To promote the quality of care for older persons in the Netherlands, one of the measures taken is the training and deployment of Registered Nurses specialized in Gerontology and Geriatrics. We focus on their professional roles in this study, to gain insight into the extent to which they fulfil their professional standards. A qualitative study, consisting of seven focus group interviews. The study population included 67 Registered Nurses. Data were collected between October 2011-May 2013. Nurses work in all seven CanMEDS roles, but not with all competences associated with these seven roles. The more distant the role is from patient activities, the less frequently competences such as social networks; design; research; innovation of care; legal, financial and organizational frameworks; professional ethics and professional innovation are mentioned. Nurses engage in activities consistent with nursing care for older people; however, despite their training, they are mainly focused on direct-patient care. Their limited awareness of the complete range of professional competences risks the stagnation of their development in professional roles such as health advocate, scholar and professional, which will not lead to an improvement in the care for older persons. © 2016 John Wiley & Sons Ltd.

Evaluating family function in caring for a geriatric group: Family APGAR applied for older adults by home care nurses.

Science.gov (United States)

Wang, Mei-Wen; Huang, Yi-Yu

2016-06-01

Family function is an essential factor affecting older adults' health. However, there has been no appropriate method to assess the family function of most older adults with fragility or poor health status. The present study aimed to explore the differences and relevance of family function estimated by home care nurses and the older adults, and to determine if nurses could represent older adults to provide the estimation. Study participants were 50 older adults who were aged older 65 years and were taken care of at home by well-trained nurses. The present study used the Family APGAR as the questionnaire. We compared the results evaluated by the older adults and their home care nurses. The results included the level of dysfunction and the total scores of the questionnaire. The paired t-test and McNemar-Bowker test were used for the analysis. Family function could be leveled as "good," "moderate dysfunction" and "severe dysfunction" according to the scores. The family function levels estimated by nurses showed no significant differences to the patients' condition (P = 0.123 > 0.05). Comparing the total scores of the older adults with those of their own home care nurses, the results showed a moderate to nearly high correlation (R = 0.689/P older adults' family problems much earlier and to improve the their health status by enhancing family support. Geriatr Gerontol Int 2015; ●●: ●●-●●. © 2015 Japan Geriatrics Society.

Stand-Alone Microgrid Inverter Controller Design for Nonlinear, Unbalanced Load with Output Transformer

Directory of Open Access Journals (Sweden)

Jae-Uk Lim

2018-04-01

Full Text Available This paper proposes a technique that compensates for unbalance and nonlinearity in microgrid inverters with power transformers operating in stand-alone mode. When a microgrid inverter is operating in stand-alone mode, providing high-quality power is very important. When an unbalanced, nonlinear load is connected, zero sequence current and negative sequence current occur, which leads to an unbalanced output voltage. This paper examines why the zero sequence component occurs differently depending on the structure of a three-phase transformer connected to the inverter output terminal, and it proposes a method for controlling the zero sequence component. It also uses a resonant controller to remove the harmonics that correspond to the negative sequence component and the nonlinear component. The proposed elements were verified by a Powersim (PSIM simulation.

Enhanced current and voltage regulators for stand-alone applications

DEFF Research Database (Denmark)

Federico, de Bosio; Pastorelli, Michele; Antonio DeSouza Ribeiro, Luiz

2016-01-01

State feedback decoupling permits to achieve a better dynamic response for Voltage Source in stand-alone applications. The design of current and voltage regulators is performed in the discrete-time domain since it provides better accuracy and allows direct pole placement. As the attainable...... bandwidth of the current loop is mainly limited by computational and PWM delays, a lead compensator structure is proposed to overcome this limitation. The design of the voltage regulator is based on the Nyquist criterion, verifying to guarantee a high sensitivity peak. Discrete-time domain implementation...

Secure stand alone positive personnel identity verification system (SSA-PPIV)

International Nuclear Information System (INIS)

Merillat, P.D.

1979-03-01

The properties of a secure stand-alone positive personnel identity verification system are detailed. The system is designed to operate without the aid of a central computing facility and the verification function is performed in the absence of security personnel. Security is primarily achieved by means of data encryption on a magnetic stripe badge. Several operational configurations are discussed. Advantages and disadvantages of this system compared to a central computer driven system are detailed

Study on Soft Phase Locked Method to Solving the Synchronization Problem of Active Power Filter in Stand-alone Power Grid

DEFF Research Database (Denmark)

Zhuo, Fang; Wu, Longhui; Chen, Zhe

2009-01-01

on zero-cross detection can't work effectively in small rating stand-alone power grid. Then a soft phase locked loop with additional filter is proposed. It can lock the phase angle on to the positive sequence of fundamental voltage accurately and rapidly. It ensures the performance of APF applied...... in the small rating stand-alone power grid. Moreover, the soft phase locked loop is easy to be implemented in a Digital Signal Processor (DSP). Simulation and experimental results validate that the soft phase locked loop has satisfactory performance.......Traditional LC filters can't work stably in small rating stand-alone power grid. So active power filter (APF) is becoming an important tool to solve the power quality problem in small rating stand-alone power grid. In most current detection algorithm of APF, it needs a synchronizing signal. Firstly...

Stand-alone version of the 11kW Gaia wind turbine

DEFF Research Database (Denmark)

Bindner, H.; Rosas, P.A.C.; Teodorescu, R.

2004-01-01

This report describes the development of a stand-alone version of the 11kW Gaia wind turbine. Various possible configurations are investigated and a configuration using a back-to-back converter is chosen. A model is developed for controller design of thefast controllers of the unit. Controllers...... assessment and controller design a dynamic performance assessment model has been developed....

Structure Optimization of Stand-Alone Renewable Power Systems Based on Multi Object Function

Directory of Open Access Journals (Sweden)

Jae-Hoon Cho

2016-08-01

Full Text Available This paper presents a methodology for the size optimization of a stand-alone hybrid PV/wind/diesel/battery system while considering the following factors: total annual cost (TAC, loss of power supply probability (LPSP, and the fuel cost of the diesel generator required by the user. A new optimization algorithm and an object function (including a penalty method are also proposed; these assist with designing the best structure for a hybrid system satisfying the constraints. In hybrid energy system sources such as photovoltaic (PV, wind, diesel, and energy storage devices are connected as an electrical load supply. Because the power produced by PV and wind turbine sources is dependent on the variation of the resources (sun and wind and the load demand fluctuates, such a hybrid system must be able to satisfy the load requirements at any time and store the excess energy for use in deficit conditions. Therefore, reliability and cost are the two main criteria when designing a stand-alone hybrid system. Moreover, the operation of a diesel generator is important to achieve greater reliability. In this paper, TAC, LPSP, and the fuel cost of the diesel generator are considered as the objective variables and a hybrid teaching–learning-based optimization algorithm is proposed and used to choose the best structure of a stand-alone hybrid PV/wind/diesel/battery system. Simulation results from MATLAB support the effectiveness of the proposed method and confirm that it is more efficient than conventional methods.

Stand-Alone Personalized Normative Feedback for College Student Drinkers: A Meta-Analytic Review, 2004 to 2014.

Directory of Open Access Journals (Sweden)

Keri B Dotson

Full Text Available Norms clarification has been identified as an effective component of college student drinking interventions, prompting research on norms clarification as a single-component intervention known as Personalized Normative Feedback (PNF. Previous reviews have examined PNF in combination with other components but not as a stand-alone intervention.To investigate the degree to which computer-delivered stand-alone personalized normative feedback interventions reduce alcohol consumption and alcohol-related harms among college students and to compare gender-neutral and gender-specific PNF.Electronic databases were searched systematically through November 2014. Reference lists were reviewed manually and forward and backward searches were conducted.Outcome studies that compared computer-delivered, stand-alone PNF intervention with an assessment only, attention-matched, or active treatment control and reported alcohol use and harms among college students.Between-group effect sizes were calculated as the standardized mean difference in change scores between treatment and control groups divided by pooled standard deviation. Within-group effect sizes were calculated as the raw mean difference between baseline and follow-up divided by pooled within-groups standard deviation.Eight studies (13 interventions with a total of 2,050 participants were included. Compared to control participants, students who received gender-neutral (dbetween = 0.291, 95% CI [0.159, 0.423] and gender-specific PNF (dbetween = 0.284, 95% CI [0.117, 0.451] reported greater reductions in drinking from baseline to follow-up. Students who received gender-neutral PNF reported 3.027 (95% CI [2.171, 3.882] fewer drinks per week at first follow-up and gender-specific PNF reported 3.089 (95% CI [0.992, 5.186] fewer drinks. Intervention effects were small for harms (dbetween = 0.157, 95% CI [0.037, 0.278].Computer-delivered PNF is an effective stand-alone approach for reducing college student

Stand-Alone Personalized Normative Feedback for College Student Drinkers: A Meta-Analytic Review, 2004 to 2014.

Science.gov (United States)

Dotson, Keri B; Dunn, Michael E; Bowers, Clint A

2015-01-01

Norms clarification has been identified as an effective component of college student drinking interventions, prompting research on norms clarification as a single-component intervention known as Personalized Normative Feedback (PNF). Previous reviews have examined PNF in combination with other components but not as a stand-alone intervention. To investigate the degree to which computer-delivered stand-alone personalized normative feedback interventions reduce alcohol consumption and alcohol-related harms among college students and to compare gender-neutral and gender-specific PNF. Electronic databases were searched systematically through November 2014. Reference lists were reviewed manually and forward and backward searches were conducted. Outcome studies that compared computer-delivered, stand-alone PNF intervention with an assessment only, attention-matched, or active treatment control and reported alcohol use and harms among college students. Between-group effect sizes were calculated as the standardized mean difference in change scores between treatment and control groups divided by pooled standard deviation. Within-group effect sizes were calculated as the raw mean difference between baseline and follow-up divided by pooled within-groups standard deviation. Eight studies (13 interventions) with a total of 2,050 participants were included. Compared to control participants, students who received gender-neutral (dbetween = 0.291, 95% CI [0.159, 0.423]) and gender-specific PNF (dbetween = 0.284, 95% CI [0.117, 0.451]) reported greater reductions in drinking from baseline to follow-up. Students who received gender-neutral PNF reported 3.027 (95% CI [2.171, 3.882]) fewer drinks per week at first follow-up and gender-specific PNF reported 3.089 (95% CI [0.992, 5.186]) fewer drinks. Intervention effects were small for harms (dbetween = 0.157, 95% CI [0.037, 0.278]). Computer-delivered PNF is an effective stand-alone approach for reducing college student drinking and

[Activating therapeutic care in geriatrics : Evaluation of a practice concept].

Science.gov (United States)

Acklau, Stefanie; Gödecker, Lisa; Kaden, Andrea; Jahn, Patrick

2016-10-01

The special feature of the concept of activating therapeutic care in geriatrics (ATP-G) is based on the focus of nursing and therapeutic elements specifically related to the elderly. Further significance lies in the bottom-up development of this concept, which shows a close proximity to the nursing practice. The research project targeted the characteristics of ATP-G from a nursing point of view. Furthermore, the resulting elements of professional nursing care understanding for inpatient geriatric rehabilitation were used to build a scientific and theoretical foundation of the ATP-G concept. In this study 12 semi-structured interviews with professional caregivers were realized. The data collection was undertaken in three different facilities of inpatient geriatric (early) rehabilitation, chosen by lot. The data analysis was based on the methodology of qualitative content analysis according to Mayring. The research project showed that the basic elements described in the ATP-G concept are consistent with the view of nursing practitioners and therefore reflect the characteristic features of routine daily practice; nonetheless, some new aspects were found, primarily the importance of interdisciplinary teamwork in geriatric settings. There were also difficulties related to the ATP-G concept which were experienced as restraints by the questioned professionals. Further research should therefore investigate the structures for optimal implementation of the ATP-G concept into standard practice.

11kW stand alone wind turbine based on proven wind turbine

DEFF Research Database (Denmark)

Bindner, H.; Wodstrup, J.; Andersen, J.

2004-01-01

and enable control of frequency and voltage independently on both the grid side and the generator side. The prototype has been installed at Risø. The paper will present results from test runs of the system both operating stand-alone supplying a single load and in parallel operation with a diesel genset....

Benchmarking the Collocation Stand-Alone Library and Toolkit (CSALT)

Science.gov (United States)

Hughes, Steven; Knittel, Jeremy; Shoan, Wendy; Kim, Youngkwang; Conway, Claire; Conway, Darrel J.

2017-01-01

This paper describes the processes and results of Verification and Validation (VV) efforts for the Collocation Stand Alone Library and Toolkit (CSALT). We describe the test program and environments, the tools used for independent test data, and comparison results. The VV effort employs classical problems with known analytic solutions, solutions from other available software tools, and comparisons to benchmarking data available in the public literature. Presenting all test results are beyond the scope of a single paper. Here we present high-level test results for a broad range of problems, and detailed comparisons for selected problems.

Leadership in Dental Hygiene Degree Completion Programs: A Pilot Study Comparing Stand-Alone Leadership Courses and Leadership-Infused Curricula.

Science.gov (United States)

Smith, Michelle L; Gurenlian, JoAnn R; Freudenthal, Jacqueline J; Farnsworth, Tracy J

2016-05-01

The aim of this study was to define the extent to which leadership and leadership skills are taught in dental hygiene degree completion programs by comparing stand-alone leadership courses/hybrid programs with programs that infuse leadership skills throughout the curricula. The study involved a mixed-methods approach using qualitative and quantitative data. Semi-structured interviews were conducted with program directors and faculty members who teach a stand-alone leadership course, a hybrid program, or leadership-infused courses in these programs. A quantitative comparison of course syllabi determined differences in the extent of leadership content and experiences between stand-alone leadership courses and leadership-infused curricula. Of the 53 U.S. dental hygiene programs that offer degree completion programs, 49 met the inclusion criteria, and 19 programs provided course syllabi. Of the program directors and faculty members who teach a stand-alone leadership course or leadership-infused curriculum, 16 participated in the interview portion of the study. The results suggested that competencies related to leadership were not clearly defined or measurable in current teaching. Reported barriers to incorporating a stand-alone leadership course included overcrowded curricula, limited qualified faculty, and lack of resources. The findings of this study provide a synopsis of leadership content and gaps in leadership education for degree completion programs. Suggested changes included defining a need for leadership competencies and providing additional resources to educators such as courses provided by the American Dental Education Association and the American Dental Hygienists' Association.

Biological therapy in geriatric patients

International Nuclear Information System (INIS)

Mego, M.

2012-01-01

Targeted biological therapy, alone or in combination with conventional chemotherapy, make significant progress in the treatment of patients with malignancy. Its use as opposed to high-dose chemotherapy is not limited by age, nevertheless, we have relatively little knowledge of the toxicity and effectiveness in geriatric patients. Aim of this article is to give an overview of the biological effectiveness and toxicity of anticancer therapy in geriatric patients, based on published data. (author)

Optimum autonomous stand-alone photovoltaic system design on the basis of energy pay-back analysis

International Nuclear Information System (INIS)

Kaldellis, J.K.; Zafirakis, D.; Kondili, E.

2009-01-01

Stand-alone photovoltaic (PV) systems comprise one of the most promising electrification solutions for covering the demand of remote consumers. However, such systems are strongly questioned due to extreme life-cycle (LC) energy requirements. For similar installations to be considered as environmentally sustainable, their LC energy content must be compensated by the respective useful energy production, i.e. their energy pay-back period (EPBP) should be found less than their service period. In this context, an optimum sizing methodology is currently developed, based on the criterion of minimum embodied energy. Various energy autonomous stand-alone PV-lead-acid battery systems are examined and two different cases are investigated; a high solar potential area and a medium solar potential area. By considering that the PV-battery (PV-Bat) system's useful energy production is equal to the remote consumer's electricity consumption, optimum cadmium telluride (CdTe) based systems yield the minimum EPBP (15 years). If achieving to exploit the net PV energy production however, the EPBP is found less than 20 years for all PV types. Finally, the most interesting finding concerns the fact that in all cases examined the contribution of the battery component exceeds 27% of the system LC energy requirements, reflecting the difference between grid-connected and stand-alone configurations.

Facilitated Learning to Advance Geriatrics: Increasing the Capacity of Nurse Faculty to Teach Students About Caring for Older Adults.

Science.gov (United States)

Krichbaum, Kathleen; Kaas, Merrie J; Wyman, Jean F; Van Son, Catherine R

2015-06-01

The Facilitated Learning to Advance Geriatrics program (FLAG) was designed to increase the numbers of nurse faculty in prelicensure programs with basic knowledge about aging and teaching effectiveness to prepare students to provide safe, high quality care for older adults. Using a framework to improve transfer of learning, FLAG was designed to include: (a) a workshop to increase basic knowledge of aging and common geriatric syndromes, and effective use of evidence-based teaching/learning strategies; (b) a year-long mentoring program to support application of workshop learning and leading change in participants' schools to ensure that geriatrics is a priority. Both formative and summative evaluation methods were used, and included self-assessment of objectives, program satisfaction, and teaching self-efficacy. FLAG achieved its overall purpose by enrolling 152 participants from 19 states including 23 faculty from associate degree programs and 102 from baccalaureate programs. Self-rated teaching effectiveness improved significantly from pre- to post-workshop each year. Achievement of learning objectives was rated highly as was satisfaction. Transfer of learning was evidenced by implementation of educational projects in home schools supported by mentoring. The FLAG program provided opportunities for nurse educators to learn to teach geriatrics more effectively and to transfer learning to their work environment. Future FLAG programs will be offered in a shortened format, incorporating online content and strategies, adding other health professionals to the audience with the same goal of increasing the knowledge and abilities of educators to prepare learners to provide competent care for older adults. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Utility of abdominal computed tomography in geriatric patients on warfarin with a fall from standing

Directory of Open Access Journals (Sweden)

Amit Bahl

2018-01-01

Full Text Available Context: Geriatric head trauma resulting from falls has been extensively studied both in the presence and absence of blood thinners. In this population, however, the prevalence and extent of abdominal injury resulting from falls are much less defined. Aim: We aim to evaluate the utility of abdominal computed tomography (CT imaging in geriatric patients on Warfarin with a recent history of fall. Setting and Design: A retrospective analysis was completed of consecutive geriatric patients who presented to a Level 1 Trauma Center emergency department after fall from standing while taking Warfarin. Methods: Inclusion criteria included age 65 years or older and fall while taking Warfarin. Incomplete medical records were excluded from the study. Data collection included the type of anticoagulant medications, demographics, physical examination, laboratories, CT/X-ray findings if ordered, and final diagnosis on admission. Categorical variables were examined using Pearson's Chi-square where appropriate (expected frequency >5, or Fisher's Exact test. Continuous variables were examined using nonparametric Wilcoxon rank tests. Results: Eight hundred and sixty-three charts were reviewed. One hundred and thirty-one subjects met inclusion criteria. Mean age was 83 years. Nearly 39.6% of patients were male. A total of 48 patients had abdominal CT imaging. Seven of the 131 patients (5.3% had an abdominal injury. Abdominal tenderness was predictive of injury, with 4 of 7 cases with abdominal injury demonstrating abdominal tenderness versus only 10 of 124 cases without abdominal injury demonstrating tenderness (P = 0.003. Abdominal CTs were ordered in 11 of 19 cases of patients that exhibited head trauma yet none of these patients were shown to have sustained abdominal trauma (P = 0.08. There was no association between international normalized ratio level and presence of abdominal injury (P = 0.99. Conclusions: A small percentage of elderly fall patients on

A new approach for sizing stand alone photovoltaic systems based in neural networks

Energy Technology Data Exchange (ETDEWEB)

Hontoria, L.; Aguilera, J. [Universidad de Jaen, Dept. de Electronica, Jaen (Spain); Zufiria, P. [UPM Ciudad Universitaria, Dept. de Matematica Aplicada a las Tecnologias de la Informacion, Madrid (Spain)

2005-02-01

Several methods for sizing stand alone photovoltaic (pv) systems has been developed. The more simplistic are called intuitive methods. They are a useful tool for a first approach in sizing stand alone photovoltaic systems. Nevertheless they are very inaccurate. Analytical methods use equations to describe the pv system size as a function of reliability. These ones are more accurate than the previous ones but they are also not accurate enough for sizing of high reliability. In a third group there are methods which use system simulations. These ones are called numerical methods. Many of the analytical methods employ the concept of reliability of the system or the complementary term: loss of load probability (LOLP). In this paper an improvement for obtaining LOLP curves based on the neural network called Multilayer Perceptron (MLP) is presented. A unique MLP for many locations of Spain has been trained and after the training, the MLP is able to generate LOLP curves for any value and location. (Author)

Fuzzy logic control of stand-alone photovoltaic system with battery storage

Science.gov (United States)

Lalouni, S.; Rekioua, D.; Rekioua, T.; Matagne, E.

Photovoltaic energy has nowadays an increased importance in electrical power applications, since it is considered as an essentially inexhaustible and broadly available energy resource. However, the output power provided via the photovoltaic conversion process depends on solar irradiation and temperature. Therefore, to maximize the efficiency of the photovoltaic energy system, it is necessary to track the maximum power point of the PV array. The present paper proposes a maximum power point tracker (MPPT) method, based on fuzzy logic controller (FLC), applied to a stand-alone photovoltaic system. It uses a sampling measure of the PV array power and voltage then determines an optimal increment required to have the optimal operating voltage which permits maximum power tracking. This method carries high accuracy around the optimum point when compared to the conventional one. The stand-alone photovoltaic system used in this paper includes two bi-directional DC/DC converters and a lead-acid battery bank to overcome the scare periods. One converter works as an MPP tracker, while the other regulates the batteries state of charge and compensates the power deficit to provide a continuous delivery of energy to the load. The Obtained simulation results show the effectiveness of the proposed fuzzy logic controller.

Learnt and perceived professional roles of a new type of nurse specialized in Gerontology and Geriatrics, a qualitative study

NARCIS (Netherlands)

Huizenga, Petra; Finnema, Evelyn; Roodbol, Petrie

Aim. To gain insight into a new type of nurse specialized in gerontology and geriatrics, how they find meaning in the care of older persons and how this relates to the seven professional roles derived from the CanMEDS theoretical framework. Background. To promote the quality of care for older

Future UK markets for stand-alone renewable energy systems

International Nuclear Information System (INIS)

Paish, O.

1999-01-01

A study to identify and quantify the market for stand-alone renewable energy supplies of power (photovoltaics, wind and micro-hydro electricity systems) was described. The study focused on small systems, generally less than a few kW installed capacity. It was suggested that in the UK, the emphasis on grid-connected renewable energy technologies (RETs) has blurred the fact that it is 'off-grid' renewable systems that can offer more immediate real commercial markets for the renewables business. With the likelihood of a significant increase in demand for renewables world wide over the next ten years, the UK needs to make a special effort to become involved

New control strategy of stand-alone brushless doubly-fed induction generator for supplying unbalanced loads in ship shaft power generation system

DEFF Research Database (Denmark)

Liu, Yi; Xu, Wei; Xiong, Fei

2017-01-01

The ship shaft power generation system based on a stand-alone brushless doubly-fed induction generator (BDFIG) have demonstrated excellent saving-energy performance. This paper presents a new control scheme of the stand-alone BDFIG for supplying unbalanced loads in the ship shaft power generation...

A New Vector Control of Brushless Doubly-Fed Inductor Generator With Transient Current Compensation for Stand-Alone Power Generation Applications

DEFF Research Database (Denmark)

Liu, Yi; Xu, Wei; Yu, Kailiang

2018-01-01

The stand-alone brushless doubly-fed induction generator (BDFIG) with the conventional control strategies suffers heavily from poor dynamic performance especially under heavy load disturbance. This paper presents a new vector control strategy of BDFIG for stand-alone power generation applications...... control strategies, and the results verify the satisfactory dynamic performance of the proposed strategy....

A strategy to address the nursing faculty shortage.

Science.gov (United States)

Ganley, Barbara J; Sheets, Ingrid

2009-07-01

This article describes one university's experience in creating a master's geriatric clinical nurse specialist-nurse educator program to address the nursing faculty shortage and the need for geriatric clinical nurse specialists. The successes and challenges are outlined, and curricular ideas that may be beneficial to other nursing programs also are presented. This program has enhanced the university's pool of clinical instructors, increased its ability to provide services to older adults, and allowed faculty to instruct and focus undergraduates in the distinctions of geriatric nursing care. The biggest challenges faced were marketing and recruitment of nurses; these challenges were addressed, and possible solutions are offered. The most immediate benefit of this program was the generation of geriatric clinical nurse specialists.

Maintenance of Segmental Lordosis and Disk Height in Stand-alone and Instrumented Extreme Lateral Interbody Fusion (XLIF).

Science.gov (United States)

Malham, Gregory M; Ellis, Ngaire J; Parker, Rhiannon M; Blecher, Carl M; White, Rohan; Goss, Ben; Seex, Kevin A

2017-03-01

A prospective single-surgeon nonrandomized clinical study. To evaluate the radiographic and clinical outcomes, by fixation type, in extreme lateral interbody fusion (XLIF) patients and provide an algorithm for determining patients suitable for stand-alone XLIF. XLIF may be supplemented with pedicle screw fixation, however, since stabilizing structures remain intact, it is suggested that stand-alone XLIF can be used for certain indications. This eliminates the associated morbidity, though subsidence rates may be elevated, potentially minimizing the clinical benefits. A fixation algorithm was developed after evaluation of patient outcomes from the surgeon's first 30 cases. This algorithm was used prospectively for 40 subsequent patients to determine the requirement for supplemental fixation. Preoperative, postoperative, and 12-month follow-up computed tomography scans were measured for segmental and global lumbar lordosis and posterior disk height. Clinical outcome measures included back and leg pain (visual analogue scale), Oswestry Disability Index (ODI), and SF-36 physical and mental component scores (PCS and MCS). Preoperatively to 12-month follow-up there were increases in segmental lordosis (7.9-9.4 degrees, P=0.0497), lumbar lordosis (48.8-55.2 degrees, P=0.0328), and disk height (3.7-5.5 mm, P=0.0018); there were also improvements in back (58.6%) and leg pain (60.0%), ODI (44.4%), PCS (56.7%), and MCS (16.1%) for stand-alone XLIF. For instrumented XLIF, segmental lordosis (7.6-10.5 degrees, P=0.0120) and disk height (3.5-5.6 mm, Plordosis decreased (51.1-45.8 degrees, P=0.2560). Back (49.8%) and leg pain (30.8%), ODI (32.3%), PCS (37.4%), and MCS (2.0%) were all improved. Subsidence occurred in 3 (7.5%) stand-alone patients. The XLIF treatment fixation algorithm provided a clinical pathway to select suitable patients for stand-alone XLIF. These patients achieved positive clinical outcomes, satisfactory fusion rates, with sustained correction of lordosis and

Developing a mobile stand alone photovoltaic generator

International Nuclear Information System (INIS)

Soler-Bientz, R.; Ricalde-Cab, L.O.; Solis-Rodriguez, L.E.

2006-01-01

This paper describes a recent work developed to create a mobile stand alone photovoltaic generator that can be easily relocated in remote areas to evaluate the feasibility of photovoltaic energy applications. A set of sensors were installed to monitor the electric current and voltage of the energy generated, the energy stored and the energy used by the loads that may be connected to the system. Other parameters like solar radiations (both on the horizontal and on the photovoltaic generation planes) and temperatures (of both the environment and the photovoltaic module) were monitored. This was done while considering the important role of temperature in the photovoltaic module performance. Finally, a measurement and communication hardware was installed to interface the system developed with a conventional computer. In this way, the performance of the overall system in real rural conditions could be evaluated efficiently. Visual software that reads, visualizes and saves the data generated by the system was also developed by means of the LabVIEW programming environment

A Novel Method for Fast Configuration of Energy Storage Capacity in Stand-Alone and Grid-Connected Wind Energy Systems

Directory of Open Access Journals (Sweden)

Haixiang Zang

2016-12-01

Full Text Available In this paper, a novel method is proposed and applied to quickly calculate the capacity of energy storage for stand-alone and grid-connected wind energy systems, according to the discrete Fourier transform theory. Based on practical wind resource data and power data, which are derived from the American Wind Energy Technology Center and HOMER software separately, the energy storage capacity of a stand-alone wind energy system is investigated and calculated. Moreover, by applying the practical wind power data from a wind farm in Fujian Province, the energy storage capacity for a grid-connected wind system is discussed in this paper. This method can also be applied to determine the storage capacity of a stand-alone solar energy system with practical photovoltaic power data.

Use of Super-Capacitor to Enhance Charging Performance of Stand-Alone Solar PV System

KAUST Repository

Huang, B. J.; Hsu, P. C.; Ho, P. Y

2011-01-01

Introduction: The battery charging performance in a stand-alone solar PV system affects the PV system efficiency and the load operating time. The New Energy Center of National Taiwan University has been devoted to the development of a PWM charging

Sizing, techno-economic and generation management analysis of a stand alone photovoltaic power unit including storage devices

International Nuclear Information System (INIS)

Jallouli, Rihab; Krichen, Lotfi

2012-01-01

Due to the mismatch between the load demand and the intermittent solar energy, a stand-alone photovoltaic-hydrogen system and an optimal control scheme are designed to maintain the high system efficiency. Based on meteorological and the load demand data, a system sizing technique is proposed to establish the minimum capacity of the system components, which are a photovoltaic (PV) panel, a proton exchange membrane fuel cell (PEMFC), a battery bank and an alkaline electrolyzer (Elz). An accurate energy management scheme that is utilized during power transfer is proposed to meet the economic requirements. Case studies are used to verify the efficiency of the energy management strategy and system sizing technique. Simulation results illustrate a simple solution to the design and processing of stand-alone PV-hydrogen (PV-H 2 ) systems. -- Highlights: ► We study a stand alone PV-hydrogen system comprising renewable devices. ► A PV generator, a battery bank, a fuel cell and an electrolyzer are modeled. ► Power management taking into account the economic arrangement and the operating conditions to ensure energy availability is proposed.

Animal assisted therapy and perception of loneliness in geriatric nursing home residents.

Science.gov (United States)

Vrbanac, Zoran; Zecević, Iva; Ljubić, Marijana; Belić, Maja; Stanin, Damir; Bottegaro, Nika Brkljaca; Jurkić, Gabrijela; Skrlin, Branimir; Bedrica, Ljiljana; Zubcić, Damir

2013-09-01

Use of animals for therapeutic purposes, animal assisted therapy or AAT is a method for improving quality of life for long-term inpatients. The object of this paper was to evaluate dog companionship as a form of AAT and its effects on perception of loneliness in geriatric nursing home residents. The participants were involved in a six-month program of dog companionship three times weekly for 90 minutes. There were 21 residents included in the program, with a mean age of 80 years. Loneliness was measured by the short version of the UCLA Scale of loneliness. Comparison of test results before and after participation in the program showed that dog companionship reduces the perception of loneliness.

Simulation of stand alone PV systems; Dokuritsugata taiyoko hatsuden system no simulation

Energy Technology Data Exchange (ETDEWEB)

Tsuda, I.; Sakuta, K. [Electrotechnical Laboratory, Tsukuba (Japan); Oshiro, T. [Japan Quality Assurance Organization, Tokyo (Japan); Kurokawa, K. [Tokyo University of Agriculture and Technology, Tokyo (Japan)

1997-11-25

Studies are performed to develop a simulation program for a stand-alone photovoltaic power generation system equipped with a lead acid battery. In this stand-alone photovoltaic power generation system, the load is connected in shunt with the solar cell array output through the intermediary of a lead acid battery and inverter. The program is a model in which the solar cell model is built taking parallel resistance into account, and the temperature-dependence of the constants is described using approximations experimentally obtained by Solar Techno Center of JQA (Japan Quality Assurance Organization), Hamamatsu. Insolation data for the model is described using METPV compiled by Japan Weather Association, and load data is described using data actually measured at Shizuoka. This program is compared with the data of operation at Hamamatsu, and the result is almost satisfactory. Simulations are conducted at five typical locations in Japan using this program, and it is found that the array load matching correction factor is dependent on seasonal changes rather than locality, that the battery contribution rate does not change much throughout the year, and that it is not dependent on locality. 5 refs., 7 figs., 3 tabs.

Coordination Control Strategy for AC/DC Hybrid Microgrids in Stand-Alone Mode

Directory of Open Access Journals (Sweden)

Dwi Riana Aryani

2016-06-01

Full Text Available Interest in DC microgrids is rapidly increasing along with the improvement of DC power technology because of its advantages. To support the integration process of DC microgrids with the existing AC utility grids, the form of hybrid AC/DC microgrids is considered for higher power conversion efficiency, lower component cost and better power quality. In the system, AC and DC portions are connected through interlink bidirectional AC/DC converters (IC with a proper control system and power management. In the stand-alone operation mode of AC/DC hybrid microgrids, the control of power injection through the IC is crucial in order to maintain the system security. This paper mainly deals with a coordination control strategy of IC and a battery energy storage system (BESS converter under stand-alone operation. A coordinated control strategy for the IC, which considers the state of charge (SOC level of BESS and the load shedding scheme as the last resort, is proposed to obtain better power sharing between AC and DC subgrids. The scheme will be tested with a hybrid AC/DC microgrid, using the tool of the PSCAD/EMTDC software.

Control strategy of wind turbine based on permanent magnet synchronous generator and energy storage for stand-alone systems

DEFF Research Database (Denmark)

Deng, Fujin; Liu, Dong; Chen, Zhe

2017-01-01

This paper investigates a variable speed wind turbine based on permanent magnet synchronous generator and a full-scale power converter in a stand-alone system. An energy storage system(ESS) including battery and fuel cell-electrolyzer combination is connected to the DC link of the full-scale power...... converter through the power electronics interface. Wind is the primary power source of the system, the battery and FC-electrolyzer combination is used as a backup and a long-term storage system to provide or absorb power in the stand-alone system, respectively. In this paper, a control strategy is proposed...... for the operation of this variable speed wind turbine in a stand-alone system, where the generator-side converter and the ESS operate together to meet the demand of the loads. This control strategy is competent for supporting the variation of the loads or wind speed and limiting the DC-link voltage of the full...

Predictors of a nursing home placement from a non-acute geriatric hospital.

Science.gov (United States)

Aditya, B S; Sharma, J C; Allen, S C; Vassallo, M

2003-02-01

Identifying patients who need Nursing Home (NH) care following a hospital admission is important. To identify the factors that predispose to an NH discharge. Prospective observational study with blinded end-point evaluation. A non-acute geriatric hospital. Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness. Discharge to an NH or home. Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p factors present: 4.28% for 0-2 factors, 25.8% for 3-4 factors and 81.8% for 5-6 factors (p factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.

Loss-of-load probabilities for stand-alone photovoltaic systems

International Nuclear Information System (INIS)

Klein, S.A.; Beckman, W.A.

1989-01-01

A general method is presented for estimating the loss-of-load probability of stand-alone photovoltaic systems. The method was developed by correlating simulation results. The simulations were driven with synthetic radiation sequences having the same statistical significance as available historical data. The methods assumes a constant nighttime load and accounts for the distribution and persistence in daily solar radiation data. It is shown that the 10 year average performance of systems having loss-of-load probabilities less than about 0.01 can vary greatly from one ten year period to the next and thereby cannot be considered realistic performance estimates of a system during its lifetime. (author). 26 refs, 15 figs, 4 tabs

Robust Power Management Control for Stand-Alone Hybrid Power Generation System

International Nuclear Information System (INIS)

Kamal, Elkhatib; Adouane, Lounis; Aitouche, Abdel; Mohammed, Walaa

2017-01-01

This paper presents a new robust fuzzy control of energy management strategy for the stand-alone hybrid power systems. It consists of two levels named centralized fuzzy supervisory control which generates the power references for each decentralized robust fuzzy control. Hybrid power systems comprises: a photovoltaic panel and wind turbine as renewable sources, a micro turbine generator and a battery storage system. The proposed control strategy is able to satisfy the load requirements based on a fuzzy supervisor controller and manage power flows between the different energy sources and the storage unit by respecting the state of charge and the variation of wind speed and irradiance. Centralized controller is designed based on If-Then fuzzy rules to manage and optimize the hybrid power system production by generating the reference power for photovoltaic panel and wind turbine. Decentralized controller is based on the Takagi-Sugeno fuzzy model and permits us to stabilize each photovoltaic panel and wind turbine in presence of disturbances and parametric uncertainties and to optimize the tracking reference which is given by the centralized controller level. The sufficient conditions stability are formulated in the format of linear matrix inequalities using the Lyapunov stability theory. The effectiveness of the proposed Strategy is finally demonstrated through a SAHPS (stand-alone hybrid power systems) to illustrate the effectiveness of the overall proposed method. (paper)

International market assessment of stand-alone photovoltaic power systems for cottage industry applications

Science.gov (United States)

Philippi, T. M.

1981-01-01

The final result of an international assessment of the market for stand-alone photovoltaic systems in cottage industry applications is reported. Nonindustrialized countries without centrally planned economies were considered. Cottage industries were defined as small rural manufacturers, employing less than 50 people, producing consumer and simple products. The data to support this analysis were obtained from secondary and expert sources in the U.S. and in-country field investigations of the Philippines and Mexico. The near-term market for photovoltaics for rural cottage industry applications appears to be limited to demonstration projects and pilot programs, based on an in-depth study of the nature of cottage industry, its role in the rural economy, the electric energy requirements of cottage industry, and a financial analysis of stand-alone photovoltaic systems as compared to their most viable competitor, diesel driven generators. Photovoltaics are shown to be a better long-term option only for very low power requirements. Some of these uses would include clay mixers, grinders, centrifuges, lathes, power saws and lighting of a workshop.

International market assessment of stand-alone photovoltaic power systems for cottage industry applications

Science.gov (United States)

Philippi, T. M.

1981-11-01

The final result of an international assessment of the market for stand-alone photovoltaic systems in cottage industry applications is reported. Nonindustrialized countries without centrally planned economies were considered. Cottage industries were defined as small rural manufacturers, employing less than 50 people, producing consumer and simple products. The data to support this analysis were obtained from secondary and expert sources in the U.S. and in-country field investigations of the Philippines and Mexico. The near-term market for photovoltaics for rural cottage industry applications appears to be limited to demonstration projects and pilot programs, based on an in-depth study of the nature of cottage industry, its role in the rural economy, the electric energy requirements of cottage industry, and a financial analysis of stand-alone photovoltaic systems as compared to their most viable competitor, diesel driven generators. Photovoltaics are shown to be a better long-term option only for very low power requirements. Some of these uses would include clay mixers, grinders, centrifuges, lathes, power saws and lighting of a workshop.

Methodology for the design of a stand-alone photovoltaic power supply

OpenAIRE

López Seguel, Julio; Seleme Junior, Seleme Isaac; Donoso-Garcia, Pedro F; Ferreira Morais, Lenin Martins; Cabaleiro Cortizo, Porfirio; Severo Mendes, Marcos A

2013-01-01

This paper presents a complete methodology for the design of an autonomous photovoltaic system to maximize the use of solar energy. It is a method that prioritizes the best cost-effective choice at every step of the project. In order to ensure the proper use and extended battery life time, a control strategy for charging the batteries is proposed. Experimental results are provided for a stand-alone photovoltaic system with low electrical power, intended primarily for the illumination and basi...

A literature review of the application of the Geriatric Depression Scale, Depression Anxiety Stress Scales and Post-traumatic Stress Disorder Checklist to community nursing cohorts.

Science.gov (United States)

Allen, Jacqui; Annells, Merilyn

2009-04-01

To explore through literature review the appropriateness of three common tools for use by community nurses to screen war veteran and war widow(er) clients for depression, anxiety and post-traumatic stress disorder. War veterans and, to a lesser extent, war widow(er)s, are prone to mental health challenges, especially depression, anxiety and post-traumatic stress disorder. Community nurses do not accurately identify such people with depression and related disorders although they are well positioned to do so. The use of valid and reliable self-report tools is one method of improving nurses' identification of people with actual or potential mental health difficulties for referral to a general practitioner or mental health practitioner for diagnostic assessment and treatment. The Geriatric Depression Scale, Depression Anxiety Stress Scales and Post-traumatic Stress Disorder Checklist are frequently recommended for mental health screening but the appropriateness of using the tools for screening war veteran and war widow(er) community nursing clients who are often aged and have functional impairment, is unknown. Systematic review. Current literature informs that the Geriatric Depression Scale accurately predicts a diagnosis of depression in community nursing cohorts. The three Depression Anxiety Stress Scales subscales of depression, anxiety and stress are valid; however, no studies were identified that compared the performance of the Depression Anxiety Stress Scales in predicting diagnoses of depression or anxiety. The Post-traumatic Stress Disorder Checklist predicts post-traumatic stress disorder in community cohorts although no studies meeting the selection criteria included male participants. This review provides recommendations for the use of the Geriatric Depression Scale, Depression Anxiety Stress Scales and The Post-traumatic Stress Disorder Checklist based on examination of the published evidence for the application of these screening tools in samples

MOSFET Loss Evaluation for a Low-Power Stand-Alone Photovoltaic-LED System

DEFF Research Database (Denmark)

Mira Albert, Maria del Carmen; Knott, Arnold; Andersen, Michael A. E.

2015-01-01

This paper presents a performance evaluation and comparison of state-of-the-art low voltage Si MOSFETs for a stand-alone photovoltaic-LED Light to Light (LtL) system. The complete system is formed by two cascaded converters that will be optimized for a determined solar irradiation and LED...... illumination profiles. The comparison is performed based on dynamic characterization and evaluation of the devices energy loss at different current levels....

Assessment of Stand-Alone Displays for Time Management in a Creativity-Driven Learning Environment

DEFF Research Database (Denmark)

Frimodt-Møller, Søren

2017-01-01

This paper considers the pros and cons of stand-alone displays, analog (e.g. billboards, blackboards, whiteboards, large pieces of paper etc.) as well as digital (e.g. large shared screens, digital whiteboards or similar), as tools for time management processes in a creativity-driven learning...

Methanol production via pressurized entrained flow biomass gasification – Techno-economic comparison of integrated vs. stand-alone production

International Nuclear Information System (INIS)

Andersson, Jim; Lundgren, Joakim; Marklund, Magnus

2014-01-01

The main objective with this work was to investigate techno-economically the opportunity for integrated gasification-based biomass-to-methanol production in an existing chemical pulp and paper mill. Three different system configurations using the pressurized entrained flow biomass gasification (PEBG) technology were studied, one stand-alone plant, one where the bark boiler in the mill was replaced by a PEBG unit and one with a co-integration of a black liquor gasifier operated in parallel with a PEBG unit. The cases were analysed in terms of overall energy efficiency (calculated as electricity-equivalents) and process economics. The economics was assessed under the current as well as possible future energy market conditions. An economic policy support was found to be necessary to make the methanol production competitive under all market scenarios. In a future energy market, integrating a PEBG unit to replace the bark boiler was the most beneficial case from an economic point of view. In this case the methanol production cost was reduced in the range of 11–18 Euro per MWh compared to the stand-alone case. The overall plant efficiency increased approximately 7%-units compared to the original operation of the mill and the non-integrated stand-alone case. In the case with co-integration of the two parallel gasifiers, an equal increase of the system efficiency was achieved, but the economic benefit was not as apparent. Under similar conditions as the current market and when methanol was sold to replace fossil gasoline, co-integration of the two parallel gasifiers was the best alternative based on received IRR. - Highlights: • Techno-economic results regarding integration of methanol synthesis processes in a pulp and paper mill are presented. • The overall energy efficiency increases in integrated methanol production systems compared to stand-alone production units. • The economics of the integrated system improves compared to stand-alone alternatives. • Tax

The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents

Science.gov (United States)

Yardimci, Bulent; Aran, Sinan N.; Ozkaya, Ismail; Aksoy, Sevki M.; Demir, Tarik; Tezcan, Gulsen; Kaptanoglu, Aysegul Y.

2016-01-01

Objectives: To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test. Methods: This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed. Results: A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 ± 8.2 years were included in the study. The residents’ annual falling averages were 1.0 ± 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass. Conclusions: The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents. PMID:27652361

Stand-alone flat-plate photovoltaic power systems: System sizing and life-cycle costing methodology for Federal agencies

Science.gov (United States)

Borden, C. S.; Volkmer, K.; Cochrane, E. H.; Lawson, A. C.

1984-01-01

A simple methodology to estimate photovoltaic system size and life-cycle costs in stand-alone applications is presented. It is designed to assist engineers at Government agencies in determining the feasibility of using small stand-alone photovoltaic systems to supply ac or dc power to the load. Photovoltaic system design considerations are presented as well as the equations for sizing the flat-plate array and the battery storage to meet the required load. Cost effectiveness of a candidate photovoltaic system is based on comparison with the life-cycle cost of alternative systems. Examples of alternative systems addressed are batteries, diesel generators, the utility grid, and other renewable energy systems.

Linguistic and Structural Analyses of Stand-Alone Literature Reviews: Seventy-Five Years of Change

Science.gov (United States)

Wright, Heidi Rachel

2016-01-01

The purpose of this dissertation is to offer a multifaceted overview of stand-alone literature reviews. These texts, literature reviews published unattached to research articles, have existed for centuries but remained largely unstudied by linguists. Thus, the goal of this project is to present these reviews' situational, grammatical, and…

Development and validation of the Psychotropic Education and Knowledge (PEAK) test on psychotropic drugs for nurses in an acute geriatric care setting

NARCIS (Netherlands)

Wauters, Maartin; Azermai, Majda; Perehudoff, Sammi-Jo; Versluys, Karen; Steeman, Els; Petrovic, Mirko

Introduction: In Belgium, psychotropic drug use is high among older people. With low proven long-term effectiveness and possible severe side effects, psychotropic drugs in geriatric patients should be prescribed with utmost caution. Nursing staff’s knowledge on psychotropic drugs can be crucial in

[Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study].

Science.gov (United States)

Bahrmann, A; Wörz, E; Specht-Leible, N; Oster, P; Bahrmann, P

2015-04-01

The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

A sizing method for stand-alone PV installations with variable demand

Energy Technology Data Exchange (ETDEWEB)

Posadillo, R. [Grupo de Investigacion en Energias y Recursos Renovables, Dpto. de Fisica Aplicada, E.P.S., Universidad de Cordoba, Avda. Menendez Pidal s/n, 14004 Cordoba (Spain); Lopez Luque, R. [Grupo de Investigacion de Fisica Para las Energias y Recursos Renovables, Dpto. de Fisica Aplicada, Edificio C2 Campus de Rabanales, 14071 Cordoba (Spain)

2008-05-15

The practical applicability of the considerations made in a previous paper to characterize energy balances in stand-alone photovoltaic systems (SAPV) is presented. Given that energy balances were characterized based on monthly estimations, the method is appropriate for sizing installations with variable monthly demands and variable monthly panel tilt (for seasonal estimations). The method presented is original in that it is the only method proposed for this type of demand. The method is based on the rational utilization of daily solar radiation distribution functions. When exact mathematical expressions are not available, approximate empirical expressions can be used. The more precise the statistical characterization of the solar radiation on the receiver module, the more precise the sizing method given that the characterization will solely depend on the distribution function of the daily global irradiation on the tilted surface H{sub g{beta}}{sub i}. This method, like previous ones, uses the concept of loss of load probability (LLP) as a parameter to characterize system design and includes information on the standard deviation of this parameter ({sigma}{sub LLP}) as well as two new parameters: annual number of system failures (f) and the standard deviation of annual number of system failures ({sigma}{sub f}). This paper therefore provides an analytical method for evaluating and sizing stand-alone PV systems with variable monthly demand and panel inclination. The sizing method has also been applied in a practical manner. (author)

Do we need community geriatrics?

LENUS (Irish Health Repository)

O'Hanlon, S

2012-01-30

Community geriatrics has evolved as a specific aspect of geriatric medicine in the UK. In Ireland there is uncertainty as to how it should be planned. This is the first national survey of consultants, specialist registrars and general practitioners to seek their opinions. Most consultants and GPs reported already having a community aspect to their current practice, e.g. nursing home visits or community hospital visits, whereas most SpRs did not. Forty three of 62 respondents (69%) agreed that there is a need for community geriatricians and that there should be integration with hospital medicine. Fifty seven of 62 respondents (92%) felt that there would be a beneficial effect on GP services, though some expressed concern about work overlap. Thirteen of the 25 SpRs (52%) in training hoped to begin practice in community geriatrics in the future.

Design and Operation Studies of A Stand-Alone PV Generation System

DEFF Research Database (Denmark)

Hu, Yanting; Chen, Zhe; Zhang, Donglai

2013-01-01

This paper discusses the modeling, design and operation of a PV powered stand-alone system, which includes a PV array, a battery bank, power electronic converters and the associated control system. The design considerations are analyzed and a design platform is presented. Furthermore the operation...... modes of the system are described. A power electronic system with the associated control scheme has been proposed and simulation models have been developed. Simulation studies have been conducted on an example system; the results have demonstrated the effectiveness of the presented methods....

Analyzing grid extension and stand-alone photovoltaic systems for the cost-effective electrification of Kenya

NARCIS (Netherlands)

Zeyringer, Marianne; Pachauri, Shonali; Schmid, Erwin; Schmidt, Johannes; Worrell, Ernst|info:eu-repo/dai/nl/106856715; Morawetz, Ulrich B.

2015-01-01

The declaration of 2014-2024 as the Decade of Sustainable Energy for All has catalyzed actions towards achieving universal electricity access. The high costs of building electric infrastructure are a major impediment to improved access, making stand-alone photovoltaic (PV) systems an attractive

Design of a Stand-Alone Photovoltaic Model for Home Lightings and Clean Environment

Energy Technology Data Exchange (ETDEWEB)

Ani, Vincent Anayochukwu, E-mail: vincent_ani@yahoo.com [Department of Electronic Engineering, University of Nigeria, Nsukka (Nigeria)

2016-01-11

This paper gives a well-documented health risk of fuel-based lighting (kerosene lamps and fuel-powered generators) and proposed a design of a stand-alone solar PV system for sustainable home lightings in rural Nigerian area. The design was done in three different patterns of electricity consumptions with energy efficient lightings (EELs) using two different battery types (Rolls Surrette 6CS25PS and Hoppecke 10 OpzS 1000) on; (i) judicious power consumption, (ii) normal power consumption, and (iii) excess power consumption; and compared them with the incandescent light bulb consumption. The stand-alone photovoltaic energy systems were designed to match the rural Nigerian sunlight and weather conditions to meet the required lightings of the household. The objective function and constraints for the design models were formulated and optimization procedures were used to demonstrate the best solution (reliability at the lowest lifecycle cost). Initial capital costs as well as annualized costs over 5, 10, 15, 20, and 25 years were quantified and documented. The design identified the most cost-effective and reliable solar and battery array among the patterns of electricity consumption with EEL options (judicious power consumption, normal power consumption, and excess power consumption).

Design of a Stand-Alone Photovoltaic Model for Home Lightings and Clean Environment

International Nuclear Information System (INIS)

Ani, Vincent Anayochukwu

2016-01-01

This paper gives a well-documented health risk of fuel-based lighting (kerosene lamps and fuel-powered generators) and proposed a design of a stand-alone solar PV system for sustainable home lightings in rural Nigerian area. The design was done in three different patterns of electricity consumptions with energy efficient lightings (EELs) using two different battery types (Rolls Surrette 6CS25PS and Hoppecke 10 OpzS 1000) on; (i) judicious power consumption, (ii) normal power consumption, and (iii) excess power consumption; and compared them with the incandescent light bulb consumption. The stand-alone photovoltaic energy systems were designed to match the rural Nigerian sunlight and weather conditions to meet the required lightings of the household. The objective function and constraints for the design models were formulated and optimization procedures were used to demonstrate the best solution (reliability at the lowest lifecycle cost). Initial capital costs as well as annualized costs over 5, 10, 15, 20, and 25 years were quantified and documented. The design identified the most cost-effective and reliable solar and battery array among the patterns of electricity consumption with EEL options (judicious power consumption, normal power consumption, and excess power consumption).

Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes

Directory of Open Access Journals (Sweden)

Beck Barbara-Beate

2009-12-01

Full Text Available Abstract Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices

Modeling, design and analysis of a stand-alone hybrid power generation system using solar/urine

International Nuclear Information System (INIS)

Wu, Wei; Zhou, Ya-Yan; Lin, Mu-Hsuan; Hwang, Jenn-Jiang

2013-01-01

Highlights: • The stand-alone hybrid power system is presented. • The urine-to-hydrogen processor is proposed. • Scenario analysis of the hybrid power dispatching and the urine/solar demands is investigated. • The design, modeling and optimization of the hybrid power system is addressed by Aspen Plus and Matlab. - Abstract: The urine turned to hydrogen as an energy conversion process is integrated into a stand-alone hybrid (PV/FC/battery) power generation system. The optimization and simulation of a new urine-to-hydrogen processor is evaluated in Aspen Plus environment. In our approach, the PV generator aims to reduce urine consumption and the lithium-ion battery can compensate the power gap due to the fuel processing delay. Based on prescribed patterns of solar irradiation and the daily load demand of a 30-persons classroom, scenario analyses of the hybrid power dispatching and operational feasibility is addressed

prfectBLAST: a platform-independent portable front end for the command terminal BLAST+ stand-alone suite.

Science.gov (United States)

Santiago-Sotelo, Perfecto; Ramirez-Prado, Jorge Humberto

2012-11-01

prfectBLAST is a multiplatform graphical user interface (GUI) for the stand-alone BLAST+ suite of applications. It allows researchers to do nucleotide or amino acid sequence similarity searches against public (or user-customized) databases that are locally stored. It does not require any dependencies or installation and can be used from a portable flash drive. prfectBLAST is implemented in Java version 6 (SUN) and runs on all platforms that support Java and for which National Center for Biotechnology Information has made available stand-alone BLAST executables, including MS Windows, Mac OS X, and Linux. It is free and open source software, made available under the GNU General Public License version 3 (GPLv3) and can be downloaded at www.cicy.mx/sitios/jramirez or http://code.google.com/p/prfectblast/.

Optimization of the photovoltaic-hydrogen supply system of a stand-alone remote-telecom application

Energy Technology Data Exchange (ETDEWEB)

Gomez, Guillermo; Martinez, Graciano; Galvez, Jose L.; Cuevas, Raquel; Maellas, Jesus [National Institute for Aerospace Technology (INTA), Renewable Energy Department, Ctra. Ajalvir km 4, E-28850 Torrejon de Ardoz, Madrid (Spain); Gila, Raul; Bueno, Emilio [Polytechnical School - Alcala de Henares University, Electronics Department, Campus Universitario, Ctra. De Madrid-Barcelona Km 33.600, Alcala de Henares, Madrid (Spain)

2009-07-15

Hydrogen is considered as the optimal carrier for the surplus energy storage from renewable resources. Although hydrogen and its application in fuel cell is considered as a high-cost energy system, some cost-efficient solutions have been found for their use in stand-alone applications, which usually depend on the variability of renewable sources that have to be oversized in order to reduce their dependence on external energy sources. This paper shows the results from the simulation of several alternatives of introducing hydrogen technologies to increase the independence of a remote-telecom application fed by photovoltaic panels. Hydrogen is obtained by electrolysis and it is used in a fuel cell when the renewable energy source is not enough to maintain the stand-alone application. TRNSYS simulation environment has been used for evaluating the proposed alternatives. The results show that the best configuration option is that considering the use of hydrogen as a way to storage the surplus of radiation and the management system can vary the number of photovoltaic panels assigned to feed the hydrogen generation, the batteries or the telecom application. (author)

Effect of an interactive E-learning tool for delirium on patient and nursing outcomes in a geriatric hospital setting: findings of a before-after study.

Science.gov (United States)

Detroyer, Elke; Dobbels, Fabienne; Teodorczuk, Andrew; Deschodt, Mieke; Depaifve, Yves; Joosten, Etienne; Milisen, Koen

2018-01-19

Education of healthcare workers is a core element of multicomponent delirium strategies to improve delirium care and, consequently, patient outcomes. However, traditional educational strategies are notoriously difficult to implement. E-learning is hypothesised to be easier and more cost effective, but research evaluating effectiveness of delirium education through e-learning is scarce at present. Aim is to determine the effect of a nursing e-learning tool for delirium on: (1) in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and (2) geriatric nurses' knowledge and recognition regarding delirium. A before-after study in a sample of patients enrolled pre-intervention (non-intervention cohort (NIC); n = 81) and post-intervention (intervention cohort (IC); n = 79), and nurses (n = 17) of a geriatric ward (university hospital). The intervention included an information session about using the e-learning tool, which consisted of 11 e-modules incorporating development of knowledge and skills in the prevention, detection and management of delirium, and the completion of a delirium e-learning tool during a three-month period. Key patient outcomes included in-hospital prevalence and duration of delirium (Confusion Assessment Method), delirium severity (Delirium Index) and mortality (in-hospital; 12 months post-admission); key nurse outcomes included delirium knowledge (Delirium Knowledge Questionnaire) and recognition (Case vignettes). Logistic regression and linear mixed models were used to analyse patient data; Wilcoxon Signed Rank tests, McNemar's or paired t-tests for nursing data. No significant difference was found between the IC and NIC for in-hospital prevalence (21.5% versus 25.9%; p = 0.51) and duration of delirium (mean 4.2 ± SD 4.8 days versus 4.9 ± SD 4.8 days; p = 0.38). A trend towards a statistically significant lower delirium severity (IC versus NIC: difference estimate

[Mobile geriatric rehabilitation in nursing homes, in short-term care facilities and private homes : Setting-specific analysis of nationwide treatment documentation (Part 2)].

Science.gov (United States)

Pippel, Kristina; Meinck, M; Lübke, N

2017-06-01

Mobile geriatric rehabilitation can be provided in the setting of nursing homes, short-term care (STC) facilities and exclusively in private homes. This study analyzed the common features and differences of mobile rehabilitation interventions in various settings. Stratified by setting 1,879 anonymized mobile geriatric rehabilitation treatments between 2011 and 2014 from 11 participating institutions were analyzed with respect to patient, process and outcome-related features. Significant differences between the settings nursing home (n = 514, 27 %), STC (n = 167, 9 %) and private homes (n = 1198, 64 %) were evident for mean age (83 years, 83 years and 80 years, respectively), percentage of women (72 %, 64 % and 55 %), degree of dependency on pre-existing care (92 %, 76 % and 64 %), total treatment sessions (TS, 38 TS, 42 TS and 41 TS), treatment duration (54 days, 61 days and 58 days) as well as the Barthel index at the start of rehabilitation (34 points, 39 points and 46 points) and the gain in the Barthel index (15 points, 21 points and 18 points), whereby the gain in the capacity for self-sufficiency was significant in all settings. The setting-specific evaluation of mobile geriatric rehabilitation showed differences for relevant patient, process and outcome-related features. Compared to inpatient rehabilitation mobile rehabilitation in all settings made an above average contribution to the rehabilitation of patients with pre-existing dependency on care. The gains in the capacity for self-sufficiency achieved in all settings support the efficacy of mobile geriatric rehabilitation under the current prerequisites for applicability.

Optimal expansion planning of stand-alone systems with stochastic simulations

Energy Technology Data Exchange (ETDEWEB)

Hoese, Alejandro [Instituto de Energia Electrica (IEE), Universidad Nacional de San Juan, (Argentina)

1997-12-31

Stand-alone systems in the range of 1 kW - 10 MW are taking relevance in the new (global) liberal concept of energy market. State and private investors are becoming increasingly attention on the use of renewable for these systems, but it must be shown that these non-conventional solutions are competitive with the established conventional ones. The high investment costs and the technical and economic uncertainties coupled with the use of time-dependent energy sources are the mainly inhibiting factors for the decision agents to choose these systems instead of conventional ones. In the paper a new model for optimal expansion planning of hybrid stand-alone generating systems under consideration of uncertainties is presented. This model is at present in {sup d}evelopment state{sup .} Results already obtained in the first steps of this research are promising and some of them are here presented. [Espanol] Los sistemas autocontenidos en el rango de 1 Kw a 10 MW estan tomando importancia en el nuevo (global) concepto liberal del mercado de la energia. Inversionistas privados y del Estado estan poniendo mayor atencion en el uso de energias renovables para estos sistemas, pero debe mostrarse que estas soluciones no-convencionales son competitivas con las convencionales establecidas. Los altos costos de inversion y las incertidumbres tecnicas y economicas aunadamente con el uso de fuentes de energia dependientes del tiempo son los principales factores inhibidores de los factores de decision para escoger estos sistemas en lugar de los convencionales. En este articulo se presenta un nuevo modelo de planeacion de expansion optima de sistemas hibridos autocontenidos de generacion electrica bajo la consideracion de incertidumbres. Este modelo esta actualmente en {sup e}stado de desarrollo{sup .} Los resultados ya obtenidos en las primeras etapas de esta investigacion son prometedores y se presentan algunos de ellos.

Optimal expansion planning of stand-alone systems with stochastic simulations

Energy Technology Data Exchange (ETDEWEB)

Hoese, Alejandro [Instituto de Energia Electrica (IEE), Universidad Nacional de San Juan, (Argentina)

1998-12-31

Stand-alone systems in the range of 1 kW - 10 MW are taking relevance in the new (global) liberal concept of energy market. State and private investors are becoming increasingly attention on the use of renewable for these systems, but it must be shown that these non-conventional solutions are competitive with the established conventional ones. The high investment costs and the technical and economic uncertainties coupled with the use of time-dependent energy sources are the mainly inhibiting factors for the decision agents to choose these systems instead of conventional ones. In the paper a new model for optimal expansion planning of hybrid stand-alone generating systems under consideration of uncertainties is presented. This model is at present in {sup d}evelopment state{sup .} Results already obtained in the first steps of this research are promising and some of them are here presented. [Espanol] Los sistemas autocontenidos en el rango de 1 Kw a 10 MW estan tomando importancia en el nuevo (global) concepto liberal del mercado de la energia. Inversionistas privados y del Estado estan poniendo mayor atencion en el uso de energias renovables para estos sistemas, pero debe mostrarse que estas soluciones no-convencionales son competitivas con las convencionales establecidas. Los altos costos de inversion y las incertidumbres tecnicas y economicas aunadamente con el uso de fuentes de energia dependientes del tiempo son los principales factores inhibidores de los factores de decision para escoger estos sistemas en lugar de los convencionales. En este articulo se presenta un nuevo modelo de planeacion de expansion optima de sistemas hibridos autocontenidos de generacion electrica bajo la consideracion de incertidumbres. Este modelo esta actualmente en {sup e}stado de desarrollo{sup .} Los resultados ya obtenidos en las primeras etapas de esta investigacion son prometedores y se presentan algunos de ellos.

Size optimization of stand-alone photovoltaic (PV) room air conditioners

International Nuclear Information System (INIS)

Chen, Chien-Wei; Zahedi, A.

2006-01-01

Sizing of a stand-alone PV system determines the main cost of the system. PV electricity cost is determined by the amount of solar energy received, hence the actual climate and weather conditions such as solar irradiance and ambient temperature affect the size required and cost of the system. Air conditioning demand also depends on the weather conditions. Therefore, sizing a PV powered air conditioner must consider the characteristics of local climate and temperature. In this paper, sizing procedures and special considerations for air conditioning under Melbourne's climatic conditions is presented. The reliability of various PV-battery size combinations is simulated by MATLAB. As a result, excellent system performance can be predicated.(Author)

Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: protocol of a cluster randomized trial

Directory of Open Access Journals (Sweden)

Suijker Jacqueline J

2012-04-01

Full Text Available Abstract Background Functional decline in community-dwelling older persons is associated with the loss of independence, the need for hospital and nursing-home care and premature death. The effectiveness of multifactorial interventions in preventing functional decline remains controversial. The aim of this study is to investigate whether functional decline in community-dwelling older persons can be delayed or prevented by a comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination. Methods/Design In a cluster randomized controlled trial, with the general practice as the unit of randomization, 1281 participants from 25 general practices will be enrolled in each condition to compare the intervention with usual care. The intervention will focus on older persons who are at increased risk for functional decline, identified by an Identification of Seniors at Risk Primary Care (ISAR-PC score (≥ 2. These older persons will receive a comprehensive geriatric assessment, an individually tailored care and treatment plan, consisting of multifactorial, evidence-based interventions and subsequent nurse-led care coordination. The control group will receive 'care as usual' by the general practitioner (GP. The main outcome after 12 months is the level of physical functioning on the modified Katz-15 index score. The secondary outcomes are health-related quality of life, psychological and social functioning, healthcare utilization and institutionalization. Furthermore, a process evaluation and cost-effectiveness analysis will be performed. Discussion This study will provide new knowledge regarding the effectiveness and feasibility of a comprehensive geriatric assessment, multifactorial interventions and nurse-led elderly care in general practice. Trial registration NTR2653 Grant Unrestricted grant 'The Netherlands Organisation for Health Research and development' no 313020201

Enhancement of a stand-alone photovoltaic system's performance: Reduction of soft and hard shading

Energy Technology Data Exchange (ETDEWEB)

Lamont, Lisa A.; El Chaar, Lana [Petroleum Institute, Electrical Engineering Department, P.O. Box 2533, Abu Dhabi (United Arab Emirates)

2011-04-15

A stand-alone photovoltaic (PV) system is the most promising solution to supply electric power to meet energy demand in isolated locations. This technology can offer an interesting alternative to other currently existing sources of energy. Due to space constraint in the remote offshore oil and gas industry, a stand-alone system is used for cathodic protection, telemetry and valve control. However in such an environment, dust accumulation and bird droppings have been critical issues to the operation of off-grid solar devices. These factors do not only reduce the available power of the modules but also makes the cost of solar devices ineffective since cleaning, especially on well-head towers, is very expensive due to the location. Hence this paper presents two technical solutions that have shown promising results in reducing the impact of these factors. (author)

Psychosocial work load and stress in the geriatric care.

Science.gov (United States)

Nübling, Matthias; Vomstein, Martin; Schmidt, Sascha G; Gregersen, Sabine; Dulon, Madeleine; Nienhaus, Albert

2010-07-21

Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain.Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database).Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration).Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity.A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the

Assessment of recovery in older patients hospitalized with different diagnoses and functional levels, evaluated with and without geriatric assessment.

Science.gov (United States)

Abrahamsen, Jenny Foss; Haugland, Cathrine; Ranhoff, Anette Hylen

2016-01-01

The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests. Prospective, observational cohort study, including 961community dwelling patients aged ≥ 70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months). Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50-79 and model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI model, cognitive impairment. Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.

Design of Stand-Alone Hybrid Power Generation System at Brumbun Beach Tulungagung East Java

Science.gov (United States)

Rahmat, A. N.; Hidayat, M. N.; Ronilaya, F.; Setiawan, A.

2018-04-01

Indonesian government insists to optimize the use of renewable energy resources in electricity generation. One of the efforts is launching Independent Energy Village plan. This program aims to fulfill the need of electricity for isolated or remote villages in Indonesia. In order to support the penetration of renewable energy resources in electricity generation, a hybrid power generation system is developed. The simulation in this research is based on the availability of renewable energy resources in Brumbun beach, Tulungagung, East Java. Initially, the electricity was supplied through stand-alone electricity generations which are installed at each house. Hence, the use of electricity between 5 p.m. – 9 p.m. requires high operational costs. Based on the problem above, this research is conducted to design a stand-alone hybrid electricity generation system, which may consist of diesel, wind, and photovoltaic. The design is done by using HOMER software to optimize the use of electricity from renewable resources and to reduce the operation of diesel generation. The combination of renewable energy resources in electricity generation resulted in NPC of 44.680, COE of 0,268, and CO2 emissions of 0,038 % much lower than the use of diesel generator only.

Feasibility and Optimal Design of a Stand-Alone Photovoltaic Energy System for the Orphanage

Directory of Open Access Journals (Sweden)

Vincent Anayochukwu Ani

2014-01-01

Full Text Available Access to electricity can have a positive psychological impact through a lessening of the sense of exclusion, and vulnerability often felt by the orphanages. This paper presented the simulation and optimization study of a stand-alone photovoltaic power system that produced the desired power needs of an orphanage. Solar resources for the design of the system were obtained from the National Aeronautics and Space Administration (NASA Surface Meteorology and Solar Energy website at a location of 6°51′N latitude and 7°35′E longitude, with annual average solar radiation of 4.92 kWh/m2/d. This study is based on modeling, simulation, and optimization of energy system in the orphanage. The patterns of load consumption within the orphanage were studied and suitably modeled for optimization. Hybrid Optimization Model for Electric Renewables (HOMER software was used to analyze and design the proposed stand-alone photovoltaic power system model. The model was designed to provide an optimal system configuration based on an hour-by-hour data for energy availability and demands. A detailed design, description, and expected performance of the system were presented in this paper.

A control strategy for PV stand-alone applications

International Nuclear Information System (INIS)

Slouma, S; Baccar, H

2015-01-01

This paper proposes a stand-alone photovoltaic (PV) system study in domestic applications. Because of the decrease in power of photovoltaic module as a consequence of changes in solar radiation and temperature which affect the photovoltaic module performance, the design and control of DC-DC buck converter was proposed for providing power to the load from a photovoltaic source.In fact, the control of this converter is carried out with integrated MPPT (Maximum Power Point Tracking) algorithm which ensures a maximum energy generated by the PV arrays. Moreover, the output stage is composed by a battery energy storage system, dc-ac inverter, LCL filter which enables higher efficiency, low distortion ac waveforms and low leakage currents. The control strategy adopted is cascade control composed by two regulation loops.Simulations performed with PSIM software were able to validate the control system.The realization and testing of the photovoltaic system were achieved in the Photovoltaic laboratory of the Centre for Research and Energy Technologies at the Technopark Borj Cedria. Experimental results verify the effeciency of the proposed system

A control strategy for PV stand-alone applications

Science.gov (United States)

Slouma, S.; Baccar, H.

2015-04-01

This paper proposes a stand-alone photovoltaic (PV) system study in domestic applications. Because of the decrease in power of photovoltaic module as a consequence of changes in solar radiation and temperature which affect the photovoltaic module performance, the design and control of DC-DC buck converter was proposed for providing power to the load from a photovoltaic source.In fact, the control of this converter is carried out with integrated MPPT (Maximum Power Point Tracking) algorithm which ensures a maximum energy generated by the PV arrays. Moreover, the output stage is composed by a battery energy storage system, dc-ac inverter, LCL filter which enables higher efficiency, low distortion ac waveforms and low leakage currents. The control strategy adopted is cascade control composed by two regulation loops.Simulations performed with PSIM software were able to validate the control system.The realization and testing of the photovoltaic system were achieved in the Photovoltaic laboratory of the Centre for Research and Energy Technologies at the Technopark Borj Cedria. Experimental results verify the effeciency of the proposed system.

Lossy Data Aggregation with Network Coding in Stand-Alone Wireless Sensor Networks

DEFF Research Database (Denmark)

Madsen, Tatiana Kozlova

2011-01-01

in chemical plants, etc. Given resource constrained operation of a sensor network where the nodes are battery powered and buffer sizes are limited, efficient methods for in-network data storage abd it subsequent fast and reliable transmission to a gateway is desirable. To save scarse resources and to prolong......This work focuses on a special type of wireless sensor networks (WSNs) that we refer to as a stand alone network. These netwoks operate in harsh and extreme environments where data collection is done only occasionally. Typical examples include habitat monitoring systems, monitoring systems...

State Feedback Decoupling with In-Loop Lead Compensator in Stand-Alone VSIs

DEFF Research Database (Denmark)

Federico, de Bosio; Pastorelli, Michele; de Sousa Ribeiro, Luiz Antonio

2016-01-01

The performance of current and voltage regulators during transients and steady-state is of primary concern for power converters intended for stand-alone applications. Dynamics performance and command tracking capability are enhanced by actively decoupling the controlled states variables. To further...... widen the current loop bandwidth while still preserving a well-damped system a lead compensator structure on the forward loop is proposed. A 3 kHz bandwidth with 0.707 damping factor is achieved for the inner current controller. Accordingly, also the voltage regulator bandwidth can be widen, thus...

The Stand-alone Heliostat; El Heliostato Autonomo

Energy Technology Data Exchange (ETDEWEB)

Garcia Navajas, G.; Egea Gea, A. [Ciemat. Madrid (Spain)

2000-07-01

The first Autonomous Heliostat has been developed by CIEMAT at PSA facilities in Almeria. This heliostat is an innovative approach to reducing the civil engineering work costs in heliostat fields of central tower plants. Channels, cables and other electric elements have been eliminated in the new heliostat. Thus, one 70-m''2, classical T glass/metal heliostat has been adapted to include all the new stand-alone concept components. A PV system is able to drive two sun-tracking DC motors between 5 and 24 Vdc, 0 and 15A. The heliostat communicates with the control room 400-m away by using a radio-modern working at 9600 baud. An anemometer, a wind switcher, light and ambient temperature sensors have been installed on the heliostat for self-protection decision-making. A PV panel integrated into the heliostat reflecting surface, eliminates cabling and other elements required for a conventional power supply. Communication lines between master control and local control have been replaced by radio-modern. Testing has validated the technical feasibility of the prototype and quantified the real consumption and efficiencies of new elements. The extra costs produced by the autonomous concepts are compared with the cost of civil work in conventional heliostat field. (Author) 8 refs.

The Stand-alone Heliostat; El Heliostato Autonomo

Energy Technology Data Exchange (ETDEWEB)

Garcia Navajas, G; Egea Gea, A [Ciemat. Madrid (Spain)

2000-07-01

The first Autonomous Heliostat has been developed by CIEMAT at PSA facilities in Almeria. This heliostat is an innovative approach to reducing the civil engineering work costs in heliostat fields of central tower plants. Channels, cables and other electric elements have been eliminated in the new heliostat. Thus, one 70-m''2, classical T glass/metal heliostat has been adapted to include all the new stand-alone concept components. A PV system is able to drive two sun-tracking DC motors between 5 and 24 Vdc, 0 and 15A. The heliostat communicates with the control room 400-m away by using a radio-modern working at 9600 baud. An anemometer, a wind switcher, light and ambient temperature sensors have been installed on the heliostat for self-protection decision-making. A PV panel integrated into the heliostat reflecting surface, eliminates cabling and other elements required for a conventional power supply. Communication lines between master control and local control have been replaced by radio-modern. Testing has validated the technical feasibility of the prototype and quantified the real consumption and efficiencies of new elements. The extra costs produced by the autonomous concepts are compared with the cost of civil work in conventional heliostat field. (Author) 8 refs.

Development of a microprocessor controller for stand-alone photovoltaic power systems

Science.gov (United States)

Millner, A. R.; Kaufman, D. L.

1984-01-01

A controller for stand-alone photovoltaic systems has been developed using a low power CMOS microprocessor. It performs battery state of charge estimation, array control, load management, instrumentation, automatic testing, and communications functions. Array control options are sequential subarray switching and maximum power control. A calculator keypad and LCD display provides manual control, fault diagnosis and digital multimeter functions. An RS-232 port provides data logging or remote control capability. A prototype 5 kW unit has been built and tested successfully. The controller is expected to be useful in village photovoltaic power systems, large solar water pumping installations, and other battery management applications.

The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.

Science.gov (United States)

Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P

2015-02-01

The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Blood pressure associates with standing balance in elderly outpatients.

Directory of Open Access Journals (Sweden)

Jantsje H Pasma

Full Text Available OBJECTIVES: Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment. MATERIALS AND METHODS: In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197 and continuously (subsample, n = 58 before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1 the ability to maintain standing balance; 2 self-reported impaired standing balance; and 3 history of falls, adjusted for age and sex. RESULTS: Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements. CONCLUSION: Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.

Hydrogen Gas Production in a Stand-Alone Wind Farm

Directory of Open Access Journals (Sweden)

M. Naziry Kordkandy

2017-04-01

Full Text Available This paper is analyzing the operation of a stand-alone wind farm with variable speed turbines, permanent magnet synchronous generators (PMSG and a system for converting wind energy during wind speed variations. On this paper, the design and modeling of a wind system which uses PMSG’s to provide the required power of a hydrogen gas electrolyzer system, is discussed. This wind farm consists of three wind turbines, boost DC-DC converters, diode full bridge rectifiers, permanent magnet synchronous generators, MPPT control and a hydrogen gas electrolyzer system. The MPPT controller based on fuzzy logic is designed to adjust the duty ratio of the boost DC-DC converters to absorb maximum power. The proposed fuzzy logic controller assimilates, with (PSF MPPT algorithm which generally used to absorb maximum power from paralleled wind turbines and stores it in form of hydrogen gas. The system is modeled and its behavior is studied using the MATLAB software.

Stand-alone version of the 11kW Gaia wind turbine

Energy Technology Data Exchange (ETDEWEB)

Bindner, H.; Rosas, P.A.C.; Teodorescu, R.; Blaabjerg, F.

2004-09-15

This report describes the development of a stand-alone version of the 11kW Gaia wind turbine. Various possible configurations are investigated and a configuration using a back-to-back converter is chosen. A model is developed for controller design of the fast controllers of the unit. Controllers are designed and a prototype is built for testing. The report documents the performance of the prototype through measurements done on the full scale prototype installed in a test facility where it has been tested both as a standalone unit and in parallel with a diesel genset. For system wide power quality assessment and controller design a dynamic performance assessment model has been developed. (au)

A Simple Sizing Algorithm for Stand-Alone PV/Wind/Battery Hybrid Microgrids

Directory of Open Access Journals (Sweden)

Jing Li

2012-12-01

Full Text Available In this paper, we develop a simple algorithm to determine the required number of generating units of wind-turbine generator and photovoltaic array, and the associated storage capacity for stand-alone hybrid microgrid. The algorithm is based on the observation that the state of charge of battery should be periodically invariant. The optimal sizing of hybrid microgrid is given in the sense that the life cycle cost of system is minimized while the given load power demand can be satisfied without load rejection. We also report a case study to show the efficacy of the developed algorithm.

Design, building and testing of a stand alone fuel cell hybrid system

Energy Technology Data Exchange (ETDEWEB)

Segura, F.; Duran, E.; Andujar, J.M. [Department of Electronic, Computer Science and Automatic Engineering, University of Huelva (Spain)

2009-08-01

This paper designs, sizes, builds and tests a stand alone fuel cell hybrid system made up of a fuel cell stack and a battery bank. This system has been sized to supply a typical telecommunication load profile, but moreover, the system can supply other profiles. For this purpose, a modular low cost electronic load bank has been designed and built. This load bank allows the power demand to be chosen by selecting different solid state relays. Moreover, a virtual instrument based on NI Labview {sup registered} has been designed to select the load power demand from the computer. (author)

Stand-Alone Ethics, Social Responsibility, and Sustainability Course Requirements: A Snapshot from Australia and New Zealand

Science.gov (United States)

Rundle-Thiele, Sharyn R.; Wymer, Walter

2010-01-01

This article analyzes the extent to which Australian and New Zealand marketing educators use dedicated or stand-alone courses to equip students with alternative views of business. A census of marketing programs in degree-granting universities was conducted. Program brochures were obtained via the Internet and were content analyzed. This study…

Modified Chaos Particle Swarm Optimization-Based Optimized Operation Model for Stand-Alone CCHP Microgrid

Directory of Open Access Journals (Sweden)

Fei Wang

2017-07-01

Full Text Available The optimized dispatch of different distributed generations (DGs in stand-alone microgrid (MG is of great significance to the operation’s reliability and economy, especially for energy crisis and environmental pollution. Based on controllable load (CL and combined cooling-heating-power (CCHP model of micro-gas turbine (MT, a multi-objective optimization model with relevant constraints to optimize the generation cost, load cut compensation and environmental benefit is proposed in this paper. The MG studied in this paper consists of photovoltaic (PV, wind turbine (WT, fuel cell (FC, diesel engine (DE, MT and energy storage (ES. Four typical scenarios were designed according to different day types (work day or weekend and weather conditions (sunny or rainy in view of the uncertainty of renewable energy in variable situations and load fluctuation. A modified dispatch strategy for CCHP is presented to further improve the operation economy without reducing the consumers’ comfort feeling. Chaotic optimization and elite retention strategy are introduced into basic particle swarm optimization (PSO to propose modified chaos particle swarm optimization (MCPSO whose search capability and convergence speed are improved greatly. Simulation results validate the correctness of the proposed model and the effectiveness of MCPSO algorithm in the optimized operation application of stand-alone MG.

Design of a Stand-Alone Photovoltaic (PV Models for Home Lightings and Clean Environment

Directory of Open Access Journals (Sweden)

Vincent Anayochukwu Ani

2016-01-01

Full Text Available This paper gives a well-documented health risks of fuel-based lighting (kerosene lamps and fuel-powered generators and proposed a design of a stand-alone solar PV system for sustainable home lightings in rural Nigerian area. The design was done in three different patterns of electricity consumptions with energy efficient lightings (EELs using two different battery types (Rolls Surrette 6CS25PS and hoppecke 10 OpzS 1000 on; i judicious power consumption, ii normal power consumption, iii excess power consumption; and compared them with the incandescent light bulb consumption. The stand-alone photovoltaic energy systems were designed to match the rural Nigerian sunlight and weather conditions to meet the required lightings of the household. The objective function and constraints for the design models were formulated and optimization procedure were used to demonstrate the best solution (reliability at the lowest lifecycle cost. Initial capital costs as well as annualized costs over 5, 10, 15, 20, and 25 years were quantified and documented. The design identified the most cost-effective and reliable solar and battery array among the patterns of electricity consumption with energy efficient lighting options (judicious power consumption, normal power consumption, and excess power consumption.

Hierarchical energy management system for stand-alone hybrid system based on generation costs and cascade control

International Nuclear Information System (INIS)

Torreglosa, J.P.; García, P.; Fernández, L.M.; Jurado, F.

2014-01-01

Highlights: • We present an energy management system for a stand-alone WT/PV/hydrogen/battery hybrid system. • Hierarchical control composed by master and slave control strategies. • Control assures reliable electricity support for stand-alone applications subject to technical and economic criteria. - Abstract: This paper presents an energy management system (EMS) for stand-alone hybrid systems composed by photovoltaic (PV) solar panels and a wind turbine (WT) as primary energy sources and two energy storage systems, which are a hydrogen system and a battery. The hydrogen system is composed of fuel cell (FC), electrolyzer and hydrogen storage tank. The EMS is a hierarchical control composed by a master control strategy and a slave control strategy. On the one hand, the master control generates the reference powers to meet several premises (such as to satisfy the load power demand, and to maintain the hydrogen tank level and the state of charge (SOC) of the battery between their target margins), taking also into account economic aspects to discriminate between using the battery or hydrogen system. On the other hand, the slave control modifies the reference powers generated by the master control according to the energy sources dynamic limitations, and maintains the DC bus voltage at its reference value. The models, implemented in MATLAB-Simulink environment, have been developed from commercially available components. To check the viability of the proposed EMS, two kinds of simulations were carried out: (1) A long-term simulation of 25 years (expected lifetime of the system) with a sample time of one hour to validate the master control of the EMS; and (2) A short-term simulation with sudden net power variations to validate the slave control of the EMS

SoC-Based Output Voltage Control for BESS with a Lithium-Ion Battery in a Stand-Alone DC Microgrid

Directory of Open Access Journals (Sweden)

Seung-Yeong Yu

2016-11-01

Full Text Available This paper proposes a new DC output voltage control for a battery energy storage system (BESS with a lithium-ion battery based on the state of charge (SoC. The proposed control scheme was verified through computer simulations for a typical stand-alone DC microgrid, which consists of a BESS, photovoltaic (PV panel, engine generator (EG, and DC load. A scaled hardware prototype for a stand-alone DC microgrid was set up in the lab, in which the proposed control scheme was loaded in a DSP controller. The experimental results were compared with the simulation results for performance verification. The proposed control scheme provides relatively lower variation of the DC grid voltage than the conventional droop control.

Improved double integral sliding mode MPPT controller based parameter estimation for a stand-alone photovoltaic system

International Nuclear Information System (INIS)

Chatrenour, Nasrin; Razmi, Hadi; Doagou-Mojarrad, Hasan

2017-01-01

Highlights: • IDISMC based MPPT algorithm is introduced. • Hurwitz stability theorem is used for switching surface coefficients computation. • GA approach is presented for parameter estimation of the stand-alone PV system. - Abstract: In this paper, an Improved Double Integral Sliding Mode MPPT Controller (IDISMC) for a stand-alone photovoltaic (PV) system is proposed. Performance of a sliding mode controller (SMC) is greatly influenced by the choice of the sliding surface. Switching surface coefficients were selected by the use of Hurwitz stability theorem. The IDISMC not only is robust against parametric and non-parametric uncertainties, but also has a very small steady-state error, thanks to the use of double integral of tracking voltage error in the definition of its sliding surface. For realistic simulation, Genetic Algorithm (GA) method was used to estimate parameters of solar panels model. The validity of the proposed double integral SMC in maximum power point tracking was approved by comparing the simulation results obtained for a sample PV system with the results of other methods.

A Meta-Analytic Review of Stand-Alone Interventions to Improve Body Image.

Directory of Open Access Journals (Sweden)

Jessica M Alleva

Full Text Available Numerous stand-alone interventions to improve body image have been developed. The present review used meta-analysis to estimate the effectiveness of such interventions, and to identify the specific change techniques that lead to improvement in body image.The inclusion criteria were that (a the intervention was stand-alone (i.e., solely focused on improving body image, (b a control group was used, (c participants were randomly assigned to conditions, and (d at least one pretest and one posttest measure of body image was taken. Effect sizes were meta-analysed and moderator analyses were conducted. A taxonomy of 48 change techniques used in interventions targeted at body image was developed; all interventions were coded using this taxonomy.The literature search identified 62 tests of interventions (N = 3,846. Interventions produced a small-to-medium improvement in body image (d+ = 0.38, a small-to-medium reduction in beauty ideal internalisation (d+ = -0.37, and a large reduction in social comparison tendencies (d+ = -0.72. However, the effect size for body image was inflated by bias both within and across studies, and was reliable but of small magnitude once corrections for bias were applied. Effect sizes for the other outcomes were no longer reliable once corrections for bias were applied. Several features of the sample, intervention, and methodology moderated intervention effects. Twelve change techniques were associated with improvements in body image, and three techniques were contra-indicated.The findings show that interventions engender only small improvements in body image, and underline the need for large-scale, high-quality trials in this area. The review identifies effective techniques that could be deployed in future interventions.

Psychosocial work load and stress in the geriatric care

Directory of Open Access Journals (Sweden)

Dulon Madeleine

2010-07-01

Full Text Available Abstract Background Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. Methods The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain. Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database. Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p Results In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC, 313 in Geriatric Nursing Homes (GNH, 164 in other professions (e.g. administration. Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195 and the total mean across all professions, COPSOQ-total (N = 11.168, the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity. A supplementary subgroup analysis showed that the degree of

[The development and benefits of working together in geriatric short stay units].

Science.gov (United States)

Dumont, Magali

2014-01-01

Ambroise-Paré hospital (AP-HP, 92) set up a new work organisation based on the nurse/nursing auxiliary partnership in the geriatric short stay unit in response to the wishes of the healthcare manager and nursing team. It was introduced over three months and in several stages in order to limit sticking points and support the team in its new practice.

Student nurses' motivation to choose gerontological nursing as a career in China: a survey study.

Science.gov (United States)

Cheng, Min; Cheng, Cheng; Tian, Yan; Fan, Xiuzhen

2015-07-01

The world's population is aging, and the need for nurses is increasing. Working with older adults, however, has always been an unpopular career choice among student nurses. It is important to understand student nurses' motivation for choosing gerontological nursing as a career. The purpose of this study was to examine the motivation for choosing gerontological nursing as a career and to identify the associated factors among student nurses. Cross-sectional survey. Participants were last-semester student nurses from 7 universities offering nursing undergraduate programs in Shandong, China. Of the 1290 student nurses, 916 completed the survey (a response rate of 71.0%). The outcome variable was the motivation to choose gerontological nursing as a career. This was measured using a motivation questionnaire that included expectancy and value subscales. Other instruments included the Chinese version of the Facts on Aging Quiz I, the Geriatrics Attitudes Scale, the Anxiety about Aging Scale, a clinical practice environment questionnaire and a self-administered general information questionnaire. Student nurses' expectancy and value aspects of motivation for choosing gerontological nursing as a career were both at a moderate level; the highest value they held was of personal interest. Clinical practice environment, anxiety about aging and the attitudes about geriatrics were the main factors influencing student nurses' motivation to choose gerontological nursing as a career in China. It is imperative for nurse educators to improve the gerontological nursing clinical practice environment for student nurses. Moreover, cultivating student nurses' positive attitudes about geriatrics and relieving anxiety about aging could be beneficial. Copyright © 2015. Published by Elsevier Ltd.

Attitudes of Nursing Facilities' Staff Toward Pharmacy Students' Interaction with its Residents.

Science.gov (United States)

Adkins, Donna; Gavaza, Paul; Deel, Sharon

2017-06-01

All Appalachian College of Pharmacy second-year students undertake the longitudinal geriatric early pharmacy practice experiences (EPPE) 2 course, which involves interacting with geriatric residents in two nursing facilities over two semesters. The study investigated the nursing staff's perceptions about the rotation and the pharmacy students' interaction with nursing facility residents. Cross-sectional study. Academic setting. 63 nursing facility staff. A 10-item attitude survey administered to nursing staff. Nursing staff attitude toward pharmacy students' interaction with geriatric residents during the course. Sixty-three responses were received (84% response rate). Most respondents were female (95.2%), who occasionally interacted with pharmacy students (54.8%) and had worked at the facilities for an average of 6.8 years (standard deviation [SD] = 6.7) years. Staff reported that pharmacy students practiced interacting with geriatric residents and nursing facility staff, learned about different medications taken by residents as well as their life as a nursing facility resident. In addition, the student visits improved the mood of residents and staff's understanding of medicines, among others. Staff suggested that students spend more time with their residents in the facility as well as ask more questions of staff. The nursing facility staff generally had favorable attitudes about pharmacy students' visits in their nursing facility. Nursing facility staff noted that the geriatric rotation was a great learning experience for the pharmacy students.

A Case Study of Control and Improved Simplified Swarm Optimization for Economic Dispatch of a Stand-Alone Modular Microgrid

Directory of Open Access Journals (Sweden)

Xianyong Zhang

2018-03-01

Full Text Available Due to the complex configuration and control framework, the conventional microgrid is not cost-effective for engineering applications with small or medium capacity. A stand-alone modular microgrid with separated AC bus and decentralized control strategy is proposed in this paper. Each module is a self-powered system, which consists of wind and solar power, a storage battery, load and three-port converter. The modules are interconnected by three-port converters to form the microgrid. Characteristics, operation principle, control of the modular microgrid and the three-port converter are analyzed in detail. Distributed storage batteries enable power exchanges among modules to enhance economic returns. Economic dispatch of the stand-alone modular microgrid is a mixed-integer programming problem. A day-ahead operation optimization model including fuel cost, battery operation cost, and power transmission cost is established. Because there are so many constraints, it is difficult to produce a feasible solution and even more difficult to have an improved solution. An improved simplified swarm optimization (iSSO method is therefore proposed. The iSSO scheme designs the new update mechanism and survival of the fittest policy. The experimental results from the demonstration project on DongAo Island reflect the effectiveness of the stand-alone modular microgrid and the economic dispatch strategy based on the iSSO method.

[Geriatrics or geriatricization of medicine : Quo vadis geriatrics?

Science.gov (United States)

Kolb, G F

2017-12-01

This article examines the question whether and how geriatrics will change in the future and whether in view of the demographic changes the trend will go more in the direction of a further expansion of geriatrics or more towards a geriatricization of individual specialist medical fields. The different development of geriatrics in the individual Federal States can only be understood historically and is absolutely problematic against the background of the new hospital remuneration system. Geriatrics is a typical cross-sectional faculty and still has demarcation problems with other faculties but has also not yet clearly defined the core competence. This certainly includes the increasing acquisition of decentralized joint treatment concepts and geriatric counselling services in the future, in addition to the classical assessment instruments. Keywords in association with this are: traumatology and othopedics of the elderly, geriatric neurology and geriatric oncology. Interdisciplinary geriatric expertise is increasingly being requested. Outpatient structures have so far not been prioritized in geriatrics. An independent research is under construction and it is gratifying that academic interest in geriatrics seems to be increasing and new professorial chairs have been established. It is not possible to imagine our hospital without geriatrics; however, there is still a certain imbalance between the clearly increased number of geriatric hospital beds, the representation of geriatrics in large hospitals (e.g. specialized and maximum care hospitals and university clinics), the secure establishment in further education regulations and the lack of a uniform nationwide concept of geriatrics.

Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units.

Science.gov (United States)

Grudzen, Corita; Richardson, Lynne D; Baumlin, Kevin M; Winkel, Gary; Davila, Carine; Ng, Kristen; Hwang, Ula

2015-05-01

Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City's Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening criteria. Newly hired ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline in these admissions cannot be confidently attributed to the GEDI WISE program because other geriatric care innovations were implemented during the study period. GEDI WISE programs are now running at Mount Sinai and two partner sites, and their potential to affect the quality and value of geriatric emergency care continues to be examined. Project HOPE—The People-to-People Health Foundation, Inc.

Diagnostic value of the stand-alone synthetic image in digital breast tomosynthesis examinations.

Science.gov (United States)

Garayoa, Julia; Chevalier, Margarita; Castillo, Maria; Mahillo-Fernández, Ignacio; Amallal El Ouahabi, Najim; Estrada, Carmen; Tejerina, Alejandro; Benitez, Olivia; Valverde, Julio

2018-02-01

To demonstrate the non-inferiority of synthetic image (SI) mammography versus full-field digital mammography (FFDM) in breast tomosynthesis (DBT) examinations. An observational, retrospective, single-centre, multireader blinded study was performed, using 2384 images to directly compare SI and FFDM based on Breast Imaging Reporting and Data System (BIRADS) categorisation and visibility of radiological findings. Readers had no access to digital breast tomosynthesis slices. Multiple reader, multiple case (MRMC) receiver operating characteristic (ROC) methodology was used to compare the diagnostic performance of SI and FFDM images. The kappa statistic was used to estimate the inter-reader and intra-reader reliability. The area under the ROC curves (AUC) reveals the non-inferiority of SI versus FFDM based on BIRADS categorisation [difference between AUC (ΔAUC), -0.014] and lesion visibility (ΔAUC, -0.001) but the differences were not statistically significant (p=0.282 for BIRADS; p=0.961 for lesion visibility). On average, 77.4% of malignant lesions were detected with SI versus 76.5% with FFDM. Sensitivity and specificity of SI are superior to FFDM for malignant lesions scored as BIRADS 5 and breasts categorised as BIRADS 1. SI is not inferior to FFDM when DBT slices are not available during image reading. SI can replace FFDM, reducing the dose by 45%. • Stand-alone SI demonstrated performance not inferior for lesion visibility as compared to FFDM. • Stand-alone SI demonstrated performance not inferior for lesion BIRADS categorisation as compared to FFDM. • Synthetic images provide important dose savings in breast tomosynthesis examinations.

Education in geriatric medicine for community hospital staff.

LENUS (Irish Health Repository)

O'Hanlon, Shane

2010-12-01

Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.

Stand-Alone Photovoltaic System Operation with Energy Management and Fault Tolerant

International Nuclear Information System (INIS)

Jmashidpour, Ehsan; Poure, Philippe; Gholipour, E.; Saadate, Shahrokh

2017-01-01

This paper presents a stand-alone photovoltaic (PV) system with a fault tolerant operation capability. An energy management method is provided to keep the balance between produced and consumed energy instantaneously. As the storage element, an Ultra-Capacitor (UC) pack is used for facing high frequency variation of the load/source, and batteries are in charge of slow load /source variations. A Maximum Power Point Tracking (MPPT) algorithm is applied to control the boost converter of the PV source to achieve the maximum power. In order to improve the micro-grid service continuity and reliability, a fast fault diagnosis method based on the converter current shape for PV source is applied. Finally, the validity of the proposed energy management and the fault diagnosis method is confirmed by the simulation and experimental results. (author)

[Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

Science.gov (United States)

Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

2009-01-01

To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

Epicardial, Biatrial Ablation With Integrated Uni-bipolar Radiofrequency Technology in Stand-alone Persistent Atrial Fibrillation.

Science.gov (United States)

Rosati, Fabrizio; Muneretto, Claudio; Merati, Elisa; Polvani, Gianluca; Moltrasio, Massimo; Tondo, Claudio; Curnis, Antonio; Cerini, Manuel; Metras, Alexandre; Bisleri, Gianluigi

Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device. Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm. Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation. Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve

Charactrization of a Li-ion battery based stand-alone a-Si photovoltaic system

International Nuclear Information System (INIS)

Hamid Vishkasougheh, Mehdi; Tunaboylu, Bahadir

2014-01-01

Highlights: • An Li-ion battery based stand-alone a-Si PV was designed. The system composed of three a-Si panels with an efficiency of 7% and 40 cells of LFP batteries. • Effects of solar radiation and environmental temperature for three cities, Istanbul, Ankara, and Adana, have been investigated on a-Si panels. • Using transition formulas BSPV outputs are predictable for any location out of standard test condition. - Abstract: The number of photovoltaic (PV) system installations is increasing rapidly. As more people learn about this versatile and often cost-effective power option, this trend will accelerate. This document presents a recommended design for a battery based stand-alone photovoltaic system (BSPV). BSPV system has the ability to be applied in different areas, including warning signals, lighting, refrigeration, communication, residential water pumping, remote sensing, and cathodic protection. The presented calculation method gives a proper idea for a system sizing technique. Based on application load, different scenarios are possible for designing a BSPV system. In this study, a battery based stand-alone system was designed. The electricity generation part is three a-Si panels, which are connected in parallel, and for the storage part LFP (lithium iron phosphate) battery was used. The high power LFP battery packs are 40 cells each 8S5P (configured 8 series 5 parallel). Each individual pack weighs 0.5 kg and is 25.6 V. In order to evaluate the efficiency of a-Si panels with respect to the temperature and the solar irradiation, cities of Istanbul, Ankara and Adana in Turkey were selected. Temperature and solar irradiation were gathered from reliable sources and by using translation equations, current and voltage output of panels were calculated. As a result of these calculations, current and energy outputs were computed by considering an average efficient solar irradiation time value per day in Turkey. The calculated power values were inserted to a

Charactrization of a Li-ion battery based stand-alone a-Si photovoltaic system

Energy Technology Data Exchange (ETDEWEB)

Hamid Vishkasougheh, Mehdi, E-mail: mehdi.hamid2@gmail.com [Istanbul Sehir University, Kubakisi Caddesi, No: 27, Altunizade, Uskudar, Istanbul 34662 (Turkey); Tunaboylu, Bahadir [Istanbul Sehir University, Kubakisi Caddesi, No: 27, Altunizade, Uskudar, Istanbul 34662 (Turkey); Marmara Research Center, Materials Institute, PO Box 21, Gebze, Kocaeli 41470 (Turkey)

2014-11-01

Highlights: • An Li-ion battery based stand-alone a-Si PV was designed. The system composed of three a-Si panels with an efficiency of 7% and 40 cells of LFP batteries. • Effects of solar radiation and environmental temperature for three cities, Istanbul, Ankara, and Adana, have been investigated on a-Si panels. • Using transition formulas BSPV outputs are predictable for any location out of standard test condition. - Abstract: The number of photovoltaic (PV) system installations is increasing rapidly. As more people learn about this versatile and often cost-effective power option, this trend will accelerate. This document presents a recommended design for a battery based stand-alone photovoltaic system (BSPV). BSPV system has the ability to be applied in different areas, including warning signals, lighting, refrigeration, communication, residential water pumping, remote sensing, and cathodic protection. The presented calculation method gives a proper idea for a system sizing technique. Based on application load, different scenarios are possible for designing a BSPV system. In this study, a battery based stand-alone system was designed. The electricity generation part is three a-Si panels, which are connected in parallel, and for the storage part LFP (lithium iron phosphate) battery was used. The high power LFP battery packs are 40 cells each 8S5P (configured 8 series 5 parallel). Each individual pack weighs 0.5 kg and is 25.6 V. In order to evaluate the efficiency of a-Si panels with respect to the temperature and the solar irradiation, cities of Istanbul, Ankara and Adana in Turkey were selected. Temperature and solar irradiation were gathered from reliable sources and by using translation equations, current and voltage output of panels were calculated. As a result of these calculations, current and energy outputs were computed by considering an average efficient solar irradiation time value per day in Turkey. The calculated power values were inserted to a

An improved synchronous reference frame phase-locked loop for stand-alone variable speed constant frequency power generation systems

DEFF Research Database (Denmark)

Liu, Yi; Xu, Wei; Ke, Longzhang

2017-01-01

The phase-locked loop (PLL) based on conventional synchronous reference frame, i.e. dqPLL, is usually employed in grid-connected variable speed constant frequency (VSCF) power generation systems (PGSs). However, the voltage amplitude drop of stand-alone PGSs is often greater than that of the grid...

Imagery rescripting as a stand-alone treatment for patients with social phobia: a case series.

Science.gov (United States)

Frets, Petra G; Kevenaar, Ciska; van der Heiden, Colin

2014-03-01

The majority of patients with social phobia reports experiencing negative images, usually linked to memories of earlier aversive social experiences. Several studies have indicated that such negative self-imagery appears to have a causal role in maintaining social phobia, which suggests that interventions aimed at dealing with these images could be beneficial in the treatment of social phobia. One potentially powerful approach is imagery rescripting (IR), a clinical intervention that focuses on changing the meaning and impact of unpleasant memories. In the treatment of social phobia IR was only used as part of a broader cognitive-behavioral treatment package. However, we propose that IR alone might also be an effective treatment for this anxiety disorder. The present study reports an initial evaluation of the application of IR as a stand-alone treatment for six adult outpatients presenting with social phobia. A single case series using an A-B replication across patients design was employed. Following a no-treatment baseline period, IR was delivered weekly and patients were followed up for 3 and 6 months. For all patients, substantial reductions were obtained on all outcome measures at post-treatment, and gains were largely maintained at 6-months follow-up. The generalizability of the effects of IR for social phobia is limited by the small number of patients treated by only one therapist. The results of this preliminary case series suggest that IR as a stand alone treatment is an apparently effective intervention in the treatment of patients with social phobia, and indicate that controlled evaluation of its efficacy might be worthwhile. Copyright © 2013 Elsevier Ltd. All rights reserved.

[The life of elderly women living alone].

Science.gov (United States)

Kim, Chunmi; Ko, Moon Hee; Kim, Moon Jeong; Kim, Joohyun; Kim, Hee Ja; Moon, Jin Ha; Baek, Kyoung Seon; Son, Haeng-Mi; Oh, SangEun; Lee, YoungAe; Choi, Jung-Sook

2008-10-01

This study aimed to uncover the fundamental nature of living alone in female elderly. The phenomenological research approach developed by van Manen was adopted. The theme was 'taking a firm stand alone on the edges of life'. The composition elements of living alone experienced by elderly women were as follows: 1) Corporeality: participants perceived their bodies by their health status. Unhealthy participants were suffering with diseases and dependant on other persons, while healthy participants were free from family responsibility and kept on moving. 2) Spatiality: participants felt both freedom and loneliness while they stayed home. 3) Relationality: participants felt pity and yearning for their bereaved husband and sometimes talked to his picture. According to their children's filial piety, participants were pleased or displeased. However, they incessantly devoted themselves to their children. 4) Temporality: participants considered the rest of their life as extra-time which was proceeding to death, and tried to keep themselves busy before they died. A nurse should understand the multifarious aspects of elderly women's life, and then intervene to consolidate their strengths for self-supporting the final years of life.

Stand-Alone Solar Organic Rankine Cycle Water Pumping System and Its Economic Viability in Nepal

OpenAIRE

Suresh Baral; Kyung Chun Kim

2015-01-01

The current study presents the concept of a stand-alone solar organic Rankine cycle (ORC) water pumping system for rural Nepalese areas. Experimental results for this technology are presented based on a prototype. The economic viability of the system was assessed based on solar radiation data of different Nepalese geographic locations. The mechanical power produced by the solar ORC is coupled with a water pumping system for various applications, such as drinking and irrigation. The thermal ef...

Boost converter with combined control loop for a stand-alone photovoltaic battery charge system

DEFF Research Database (Denmark)

Mira Albert, Maria del Carmen; Knott, Arnold; Thomsen, Ole Cornelius

2013-01-01

frequency avoids perturbations in the load being propagated to the photovoltaic panel and thus deviating the operating point. Linearization of the photovoltaic panel and converter state-space modeling is performed. In order to achieve stable operation under all operating conditions, the photovoltaic panel......The converter control scheme plays an important role in the performance of maximum power point tracking (MPPT) algorithms. In this paper, an input voltage control with double loop for a stand-alone photovoltaic system is designed and tested. The inner current control loop with high crossover...

Associations of Various Health-Ratings with Geriatric Giants, Mortality and Life Satisfaction in Older People

DEFF Research Database (Denmark)

Puvill, Thomas; Lindenberg, Jolanda; Gussekloo, Jacobijn

2016-01-01

Self-rated health is routinely used in research and practise among general populations. Older people, however, seem to change their health perceptions. To accurately understand these changed perceptions we therefore need to study the correlates of older people's self-ratings. We examined self......-rated, nurse-rated and physician-rated health's association with common disabilities in older people (the geriatric giants), mortality hazard and life satisfaction. For this, we used an age-representative population of 501 participant aged 85 from a middle-sized city in the Netherlands: the Leiden 85-plus......) were included as geriatric giants. Participants provided a score for life satisfaction and were followed up for vital status. Concordance of self-rated health with physician-rated (k = .3 [.0]) and nurse-rated health (k = .2 [.0]) was low. All three ratings were associated with the geriatric giants...

System design optimization for stand-alone photovoltaic systems sizing by using superstructure model

International Nuclear Information System (INIS)

Azau, M A M; Jaafar, S; Samsudin, K

2013-01-01

Although the photovoltaic (PV) systems have been increasingly installed as an alternative and renewable green power generation, the initial set up cost, maintenance cost and equipment mismatch are some of the key issues that slows down the installation in small household. This paper presents the design optimization of stand-alone photovoltaic systems using superstructure model where all possible types of technology of the equipment are captured and life cycle cost analysis is formulated as a mixed integer programming (MIP). A model for investment planning of power generation and long-term decision model are developed in order to help the system engineer to build a cost effective system.

Cultural competence in the baccalaureate degree nursing curriculum

Science.gov (United States)

Silvestri, Angela

were analyzed and reported. The results of the study indicated the following: (a) a low number of schools incorporating a stand-alone nursing course in the curriculum; (b) differences among various teaching methods among regions and program types; (c) differences among the incorporation of Campinha-Bacote's (2007b) cultural constructs in the curriculum; and (d) differences among various evaluation methods among regions and program types. Implications for nursing education include the following: (a) programs should make an effort to incorporate one-to-one instruction and simulation when planning teaching encounters in order to adequately address all learning domains; (b) when planning curriculum structure, programs should consider using a theoretical framework such as Campinha-Bacote's (2007b) "The Process of Cultural Competence in the Delivery of Health Care Service" in order to address student learning needs thoroughly; (c) nursing faculty members need to be creative in their teaching and make a conscious effort to continually address cultural learning needs of their students; and (d) concept mapping should be used to determine where and how many times cultural concepts are addressed in the curriculum. Recommendations for future research include: (a) determining which teaching methods are most effective in promoting cultural competence; (b) determining the use and effectiveness of curriculum methods that incorporate Campinha-Bacote's (2007b) cultural constructs; (c) determining which evaluation methods are most effective in determining student ability to care for others of another culture; and (d) learning about faculty comfort and preparedness to teach culture-related nursing content. It is also recommended that the relationship between a stand-alone nursing course versus and integrated course and cultural competence be investigated.

Study of Stand-Alone Microgrid under Condition of Faults on Distribution Line

Science.gov (United States)

Malla, S. G.; Bhende, C. N.

2014-10-01

The behavior of stand-alone microgrid is analyzed under the condition of faults on distribution feeders. During fault since battery is not able to maintain dc-link voltage within limit, the resistive dump load control is presented to do so. An inverter control is proposed to maintain balanced voltages at PCC under the unbalanced load condition and to reduce voltage unbalance factor (VUF) at load points. The proposed inverter control also has facility to protect itself from high fault current. Existing maximum power point tracker (MPPT) algorithm is modified to limit the speed of generator during fault. Extensive simulation results using MATLAB/SIMULINK established that the performance of the controllers is quite satisfactory under different fault conditions as well as unbalanced load conditions.

Multi-objective optimal planning of the stand-alone microgrid system based on different benefit subjects

International Nuclear Information System (INIS)

Guo, Li; Wang, Nan; Lu, Hai; Li, Xialin; Wang, Chengshan

2016-01-01

As an important means to realize the energetic complementarity and improve the efficiency of renewable resources, the stand-alone microgrid (SAMG) system gains attention increasingly, especially in islands and remote areas. In this paper, considering the interest conflict of the distribution company and the distributed generation owner, a new multi-objective optimal planning model is formulated for medium voltage SAMG. Besides, to avoid the power constraint of distributed generation (DG) once the over-limit voltage occurs, a novel two-step power dispatch control method including the voltage regulation strategy is proposed, in which the absorption of distributed power by energy storage system (ESS) and the reactive power adjustment though its power control system are used to regulate voltage. The goal of this paper is to search the Pareto-optimal front of the site and capacity of DG as well as the contract price between both parties, and thus can provide effective references for practical planning of SAMG. Considering the high cost of ESS, the investment analysis of ESS is also discussed in the paper. - Highlights: • A multi-objective planning model based on different benefit subjects is proposed. • A two-step power dispatch method including the voltage regulation is proposed. • The economical efficiency of the proposed model is analyzed. • The effective reference for the stand-alone microgrid planning is provided.

Efficiency of the hybrid solar-wind systems for electricity supply to the stand-alone sites

International Nuclear Information System (INIS)

Abdullaev, D.A.; Isaev, R.I.

2000-01-01

The features of stand-alone sites and principles of their electricity supply is described there is going observation of the works about conditions of production and efficiency of using autonomy wind turbines and photovoltaics. Their unsufficiency is estimated. The advantages of hybrid systems and their realization schemes is described. The advantage of hybrid solar-wind Battery system (HSWBS) on the basis of own researches and the facts of other authors are given. The conception overall discounting cost is developed on HSWBS case. (Author)

A Control Approach and Supplementary Controllers for a Stand-Alone System with Predominance of Wind Generation

Directory of Open Access Journals (Sweden)

Tiago Lukasievicz

2018-02-01

Full Text Available This paper proposes a control approach and supplementary controllers for the operation of a hybrid stand-alone system composed of a wind generation unit and a conventional generation unit based on synchronous generator (CGU. The proposed controllers allow the islanded or isolated operation of small power systems with predominance of wind generation. As an advantage and a paradigm shift, the DC-link voltage of the wind unit is controlled by means of a conventional synchronous generator connected to the AC grid of the system. Two supplementary controllers, added to a diesel generator (DIG and to a DC dump load (DL, are proposed to control the DC-link voltage. The wind generation unit operates in V-f control mode and the DIG operates in PQ control mode, which allows the stand-alone system to operate either in wind-diesel (WD mode or in wind-only (WO mode. The strong influence of the wind turbine speed variations in the DC-link voltage is mitigated by a low-pass filter added to the speed control loop of the wind turbine. The proposed control approach does not require the use battery bank and ultra-capacitor to control the DC-link voltage in wind generation units based on fully rated converter.

Multidisciplinary education in geriatrics: an experimental course at the Middlesex Hospital.

Science.gov (United States)

Beynon, G P; Wedgwood, J; Newman, J; Hutt, A

1978-11-01

For two years mixed groups of medical, nursing and physiotherapy students have taken part in an experimental course in geriatric medicine. The course organization and content are described and the students' evaluation of the course is discussed.

Energy management system for stand-alone diesel-wind-biomass microgrid with energy storage system

International Nuclear Information System (INIS)

Wang, Chengshan; Liu, Yixin; Li, Xialin; Guo, Li; Qiao, Lei; Lu, Hai

2016-01-01

An energy management system for stand-alone microgrid composed of diesel generators, wind turbine generator, biomass generator and an ESS (energy storage system) is proposed in this paper. Different operation objectives are achieved by a hierarchical control structure with different time scales. Firstly, the optimal schedules of the diesel generators, wind turbine generator, biomass generator and ESS are determined fifteen minutes ahead according to the super short-term forecast of load and wind speed in the optimal scheduling layer. Comprehensive analysis which takes the uncertainty of load and wind speed into account is conducted in this layer to minimize the operation cost of the system and ensure a desirable range of the state of charge of the ESS. Secondly, the operation points of each unit are regulated dynamically to guarantee real-time power balance and safety range of diesel generation in the real-time control layer, based on which the response capability when suffering significant forecast deviation and other emergency issues, e.g. sudden load-up can be improved. Finally, the effectiveness of the proposed energy management strategy is verified on an RT-Lab based real-time simulation platform, and the economic performances with different types of ESS are analyzed as well. - Highlights: • A hierarchical control strategy is proposed for a stand-alone microgrid. • The uncertainties of load and wind speed have been considered. • Better economic performance and high reliability of the system can be achieved. • The influences of different energy storage systems have been analyzed.

Use of appliances in stand-alone PV power supply systems: problems and solutions. Task 3 use of photovoltaic power systems in stand-alone and island applications

Energy Technology Data Exchange (ETDEWEB)

Vallve, X.; Gafas, G. [IEA PVPS, Task 3 (Spain); Villoz, M. [IEA PVPS, Task 3 (Switzerland); Wilshaw, A. [IEA PVPS, Task 3 (United Kingdom); Jacquin, P. [IEA PVPS, Task 3 (France)

2002-09-15

In Stand-Alone Photovoltaic Systems (SAPV systems), special attention must be paid to the used appliances and loads. Inappropriate loads are very often the origin of PV system malfunction or failure. Start-up power peaks, or reactive power and harmonic distortion can cause system signal instability and protective devices will close the system down. A well-matched load together with a carefully selected choice of appliances can lead to significant savings in terms of reduced need for PV and electricity storage capacity. Conversely, inefficient appliances and processes, standby loads and inappropriate loads will increase the requirement for expensive PV and storage capacity. This paper presents a survey of real cases with load related problems in worldwide applications, their effect on quality and cost of the service and the solutions that were adopted and suggested alternative solutions. One of the main conclusions of the work is the importance to integrate the choice of the appliance while designing the SAPV system. (author)

The Future of Gero-Oncology Nursing.

Science.gov (United States)

Kagan, Sarah H

2016-02-01

To project the future of gero-oncology nursing as a distinct specialty, framed between analysis of current challenges and explication of prospective solutions. Peer-reviewed literature, policy directives, web-based resources, and author expertise. Oncology nursing faces several challenges in meeting the needs of older people living with cancer. Realigning cancer nursing education, practice, and research to match demographic and epidemiological realities mandates redesign. Viewing geriatric oncology as an optional sub-specialty limits oncology nursing, where older people represent the majority of oncology patients and cancer survivors. The future of gero-oncology nursing lies in transforming oncology nursing itself. Specific goals to achieve transformation of oncology nursing into gero-oncology nursing include assuring integrated foundational aging and cancer content across entry-level nursing curricula; assuring a gero-competent oncology nursing workforce with integrated continuing education; developing gero-oncology nurse specialists in advanced practice roles; and cultivating nurse leadership in geriatric oncology program development and administration along with expanding the scope and sophistication of gero-oncology nursing science. Copyright © 2015 Elsevier Inc. All rights reserved.

49 CFR 1109.4 - Mandatory mediation in rate cases to be considered under the stand-alone cost methodology.

Science.gov (United States)

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Mandatory mediation in rate cases to be considered... § 1109.4 Mandatory mediation in rate cases to be considered under the stand-alone cost methodology. (a) A... methodology must engage in non-binding mediation of its dispute with the railroad upon filing a formal...

Optimization of stand-alone photovoltaic systems with hydrogen storage for total energy self-sufficiency

Energy Technology Data Exchange (ETDEWEB)

Lund, P D [Helsinki Univ. of Technology, Espoo (Finland). Dept. of Technical Physics

1991-01-01

A new method for optimization of stand-alone photovoltaic-hydrogen energy systems is presented. The methodology gives the optimum values for the solar array and hydrogen storage size for any given system configuration and geographical site. Sensitivity analyses have been performed to study the effect of subsystem efficiencies on the total system performance and sizing, and also to identify possibilities for further improvements. Optimum system configurations have also been derived. The results indicate that a solar-hydrogen energy system is a very promising potential alternative for low power applications requiring a total electricity self-sufficiency. (Author).

GOssTo: a stand-alone application and a web tool for calculating semantic similarities on the Gene Ontology.

Science.gov (United States)

Caniza, Horacio; Romero, Alfonso E; Heron, Samuel; Yang, Haixuan; Devoto, Alessandra; Frasca, Marco; Mesiti, Marco; Valentini, Giorgio; Paccanaro, Alberto

2014-08-01

We present GOssTo, the Gene Ontology semantic similarity Tool, a user-friendly software system for calculating semantic similarities between gene products according to the Gene Ontology. GOssTo is bundled with six semantic similarity measures, including both term- and graph-based measures, and has extension capabilities to allow the user to add new similarities. Importantly, for any measure, GOssTo can also calculate the Random Walk Contribution that has been shown to greatly improve the accuracy of similarity measures. GOssTo is very fast, easy to use, and it allows the calculation of similarities on a genomic scale in a few minutes on a regular desktop machine. alberto@cs.rhul.ac.uk GOssTo is available both as a stand-alone application running on GNU/Linux, Windows and MacOS from www.paccanarolab.org/gossto and as a web application from www.paccanarolab.org/gosstoweb. The stand-alone application features a simple and concise command line interface for easy integration into high-throughput data processing pipelines. © The Author 2014. Published by Oxford University Press.

Biomechanical comparison of a new stand-alone anterior lumbar interbody fusion cage with established fixation techniques – a three-dimensional finite element analysis

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Hsieh Pang-Hsing

2008-06-01

Full Text Available Abstract Background Initial promise of a stand-alone interbody fusion cage to treat chronic back pain and restore disc height has not been realized. In some instances, a posterior spinal fixation has been used to enhance stability and increase fusion rate. In this manuscript, a new stand-alone cage is compared with conventional fixation methods based on the finite element analysis, with a focus on investigating cage-bone interface mechanics and stress distribution on the adjacent tissues. Methods Three trapezoid 8° interbody fusion cage models (dual paralleled cages, a single large cage, or a two-part cage consisting of a trapezoid box and threaded cylinder were created with or without pedicle screws fixation to investigate the relative importance of the screws on the spinal segmental response. The contact stress on the facet joint, slip displacement of the cage on the endplate, and rotational angle of the upper vertebra were measured under different loading conditions. Results Simulation results demonstrated less facet stress and slip displacement with the maximal contact on the cage-bone interface. A stand-alone two-part cage had good slip behavior under compression, flexion, extension, lateral bending and torsion, as compared with the other two interbody cages, even with the additional posterior fixation. However, the two-part cage had the lowest rotational angles under flexion and torsion, but had no differences under extension and lateral bending. Conclusion The biomechanical benefit of a stand-alone two-part fusion cage can be justified. This device provided the stability required for interbody fusion, which supports clinical trials of the cage as an alternative to circumferential fixations.

Use of small stand-alone Internet nodes as a distributed control system

Science.gov (United States)

Goodwin, Robert W.; Kucera, Michael J.; Shea, Michael F.

1994-12-01

For several years, the standard model for accelerator control systems has been workstation consoles connected to VME local stations by a Local Area Network with analog and digital data being accessed via a field bus to custom I/O interface electronics. Commercially available hardware has now made it possible to implement a small stand-alone data acquisition station that combines the LAN connection, the computer, and the analog and digital I/O interface on a single board. This eliminates the complexity of a field bus and the associated proprietary I/O hardware. A minimum control system is one data acquisition station and a Macintosh or workstation console, both connected to the network; larger systems have more consoles and nodes. An implementation of this architecture is described along with performance and operational experience.

Improved Functional Performance in Geriatric Patients During Hospital Stay

DEFF Research Database (Denmark)

Karlsen, Anders; Loeb, Mads Rohde; Andersen, Kristine Bramsen

2017-01-01

OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.Measurement......OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.......Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (Activ...... in 30-s CST (P performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay...

Geriatric health care in India - Unmet needs and the way forward

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Prabha Adhikari

2017-01-01

Full Text Available India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly.

Factors influencing the life satisfaction in the older Korean women living alone.

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Kim, Sook-Young; Sok, Sohyune R

2013-04-01

The population of Korea is aging rapidly. The older population varies in characteristics in accordance with a wide-range of circumstances; therefore, categorizing the overall older population as a homogeneous group, could misrepresent their issues. For that reason, the study of older people should be focused on the diversity of characteristics among the older population. The aims of this study were to examine and identify the factors related to life satisfaction in older Korean women living alone. This study was a cross-sectional survey design. The participants comprised of 243 older women over the age of 65, who met eligibility criteria. Measures were a demographic characteristics form, the Health Self-Rating Scale, the Self-Esteem Scale (RSES), the Korean Geriatric Depression Scale Short Form, and the Life Satisfaction Instrument. Degrees of the perceived health status, self-esteem, and depression were higher than the median. Life satisfaction was lower than the median. Predictors that determine life satisfaction in older Korean women living alone were depression, perceived health status, self-esteem, and monthly allowance. All these predictors, or factors, had an explanatory power of 48.2% for life satisfaction among older Korean women living alone. Of all these predictor factors, depression had the largest impact. The major factor influencing the life satisfaction in older Korean women living alone was depression. These findings suggest that there is a need to develop nursing strategies aimed at decreasing depression in order to increase life satisfaction in older women living alone.

Geriatric trauma.

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Adams, Sasha D; Holcomb, John B

2015-12-01

The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium.

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Piers, Ruth D; Versluys, Karen J J; Devoghel, Johan; Lambrecht, Sophie; Vyt, André; Van Den Noortgate, Nele J

2017-09-01

To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. Cross-sectional multicenter study. Acute geriatric units in Belgium. Team members of different professional backgrounds. Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Studying feasibility and effects of a two-stage nursing staff training in residential geriatric care using a 30 month mixed-methods design [ISRCTN24344776

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Hantikainen Virpi

2011-05-01

Full Text Available Abstract Background Transfer techniques and lifting weights often cause back pain and disorders for nurses in geriatric care. The Kinaesthetics care conception claims to be an alternative, yielding benefits for nurses as well as for clients. Starting a multi-step research program on the effects of Kinaesthetics, we assess the feasibility of a two-stage nursing staff training and a pre-post research design. Using quantitative and qualitative success criteria, we address mobilisation from the bed to a chair and backwards, walking with aid and positioning in bed on the staff level as well as on the resident level. In addition, effect estimates should help to decide on and to prepare a controlled trial. Methods/Design Standard basic and advanced Kinaesthetics courses (each comprising four subsequent days and an additional counselling day during the following four months are offered to n = 36 out of 60 nurses in a residential geriatric care home, who are in charge of 76 residents. N = 22 residents needing movement support are participating to this study. On the staff level, measurements include focus group discussions, questionnaires, physical strain self-assessment (Borg scale, video recordings and external observation of patient assistance skills using a specialised instrument (SOPMAS. Questionnaires used on the resident level include safety, comfort, pain, and level of own participation during mobilisation. A functional mobility profile is assessed using a specialised test procedure (MOTPA. Measurements will take place at baseline (T0, after basic training (T1, and after the advanced course (T2. Follow-up focus groups will be offered at T1 and 10 months later (T3. Discussion Ten criteria for feasibility success are established before the trial, assigned to resources (missing data, processes (drop-out of nurses and residents and science (minimum effects criteria. This will help to make rational decision on entering the next stage of the research

Human microRNA target analysis and gene ontology clustering by GOmir, a novel stand-alone application.

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Roubelakis, Maria G; Zotos, Pantelis; Papachristoudis, Georgios; Michalopoulos, Ioannis; Pappa, Kalliopi I; Anagnou, Nicholas P; Kossida, Sophia

2009-06-16

microRNAs (miRNAs) are single-stranded RNA molecules of about 20-23 nucleotides length found in a wide variety of organisms. miRNAs regulate gene expression, by interacting with target mRNAs at specific sites in order to induce cleavage of the message or inhibit translation. Predicting or verifying mRNA targets of specific miRNAs is a difficult process of great importance. GOmir is a novel stand-alone application consisting of two separate tools: JTarget and TAGGO. JTarget integrates miRNA target prediction and functional analysis by combining the predicted target genes from TargetScan, miRanda, RNAhybrid and PicTar computational tools as well as the experimentally supported targets from TarBase and also providing a full gene description and functional analysis for each target gene. On the other hand, TAGGO application is designed to automatically group gene ontology annotations, taking advantage of the Gene Ontology (GO), in order to extract the main attributes of sets of proteins. GOmir represents a new tool incorporating two separate Java applications integrated into one stand-alone Java application. GOmir (by using up to five different databases) introduces miRNA predicted targets accompanied by (a) full gene description, (b) functional analysis and (c) detailed gene ontology clustering. Additionally, a reverse search initiated by a potential target can also be conducted. GOmir can freely be downloaded BRFAA.

Information systems for the materials management department: stand-alone and enterprise resource planning systems.

Science.gov (United States)

2005-03-01

Materials management information systems (MMISs) incorporate information tools that hospitals can use to automate certain business processes, increase staff compliance with these processes, and identify opportunities for cost savings. Recently, there has been a push by hospital administration to purchase enterprise resource planning (ERP) systems, information systems that promise to integrate many more facets of healthcare business. We offer this article to help materials managers, administrators, and others involved with information system selection understand the changes that have taken place in materials management information systems, decide whether they need a new system and, if so, whether a stand-alone MMIS or an ERP system will be the best choice.

Nurses' Learning Experiences with the Kinaesthetics Care Concept Training in a Nursing Home: A Qualitative Descriptive Study

Science.gov (United States)

Fringer, André; Huth, Martina; Hantikainen, Virpi

2015-01-01

In geriatric care, movement support skills of nurses are often limited, resulting in unnecessary functional decline of older adult residents and physical strain of nurses. Kinaesthetics training aims to improve movement competences of nurses and residents. The aim of this qualitative descriptive study is to describe nursing teams' experience with…

A Graduate Nursing Curriculum for the Evaluation and Management of Urinary Incontinence

Science.gov (United States)

Rogalski, Nicole

2005-01-01

Geriatric nurse practitioners should be educated in the evaluation and treatment of common geriatric syndromes like urinary incontinence. However, many advanced-practice nursing programs do not place an educational emphasis on urinary incontinence management. The purpose of this project is to provide information that supports the need for…

An optimized Fuzzy Logic Controller by Water Cycle Algorithm for power management of Stand-alone Hybrid Green Power generation

International Nuclear Information System (INIS)

Sarvi, Mohammad; Avanaki, Isa Nasiri

2015-01-01

Highlights: • A new method to improve the performance of renewable power management is proposed. • The proposed method is based on Fuzzy Logic optimized by the Water Cycle Algorithm. • The proposed method characteristics are compared with two other methods. • The comparisons confirm that the proposed method is robust and effectiveness one. - Abstract: This paper aims to improve the power management system of a Stand-alone Hybrid Green Power generation based on the Fuzzy Logic Controller optimized by the Water Cycle Algorithm. The proposed Stand-alone Hybrid Green Power consists of wind energy conversion and photovoltaic systems as primary power sources and a battery, fuel cell, and Electrolyzer as energy storage systems. Hydrogen is produced from surplus power generated by the wind energy conversion and photovoltaic systems of Stand-alone Hybrid Green Power and stored in the hydrogen storage tank for fuel cell later using when the power generated by primary sources is lower than load demand. The proposed optimized Fuzzy Logic Controller based power management system determines the power that is generated by fuel cell or use by Electrolyzer. In a hybrid system, operation and maintenance cost and reliability of the system are the important issues that should be considered in studies. In this regard, Water Cycle Algorithm is used to optimize membership functions in order to simultaneously minimize the Loss of Power Supply Probability and operation and maintenance. The results are compared with the particle swarm optimization and the un-optimized Fuzzy Logic Controller power management system to prove that the proposed method is robust and effective. Reduction in Loss of Power Supply Probability and operation and maintenance, are the most advantages of the proposed method. Moreover the level of the State of Charge of the battery in the proposed method is higher than other mentioned methods which leads to increase battery lifetime.

Valoración enfermera geriátrica: Un modelo de registro en residencias de ancianos Geriatric nurse assessment: A model of register in nursing home care

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Jesús Manuel Vallejo Sánchez

2007-06-01

detect the needs of the elder, to consider the risk of geriatric syndromes appearance and to plan the suitable care. Methods: Creation of workgroup, establishment of aims by consensus, bibliographical review, development of elaboration's criteria, coordination with the rest of the staff and validation of the document. Results: We obtain a nurse assessment register for elder institutionalized in nursing home care, of 8 pages, with opened and closed items, based on the model of Virginia Henderson's 14 needs and supported by nine scales of valuation, with its own cumplimentation guide. Conclusions: The time used in the geriatric nurse assessment is a necessary investment to assure a suitable and adequate assistance. It represents a useful tool for the nurses and the rest of the staff, as it allows to individualize the care, to quantify the disabilities and to provide the most adapted level of assistance to every single resident.

An international definition for "nursing home"

NARCIS (Netherlands)

Sanford, A.M.; Orrell, M.; Tolson, D.; Abbatecola, A.M.; Arai, H.; Bauer, J.M.; Cruz-Jentoft, A.J.; Dong, B.; Ga, H.; Goel, A.; Hajjar, R.; Holmerova, I.; Katz, P.R.; Koopmans, R.T.; Rolland, Y.; Visvanathan, R.; Woo, J.; Morley, J.E.; Vellas, B.

2015-01-01

There is much ambiguity regarding the term "nursing home" in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a

[Geriatrics, a form of holistic health care. A bright spot in difficult financial economic times?].

Science.gov (United States)

Dillmann, E B

1984-02-01

Geriatrics has a functional aim, also in a clinical setting; it determines meaningful priorities in the process of diagnosis and treatment of the vulnerable elderly patient and is of a horizontal nature within the other specializations. Additional tasks of geriatrics are the development of adjusted methods for examination and treatment, the pursuing of early onset diagnostics, to supply specific information and the training of geriatric specialists. Clinical geriatric examination should only take place after evaluating the patient in his or her living conditions at home. The patient should thereby fulfil the geriatric trias, that no admission in a nursery home or psychiatric hospital is indicated, that examination at home or at the outpatient department is impossible and that an emergency situation necessitates admission. Ambulantory geriatric care is indispensable for the well functioning of a clinical geriatric department and the two should form an unbreakable tie, which could eventually be transformed into a personal union. A geriatric department in a general hospital is limited in its indications for the admission of geriatric patients, has high operating costs and should be restricted in size per regio, having a minimal capacity of 25 to 30 beds. The geriatric team is broad in composition and strong in coherence. The period of admission of the patient should not exceed six weeks. A regional social-geriatric circuit combines a geriatric department of a general hospital with the ambulantory social-geriatric service, the admission and indication committee of nursing homes into a well tuned system of provisions for the aged.(ABSTRACT TRUNCATED AT 250 WORDS)

Diminished Dynamic Physical Performance Is Associated With Orthostatic Hypotension in Geriatric Outpatients.

Science.gov (United States)

de Bruïne, Eline S; Reijnierse, Esmee M; Trappenburg, Marijke C; Pasma, Jantsje H; de Vries, Oscar J; Meskers, Carel G M; Maier, Andrea B

2018-03-23

Orthostatic hypotension (OH), a blood pressure drop after postural change, is a highly prevalent and disabling syndrome in older adults. Yet, the association between physical performance and OH is not clearly established. The aim of this study was to determine whether different types of physical performance are associated with OH in a clinically relevant population of geriatric outpatients. This cross-sectional study included 280 geriatric outpatients (mean age: 82.2 years, standard deviation: 7.1). Orthostatic hypotension was determined using intermittently measured blood pressure and continuously measured blood pressure in a random subgroup of 58 patients. Physical performance was classified into a dynamic type (4-m Walk Test, Chair Stand Test, and Timed Up and Go test) and a static type (standing balance tests, handgrip strength). Associations were analyzed using logistic regression models with adjustments for age, sex, weight, and height. Diminished physical performance on the Chair Stand Test was associated with OH measured intermittently. Diminished physical performance on all dynamic physical domains (4-m Walk Test, Chair Stand Test, and Timed Up and Go test) was associated with OH measured continuously. Static physical performance was not significantly associated with OH. Dynamic physical performance tests with a substantial postural change and center of mass displacement were significantly associated with OH. The influence of physical performance on OH in daily routine activities should be further explored to establish counteracting interventions.

Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages.

Science.gov (United States)

Shiban, Ehab; Gapon, Karina; Wostrack, Maria; Meyer, Bernhard; Lehmberg, Jens

2016-02-01

To evaluate long-term results after one-, two-, and three-level anterior cervical discectomy and fusion (ACDF) with stand-alone empty polyetheretherketone (PEEK) cages. We performed a retrospective review of a consecutive patient cohort that underwent ACDF with stand-alone empty PEEK cages between 2007 and 2010 with a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared to radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain visual analog scale (VAS), and health-related quality of life (HRQL) using the EuroQOL questionnaire (EQ-5D). Analysis of associations between fusion, subsidence, cervical alignment, and clinical outcome parameters were performed. Of 407 consecutive cases, 318 met all inclusion criteria. Follow-up data were obtained from 265 (83 %) cases. The mean age at presentation was 55 years and 139 patients were male (52 %). In the sample, 127, 125, and 13 patients had one-, two-, and three-level surgeries, respectively; 132 (49 %) presented with spondylotic cervical myelopathy and 133 (50 %) with cervical radiculopathy. Fusion was achieved in 85, 95, and 94 % of segments in one-, two-, and three-level surgeries, respectively. Non-fusion was associated with higher VAS pain levels. Radiographic adjacent segment disease (ASD) was observed in 20, 29, and 15 % in one-, two-, and three-level surgeries, respectively. ASD was associated with lower HRQL. Subsidence was observed in 25, 27, and 15 % of segments in one-, two-, and three-level surgeries, respectively. However, this had no influence on clinical outcome. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 16 (6 %) and four (1.5 %) cases, respectively. Younger age was associated with better clinical outcome. Multilevel surgery favored better myelopathy outcomes and fusion reduced overall

US and Dutch nurse experiences with fall prevention technology within nursing home environment and workflow: a qualitative study

NARCIS (Netherlands)

Vandenberg, Ann E.; van Beijnum, Bernhard J.F.; Overdevest, Vera G.P.; Capezuti, Elizabeth; Johnson II, Theodore M.

2017-01-01

Falls remain a major geriatric problem, and the search for new solutions continues. We investigated how existing fall prevention technology was experienced within nursing home nurses' environment and workflow. Our NIH-funded study in an American nursing home was followed by a cultural learning

US and Dutch nurse experiences with fall prevention technology within nursing home environment and workflow : a qualitative study

NARCIS (Netherlands)

Vandenberg, Ann E.; van Beijnum, Bernhard J.F.; Overdevest, Vera G.P.; Capezuti, Elizabeth; Johnson II, Theodore M.

2017-01-01

Falls remain a major geriatric problem, and the search for new solutions continues. We investigated how existing fall prevention technology was experienced within nursing home nurses' environment and workflow. Our NIH-funded study in an American nursing home was followed by a cultural learning

Economic and Environmental Assessment of a Renewable Stand-Alone Energy Supply System Using Multi-objective Optimization

Energy Technology Data Exchange (ETDEWEB)

Lee, Dohyun; Han, Seulki; Kim, Jiyong Kim [Incheon National University, Incheon (Korea, Republic of)

2017-06-15

This study aims to propose a new optimization-based approach for design and analysis of the stand-alone hybrid energy supply system using renewable energy sources (RES). In the energy supply system, we include multiple energy production technologies such as Photovoltaics (PV), Wind turbine, and fossil-fuel-based AC generator along with different types of energy storage and conversion technologies such as battery and inverter. We then select six different regions of Korea to represent various characteristics of different RES potentials and demand profiles. We finally designed and analyzed the optimal RES stand-alone energy supply system in the selected regions using multiobjective optimization (MOOP) technique, which includes two objective functions: the minimum cost and the minimum CO{sub 2} emission. In addition, we discussed the feasibility and expecting benefits of the systems by comparing to conventional systems of Korea. As a result, the region of the highest RES potential showed the possibility to remarkably reduce CO{sub 2} emissions compared to the conventional system. Besides, the levelized cost of electricity (LCOE) of the RES-based energy system is identified to be slightly higher than conventional energy system: 0.35 and 0.46 $/kWh, respectively. However, the total life-cycle emission of CO{sub 2} (LCECO{sub 2}) can be reduced up to 470 gCO{sub 2}/kWh from 490 gCO{sub 2}/kWh of the conventional systems.

Clinician's perspectives of the relocation of a regional child and adolescent mental health service from co-located to stand alone premises.

Science.gov (United States)

Francis, K J; Boyd, C P; Sewell, J; Nurse, S

2008-01-01

Australia's National Mental Health Strategy's statement of rights and responsibilities states that children and adolescents admitted to a mental health facility or community program have the right to be separated from adult patients and provided with programs suited to their developmental needs. However, in rural Australia, where a lack of healthcare services, financial constraints, greater service delivery areas and fewer mental healthcare specialists represent the norm, Child and Adolescent Mental Health Services (CAMHS) are sometimes co-located with adult mental health services. The aim of the present study was to evaluate the impact of a recent relocation of a regional CAMHS in Victoria from co-located to stand alone premises. Six CAMHS clinicians who had experienced service delivery at a co-located setting and the current stand-alone CAMHS setting were interviewed about their perceptions of the impact of the relocation on service delivery. An exploratory interviewing methodology was utilized due to the lack of previous research in this area. Interview data were transcribed and analysed according to interpretative phenomenological analysis techniques. Findings indicated a perception that the relocation was positive for clients due to the family-friendly environment at the new setting and separation of CAMHS from adult psychiatric services. However, the impact of the relocation on clinicians was marked by a perceived loss of social capital from adult psychiatric service clinicians. These results provide increased understanding of the effects of service relocation and the influence of co-located versus stand-alone settings on mental health service delivery - an area where little prior research exists.

The cost of dysphagia in geriatric patients

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Westmark S

2018-06-01

Full Text Available Signe Westmark,1 Dorte Melgaard,1,2 Line O Rethmeier,3 Lars Holger Ehlers3 1Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; 2Department of Physiotherapy and Occupational Therapy, North Denmark Regional Hospital, Hjørring, Denmark; 3Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark Objectives: To estimate the annual cost at the hospital and in the municipality (social care due to dysphagia in geriatric patients.Design: Retrospective cost analysis of geriatric patients with dysphagia versus geriatric patients without dysphagia 1 year before hospitalization.Setting: North Denmark Regional Hospital, Hjørring Municipality, Frederikshavn Municipality, and Brønderslev Municipality.Subjects: A total of 258 hospitalized patients, 60 years or older, acute hospitalized in the geriatric department.Materials and methods: Volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for data collection. A Charlson Comorbidity Index score measured comorbidity, and functional status was measured by Barthel-100. To investigate the cost of dysphagia, patient-specific data on health care consumption at the hospital and in the municipality (nursing, home care, and training were collected from medical registers and records 1 year before hospitalization including the hospitalization for screening for dysphagia. Multiple linear regression analyses were conducted to determine the relationship between dysphagia and hospital and municipality costs, respectively, adjusting for age, gender, and comorbidity.Results: Patients with dysphagia were significantly costlier than patients without dysphagia in both hospital (p=0.013 and municipality costs (p=0.028 compared to patients without dysphagia. Adjusted annual hospital costs in patients with dysphagia were 27,347 DKK (3,677 EUR, 4,282 USD higher than patients without dysphagia at the hospital, and annual health care costs in the

A compact seven switches topology and reduced DC-link capacitor size for single-phase stand-alone PV system with hybrid energy storages

DEFF Research Database (Denmark)

Liu, Xiong; Wang, Peng; Loh, Poh Chiang

2011-01-01

Single-phase stand-alone PV system is suitable for household applications in remote area. Hybrid battery/ultra-capacitor energy storage can reduce charge and discharge cycles and avoid deep discharges of battery. This paper proposes a compact seven switches structure for stand-alone PV system......, which otherwise needs nine switches configuration, inclusive of one switch for boost converter, four switches for single-phase inverter and four switches for two DC/DC converters of battery and ultra-capacitor. It is well-known that a bulky DC-link capacitor is always required to absorb second......-order harmonic current caused by single-phase inverter. In the proposed compact topology, a small size DC-link capacitor can achieve the same function through charging/discharging control of ultra-capacitor to mitigate second-order ripple current. Simulation results are provided to validate the effectiveness...

Multidisciplinary education in geriatric medicine. Continuing experience at the Middlesex Hospital.

Science.gov (United States)

Beynon, G P; Croker, J

1983-01-01

The unique feature about the course in teaching geriatric medicine to undergraduates at the Middlesex Hospital is its multidisciplinary nature. The course lasts for three weeks during the first or second clinical year and involves medical students together with student physiotherapists, nurses and occupational therapists. All take part in seminars, ward rounds and multidisciplinary case presentations. A full-time course organizer funded by the School of Nursing manages the course. Assessment includes MCQ and course evaluation questionnaire and an essay.

Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions.

Science.gov (United States)

Lichtenstein, Brian J; Reuben, David B; Karlamangla, Arun S; Han, Weijuan; Roth, Carol P; Wenger, Neil S

2015-10-01

The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Comparison of pulp-mill-integrated hydrogen production from gasified black liquor with stand-alone production from gasified biomass

International Nuclear Information System (INIS)

Andersson, E.; Harvey, S.

2007-01-01

When gasified black liquor is used for hydrogen production, significant amounts of biomass must be imported. This paper compares two alternative options for producing hydrogen from biomass: (A) pulp-mill-integrated hydrogen production from gasified back liquor; and (B) stand-alone production of hydrogen from gasified biomass. The comparison assumes that the same amount of biomass that is imported in Alternative A is supplied to a stand-alone hydrogen production plant and that the gasified black liquor in Alternative B is used in a black liquor gasification combined cycle (BLGCC) CHP unit. The comparison is based upon equal amounts of black liquor fed to the gasifier, and identical steam and power requirements for the pulp mill. The two systems are compared on the basis of total CO 2 emission consequences, based upon different assumptions for the reference energy system that reflect different societal CO 2 emissions reduction target levels. Ambitions targets are expected to lead to a more CO 2 -lean reference energy system, in which case hydrogen production from gasified black liquor (Alternative A) is best from a CO 2 emissions' perspective, whereas with high CO 2 emissions associated with electricity production, hydrogen from gasified biomass and electricity from gasified black liquor (Alternative B) is preferable. (author)

Can aqueous hydrogen peroxide be used as a stand-alone energy source?

International Nuclear Information System (INIS)

Disselkamp, Robert S.

2010-01-01

A novel electrochemical scheme to convert a stand-alone supply of aqueous hydrogen peroxide into a fuel cell-ready stream of hydrogen gas plus aqueous hydrogen peroxide is described. The electrochemical cell, consisting of a solid base and solid acid electrocatalyst, together with a proton exchange membrane, comprise the system that converts aqueous hydrogen peroxide into separate gas streams of oxygen and hydrogen. Aqueous hydrogen peroxide is contained in the anode compartment only and exists in the region where oxygen gas is formed, whereas the cathode compartment is where hydrogen gas is generated and therefore exists in a reduced state. A near zero theoretical over-potential can be achieved by the choice of basicity and acidity of the electrode materials. The primary cost of the electrochemical cell is electrode construction and the aqueous hydrogen peroxide energy storage compound. Additional research effort is required to experimentally validate the concept and explore the full economic impact should initial studies, based on the design presented here, prove promising. (author)

Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages.

Science.gov (United States)

Kim, Chi Heon; Chung, Chun Kee; Jahng, Tae-Ahn; Park, Sung Bae; Sohn, Seil; Lee, Sungjoon

2015-02-01

Retrospective comparative study. Two polyetheretherketone (PEEK) cages of different designs were compared in terms of the postoperative segmental kyphosis after anterior cervical discectomy and fusion. Segmental kyphosis occasionally occurs after the use of a stand-alone cage for anterior cervical discectomy and fusion. Although PEEK material seems to have less risk of segmental kyphosis compared with other materials, the occurrence of segmental kyphosis for PEEK cages has been reported to be from 0% to 29%. There have been a few reports that addressed the issue of PEEK cage design. A total of 41 consecutive patients who underwent single-level anterior discectomy and fusion with a stand-alone cage were included. Either a round tube-type (Solis; 18 patients, S-group) or a trapezoidal tube-type (MC+; 23 patients, M-group) cage was used. The contact area between the cage and the vertebral body is larger in MC+ than in Solis, and anchoring pins were present in the Solis cage. The effect of the cage type on the segmental angle (SA) (lordosis vs. kyphosis) at postoperative month 24 was analyzed. Preoperatively, segmental lordosis was present in 12/18 S-group and 16/23 M-group patients (P=0.84). The SA was more lordotic than the preoperative angle in both groups just after surgery, with no difference between groups (P=0.39). At 24 months, segmental lordosis was observed in 9/18 S-group and 20/23 M-group patients (P=0.01). The patients in M-group were 7.83 times more likely than patients in S-group (P=0.04; odds ratio, 7.83; 95% confidence interval, 1.09-56.28) not to develop segmental kyphosis. The design of the PEEK cage used may influence the SA, and this association needs to be considered when using stand-alone PEEK cages.

Key factors for the implementation of successful, stand-alone village electrification schemes in Peru

Science.gov (United States)

Sanchez-Campos, Teodoro

The hypothesis of this work is that there are social, financial, technical, managerial institutional and political key factors that may either support or prevent the success of small stand alone energy systems in rural areas. This research work aims at contributing to the identification of such factors and study their relevance to the performance and sustainability of stand alone energy systems in rural areas; to meet its purpose, a wide range of literature was reviewed including rural electrification programmes and projects, research and development projects on access to electricity in rural areas, impact studies and others, and a field research survey was done the Andes and Upper Jungle regions in Peru. Nineteen possible critical factors were identified, thirteen with relevance at the local context (the community or village), and six with relevance at the national (or wider) context. From literature review it was found that the possible local critical factors were relevant only to four categories of factors instead of the six considered initially (i.e. social, financial, technological and managerial): the other two categories, political and institutional were found to be more relevant to the national context, therefore those were included in the group of possible critical factors of wider context. A series of questionnaires were designed to collect field data information, which was later used to analyse and establish the relation of each identified factor with the success of the systems studied. The survey research was implemented in 14 villages, 7 with small diesel sets and 7 with small hydropower schemes, all spread in the Andes and Upper Jungle of Peru, which were carefully selected to be representative of regions with isolated stand alone systems and with different socioeconomic background. Out of the 13 possible critical factors of local context, it was found that only 3 are really critical, the others are important but not critical; one of them (technical

Effekt of a two-stage nursing assesment and intervention - a randomized intervention study

DEFF Research Database (Denmark)

Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

% of geriatric patients have complex and often unresolved caring needs. The objective was to examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...... nursing assessment comprising a checklist of 10 physical, mental, medical and social items. The focus was on unresolved problems which require medical intervention, new or different home care services, or comprehensive geriatric assessment. Following this the nurses made relevant referrals...... to the geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: Primary endpoints will be presented as unplanned readmission to ED; admission to nursing home; and death. Secondary endpoints will be presented as physical function; depressive symptoms...

Study on the optimization of stand-alone type photovoltaic systems. 2

Energy Technology Data Exchange (ETDEWEB)

Lee, Man Geun; Song, Jin Soo; Kim, Boo ho; Park, I June; Jung, Meung Woong; Yoo, Kyun Joung; Kim, Hong Woo [Korea Inst. of Energy Research, Taejon (Korea, Republic of)

1995-12-01

The objectives of this study are to make a maximization of the operating efficiency of photovoltaic power systems, to improve stand- align PV systems design, technical operation and system analysis, and to promote technical cooperation of mutual interest in the area of IEA/PVPS program. This study aims to investigating the problems of applied photovoltaic power systems currently in operation to improve a system design, seeking remedies of individual PVPS applications to improve the system efficiency and reliability and to raise the system economics, and reporting the international movements of PV system dissemination and technical cooperation for developing countries. For the purpose of this works 1) Investigations of applications of existing photovoltaic power systems: - Photovoltaic electric sources used for expressway lamps - Optimum design of solar light with low pressure sodium lamps under 8 hours lighting a day at night by program-able electronic timer. 2) Comparative analyses of Marado PV system and propose a new reliable PV-diesel hybrid system and high efficiency operations. 3) Overall review of Hahwado 60 KWp PV system extending from 25 KWp and the remote monitoring systems for measurement of its operating results. 4) Introduction of IEA/PVPS international cooperating program, especially in task III for stand- alone PV systems and isolated islands and Exco meeting. As results, investigative findings of PVPS currently in operation and the work for improvement - Propose a prescription of Marado PV systems being blocked up by explosion of electrical demands from residence, parallel operational dual inverter with a big capacity. - There are shortage of solar generated power due to shortage of solar cell capacity that results in an increased operating time of diesel generator. Hence the insolation capacity of solar cell per household is continuously increased from the 0.5 KWp to 2 KWp in Hanwado island electrification.

The effect of flooring on musculoskeletal symptoms in the lower extremities and low back among female nursing assistants.

Science.gov (United States)

Wahlström, Jens; Ostman, Christina; Leijon, Ola

2012-01-01

This study examines the effect of changing the floor from a 2-mm homogenous vinyl floor to a 4-mm heterogeneous vinyl floor (1.5-mm wear layer and 2.5-mm foam layer) on musculoskeletal symptoms in the lower extremities and low back among nursing assistants in a geriatric care centre. A pre-post design with a reference group consisting of nursing assistants from a similar geriatric care centre was used. Follow-up measurements were carried out 12 and 24 months after the intervention by means of questionnaires. At the 1-year follow-up, the pain intensity score in the feet of the intervention group had decreased compared with the baseline value and remained statistically significant at the 2-year follow-up. The decrease in pain intensity score of the feet in the intervention group was statistically significantly different from the reference group, both after 1 and 2 years. The results show the importance of flooring in the workplace with regard to reducing musculoskeletal symptoms. Appropriate flooring is especially important in the female-dominated health care sector, where workers must stand or walk for long periods.

Geriatric Foot Care: A Model Educational Program for Mid-Level Practitioners.

Science.gov (United States)

Suggs, Patricia K.; Krissak, Ruth; Caruso, Frank; Teasdall, Robert

2002-01-01

An educational program on geriatric foot care was completed by 59 nurse practitioners, 12 physicians' assistants, and 1 physician. The 3 1/2 day program included interactive sessions, observation, and hands-on patient care. Posttest results and 6-month follow-up showed significant knowledge increases and incorporation of learning into practice.…

The uniqueness of elderly care: registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care.

Science.gov (United States)

Carlson, Elisabeth; Bengtsson, Mariette

2014-04-01

The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments. © 2013.

Narrative of a Teaching Practice. An Autoethnography about Being a Geriatrics Professor

Science.gov (United States)

Bulgarelli, Alexandre F.; Toassi, Ramona F. C.

2018-01-01

This study was developed to show a professor's perspective to comprehend his difficulties and challenges, within a different scenario and culture of teaching geriatric dentistry in a nursing home. It was a self-analysis theoretically supported by the Social Constructionism and the Interpretative Autoethnography perspective. Data were constructed…

Association of polypharmacy with fall risk among geriatric outpatients.

Science.gov (United States)

Kojima, Taro; Akishita, Masahiro; Nakamura, Tetsuro; Nomura, Kazushi; Ogawa, Sumito; Iijima, Katsuya; Eto, Masato; Ouchi, Yasuyoshi

2011-10-01

To investigate the association of fall risk with comorbidities and medications in geriatric outpatients in a cross-sectional design.   A total of 262 outpatients (84 men and 178 women, mean age 76.2±6.8years) were evaluated. Physical examination, clinical histories and medication profile were obtained from each patient. History of falls in the past year, 22-item fall risk index, 13-point simple screening test for fall, and time interval of one-leg standing test were examined as markers of fall risk. On univariate analysis, older age, female sex, hypertension, osteoporosis, history of stroke, number of comorbidities, use of antihypertensives, aspirin, bisphosphonates, hypnotics and number of prescribed drugs were significantly associated with either of four indices. On multiple regression analysis, the number of drugs was associated with all of the four indices, independent of other factors associated in the univariate analysis. The association of number of drugs with fall risk indices was stepwise. In geriatric outpatients, polypharmacy rather than number of comorbidities was associated with fall risk. Prospective and intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidities and fall risk. © 2011 Japan Geriatrics Society.

SedInConnect: a stand-alone, free and open source tool for the assessment of sediment connectivity

Science.gov (United States)

Crema, Stefano; Cavalli, Marco

2018-02-01

There is a growing call, within the scientific community, for solid theoretic frameworks and usable indices/models to assess sediment connectivity. Connectivity plays a significant role in characterizing structural properties of the landscape and, when considered in combination with forcing processes (e.g., rainfall-runoff modelling), can represent a valuable analysis for an improved landscape management. In this work, the authors present the development and application of SedInConnect: a free, open source and stand-alone application for the computation of the Index of Connectivity (IC), as expressed in Cavalli et al. (2013) with the addition of specific innovative features. The tool is intended to have a wide variety of users, both from the scientific community and from the authorities involved in the environmental planning. Thanks to its open source nature, the tool can be adapted and/or integrated according to the users' requirements. Furthermore, presenting an easy-to-use interface and being a stand-alone application, the tool can help management experts in the quantitative assessment of sediment connectivity in the context of hazard and risk assessment. An application to a sample dataset and an overview on up-to-date applications of the approach and of the tool shows the development potential of such analyses. The modelled connectivity, in fact, appears suitable not only to characterize sediment dynamics at the catchment scale but also to integrate prediction models and as a tool for helping geomorphological interpretation.

Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel.

Science.gov (United States)

Ben Natan, Merav; Heyman, Neomi; Ben Israel, Joshua

2016-01-01

To identify risk factors for elder falls in a geriatric rehabilitation center in Israel. Retrospective chart review study. Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not. Of elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition. The research findings single out patients who are allegedly at a lower risk of falls than more complex patients. Caregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular. © 2014 Association of Rehabilitation Nurses.

Venlafaxine-Induced Orthostatic Hypotension in a Geriatric Patient

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Vidyashree Chikkaramanjegowda

2013-01-01

Full Text Available Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in geriatric patients. Our patient did not have orthostatic hypotension when she was taking venlafaxine at 60 years of age in higher venlafaxine doses (300 mg/day but developed this adverse drug reaction when venlafaxine was restarted at the geriatric age. This case indicates that a history of prior tolerance to venlafaxine does not guarantee tolerance after 65 years of age. If a clinician decides to use venlafaxine in geriatric patients, the clinician should warn the patient about the risk of orthostatic hypotension and consider very slow titration and low doses.

Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis

Directory of Open Access Journals (Sweden)

Nunley PD

2017-09-01

Full Text Available Pierce D Nunley,1 Vikas V Patel,2 Douglas G Orndorff,3 William F Lavelle,4 Jon E Block,5 Fred H Geisler6 1Spine Institute of Louisiana, Shreveport, LA, 2The Spine Center, University of Colorado Hospital, Denver, CO, 3Spine Colorado, Mercy Regional Hospital, Durango, CO, 4Upstate Bone and Joint Center, East Syracuse, NY, 5Independent Consultant, San Francisco, CA, 6Independent Consultant, Chicago, IL, USA Background: Lumbar spinal stenosis is the most common indication for spine surgery in older adults. Interspinous process decompression (IPD using a stand-alone spacer that functions as an extension blocker offers a minimally invasive treatment option for intermittent neurogenic claudication associated with spinal stenosis.Methods: This study evaluated the 5-year clinical outcomes for IPD (Superion® from a randomized controlled US Food and Drug Administration (FDA noninferiority trial. Outcomes included Zurich Claudication Questionnaire (ZCQ symptom severity (ss, physical function (pf, and patient satisfaction (ps subdomains, leg and back pain visual analog scale (VAS, and Oswestry Disability Index (ODI.Results: At 5 years, 84% of patients (74 of 88 demonstrated clinical success on at least two of three ZCQ domains. Individual ZCQ domain success rates were 75% (66 of 88, 81% (71 of 88, and 90% (79 of 88 for ZCQss, ZCQpf, and ZCQps, respectively. Leg and back pain success rates were 80% (68 of 85 and 65% (55 of 85, respectively, and the success rate for ODI was 65% (57 of 88. Percentage improvements over baseline were 42%, 39%, 75%, 66%, and 58% for ZCQss, ZCQpf, leg and back pain VAS, and ODI, respectively (all P<0.001. Within-group effect sizes were classified as very large for four of five clinical outcomes (ie, >1.0; all P<0.0001. Seventy-five percent of IPD patients were free from reoperation, revision, or supplemental fixation at their index level at 5 years.Conclusion: After 5 years of follow-up, IPD with a stand-alone spacer provides

Multi-objective analytical model for optimal sizing of stand-alone photovoltaic water pumping systems

International Nuclear Information System (INIS)

Olcan, Ceyda

2015-01-01

Highlights: • An analytical optimal sizing model is proposed for PV water pumping systems. • The objectives are chosen as deficiency of power supply and life-cycle costs. • The crop water requirements are estimated for a citrus tree yard in Antalya. • The optimal tilt angles are calculated for fixed, seasonal and monthly changes. • The sizing results showed the validity of the proposed analytical model. - Abstract: Stand-alone photovoltaic (PV) water pumping systems effectively use solar energy for irrigation purposes in remote areas. However the random variability and unpredictability of solar energy makes difficult the penetration of PV implementations and complicate the system design. An optimal sizing of these systems proves to be essential. This paper recommends a techno-economic optimization model to determine optimally the capacity of the components of PV water pumping system using a water storage tank. The proposed model is developed regarding the reliability and cost indicators, which are the deficiency of power supply probability and life-cycle costs, respectively. The novelty is that the proposed optimization model is analytically defined for two-objectives and it is able to find a compromise solution. The sizing of a stand-alone PV water pumping system comprises a detailed analysis of crop water requirements and optimal tilt angles. Besides the necessity of long solar radiation and temperature time series, the accurate forecasts of water supply needs have to be determined. The calculation of the optimal tilt angle for yearly, seasonally and monthly frequencies results in higher system efficiency. It is, therefore, suggested to change regularly the tilt angle in order to maximize solar energy output. The proposed optimal sizing model incorporates all these improvements and can accomplish a comprehensive optimization of PV water pumping systems. A case study is conducted considering the irrigation of citrus trees yard located in Antalya, Turkey

Integrated Three-Port DC-DC Converter for Photovoltaic (PV) Battery Stand-alone Systems

DEFF Research Database (Denmark)

Ouyang, Ziwei; Andersen, Michael A. E.

2016-01-01

of solar energy. Moreover, a novel transformer configuration enables variable turns ratio controlled by the phase between the two current excitations subjected to the primary windings, allowing a wider input/output range. 1 kW experimental prototype has been built to demonstrate a wellmanaged power flow......Several power sources such as PV solar arrays and battery are often used to manage the power flow for a photovoltaic (PV) based stand-alone power system due to the fluctuation nature of solar energy resource, and deliver a continuous power to the users in an appropriate form. Traditionally, three...... different single-input single-output (SISO) dc/dc converters would have been used. To reduce the cost and improve the power density of the system, an integrated three-port isolated dc/dc converter is proposed in this paper. It can realize all functions of the energy delivery due to the fluctuation nature...

JAERI Fuel Cleanup System (J-FCU) stand-alone tritium test at the TSTA

International Nuclear Information System (INIS)

Konishi, Satoshi; Hayashi, Takumi; Inoue, Masahiko

1993-03-01

JAERI designed, fabricated, and installed the JAERI Fuel Cleanup System (J-FCU) as a subsystem of simulated fusion fuel loop at the TSTA. The main function of the J-FCU is to purify and to recover hydrogen isotopes from simulated plasma exhaust while exhausting tritium free impurities. After a lot of deuterium tests, a first tritium test of the J-FCU was performed with one gram of tritium at the TSTA on June 1991. Main purpose of this test was to evaluate the total integrity and function of the J-FCU system with a DT mixture. Through this test, the J-FCU was operated well and its function with tritium was demonstrated. This report describes the detail test results of the J-FCU first tritium test and discuss its functions by stand-alone mode. Residual tritium inventory of the J-FCU system was also discussed. (author)

System Simulation by Recursive Feedback: Coupling a Set of Stand-Alone Subsystem Simulations

Science.gov (United States)

Nixon, D. D.

2001-01-01

Conventional construction of digital dynamic system simulations often involves collecting differential equations that model each subsystem, arran g them to a standard form, and obtaining their numerical gin solution as a single coupled, total-system simultaneous set. Simulation by numerical coupling of independent stand-alone subsimulations is a fundamentally different approach that is attractive because, among other things, the architecture naturally facilitates high fidelity, broad scope, and discipline independence. Recursive feedback is defined and discussed as a candidate approach to multidiscipline dynamic system simulation by numerical coupling of self-contained, single-discipline subsystem simulations. A satellite motion example containing three subsystems (orbit dynamics, attitude dynamics, and aerodynamics) has been defined and constructed using this approach. Conventional solution methods are used in the subsystem simulations. Distributed and centralized implementations of coupling have been considered. Numerical results are evaluated by direct comparison with a standard total-system, simultaneous-solution approach.

Toward the realization of a better aged society: messages from gerontology and geriatrics.

Science.gov (United States)

Arai, Hidenori; Ouchi, Yasuyoshi; Yokode, Masayuki; Ito, Hideki; Uematsu, Hiroshi; Eto, Fumio; Oshima, Shinichi; Ota, Kikuko; Saito, Yasushi; Sasaki, Hidetada; Tsubota, Kazuo; Fukuyama, Hidenao; Honda, Yoshihito; Iguchi, Akihisa; Toba, Kenji; Hosoi, Takayuki; Kita, Toru

2012-01-01

. (2) Fostering medical specialists for aging Older people often suffer from many diseases, together with geriatric syndromes with multiple etiologies. Signs and symptoms vary according to each individual, and are often atypical; therefore, the patients visit different hospitals and receive many screening tests and prescriptions at the same time. To solve this problem, an effective screening system carried out by a primary-care doctor, and privacy-preserving medical data sharing among hospitals and clinics are needed. In a geriatric clinical setting, health-care professionals should be aware of the physical traits of older people who often develop not only dementia, but also geriatric syndromes, such as depression, falls and urinary incontinence, so that a holistic approach with consideration of nursing care is required. However, the existing Japanese medical education system is not prepared for medical professionals enabled to respond to the aforementioned requirements. Thus, the fostering of medical professionals who can provide comprehensive care - especially for the oldest-old - such as geriatric specialists and medical professionals who understand the principles of elderly care, is urgently needed. (3) Diagnosis of elderly-specific diseases and reform of medical-care services In Japan, the diagnostic system for elderly-specific diseases, including dementia, and reform of medical care services are markedly delayed. The current status concerning diagnosis, care and nursing should be investigated to collect academic data. In order to accumulate evidence for providing safe elderly care and nursing, the promotion of clinical research and a marked expansion of geriatric medical centers with high-level medical services are eagerly awaited. (4) Promotion of home-based care and multidisciplinary care To reduce the length of stay in acute hospitals, to reduce the physical burden of health-care professionals working at acute hospitals and to meet the demand of older people

DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study

Energy Technology Data Exchange (ETDEWEB)

Kaiser, Clemens G.; Krammer, J.; Wasser, K.; Schoenberg, S.O. [University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Reich, C.; Kaiser, W.A. [Friedrich-Schiller-University Hospital Jena, Institute of Diagnostic and Interventional Radiology I, Jena (Germany); Dietzel, M. [Friedrich-Alexander-University Hospital Erlangen-Nuernberg, Department of Neuroradiology, Erlangen (Germany); Baltzer, P.A.T. [Medical University Vienna, Institute of Radiology and Nuclear Medicine, Vienna (Austria)

2015-06-01

To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. (orig.)

DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study

International Nuclear Information System (INIS)

Kaiser, Clemens G.; Krammer, J.; Wasser, K.; Schoenberg, S.O.; Reich, C.; Kaiser, W.A.; Dietzel, M.; Baltzer, P.A.T.

2015-01-01

To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. (orig.)

Control of a Stand-Alone Variable Speed Wind Energy Supply System †

Directory of Open Access Journals (Sweden)

Mohamed M. Hamada

2013-04-01

Full Text Available This paper presents a simple control strategy for the operation of a variable speed stand-alone wind turbine with a permanent magnet synchronous generator (PMSG. The PMSG is connected to a three phase resistive load through a switch mode rectifier and a voltage source inverter. Control of the generator side converter is used to achieve maximum power extraction from the available wind power. Control of the DC-DC bidirectional buck-boost converter, which is connected between batteries bank and DC-link voltage, is used to maintain the DC-link voltage at a constant value. It is also used to make the batteries bank stores the surplus of wind energy and supplies this energy to the load during a wind power shortage. The load side voltage source inverter uses a relatively complex vector control scheme to control the output load voltage in terms of amplitude and frequency. The control strategy works under wind speed variation as well as with variable load. Extensive simulation results have been performed using MATLAB/SIMULINK.

Stand-alone excitation synchronous wind power generators with power flow management strategy

Directory of Open Access Journals (Sweden)

Tzuen-Lih Chern

2014-09-01

Full Text Available This study presents a stand-alone excitation synchronous wind power generator (SESWPG with power flow management strategy (PFMS. The rotor speed of the excitation synchronous generator tracks the utility grid frequency by using servo motor tracking technologies. The automatic voltage regulator governs the exciting current of generator to achieve the control goals of stable voltage. When wind power is less than the needs of the consumptive loading, the proposed PFMS increases motor torque to provide a positive power output for the loads, while keeping the generator speed constant. Conversely, during the periods of wind power greater than output loads, the redundant power of generator production is charged to the battery pack and the motor speed remains constant with very low power consumption. The advantage of the proposed SESWPG is that the generator can directly output stable alternating current (AC electricity without using additional DC–AC converters. The operation principles with software simulation for the system are described in detail. Experimental results of a laboratory prototype are shown to verify the feasibility of the system.

One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment

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Daphne Eschbach

2016-01-01

Full Text Available Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU treatment, including invasive ventilatory management (IVM and hemodiafiltration (CVVHDF, is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA classification, and the Barthel index (BI were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% 3d cohort were significantly increased (p=0.001. Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.

Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines.

Science.gov (United States)

Southerland, Lauren T; Gure, Tanya R; Ruter, Daniel I; Li, Michael M; Evans, David C

2017-08-01

The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures. This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma). The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P quality indicators is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Geriatric syndromes: medical misnomer or progress in geriatrics?

NARCIS (Netherlands)

Olde Rikkert, M.G.M.; Rigaud, A.S.; Hoeyweghen, R.J. van; Graaf, J. de

2003-01-01

Both in geriatric and internal medicine journals, and in medical textbooks certain (aggregates of) symptoms are labelled as 'geriatric syndromes'. In frail elderly patients a large number of diseases present with well-known and highly prevalent atypical symptoms (e.g. immobility, instability,

Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.

Science.gov (United States)

Díez-Manglano, Jesús; de Escalante Yangüela, Begoña; García-Arilla Calvo, Ernesto; Ubis Díez, Elena; Munilla López, Eulalia; Clerencia Sierra, Mercedes; Revillo Pinilla, Paz; Omiste Sanvicente, Teresa

2013-12-01

To determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units. A cross-sectional multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index wasinternal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p=.01), digestive (8.3% vs 3.0%; p=.04) and oncohematological diseases (30.2% vs 18.8%; p=.01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; pinternal medicine inpatients [4.0(2.1) vs 3.5(2.1); p=.04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); pinternal medicine and geriatrics departments. © 2013.

Geriatric Fever Score: a new decision rule for geriatric care.

Directory of Open Access Journals (Sweden)

Min-Hsien Chung

Full Text Available Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups.Consecutive geriatric patients (≥65 years old visiting the emergency department (ED of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done.Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3, Severe coma (GCS ≤ 8, and Thrombocytopenia (platelets <150 10(3/mm3 (LST. After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0% (95% CI: 2.3-6.9%: a general ward or treatment in the ED then discharge and high (30.3% (95% CI: 17.4-47.3%: consider the intensive care unit. The area under the curve for the rule was 0.73.We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need.

Performance and Simulation of a Stand-alone Parabolic Trough Solar Thermal Power Plant

Science.gov (United States)

Mohammad, S. T.; Al-Kayiem, H. H.; Assadi, M. K.; Gilani, S. I. U. H.; Khlief, A. K.

2018-05-01

In this paper, a Simulink® Thermolib Model has been established for simulation performance evaluation of Stand-alone Parabolic Trough Solar Thermal Power Plant in Universiti Teknologi PETRONAS, Malaysia. This paper proposes a design of 1.2 kW parabolic trough power plant. The model is capable to predict temperatures at any system outlet in the plant, as well as the power output produced. The conditions that are taken into account as input to the model are: local solar radiation and ambient temperatures, which have been measured during the year. Other parameters that have been input to the model are the collector’s sizes, location in terms of latitude and altitude. Lastly, the results are presented in graphical manner to describe the analysed variations of various outputs of the solar fields obtained, and help to predict the performance of the plant. The developed model allows an initial evaluation of the viability and technical feasibility of any similar solar thermal power plant.

Power quality improvement of a stand-alone power system subjected to various disturbances

Science.gov (United States)

Lone, Shameem Ahmad; Mufti, Mairaj Ud-Din

In wind-diesel stand-alone power systems, the disturbances like random nature of wind power, turbulent wind, sudden changes in load demand and the wind park disconnection effect continuously the system voltage and frequency. The satisfactory operation of such a system is not an easy task and the control design has to take in to account all these subtleties. For maintaining the power quality, generally, a short-term energy storage device is used. In this paper, the performance of a wind-diesel system associated with a superconducting magnetic energy storage (SMES) system is studied. The effect of installing SMES at wind park bus/load bus, on the system performance is investigated. To control the exchange of real and reactive powers between the SMES unit and the wind-diesel system, a control strategy based on fuzzy logic is proposed. The dynamic models of the hybrid power system for most common scenarios are developed and the results presented.

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

Science.gov (United States)

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

2015-03-01

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

Evaluation of a proper controller performance for maximum-power point tracking of a stand-alone PV system

Energy Technology Data Exchange (ETDEWEB)

Nafeh, A.E.-S.A.; Fahmy, F.H. [Electronics Research Institute, Cairo (Egypt); El-Zahab, E.M.A. [Cairo University, Giza (Egypt). Faculty of Engineering

2003-02-01

In this paper the implementation of a suggested stand-alone PV system, for maximum-power point tracking (MPPT), is carried out. Also, this paper presents a comparative study, through experimental work, between the conventional PI controller and the fuzzy logic controller (FLC) under different atmospheric conditions. The implemented system with both the PI controller and the FLC gives a good maximum-power operation of the PV array, but the tracking capability for different optimum operating points is better and faster for the case of using the FLC compared to the case of using the PI controller. (author)

Feed-back between geriatric syndromes: general system theory in geriatrics.

Science.gov (United States)

Musso, Carlos G; Núñez, Juan F Macías

2006-01-01

Geriatrics has described three entities: confusional syndrome, incontinente and gait disorders, calling them geriatric giants. Aging process also induces changes in renal physiology such as glomerular filtration rate reduction, and alteration in water and electrolytes handling. These ageing renal changes have been named as nephrogeriatric giants. These two groups of giants, geriatric and nephrogeriatric, can predispose and potentiate each other leading old people to fatal outcomes. These phenomenon of feed-back between these geriatric syndromes has its roots in the loss of complexity that the ageing process has. Complexity means that all the body systems work harmoniously. The process of senescence weakens this coordination among systems undermining complexity and making the old person frail.

Antidepressant treatment of depression in rural nursing home residents.

Science.gov (United States)

Kerber, Cindy Sullivan; Dyck, Mary J; Culp, Kennith R; Buckwalter, Kathleen

2008-09-01

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.

Nurses stand by, on standby

DEFF Research Database (Denmark)

Kjær, Malene; Raudaskoski, Pirkko Liisa

Nursing profession consists of never-ending diagnostic work and she has to treat smells, visual cues and noises from people and machines as being potentially relevant next attention and action spaces A nurse needs to have a broad perspective on the daily routines: which patient is next in line...... for surgery, does any colleague need assistance, and so on. To do this diagnostic work, nurses move within and between different hospital spaces and, at the same time, their level of attention (Norris, 2004) shifts between local, often occasioned, sites of engagement (Scollon & Scollon, 2004) or contextual...... configurations (Goodwin, 2000) and more overall activities (that are, of course, also accomplished locally). In the professional literature, this alertness is often ‘hidden’ in the definition of nursing as a symbiosis of communication, ethics for the patient and technical skills. With this study we want to fill...

Can electrical stimulation enhance effects of a functional training program in hospitalized geriatric patients?

Science.gov (United States)

Zinglersen, Amanda Hempel; Halsteen, Malte Bjoern; Kjaer, Michael; Karlsen, Anders

2018-06-01

Hospitalization of older medical patients may lead to functional decline. This study investigated whether simultaneously applied neuromuscular electrical stimulation (NMES) can enhance the effects of a functional training program in hospitalized geriatric patients. This was a quasi-randomized controlled trial in geriatric hospitalized patients (N = 16, age = 83.1 ± 8.1 years, mean ± SD). The patients performed a simple and time efficient chair-stand based functional exercise program daily, either with (FT + NMES, N = 8) or without (FT, N = 8) simultaneous NMES to the knee extensor muscles. Physical function was assessed at day 2 and 6-10 of the hospitalization with the De Morton Mobility Index (DEMMI), a 30-second chair stand test (30 s-CST) and a 4-meter gait speed test (4 m-GST). Additionally, the pooled results of training from the two training groups (TRAINING, N = 16) was compared to a similar historical control-group (CON, N = 48) receiving only standard-care. Eight patients were assigned to FT, 12 to FT+NMES with 4 dropouts during intervention. During the 6-10 days of hospitalization, both groups improved in all functional measures (p  0.05). The training sessions within the FT+NMES-group were more time consuming (~11 vs ~7 min) and entailed higher levels of discomfort than FT-training sessions. Compared to standard-care, training resulted in significantly larger improvements in the 30 s-CST (TRAINING: +3.8 repetitions; CON: +1.4 repetitions, p functional training program improves chair stand performance in hospitalized geriatric patients, with no additional effect of simultaneous electrical muscle stimulation. Copyright © 2018 Elsevier Inc. All rights reserved.

Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment

DEFF Research Database (Denmark)

Sletvold, O; Tilvis, R; Jonsson, A

1996-01-01

A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help f...... languages, and the translated versions should ideally have been subjected to validity and reliability testing. However, so far no scale meets these demands regarding all the five Nordic languages.......A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help...... for the clinician concerned with hospital based geriatric medicine. It may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriatricians. To some extent, the position of geriatric medicine in the Nordic countries varies between the countries. However...

The RBANS Effort Index: base rates in geriatric samples.

Science.gov (United States)

Duff, Kevin; Spering, Cynthia C; O'Bryant, Sid E; Beglinger, Leigh J; Moser, David J; Bayless, John D; Culp, Kennith R; Mold, James W; Adams, Russell L; Scott, James G

2011-01-01

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

Geriatric simulation: practicing management and leadership in care of the older adult.

Science.gov (United States)

Miller, Sally; Overstreet, Maria

2015-06-01

According to the Centers for Disease Control and Prevention, patients age 65 and older account for 43% of hospital days. The complexity of caring for older adults affords nursing students opportunities to assess, prioritize, intervene, advocate, and experience being a member of an interdisciplinary health care team. However, these multifaceted hospital experiences are not consistently available for all students. Nursing clinical simulation (NCS) can augment or replace specific clinical hours and provide clinically relevant experiences to practice management and leadership skills while caring for older adults. This article describes a geriatric management and leadership NCS. Copyright © 2015 Elsevier Inc. All rights reserved.

Probabilistic modelling and analysis of stand-alone hybrid power systems

International Nuclear Information System (INIS)

Lujano-Rojas, Juan M.; Dufo-López, Rodolfo; Bernal-Agustín, José L.

2013-01-01

As a part of the Hybrid Intelligent Algorithm, a model based on an ANN (artificial neural network) has been proposed in this paper to represent hybrid system behaviour considering the uncertainty related to wind speed and solar radiation, battery bank lifetime, and fuel prices. The Hybrid Intelligent Algorithm suggests a combination of probabilistic analysis based on a Monte Carlo simulation approach and artificial neural network training embedded in a genetic algorithm optimisation model. The installation of a typical hybrid system was analysed. Probabilistic analysis was used to generate an input–output dataset of 519 samples that was later used to train the ANNs to reduce the computational effort required. The generalisation ability of the ANNs was measured in terms of RMSE (Root Mean Square Error), MBE (Mean Bias Error), MAE (Mean Absolute Error), and R-squared estimators using another data group of 200 samples. The results obtained from the estimation of the expected energy not supplied, the probability of a determined reliability level, and the estimation of expected value of net present cost show that the presented model is able to represent the main characteristics of a typical hybrid power system under uncertain operating conditions. - Highlights: • This paper presents a probabilistic model for stand-alone hybrid power system. • The model considers the main sources of uncertainty related to renewable resources. • The Hybrid Intelligent Algorithm has been applied to represent hybrid system behaviour. • The installation of a typical hybrid system was analysed. • The results obtained from the study case validate the presented model

Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment

Directory of Open Access Journals (Sweden)

Samuel Silva

2018-04-01

Full Text Available The Comprehensive Geriatric Assessment (CGA is a multidisciplinary diagnosis approach that considers several dimensions of fragility in older adults to develop an individualized plan to improve their overall health. Despite the evidence of its positive impact, CGA is still applied by a reduced number of professionals in geriatric care in many countries, mostly using a paper-based approach. In this context, we collaborate with clinicians to bring CGA to the attention of more healthcare professionals and to enable its easier application in clinical settings by proposing a mobile application, Geriatric Helper, to act as a pocket guide that is easy to update remotely with up-to-date information, and that acts as a tool for conducting CGA. This approach reduces the time spent on retrieving the scales documentation, the overhead of calculating the results, and works as a source of information for non-specialists. Geriatric Helper is a tool for the health professionals developed considering an iterative, User-Centred Design approach, with extensive contributions from a broad set of users including domain experts, resulting in a highly usable and accepted system. Geriatric Helper is currently being tested in Portuguese healthcare units allowing for any clinician to apply the otherwise experts-limited geriatric assessment.

An Analysis of Stand-alone GPS Quality and Simulated GNSS Quality for Road Pricing

DEFF Research Database (Denmark)

Zabic, Martina; Nielsen, Otto Anker

2006-01-01

Use of GPS for road pricing has often been suggested as the way of creating more efficient charging strategies than existing systems based on cordon lines or time use. In Denmark, Copenhagen participated with the AKTA project in the PRoGRESS programme, sponsored by the EU. The major part...... of the AKTA project was to equip 500 cars with GPS receivers. The paper presents the methods and results from a study of GPS quality in relation to road pricing in a dense urban area. The collected data from 500 cars over a two-year period in the Copenhagen region was analyzed in order to determine whether...... the stand alone GPS quality and reliability is adequate for implementation of an operational road pricing system in Copenhagen. The results from the analysis show that the satellite availability in Copenhagen is not sufficient to form the basis for a reliable operational road pricing system. The narrow...

Why geriatrics? Academic geriatricians' perceptions of the positive, attractive aspects of geriatrics.

Science.gov (United States)

Cravens, D D; Campbell, J D; Mehr, D R

2000-01-01

Recruitment of geriatrics trainees has been poor, and the current shortage of academic geriatricians is expected to worsen. Although barriers to entering geriatrics practice have been identified, a review of the literature found few studies about why people choose to enter geriatrics. We used qualitative methods to investigate the positive, attractive aspects of geriatrics. Long interviews with six academic geriatricians were taped and transcribed. Transcripts were entered into a textual database computer program and reviewed independently by two investigators. Six themes emerged: 1) traditional learning experiences, 2) value on personal relationships, 3) a perception of distinctive differences, 4) a desire to feel needed personally and societally, 5) prefer democracy versus autocracy, and 6) desire intellectual challenges. Academic geriatrics, therefore, is particularly attractive to people who value enduring relationships, see challenges in complexity, practice social responsibility, prefer working within a multidisciplinary team, and derive satisfaction from making seemingly small but nonetheless important changes in peoples' lives. If further studies validate these findings, they could promote geriatrics as a career, by, for example, identifying students and family practice and internal medicine residents who share these values, beliefs, and attitudes and encouraging them to consider this important field.

Content Validity and Psychometric Characteristics of the "Knowledge about Older Patients Quiz" for Nurses Using Item Response Theory.

Science.gov (United States)

Dikken, Jeroen; Hoogerduijn, Jita G; Kruitwagen, Cas; Schuurmans, Marieke J

2016-11-01

To assess the content validity and psychometric characteristics of the Knowledge about Older Patients Quiz (KOP-Q), which measures nurses' knowledge regarding older hospitalized adults and their certainty regarding this knowledge. Cross-sectional. Content validity: general hospitals. Psychometric characteristics: nursing school and general hospitals in the Netherlands. Content validity: 12 nurse specialists in geriatrics. Psychometric characteristics: 107 first-year and 78 final-year bachelor of nursing students, 148 registered nurses, and 20 nurse specialists in geriatrics. Content validity: The nurse specialists rated each item of the initial KOP-Q (52 items) on relevance. Ratings were used to calculate Item-Content Validity Index and average Scale-Content Validity Index (S-CVI/ave) scores. Items with insufficient content validity were removed. Psychometric characteristics: Ratings of students, nurses, and nurse specialists were used to test for different item functioning (DIF) and unidimensionality before item characteristics (discrimination and difficulty) were examined using Item Response Theory. Finally, norm references were calculated and nomological validity was assessed. Content validity: Forty-three items remained after assessing content validity (S-CVI/ave = 0.90). Psychometric characteristics: Of the 43 items, two demonstrating ceiling effects and 11 distorting ability estimates (DIF) were subsequently excluded. Item characteristics were assessed for the remaining 30 items, all of which demonstrated good discrimination and difficulty parameters. Knowledge was positively correlated with certainty about this knowledge. The final 30-item KOP-Q is a valid, psychometrically sound, comprehensive instrument that can be used to assess the knowledge of nursing students, hospital nurses, and nurse specialists in geriatrics regarding older hospitalized adults. It can identify knowledge and certainty deficits for research purposes or serve as a tool in educational

Geriatric fall-related injuries.

African Journals Online (AJOL)

Conclusion: The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk fac- tors for falls including home hazards is essential for prevention of geriatric fall-related injuries. Keywords: Accidental fall, geriatrics, injury, trauma registry. DOI: http://dx.doi.org/10.4314/ahs.v16i2.24.

Online retrieval of patient information by asynchronous communication between general purpose computer and stand-alone personal computer

International Nuclear Information System (INIS)

Tsutsumi, Reiko; Takahashi, Kazuei; Sato, Toshiko; Komatani, Akio; Yamaguchi, Koichi

1988-01-01

Asynchronous communication was made between host (FACOM M-340) and personal computer (OLIBETTIE S-2250) to get patient's information required for RIA test registration. The retrieval system consists of a keyboad input of six numeric codes, patient's ID, and a real time reply containing six parameters for the patient. Their identified parameters are patient's name, sex, date of birth (include area), department, and out- or inpatient. Linking this program to RIA registration program for individual patient, then, operator can input name of RIA test requested. Our simple retrieval program made a useful data network between different types of host and stand-alone personal computers, and enabled us accurate and labor-saving registration for RIA test. (author)

Efficiency of hydrogen gas production in a stand-alone solar hydrogen system

International Nuclear Information System (INIS)

Singh, K.; Tamakloe, R.Y.

2003-01-01

Many photovoltaic systems operate in a decentralised electricity producing system, or stand-alone mode and the total energy demand is met by the output of the photovoltaic array. The output of the photovoltaic system fluctuates and is unpredictable for many applications making some forms of energy storage system necessary. The role of storage medium is to store the excess energy produced by the photovoltaic arry, to absorb momentary power peaks and to supply energy during sunless periods. One of the storage modes is the use of electrochemical techniques, with batteries and water electrolysis as the most important examples. The present study includes three main parts: the first one is the hydrogen production form the electrolysis of water depending on the DC output current of the photovoltaic (PV) energy source and the charging of the battery. The second part presents the influence of various parameters on the efficiency of hydrogen gas production. The final part includes simulation studies with focus on solar hydrogen efficiency under the influence of various physical and chemical parameters. For a 50W panel-battery-electrolyser system, the dependence of volume of hydrogen gas on voltage, current and power yielded a maximum efficiency of 13.6% (author)

Optimal sizing method for constituent elements of stand-alone photovoltaic power systems

Energy Technology Data Exchange (ETDEWEB)

Otsuka, Hirotada; Oi, Yoichi [Hokuriku Electric Power Co., Inc. Toyama (Japan)

1988-12-25

The purpose of the report was to calculate the optimal volume of constituent elements of stand-alone photovoltaic power systems, based on the distribution of global radiation on an inclined surface (herein-after called flux of solar radiation), which had been previously measured, and the size of load to be supplied. The least power generation cost was calculated, supposing that setting load was 176kWh/month and the loss of load probability (LOLP) was 1%, by using actual amount of solar radiation in May 1985. The cost was divided into two components: one was proportionate to the size of solar cell, and the other was in proportion to the battery volume. And then, the cost of twenty-year operation(TLC) was calculated. The size of array and the battery volume, which minimize the cost, can be determined when TLC is differentiate. Since auxiliary power source is not attached to this system, it is necessary to restrict the load in order to meet the electric power shortage. In case of the cost at construction in 1984, a standard model indicating the least power generation cost is a photovoltaic system with the array size of A=49.0m{sup 2} and the battery volume of Q=568(Ah). 4 refs., 9 figs., 10 tabs.

International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

NARCIS (Netherlands)

Wildiers, Hans; Heeren, Pieter; Puts, Martine; Topinkova, Eva; Janssen-Heijnen, Maryska L. G.; Extermann, Martine; Falandry, Claire; Artz, Andrew; Brain, Etienne; Colloca, Giuseppe; Flamaing, Johan; Karnakis, Theodora; Kenis, Cindy; Audisio, Riccardo A.; Mohile, Supriya; Repetto, Lazzaro; Van Leeuwen, Barbara; Milisen, Koen; Hurria, Arti

2014-01-01

Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the

Solar pv fed stand-alone excitation system of a synchronous machine for reactive power generation

Science.gov (United States)

Sudhakar, N.; Jain, Siddhartha; Jyotheeswara Reddy, K.

2017-11-01

This paper presents a model of a stand-alone solar energy conversion system based on synchronous machine working as a synchronous condenser in overexcited state. The proposed model consists of a Synchronous Condenser, a DC/DC boost converter whose output is fed to the field of the SC. The boost converter is supplied by the modelled solar panel and a day time variable irradiance is fed to the panel during the simulation time. The model also has one alternate source of rechargeable batteries for the time when irradiance falls below a threshold value. Also the excess power produced when there is ample irradiance is divided in two parts and one is fed to the boost converter while other is utilized to recharge the batteries. A simulation is done in MATLAB-SIMULINK and the obtained results show the utility of such modelling for supplying reactive power is feasible.

Geriatric Cardiology: An Emerging Discipline.

Science.gov (United States)

Dodson, John A; Matlock, Daniel D; Forman, Daniel E

2016-09-01

Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists are encountering patients with a greater number of comorbid illnesses as well as "geriatric conditions," such as cognitive impairment and frailty, which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine to everyday cardiology practice. Accordingly, the tasks of a "geriatric cardiologist" may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review, we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Systematic Multi-variable H-infinity Control Design for Primary Frequency Regulation in Stand-alone Microgrids with High Penetration of Renewable Energy Sources

OpenAIRE

Lam , Quang Linh; Bratcu , Antoneta Iuliana; Riu , Delphine

2016-01-01

International audience; In this paper, a systematic design of a robust multi-variable control structure for primary frequency regulation in microgrids with high rate of renewable source penetration is proposed. The considered microgrid represents a diesel-photovoltaic-supercapacitor hybrid power generation system operating in stand-alone mode. The proposed control structure relies on a two-level architecture: classical PI-based current tracking controllers are placed on the low control level ...

Multi-muscle electrical stimulation and stand training: Effects on standing.

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Momeni, Kamyar; Ramanujam, Arvind; Garbarini, Erica L; Forrest, Gail F

2018-02-15

To examine the biomechanical and neuromuscular effects of a longitudinal multi-muscle electrical stimulation (submaximal intensities) training of the lower limbs combined with/without activity-based stand training, on the recovery of stability and function for one individual with spinal cord injury (SCI). Single-subject, longitudinal study. Neuroplasticity laboratory. A 34-year-old male, with sensory- and motor-complete SCI (C5/C6). Two consecutive interventions: 61 hours of supine, lower-limb ES (ES-alone) and 51 hours of ES combined with stand training using an overhead body-weight support system (ST + ES). Clinical measures, trunk stability, and muscle activity were assessed and compared across time points. Trunk Stability Limit (TSL) determined improvements in trunk independence. Functional clinical values increased after both interventions, with further increases post ST + ES. Post ES-alone, trunk stability was maintained at 81% body-weight (BW) loading before failure; post ST + ES, BW loading increased to 95%. TSL values decreased post ST + ES (TSL A/P =54.0 kg.cm, TSL M/L =14.5 kg.cm), compared to ES-alone (TSL A/P =8.5 kg.cm, TSL M/L =3.9 kg.cm). Trunk muscle activity decreased post ST + ES training, compared to ES-alone. Neuromuscular and postural trunk control dramatically improved following the multi-muscle ES of the lower limbs with stand training. Multi-muscle ES training paradigm of the lower limb, using traditional parameters, may contribute to the functional recovery of the trunk.

A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

Directory of Open Access Journals (Sweden)

Chong Mei

2011-08-01

Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

Occupational contact sensitization in female geriatric nurses: Data of the Information Network of Departments of Dermatology (IVDK) 2005-2014.

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Schubert, S; Bauer, A; Molin, S; Skudlik, C; Geier, J

2017-03-01

Geriatric nurses (GN) have a high risk of occupational contact dermatitis (OCD), with chronic irritant contact dermatitis predominating. However, allergic contact dermatitis is an important issue as well. Little is known whether the relevant occupational allergen spectrum reported in the 1990s, including fragrances, preservatives, rubber chemicals and ingredients of surface disinfectants to be the most common sensitizers in GN, is still valid. To monitor the current allergen spectrum in GN with OCD and verify the validity of the patch test recommendations (baseline-, preservative-, ointment base-, rubber-, disinfectant, series and fragrances) in GN with suspected OCD given by the German Contact Dermatitis Research Group (DKG). Retrospective analysis of IVDK data (2005-2014) of 743 female GN with OCD, in comparison to 695 GN without OCD. GN with OCD reacted significantly more frequently to both fragrance mixes, hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), thiuram mix, zinc diethyldithiocarbamate and mercaptobenzothiazole than GN without OCD. Reactions to MDBGN, methylchloroisothiazolinone/methylisothiazolinone and oil of turpentine occurred substantially, but not significantly more frequently among GN with OCD. The latter may be due to former use of a special alcoholic liniment in geriatric care. Among material from the patients' workplaces, tetrazepam was a frequent allergen, due to dust exposure from pill crushing. Furthermore, occupationally used protective gloves, body care products as well as surface disinfectants were often tested positively. The general allergen spectrum in GN with OCD is unchanged, so the DKG patch test recommendations are still valid. Prevention of occupational sensitization should focus on fragrance-free hygiene and body care products, usage of accelerator-free protective gloves and avoidance of drug dust exposure. © 2016 European Academy of Dermatology and Venereology.

Prevalence of depressive symptoms in older nursing home residents with intact cognitive function in Taiwan.

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Hu, Sophia H; Chuang, Yeu-Hui; Ting, Yeh-Feng; Lin, Kuan-Yu; Hsieh, Chia-Jung

2018-03-25

The investigators aimed to explore the prevalence of depressive symptoms and associated factors among older residents with intact cognitive function in nursing homes in Taiwan. A cross-sectional descriptive and correlational research design was used. A convenience sample of 178 older residents without cognitive impairment was recruited from 36 nursing homes in Southern Taiwan. The questionnaires included demographic data; the Barthel Index, which assesses the ability to perform activities of daily living; and the Geriatric Depression Scale Short Form. Among older residents in nursing homes with intact cognitive function, 39.3% had depressive symptoms. Age, religion, previous living status, previous working status, being totally dependent in physical function, and being severely dependent in physical function were significant predictors of depressive symptoms among cognitively intact older residents. The findings highlight the critical mental healthcare issues among older residents with intact cognitive function in nursing homes. Practical strategies for preventing the occurrence of depressive symptoms and caring for those who have depressive symptoms should be developed, especially for younger or dependent older residents or residents who have never been employed, have no religious beliefs, or have lived alone before they moved into an institution. © 2018 Wiley Periodicals, Inc.

Developing osteopathic competencies in geriatrics for medical students.

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Noll, Donald R; Channell, Millicent King; Basehore, Pamela M; Pomerantz, Sherry C; Ciesielski, Janice; Eigbe, Patrick Arekhandia; Chopra, Anita

2013-04-01

Minimum core competencies for allopathic medical students in the specialty area of geriatrics have been developed, comprising 26 competencies divided into 8 topical domains. These competencies are appropriate for osteopathic medical students, but they do not include competencies relating to osteopathic principles and practice (OPP) in geriatrics. There remains a need within the osteopathic profession to develop specialty-specific competencies specific to OPP. To develop more specific and comprehensive minimum competencies in OPP for osteopathic medical students in the field of geriatric medicine. The Delphi technique (a structured communication technique that uses a panel of experts to reach consensus) was adapted to generate new core competencies relating to OPP. Osteopathic geriatricians and members of the Educational Council on Osteopathic Principles (ECOP) of the American Association of Colleges of Osteopathic Medicine participated in a breakout session and 2 rounds of surveys. Proposed competencies with 80% of the participants ranking it as "very important and should be added as a competency" were retained. Participants were also asked if they agreed that competencies in OPP should include specific types of osteopathic manipulative treatment techniques for the elderly. Responses were received from 26 osteopathic physician experts: 17 ECOP members and 9 geriatricians. Fourteen proposed competencies were developed: 7 related to the existing topic domains, and 7 were placed into a new domain of osteopathic manipulative medicine (OMM). Six proposed competencies were retained, all of which were in the new OMM domain. These competencies related to using OMM for gait and balance assessment, knowing adverse events and contraindications of OMM, using OMM for pain relief and end-of-life care, using OMM in the hospital and nursing home setting, adapting OMM to fit an elderly individual, and using OMM to address limited range of motion and ability to perform activities of

Geriatric study in Europe on health effects of air quality in nursing homes (GERIE study) profile: objectives, study protocol and descriptive data.

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Annesi-Maesano, Isabella; Norback, Dan; Zielinski, Jan; Bernard, Alfred; Gratziou, Cristina; Sigsgaard, Torben; Sestini, Piersante; Viegi, Giovanni

2013-11-21

Indoor air pollution (IAP) constitutes a major global public health problem requiring increasing efforts in research and policymaking that may have special significance for elderly that are likely to spend most of their day indoors and appear to be particularly susceptible to adverse effects of chemical pollutants and bio-contaminants. Yet, evidence existing on the effects of IAP in elderly is scanty. The Geriatric study in Europe on health effects of air quality in nursing homes (GERIE) study aimed to assess health effects of major indoor air pollutants and thermal conditions in elderly (> 70 years) living stably in nursing homes (NH) across Europe. Respiratory effects were particularly considered as airways and lung constitute the first target of air pollutants. We describe here the rationale and the methods of the GERIE Study. 8 nursing homes were randomly selected in 7 European countries. Twenty individuals were randomly selected in each nursing home. Major indoor and outdoor air chemical pollutants (PM10, PM2.5, PM0.1, formaldehyde, NO2; O3, VOC, CO2) and bio-contaminants (moulds, allergens) were assessed objectively with standardized procedures. Major health status indicators were assessed through a standardized questionnaire, non-invasive clinical tests and blood and urine biomarkers as well as saliva for ADN. The GERIE study has given the opportunity to publish two reviews on respiratory health effects of indoor and outdoor air pollution in elderly. In addition it has provided the inventory of air quality and thermal conditions in 50 nursing homes across Europe and data on respiratory health status in 600 elderly aged 82 years in mean. Major future results will include the relationships between NH environment and health in elderly. The main long-term purpose of the GERIE study is to improve the health of elderly who permanently reside in nursing homes or of those who are exposed to indoor air pollution because of reduced mobility.

Particulate matter concentrations in residences: an intervention study evaluating stand-alone filters and air conditioners.

Science.gov (United States)

Batterman, S; Du, L; Mentz, G; Mukherjee, B; Parker, E; Godwin, C; Chin, J-Y; O'Toole, A; Robins, T; Rowe, Z; Lewis, T

2012-06-01

This study, a randomized controlled trial, evaluated the effectiveness of free-standing air filters and window air conditioners (ACs) in 126 low-income households of children with asthma. Households were randomized into a control group, a group receiving a free-standing HEPA filter placed in the child's sleeping area, and a group receiving the filter and a window-mounted AC. Indoor air quality (IAQ) was monitored for week-long periods over three to four seasons. High concentrations of particulate matter (PM) and carbon dioxide were frequently seen. When IAQ was monitored, filters reduced PM levels in the child's bedroom by an average of 50%. Filter use varied greatly among households and declined over time, for example, during weeks when pollutants were monitored, filter use was initially high, averaging 84±27%, but dropped to 63±33% in subsequent seasons. In months when households were not visited, use averaged only 34±30%. Filter effectiveness did not vary in homes with central or room ACs. The study shows that measurements over multiple seasons are needed to characterize air quality and filter performance. The effectiveness of interventions using free-standing air filters depends on occupant behavior, and strategies to ensure filter use should be an integral part of interventions. Environmental tobacco smoke (ETS) increased particulate matter (PM) levels by about 14 μg/m3 and was often detected using ETS-specific tracers despite restrictions on smoking in the house as reported on questionnaires administered to caregivers. PM concentrations depended on season, filter usage, relative humidity, air exchange ratios, number of children, outdoor PM levels, sweeping/dusting, and presence of a central air conditioner (AC). Free-standing air filters can be an effective intervention that provides substantial reductions in PM concentrations if the filters are used. However, filter use was variable across the study population and declined over the study duration, and

The Past and Future of Nursing Research

Directory of Open Access Journals (Sweden)

Margaret M. Heitkemper, PhD, RN, FAAN

2007-06-01

Full Text Available The past three decades have witnessed a remarkable growth in nursing science development. In both Korea and the United States, nurse scientists are poised to address important issues related to the prevention and management of significant health care problems. The need for greater nursing science development in the areas of self management, genetics, geriatrics, health promotion across the lifespan, technology, and mental health are briefly highlighted. Future research efforts will be enhanced by interdisciplinary collaboration and the creation of international nursing research centers. At the same time, we need to remain cognizant of the importance of mentoring future nurse scientists.

Co-creation by the ABIM Geriatric Medicine Board and the AGS - Helping Move Geriatrics Forward.

Science.gov (United States)

Leff, Bruce; Lundjeberg, Nancy E; Brangman, Sharon A; Dubow, Joyce; Levine, Sharon; Morgan-Gouveia, Melissa; Schlaudecker, Jeffrey; Lynn, Lorna; McDonald, Furman S

2017-10-01

The American board of internal medicine (ABIM) establishes standards for physicians. The American geriatrics society (AGS) is a not-for-profit membership organization of nearly 6,000 health professionals devoted to improving the health, independence, and quality of life of all older people. Beginning in 2013, ABIM redesigned its governance structure, including the role of the specialty boards. Specialty boards are charged with responsibilities for oversight in four main areas: (1) the assessments used in initial certification and maintenance of certification (MOC); (2) medical knowledge self-assessment and practice assessment in the specialty; (3) building relationships with relevant professional societies and other organizational stakeholders; and (4) issues related to training requirements for initial certification eligibility within the specialty. The aim of this paper is to inform the geriatrics community regarding the function of geriatric medicine board (GMB) of the ABIM, and to invite the geriatrics community to fully engage with and leverage the GMB as a partner to: (1) develop better certification examinations and processes, identifying better knowledge and practice assessments, and in establishing appropriate training and MOC requirements for geriatric medicine; (2) leverage ABIM assets to conduct applied research to guide the field in the areas of training and certification and workforce development in geriatric medicine; (3) make MOC relevant for practicing geriatricians. Active engagement of the geriatrics community with ABIM and the GMB will ensure that certification in geriatric medicine provides the greatest possible value and meaning to physicians, patients, and the public. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology.

Science.gov (United States)

Won, A; Lapane, K; Gambassi, G; Bernabei, R; Mor, V; Lipsitz, L A

1999-08-01

Nonmalignant pain is a common problem among older people. The prevalence of pain in the nursing home is not well studied. We looked at the association between nonmalignant pain, psychological and functional health, and the practice patterns for pain management in the nursing home. A cross-sectional study. Nursing Home in four US states. A total of 49,971 nursing home residents from 1992 to 1995. We used the SAGE database (Systematic Assessment of Geriatric drug use via Epidemiology), which linked information from the Minimum Data Set and nursing home drug utilization data. The MDS items measured included pain, activities of daily living (ADL) function, mood, and time involved in activities. The use of analgesics, anxiolytics, and antidepressants was also documented. Daily pain was reported in 26% of nursing home residents. The prevalence was lower among men, persons more than age 85, and racial minorities. Persons suffering pain daily were more likely to have severe ADL impairment, odds ratio (OR) (2.47 (95% CI, 2.34-2.60)), more depressive signs and symptoms (OR 1.66 (95% CI, 1.57-1.75)), and less frequent involvement in activities (OR 1.35 (95% CI, 1.29-1.40)). Approximately 25% of persons with daily pain received no analgesics. Residents who were more than 85 years old (OR 1.15 (95% CI 1.02-1.28)), cognitively impaired, (OR 1.44 (95% CI, 1.29-1.61)), of male gender (OR 1.17 (95% CI, 1.06-1.29)), or a racial minority (OR 1.69 (95% CI, 1.40-2.05) and OR 1.56 (95% CI, 0.70-1.04) for blacks and Hispanics, respectively) were at greater risk of not receiving analgesics. Approximately 50% of those in pain used physical and occupational therapies, which was more than two times higher (OR 2.44 (95% CI, 2.34-2.54)), than use for those not in pain. Daily nonmalignant pain is prevalent among nursing home residents and is often associated with impairments in ADL, mood, and decreased activity involvement. Even when pain was recognized, men, racial minorities, and cognitively

The psychotropic education and knowledge test for nurses in nursing homes : Striving for PEAK performance

NARCIS (Netherlands)

Perehudoff, Katrina; Azermai, Majda; Wauters, Maarten; Van Acker, Sandra; Versluys, Karen; Steeman, Els; Petrovic, Mirko

2016-01-01

Objectives: The psychotropic education and knowledge test for nurses in acute geriatric care (PEAK-AC) measures knowledge of psychotropic indications, doses and adverse drug reactions in older inpatients. Given the low internal consistency and poor discrimination of certain items, this study aims to

Design of a reliable and low-cost stand-alone micro hydropower station

Energy Technology Data Exchange (ETDEWEB)

Kusakana, K.; Munda, J.L. [Tshwane Univ. of Technology, Pretoria (South Africa)

2008-07-01

A stand-alone micro-hydropower station was presented. The plant was comprised of a squirrel cage induction machine coupled to a Kaplan water turbine. Power converters were used to control the variable frequency and voltage outputs of the generator caused by variations in water flow. The hydropower plant was installed a farm in the Kwazulu-Natal region of South Africa, and was designed to provide electricity in relation to the low power demand of users in the region as well as according to the site's hydrology and topology. Load forecasts for the 8 houses using the system were conducted. A generator with a higher output than the average power needed to feed the load was selected in order to ensure load supply during peak demand. The system was designed to shore energy generated during off-peak periods in batteries. An AC-DC-AC converter was used as an interface between the generator and the load in order to ensure voltage and frequency stabilization. Simulations of plant components were conducted to demonstrate output power supply during water flow variations. Results of the modelling study indicated that power converters are needed to stabilize generator outputs. The hydropower design is a cost-effective means of supplying power to low-income households. 10 refs., 2 tabs., 7 figs.

Battery Storage Technologies for Electrical Applications: Impact in Stand-Alone Photovoltaic Systems

Directory of Open Access Journals (Sweden)

Daniel Akinyele

2017-11-01

Full Text Available Batteries are promising storage technologies for stationary applications because of their maturity, and the ease with which they are designed and installed compared to other technologies. However, they pose threats to the environment and human health. Several studies have discussed the various battery technologies and applications, but evaluating the environmental impact of batteries in electrical systems remains a gap that requires concerted research efforts. This study first presents an overview of batteries and compares their technical properties such as the cycle life, power and energy densities, efficiencies and the costs. It proposes an optimal battery technology sizing and selection strategy, and then assesses the environmental impact of batteries in a typical renewable energy application by using a stand-alone photovoltaic (PV system as a case study. The greenhouse gas (GHG impact of the batteries is evaluated based on the life cycle emission rate parameter. Results reveal that the battery has a significant impact in the energy system, with a GHG impact of about 36–68% in a 1.5 kW PV system for different locations. The paper discusses new batteries, strategies to minimize battery impact and provides insights into the selection of batteries with improved cycling capacity, higher lifespan and lower cost that can achieve lower environmental impacts for future applications.

Simulation of stand alone PV system; Dokuritsugata taiyoko hatsuden system no simulation

Energy Technology Data Exchange (ETDEWEB)

Kondo, H; Ogawa, H; Sekii, Y [Chiba Institute of Technology, Chiba (Japan); Tsuda, I; Nozaki, K [Electrotechnical Laboratory, Tsukuba (Japan); Kurokawa, K [Tokyo University of Agriculture and Technology, Tokyo (Japan)

1996-10-27

In order to evaluate the simulation results of a photovoltaic power generation system, an operation simulation was carried out using the actual measured data of a stand alone PV system in Miyakojima, Okinawa Prefecture, so as to make a comparison with the actual operation data. The electric power was supplied to 250 houses and primary/junior high schools in the surrounding villages, which had an average demand load of approximately 90kw and the maximum of approximately 200kw. The power was supplied through the PV power generation in the duration of the sunshine, with an excess power charged in storage batteries and then supplied from the batteries at night. The array capacity was made 750kWp, the output current and storage batteries being characteristic type with an actual efficiency curve used for the inverter. The weather data used were the actual inclined insolation quantity and the outside air temperature data for a period of one month of November. The power charged in excess of 100% in the batteries was termed as an overflow power. With the charging condition 30% or less, a diesel generator was run for a rated operation for one hour, the power of which was termed as a backup power. As a result, the simulation was found nearly in agreement with the actual measurements. 5 refs., 7 figs., 2 tabs.

Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

Science.gov (United States)

Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet Akif

2015-01-01

The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A soil-canopy scheme for use in a numerical model of the atmosphere: 1D stand-alone model

Science.gov (United States)

Kowalczyk, E. A.; Garratt, J. R.; Krummel, P. B.

We provide a detailed description of a soil-canopy scheme for use in the CSIRO general circulation models (GCMs) (CSIRO-4 and CSIRO-9), in the form of a one-dimensional stand-alone model. In addition, the paper documents the model's ability to simulate realistic surface fluxes by comparison with mesoscale model simulations (involving more sophisticated soil and boundary-layer treatments) and observations, and the diurnal range in surface quantities, including extreme maximum surface temperatures. The sensitivity of the model to values of the surface resistance is also quantified. The model represents phase 1 of a longer-term plan to improve the atmospheric boundary layer (ABL) and surface schemes in the CSIRO GCMs.

Geriatric nursing: an idea whose time has gone? A polemic.

Science.gov (United States)

Nolan, M

1994-12-01

The future role of the nursing profession in providing health care for older people is considered. It is argued that, despite claims to holism, nursing has maintained a narrow focus, concentrating mainly on acute hospital care. The concepts of professional protectionism and professional reductionism are used to explain the manifest failure of nursing and other professions working with older people and their carers to place the needs of their clients at the top of their agendas. A reorientation of nursing practice is advocated in order that the profession fulfils its potential with respect to older people.

How to Measure Physical Motion and the Impact of Individualized Feedback in the Field of Rehabilitation of Geriatric Trauma Patients.

Science.gov (United States)

Altenbuchner, Amelie; Haug, Sonja; Kretschmer, Rainer; Weber, Karsten

2018-01-01

This preparatory study accelerates an implementation of individualized monitoring and feedback of physical motion using conventional motion trackers in the rehabilitation process of geriatric trauma patients. Regaining mobility is accompanied with improved quality of life in persons of very advanced age recovering from fragility fractures. Quantitative survey of regaining physical mobility provides recommendations for action on how to use motion trackers effectively in a clinical geriatric setting. Method mix of quantitative and qualitative interdisciplinary and mutual complementary research approaches (sociology, health research, philosophy/ethics, medical informatics, nursing science, gerontology and physical therapy). While validating motion tracker use in geriatric traumatology preliminary data are used to develop a target group oriented motion feedback. In addition measurement accuracy of a questionnaire about quality of life of multimorbid geriatric patients (FLQM) is tested. Implementing a new technology in a complex clinical setting needs to be based on a strong theoretical background but will not succeed without careful field testing.

Geriatric imaging

Energy Technology Data Exchange (ETDEWEB)

Guglielmi, Giuseppe [Scientific Institute Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Italy). Dept. of Radiology; Peh, Wilfred C.G. [Khoo Teck Puat Hospital, Singapore (Singapore). Dept. of Diagnostic Radiology; Guermazi, Ali (eds.) [Boston Univ. School of Medicine, Boston, MA (United States). Dept. of Radiology

2013-08-01

Considers all aspect of geriatric imaging. Explains clearly how to distinguish the healthy elderly from those in need of treatment. Superbly illustrated. Written by recognized experts in field. In the elderly, the coexistence of various diseases, the presence of involutional and degenerative changes, and the occurrence of both physical and cognitive problems represent ''the norm.'' It is therefore important to know how to distinguish the healthy elderly from those in need of treatment as a sound basis for avoiding overdiagnosis and overtreatment. This aspect is a central theme in Geriatric Imaging, which covers a wide range of applications of different imaging techniques and clearly explains both the potential and the limitations of diagnostic imaging in geriatric patients. Individual sections are devoted to each major region or system of the body, and a concluding section focuses specifically on interventional procedures. The book, written by recognized experts in the field, is superbly illustrated and will be an ideal resource for geriatricians, radiologists, and trainees.

The international phase 4 validation study of the EORTC QLQ-SWB32: A stand-alone measure of spiritual well-being for people receiving palliative care for cancer

NARCIS (Netherlands)

Vivat, B.; Young, T. E.; Winstanley, J.; Arraras, J. I.; Black, K.; Boyle, F.; Bredart, A.; Costantini, A.; Guo, J.; Irarrazaval, M. E.; Kobayashi, K.; Kruizinga, R.; Navarro, M.; Omidvari, S.; Rohde, G. E.; Serpentini, S.; Spry, N.; van Laarhoven, H. W. M.; Yang, G. M.

2017-01-01

The EORTC Quality of Life Group has just completed the final phase (field-testing and validation) of an international project to develop a stand-alone measure of spiritual well-being (SWB) for palliative cancer patients. Participants (n = 451)-from 14 countries on four continents; 54% female; 188

Endodontic treatment in geriatric patients

Directory of Open Access Journals (Sweden)

Milly Armilya Andang

2007-11-01

Full Text Available With the increased number of geriatric population, it is predicted that the need for dental treatment also increases. The needs for esthetic factors and function of geriatric patient are maybe similar to young patient. The number of geriatric patients who refuse dental extraction is increasing if there are still other alternative. They can be more convinced when the clinician said that the dental disease experienced is a focal infection so that the loss of the tooth can be accepted as the best option. But if it is possible, they will prefer endodontic treatment, because they want to keep their teeth according to the treatment plan or based on patient's request, as a less traumatic alternative compared to extraction.Endodontic treatment consideration for geriatric patient is quite similar to younger patients. The technique is also the same, although the problem may be bigger. The problem or obstacle that may arise in endodontic treatment for geriatric patient relates to the visit duration, problems during x-ray, problems in defining root canal location, vertical root fracture, and in some cases, decreased pulp tissue recovery ability. Due to the fact that the challenge is quite big, the success of endodontic treatment in geriatric patients needs to be considered. This paper will explain the endodontic treatment prognosis for geriatric patients.

[Biomechanicsl evaluation of a stand-alone interbody fusion cage based on porous TiO2/glass-ceramic on the human cervical spine].

Science.gov (United States)

Korinth, M C; Moersch, S; Ragoss, C; Schopphoff, E

2003-12-01

Recently, there has been a rapid increase in the use of cervical spine interbody fusion cages, differing in design and biomaterial used, in competition to autologous iliac bone graft and bone cement (PMMA). Limited biomechanical differences in primary stability, as well as advantages and disadvantages of each cage or material have been investigated in studies, using an in vitro human cervical spine model. 20 human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO2/glass composite (Ecopore) or PMMA after discectomy. Non-destructive biomechanical testing was performed, including flexion/extension and lateral bending using a spine testing apparatus. Three-dimensional segmental range of motion (ROM) was evaluated using an ultrasound measurement system. ROM increased more in flexion/extension and lateral bending after PMMA fusion (26.5%/36.1%), then after implantation of the Ecopore-cage (8.1%/7.8%). In this first biomechanical in vitro examination of a new porous ceramic bone replacement material a) the feasibility and reproducibility of biomechanical cadaveric cervical examination and its applicability was demonstrated, b) the stability of the ceramic cage as a stand alone interbody cage was confirmed in vitro, and c) basic information and knowledge for our intended biomechanical and histological in vivo testing, after implantation of Ecopore in cervical sheep spines, were obtained.

Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels.

Science.gov (United States)

Kao, Ting-Hsien; Wu, Chen-Hao; Chou, Yu-Ching; Chen, Hsien-Te; Chen, Wen-Hsien; Tsou, Hsi-Kai

2014-10-01

To determine risk factors for subsidence in patients treated with anterior cervical discectomy and fusion (ACDF) and stand-alone polyetheretherketone (PEEK) cages. Records of patients with degenerative spondylosis or traumatic disc herniation resulting in radiculopathy or myelopathy between C2 and C7 who underwent ACDF with stand-alone PEEK cages were retrospectively reviewed. Cages were filled with autogenous cancellous bone harvested from iliac crest or hydroxyapatite. Subsidence was defined as a decrease of 3 mm or more of anterior or posterior disc height from that measured on the postoperative radiograph. Eighty-two patients (32 males, 50 females; 182 treatment levels) were included in the analysis. Most patients had 1-2 treatment levels (62.2 %), and 37.8 % had 3-4 treatment levels. Treatment levels were from C2-7. Of the 82 patients, cage subsidence occurred in 31 patients, and at 39 treatment levels. Multivariable analysis showed that subsidence was more likely to occur in patients with more than two treatment levels, and more likely to occur at treatment levels C5-7 than at levels C2-5. Subsidence was not associated with postoperative alignment change but associated with more disc height change (relatively oversized cage). Subsidence is associated with a greater number of treatment levels, treatment at C5-7 and relatively oversized cage use.

Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life.

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Kapetanakis, Stylianos; Thomaidis, Tryfon; Charitoudis, George; Pavlidis, Pavlos; Theodosiadis, Panagiotis; Gkasdaris, Grigorios

2017-09-01

Anterior cervical discectomy and fusion (ACDF) constitutes the conventional treatment of cervical disc herniation due to degenerative disc disease (DDD). ACDF with plating presents a variety of complications postoperatively and stand-alone cages are thought to be a promising alternative. The aim of this study was firstly, to analyze prospectively collected data from a sample of patients treated with single ACDF using C-Plus self-locking stand-alone PEEK cage system, without the use of plates or screws, in order to evaluate pain levels of patients, utilizing Neck and Arm Pain scale as an expression of visual analogue scale (VAS). Secondly, we aimed to evaluate health-related quality of life, via the short-form 36 (SF-36) and Neck Disability Index (NDI). Thirty-six patients (19 male and 17 female) with mean age 49.6±7 years old who underwent successful single ACDF using self-locking stand-alone PEEK cage for symptomatic cervical DDD were selected for the study. Neck and Arm pain, as well as SF-36 and NDI were estimated preoperatively and 1, 3, 6, and 12 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological and radiological evaluation. The clinical and radiological outcomes were satisfactory after a minimum 1-year follow-up. All results were statistically important (P<0.05), excluding improvement in NDI measured between 6 and 12 months. SF-36, Neck Pain, as well as Arm Pain featured gradual and constant improvement during follow-up, with best scores presenting at 12 months after surgery, while NDI reached its best at 6 months postoperatively. Generally, all scores showed improvement postoperatively during the different phases of the follow-up. Subsequently, ACDF using C-Plus cervical cage constitutes an effective method for cervical disc herniation treatment, in terms of postoperative improvement on pain levels and health-related quality of life and a safe alternative to the conventional method of treatment for cervical DDD.

Practice of geriatric oncology in the setting of a comprehensive cancer center

International Nuclear Information System (INIS)

Droz, J.

2004-01-01

subjectively appreciate performance status. Folstein’s Mini Mental State Examination (MMSE) was used to evaluate patient cognitive status. Depressive symptoms were detected with the Geriatric Depression Scale (GDS). Nutritional status was assessed through the Mini-Nutritional Assessment (MNA). The Performance-Oriented Assessment of Mobility instrument provided information on patient physical ability and fall risk. Co morbidity, that corresponds to all medical conditions a patient may have, excluding the disease of primary interest, was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). This scale classifies co morbid events by organ system affected, and rates their severity from 0 to 4, with a grading similar to that of the Common Toxicity Criteria scale (none, mild, moderate, severe, extremely severe/life-threatening). This scale has 14 organ system categories and collects information such as the total number of categories involved, total score, severity index (total score/total number of categories involved), the number of categories at level 3 severity, the number of categories at level 4 severity. We also assessed biological functions such as hemoglobin, white blood cell count and differential, creatinine clearance, serum albumin level. Mini-CGA is performed by a multidisciplinary team, including a geriatric ian, a medical oncologist (geriatrics certified), a social worker, a dietician, a physiotherapist, a pharmacist and a research nurse. Each mini-CGA evaluation lasts from ninety to one hundred and twenty minutes. At the end of the procedure, both the geriatric ian and the oncologist draw up an inventory of the different problems identified, and propose an individualized intervention program with specific advice on cancer treatment options

The relationship between geriatric depression and health-promoting behaviors among community-dwelling seniors.

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Chang, Chyong-Fang; Lin, Mei-Hsiang; Wang, Jeng; Fan, Jun-Yu; Chou, Li-Na; Chen, Mei-Yen

2013-06-01

People older than 65 years old account for about 10.9% of Taiwan's total population; it is also known that the older adults experience a higher incidence of depression. Public health nurses play an important role in promoting community health. Policymaking for community healthcare should reflect the relationship between health-promoting behavior and depression in community-dwelling seniors. Therefore, the encouragement of healthy aging requires strategic planning by those who provide health promotion services. This study was designed to elicit the health-promoting behaviors of community seniors and investigate the relationship between geriatric depression and health-promoting behaviors among seniors who live in rural communities. We used a cross-sectional, descriptive design and collected data using a demographic information datasheet, the Health Promotion for Seniors and Geriatric Depression Scale short forms. The study included 427 participants. Most were women; mean age was 75.8 years. Most were illiterate; roughly half engaged in a limited number of health-promoting activities. The Geriatric Depression Scale score was negatively associated with health-promoting behavior. Social participation, health responsibility, self-protection, active lifestyle, and total Health Promotion for Seniors score all reached statistical significance. Multivariate analysis indicated that geriatric depression and physical discomfort were independent predictors of health-promoting behavior after controlling the confounding factors. Participants practiced less than the recommended level of health-promoting behaviors. We found a negative correlation between the geriatric depression score and health-promoting behavior. Results can be referenced to develop strategies to promote healthy aging in the community, especially with regard to promoting greater social participation and increased activity for community-dwelling older adults experiencing depression.

The sharing of self in geriatric clinical practice: case report and analysis.

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Nowak, K B; Wandel, J C

1998-01-01

We relate a case history that involved the therapeutic sharing of self with an elderly patient. The potential usefulness of this kind of intervention is discussed in light of the literature on self-disclosure and the use of self in clinical practice. We discuss how these concepts might relate to other well-described phenomena in geriatric nursing, including reminiscence, life review, loneliness, and storytelling. Recommendations for use in clinical practice and for qualitative studies are given.

Stand quality management in a late-rotation, red oak-sweetgum stand in east Mississippi: preliminary results following thinning

Science.gov (United States)

James S. Meadows; Daniel A. Skojac

2012-01-01

Stand quality management is a new management strategy in which thinning prescriptions are based solely on tree quality rather than a quantitative level of residual stand density. As long as residual density falls within fairly broad limits, prescriptions are based on tree quality alone. We applied four thinning prescriptions based on stand quality management, along...

Evaluation of geriatric changes in dogs

OpenAIRE

Pati, Soumyaranjan; Panda, S. K.; Acharya, A. P.; Senapati, S.; Behera, M.; Behera, S. S.

2015-01-01

Aim: The present study has been envisaged to ascertain the old age for critical management of geriatric dogs considering the parameters of externally visible changes, haemato-biochemical alterations and urine analysis in geriatric dogs approaching senility. Materials and Methods: The study was undertaken in the Department of Veterinary Pathology in collaboration with Teaching Veterinary Clinic complex spanning a period of 1 year. For screening of geriatric dogs, standard geriatric age chart o...

Stand-Alone Photovoltaic System Assessment in Warmer Urban Areas in Mexico

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Alberto-Jesus Perea-Moreno

2018-01-01

Full Text Available The aim of this study is to examine the possibility of using a stand-alone photovoltaic system (SAPVS for electricity generation in urban areas in Southern Mexico. In Mexico, an urban area is defined as an area where more than 2500 inhabitants live. Due to constant migration from the countryside to the cities, the number of inhabitants of urban localities has been increasing. Global horizontal irradiation (GHI data were recorded every 10 min during 2014–2016 in Coatzacoalcos in the state of Veracruz located on 18°08′09″ N and 94°27′48″ W. In this study, batteries represented 77% of the total cost, 12 PV panels of 310 W could export 5.41 MWh to the grid, and an inverter with an integrated controller and charger was selected, which decreased the initial cost. The city of Coatzacoalcos was chosen because the average annual temperature is 28°, with an average relative humidity of 75% and an average irradiance of 5.3 kWh/m2/day. An emission factor 0.505 tCO2/MWh of greenhouse gases (GHG were obtained, based on the power system, the reduction of net annual GHG would be 11 tCO2 and a financial revenue of 36.951 × 103 $/tCO2 would be obtained. Financial parameters such as a 36.3% Internal Rate Return (IRR and 3.4 years payback show the financial viability of this investment. SAPVSs in urban areas in Mexico could be a benefit as long as housing has a high consumption of electricity.

The eBioKit, a stand-alone educational platform for bioinformatics.

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Hernández-de-Diego, Rafael; de Villiers, Etienne P; Klingström, Tomas; Gourlé, Hadrien; Conesa, Ana; Bongcam-Rudloff, Erik

2017-09-01

Bioinformatics skills have become essential for many research areas; however, the availability of qualified researchers is usually lower than the demand and training to increase the number of able bioinformaticians is an important task for the bioinformatics community. When conducting training or hands-on tutorials, the lack of control over the analysis tools and repositories often results in undesirable situations during training, as unavailable online tools or version conflicts may delay, complicate, or even prevent the successful completion of a training event. The eBioKit is a stand-alone educational platform that hosts numerous tools and databases for bioinformatics research and allows training to take place in a controlled environment. A key advantage of the eBioKit over other existing teaching solutions is that all the required software and databases are locally installed on the system, significantly reducing the dependence on the internet. Furthermore, the architecture of the eBioKit has demonstrated itself to be an excellent balance between portability and performance, not only making the eBioKit an exceptional educational tool but also providing small research groups with a platform to incorporate bioinformatics analysis in their research. As a result, the eBioKit has formed an integral part of training and research performed by a wide variety of universities and organizations such as the Pan African Bioinformatics Network (H3ABioNet) as part of the initiative Human Heredity and Health in Africa (H3Africa), the Southern Africa Network for Biosciences (SAnBio) initiative, the Biosciences eastern and central Africa (BecA) hub, and the International Glossina Genome Initiative.

[Non-pharmacological treatment of dementia in geriatric psychiatry care units : Scoping review].

Science.gov (United States)

Göhner, Anne; Hüll, Michael; Voigt-Radloff, Sebastian

2018-02-01

The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.

Analysis and control of induction generator supplying stand-alone AC loads employing a Matrix Converter

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Sumedha Mahajan

2017-04-01

Full Text Available This paper proposes a Capacitor Excited Induction Generator (CEIG-Matrix Converter (MC system for feeding stand-alone AC loads. The variable output voltage magnitude and frequency from CEIG is converted into a constant voltage magnitude and frequency at the load terminals by controlling MC using Space Vector Modulation (SVM technique. This single-stage MC is turned up as a good alternative for the proposed system against commonly used AC/DC/AC two stage power converters. The configuration and implementation of the closed-loop control scheme employing dSPACE 1103 real time controller have been fully described in the paper. The proposed closed-loop controller regulates the AC load voltage irrespective of changes in the prime mover speed and load. A method for predetermining the steady-state performance of the proposed system has been developed and described with relevant analytical expressions. The effectiveness of the proposed system is exemplified through simulation results for various operating conditions. The proposed control technique is further validated using an experimental setup developed in the laboratory.

An intelligent stand-alone ultrasonic device for monitoring local structural damage: implementation and preliminary experiments

International Nuclear Information System (INIS)

Pertsch, Alexander; Kim, Jin-Yeon; Wang, Yang; Jacobs, Laurence J

2011-01-01

Continuous structural health monitoring has the potential to significantly improve the safety management of aged, in-service civil structures. In particular, monitoring of local damage growth at hot-spot areas can help to prevent disastrous structural failures. Although ultrasonic nondestructive evaluation (NDE) has proved to be effective in monitoring local damage growth, conventional equipment and devices are usually bulky and only suitable for scheduled human inspections. The objective of this research is to harness the latest developments in embedded hardware and wireless communication for developing a stand-alone, compact ultrasonic device. The device is directed at the continuous structural health monitoring of civil structures. Relying on battery power, the device possesses the functionalities of high-speed actuation, sensing, signal processing, and wireless communication. Integrated with contact ultrasonic transducers, the device can generate 1 MHz Rayleigh surface waves in a steel specimen and measure response waves. An envelope detection algorithm based on the Hilbert transform is presented for efficiently determining the peak values of the response signals, from which small surface cracks are successfully identified

Modeling and Experimental Test of Grid-Tied Photovoltaic Cell Emulating System in the Stand-alone Mode

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Vu Minh Phap

2017-06-01

Full Text Available In recent decades, generation of electricity from solar arrays has been increased to meet the world's growing energy demand. However, the utilization rate of the power conditioner in the grid-tied solar power system is low because the operation of solar panels is dependent on sunlight. Thus, we studied the method that the small scale wind power generating system in size from a few hundred watts to two or three kilowatts can be connected to the grid-tied power conditioner of the solar power system for residential applications with low power ratings (single phase, size is limited to 10kW by emulating characteristic of the solar panel. In this paper, we introduce the application of the grid-tied PV cell emulating system in the stand-alone mode to improve the utilization rate of the power conditioner. The simulation and experimental test results verify that the PV cell emulating system can operate the power conditioner of the gridtied solar power system.

Hydrogen-based energy storage unit for stand alone PV systems

International Nuclear Information System (INIS)

Labbe, J.

2006-12-01

Stand alone systems supplied only by a photovoltaic generator need an energy storage unit to be fully self sufficient. Lead acid batteries are commonly used to store energy because of their low cost, despite several operational constraints. A hydrogen-based energy storage unit (HESU) could be another candidate, including an electrolyser, a fuel cell and a hydrogen tank. However many efforts still need to be carried out for this technology to reach an industrial stage. In particular, market outlets must be clearly identified. The study of small stationary applications (few kW) is performed by numerical simulations. A simulator is developed in the Matlab/Simulink environment. It is mainly composed of a photovoltaic field and a storage unit (lead acid batteries, HESU, or hybrid storage HESU/batteries). The system component sizing is achieved in order to ensure the complete system autonomy over a whole year of operation. The simulator is tested with 160 load profiles (1 kW as a yearly mean value) and three locations (Algeria, France and Norway). Two coefficients are set in order to quantify the correlation between the power consumption of the end user and the renewable resource availability at both daily and yearly scales. Among the tested cases, a limit value of the yearly correlation coefficient came out, enabling to recommend the use of the most adapted storage to a considered case. There are cases for which using HESU instead of lead acid batteries can increase the system efficiency, decrease the size of the photovoltaic field and improve the exploitation of the renewable resource. In addition, hybridization of HESU with batteries always leads to system enhancements regarding its sizing and performance, with an efficiency increase by 10 to 40 % depending on the considered location. The good agreement between the simulation data and field data gathered on real systems enabled the validation of the models used in this study. (author)

The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers.

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Rouxel, Géraldine; Michinov, Estelle; Dodeler, Virginie

2016-10-01

Previous studies have demonstrated that geriatric care employees are exposed to a large number of factors that can affect their levels of job satisfaction and occupational stress. Although working with elderly people is emotionally demanding, little research has been done on the role played by perceptions of emotional display rules, alongside more traditional work characteristics and individual factors, in the prediction of geriatric care employees' wellbeing. The aim of the present study was to examine the role played by work characteristics (job demands, job control, emotional display rules) and individual (affectivity) factors to predict job satisfaction and burnout among French geriatric care nurses. Questionnaires were sent to 891 employees working in 32 geriatric care centers in France. A total of 371 valid questionnaires (response rate: 41.60%) were analyzed using structural equation modeling techniques. Results revealed two main processes of burnout and job satisfaction among women geriatric care workers, namely a salutogenic process and a pathogenic process. As expected, negative affectivity, low job status, perceived negative display rules and job demands are involved in the pathogenic process; while positive affectivity, perceived positive display rules and job control are implied in the salutogenic one. More specifically, as expected, negative affectivity is a positive predictor of burnout, both directly and indirectly through its impact on perceived negative display rules and job demands. Moreover, negative affectivity was negatively related to job satisfaction. Simultaneously, positive affectivity can predict job satisfaction, both directly and indirectly through its impact on perceived positive display rules and job control. Positive affectivity is also a negative predictor of burnout. Practical implications are discussed to support intervention programs that develop healthy workplaces, and also to inform nurses about how to manage emotional display

Building a comprehensive geriatric health care system: a case study.

Science.gov (United States)

Bleiweiss, L; Simson, S

1976-01-01

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

[Clinical application of stand-alone MC+PEEK cage in the anterior cervical fusion].

Science.gov (United States)

Jiang, Bing; Cao, Yan-Qing; Pan, Hong; Zhu, Cheng-Run; Zhang, Xiao-Jun; Tao, Yue-Feng; Liu, Zhen

2015-04-01

To explore the effect of clinical application of stand-alone MC+PEEK cage in anterior cervical fusion. From January 2011 to January 2014,50 patients were treated with the MC+PEEK cage filled with autogenous cancellous illic-bone graft after anterior cervical discectomy. There were 22 patients with cervical spondylosis,26 patients with traumatic cervical disc herniation, 2 patients with cervical instability in these patients. There were 32 males and 18 females, aged from 30 to 79 years old with an average of 53.30 years old. There were 32 patients with single segment, 15 patients with double segments and 3 patients with three segments. Cervical AP and lateral and the flexion-extension X-rays were regularly taken in order to assess the cervical physiological curvature, the graft fusion and internal fixation related complications. Nerve function, clinical effect and bone fusion were respectively evaluated according to Japan Orthopedic Association (JOA), Otani grade and Suk method. All patients were followed up from 6 to 36 months with an average of 20 months. No correlated surgical complications were found and all patients obtained bony fusion with an average time of 4.30 months. JOA score had significantly improvement after surgery (P cervical fusion can obtain satisfactory clinical effect with less operation injury and reduce the complications. It is a better fusion method in anterior cervical fusion.

On the economics of stand-alone renewable hybrid power plants in remote regions

International Nuclear Information System (INIS)

Petrakopoulou, Fontina

2016-01-01

Highlights: • Economic evaluation of three renewable hybrid power plants for off-grid operation. • The high electricity cost of remote regions increases the competitiveness of renewable energy. • The proposed plants are economically viable when compared to the existing situation. • The zero direct emissions of the plants constitute an additional advantage of the plants. - Abstract: In recent years ever more examples of regions that have managed to achieve or orientate themselves toward renewable energy sufficiency are emerging. However, actions to create energy autonomy are mainly the result of isolated activities and they are less driven from fully organized movements. In addition, total energy independence without the support of a centralized electrical grid is yet to be achieved. The objectives of this work are to investigate the associated costs of stand-alone renewable hybrid power plants on a Greek island and compare them to the cost of the currently used fossil-fuel-based conventional plant. The plants examined here are designed to fully cover the electricity needs of the island. Islands may face numerous energy problems and rely heavily on foreign and environmentally-harmful fuels. It is shown that the relatively high cost of electricity of such a remote region can increase the competitiveness and promote the wider incorporation of technologies based on renewable energy sources that may, in other cases, seem economically inferior to business-as-usual energy solutions.

MIRNA-DISTILLER: a stand-alone application to compile microRNA data from databases

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Jessica K. Rieger

2011-07-01

Full Text Available MicroRNAs (miRNA are small non-coding RNA molecules of ~22 nucleotides which regulate large numbers of genes by binding to seed sequences at the 3’-UTR of target gene transcripts. The target mRNA is then usually degraded or translation is inhibited, although thus resulting in posttranscriptional down regulation of gene expression at the mRNA and/or protein level. Due to the bioinformatic difficulties in predicting functional miRNA binding sites, several publically available databases have been developed that predict miRNA binding sites based on different algorithms. The parallel use of different databases is currently indispensable, but highly uncomfortable and time consuming, especially when working with numerous genes of interest. We have therefore developed a new stand-alone program, termed MIRNA-DISTILLER, which allows to compile miRNA data for given target genes from public databases. Currently implemented are TargetScan, microCosm, and miRDB, which may be queried independently, pairwise, or together to calculate the respective intersections. Data are stored locally for application of further analysis tools including freely definable biological parameter filters, customized output-lists for both miRNAs and target genes, and various graphical facilities. The software, a data example file and a tutorial are freely available at http://www.ikp-stuttgart.de/content/language1/html/10415.asp

MIRNA-DISTILLER: A Stand-Alone Application to Compile microRNA Data from Databases.

Science.gov (United States)

Rieger, Jessica K; Bodan, Denis A; Zanger, Ulrich M

2011-01-01

MicroRNAs (miRNA) are small non-coding RNA molecules of ∼22 nucleotides which regulate large numbers of genes by binding to seed sequences at the 3'-untranslated region of target gene transcripts. The target mRNA is then usually degraded or translation is inhibited, although thus resulting in posttranscriptional down regulation of gene expression at the mRNA and/or protein level. Due to the bioinformatic difficulties in predicting functional miRNA binding sites, several publically available databases have been developed that predict miRNA binding sites based on different algorithms. The parallel use of different databases is currently indispensable, but highly uncomfortable and time consuming, especially when working with numerous genes of interest. We have therefore developed a new stand-alone program, termed MIRNA-DISTILLER, which allows to compile miRNA data for given target genes from public databases. Currently implemented are TargetScan, microCosm, and miRDB, which may be queried independently, pairwise, or together to calculate the respective intersections. Data are stored locally for application of further analysis tools including freely definable biological parameter filters, customized output-lists for both miRNAs and target genes, and various graphical facilities. The software, a data example file and a tutorial are freely available at http://www.ikp-stuttgart.de/content/language1/html/10415.asp.

Senile anorexia in different geriatric settings in Italy.

Science.gov (United States)

Donini, L M; Dominguez, L J; Barbagallo, M; Savina, C; Castellaneta, E; Cucinotta, D; Fiorito, A; Inelmen, E M; Sergi, G; Enzi, G; Cannella, C

2011-11-01

Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status. Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto). 526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile"). Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication. The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet

Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

DEFF Research Database (Denmark)

Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise

2013-01-01

OBJECTIVE: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation an...... reconciliation and focused medication reviews. Further randomized, controlled studies including a larger number of patients are required to elucidate whether these observations are of significance and of importance for securing patient safety....... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

Nonpharmacological therapeutic techniques to decrease agitation in geriatric psychiatric patients with dementia.

Science.gov (United States)

Mitchell, Ann M; Chiappetta, Laurel; Boucek, Lynn; Cain, Michelle; Patterson, Georgia; Owens, Kim; Herisko, Camellia; Stark, Kirsti Hetager

2015-02-01

Agitation is not only a frequent and disturbing behavior for many patients with dementia, but it also troubles their caregivers and families. Many serious problems and side effects are associated with the use of medications to treat agitation; therefore, alternative approaches to treating agitation must be assessed. The current article presents results from a quality improvement pilot project that examined the usefulness of a specially designed, multisensory room intervention for geriatric psychiatric inpatients with mild to moderate agitation. Thirty-two visits to the sensory room were made by 13 inpatients with dementia. A significant decrease occurred in the Pittsburgh Agitation Scale (PAS) total scores over time from pre-room to post-room intervention, as well as 1-hour post-room intervention (F = 95.3, p agitation, and resistance to care), with the exception of the aggression subscale. The multisensory room intervention was effective in decreasing some symptoms of agitation in the geriatric psychiatric patient, thus contributing to positive patient, family, and nursing outcomes. Copyright 2015, SLACK Incorporated.

Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients.

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Liesbeth Hempenius

Full Text Available The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined.A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life.Data of 260 patients (intervention n = 127, Control n = 133 were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02-6.88, an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02-5.87 and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07-0.49.A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed.Nederlands Trial Register, Trial ID NTR 823.

Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: A field research

Directory of Open Access Journals (Sweden)

Sang Heon Lee

2017-01-01

Full Text Available Purpose: We aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea. Materials and Methods: Questionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas. Results: The study was carried out from July to December 2014; 75.6% of patients (1,858/2,458 and 77.5% (779/1,031 of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110–367, 189.1 patients (range, 90–345, and 40.2 nurses (range, 10–83. The average number of physicians was 6.2 (range, 3–11, but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%, indwelling catheters (19.5%, clean intermittent catheters (12.2%, and external collection urinary drainage (7.9%. However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%. Conclusions: Urologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.

Stand alone solution for generation and storage of hydrogen and electric energy

International Nuclear Information System (INIS)

Gany, Alon; Elitzur, Shani; Valery

2015-01-01

A novel method enabling safe, simple, and controllable production, storage, and use of hydrogen as well as compact electric energy storage and generation via hydrogen- oxygen fuel cells has been developed. The technology indicates, in our opinion, a significant milestone in the search for practical utilization of hydrogen as an alternative energy source. It consists of an original thermal-chemical treatment / activation of aluminum powders to react spontaneously with water to produce hydrogen at regular conditions according to the reaction Al+3H 2 O=Al (OH) 3 +3/2H 2 . Only about 1-2% of lithium, based activator is applied, and any type of water including tap water, sea water and waste water may be used, making the method attractive for variety of applications. 11% of hydrogen compared to the aluminum mass can be obtained, and our experiments reveal 90% reaction yield and more. The technology has a clear advantage over batteries, providing specific electric energy of over 2 kW h/kg Al, 5-10 times greater than that of commonly used lithium-ion batteries. Combined with a fuel cell it may be particularly beneficial for stand-alone electric power generators, where there is no access to the grid. Such applications include emergency generators (e.g., in hospitals), electricity backup systems, and power generation in remote communication posts. Automotive applications may be considered as well. The technology provides green electric energy and quiet operation as well as additional heat energy resulting mainly from the exothermic aluminum-water reaction. (full text)

Recognition of geriatric popular song repertoire: a comparison of geriatric clients and music therapy students.

Science.gov (United States)

VanWeelden, Kimberly; Cevasco, Andrea M

2010-01-01

The purposes of the current study were to determine geriatric clients' recognition of 32 popular songs and songs from musicals by asking whether they: (a) had heard the songs before; (b) could "name the tune" of each song; and (c) list the decade that each song was composed. Additionally, comparisons were made between the geriatric clients' recognition of these songs and by music therapy students' recognition of the same, songs, based on data from an earlier study (VanWeelden, Juchniewicz, & Cevasco, 2008). Results found 90% or more of the geriatric clients had heard 28 of the 32 songs, 80% or more of the graduate students had heard 20 songs, and 80% of the undergraduates had heard 18 songs. The geriatric clients correctly identified 3 songs with 80% or more accuracy, which the graduate students also correctly identified, while the undergraduates identified 2 of the 3 same songs. Geriatric clients identified the decades of 3 songs with 50% or greater accuracy. Neither the undergraduate nor graduate students identified any songs by the correct decade with over 50% accuracy. Further results are discussed.

American Association for Geriatric Psychiatry

Science.gov (United States)

... Position Statements Publications Bookstore American Journal of Geriatric Psychiatry Legislative & Regulatory Agenda AAGP eNews (Members Only) Tools ... Funding Training Resources and Curricula For Clinicians >> Geriatric Psychiatry Identifier Webinar: Billing and Coding Consumer Material Clinical ...

Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients.

Science.gov (United States)

Sheeran, Thomas; Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L; Bruce, Martha L

2011-10-01

The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up. Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.

Use of a screening tool and primary health care gerontology nurse specialist for high-needs older people.

Science.gov (United States)

King, Anna; Boyd, Michal; Dagley, Lynelle

2017-02-01

To describe implementation of an innovative gerontology nurse specialist role within one primary health organisation in Auckland, New Zealand. Quantitative outcomes of the screening tool as well as the nurse specialist assessment will be presented. The intervention involved use of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify high-needs older people with subsequent comprehensive geriatric assessment (CGA) performed by the gerontology nurse specialist. A total 384 of the 416 BRIGHTs were completed (92% response rate) and 15% of these were identified as high risk (n = 57). The BRIGHTs for high-risk older people revealed the highest scoring question was 'needing help with housework' (26%). The most frequent intervention by the gerontology nurse specialist was education (30%). The primary health care gerontology nurse specialist model delivers a proactive case finding and specialist gerontology intervention for older people at high risk of functional or health decline.

Use of Super-Capacitor to Enhance Charging Performance of Stand-Alone Solar PV System

KAUST Repository

Huang, B. J.

2011-01-01

Introduction: The battery charging performance in a stand-alone solar PV system affects the PV system efficiency and the load operating time. The New Energy Center of National Taiwan University has been devoted to the development of a PWM charging technique to continue charging the lead-acid battery after the overcharge point to increase the battery storage capacity by more than 10%. The present study intends to use the super-capacitor to further increase the charge capacity before the overcharge point of the battery. The super-capacitor is connected in parallel to the lead-acid battery. This will reduce the overall charging impedance during the charge and increase the charging current, especially in sunny weather. A system dynamics model of the lead-acid battery and super-capacitor was derived and the control system simulation was carried out to predict the charging performance for various weathers. It shows that the overall battery impedance decreases and charging power increases with increasing solar radiation. An outdoor comparative test for two identical PV systems with and without supercapacitor was carried out. The use of super-capacitor is shown to be able to increase the lead-acid charging capacity by more than 25% at sunny weather and 10% in cloudy weather. © Springer-Verlag Berlin Heidelberg 2011.

Positioning Medical Students for the Geriatric Imperative: Using Geriatrics to Effectively Teach Medicine

Science.gov (United States)

Nguyen, Annie L.; Duthie, Elizabeth A.; Denson, Kathryn M.; Franco, Jose; Duthie, Edmund H.

2013-01-01

Medical schools must consider innovative ways to ensure that graduates are prepared to care for the aging population. One way is to offer a geriatrics clerkship as an option for the fulfillment of a medical school's internal medicine rotation requirement. The authors' purpose was to evaluate the geriatrics clerkship's impact on internal medicine…

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

Directory of Open Access Journals (Sweden)

Jennifer C. Reneker

2016-10-01

Full Text Available This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen’s d-values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15–0.30. Two perceptions of geriatric physical therapy demonstrated a significant positive increase (P<0.05 with moderate effect sizes (d=0.47 and d=0.50. The students’ perceptions of geriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68 and enjoyment (d=1.96. Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

[Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013].

Science.gov (United States)

Singler, K; Stuck, A E; Masud, T; Goeldlin, A; Roller, R E

2014-11-01

Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students' perceptions of geriatrics and geriatric education in the United States.

Science.gov (United States)

Reneker, Jennifer C; Weems, Kyra; Scaia, Vincent

2016-01-01

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21-33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen's d values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15-0.30). Two perceptions of geriatric physical therapy demonstrated a significant positive increase (Pgeriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68) and enjoyment (d=1.96). Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

Grid parity analysis of stand-alone hybrid microgrids: A comparative study of Germany, Pakistan, South Africa and the United States

Science.gov (United States)

Siddiqui, Jawad M.

Grid parity for alternative energy resources occurs when the cost of electricity generated from the source is lower than or equal to the purchasing price of power from the electricity grid. This thesis aims to quantitatively analyze the evolution of hybrid stand-alone microgrids in the US, Germany, Pakistan and South Africa to determine grid parity for a solar PV/Diesel/Battery hybrid system. The Energy System Model (ESM) and NREL's Hybrid Optimization of Multiple Energy Resources (HOMER) software are used to simulate the microgrid operation and determine a Levelized Cost of Electricity (LCOE) figure for each location. This cost per kWh is then compared with two distinct estimates of future retail electricity prices at each location to determine grid parity points. Analysis results reveal that future estimates of LCOE for such hybrid stand-alone microgrids range within the 35-55 cents/kWh over the 25 year study period. Grid parity occurs earlier in locations with higher power prices or unreliable grids. For Pakistan grid parity is already here, while Germany hits parity between the years 2023-2029. Results for South Africa suggest a parity time range of the years 2040-2045. In the US, places with low grid prices do not hit parity during the study period. Sensitivity analysis results reveal the significant impact of financing and the cost of capital on these grid parity points, particularly in developing markets of Pakistan and South Africa. Overall, the study helps conclude that variations in energy markets may determine the fate of emerging energy technologies like microgrids. However, policy interventions have a significant impact on the final outcome, such as the grid parity in this case. Measures such as eliminating uncertainty in policies and improving financing can help these grids overcome barriers in developing economies, where they may find a greater use much earlier in time.

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

Science.gov (United States)

Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold

2017-10-01

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.

Solar photovoltaic applications seminar: design, installation and operation of small, stand-alone photovoltaic power systems

Energy Technology Data Exchange (ETDEWEB)

1980-07-01

This seminar material was developed primarily to provide solar photovoltaic (PV) applied engineering technology to the Federal community. An introduction to photoconductivity, semiconductors, and solar photovoltaic cells is included along with a demonstration of specific applications and application identification. The seminar details general systems design and incorporates most known information from industry, academia, and Government concerning small solar cell power system design engineering, presented in a practical and applied manner. Solar PV power system applications involve classical direct electrical energy conversion and electric power system analysis and synthesis. Presentations and examples involve a variety of disciplines including structural analysis, electric power and load analysis, reliability, sizing and optimization; and, installation, operation and maintenance. Four specific system designs are demonstrated: water pumping, domestic uses, navigational and aircraft aids, and telecommunications. All of the applications discussed are for small power requirement (under 2 kilowatts), stand-alone systems to be used in remote locations. Also presented are practical lessons gained from currently installed and operating systems, problems at sites and their resolution, a logical progression through each major phase of system acquisition, as well as thorough design reviews for each application.

Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial.

Science.gov (United States)

McVey, L J; Becker, P M; Saltz, C C; Feussner, J R; Cohen, H J

1989-01-01

To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. Randomized controlled clinical trial. University-affiliated referral Veterans Administration Medical Center. One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units. Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients' physicians. Ninety control group patients received only usual care. Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant. Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in

Comparative analysis of distributed MPPT controllers for partially shaded stand alone photovoltaic systems

International Nuclear Information System (INIS)

Muthuramalingam, M.; Manoharan, P.S.

2014-01-01

Highlights: • Analyzes the performance of ANN and ANFIS MPPT algorithms by stand alone PV system. • ISSBC with ANFIS can provide the overall efficiency higher than ANN. • CHBMLI integrate with SHE ANN modulation technique improve output voltage quality. • Simulation and hardware results show the ANFIS algorithm efficient than ANN algorithm. - Abstract: This paper presents a unique combination of an interleaved soft switched boost converter (ISSBC) run by a set of two photovoltaic panel (PV) with a distributed MPPT, suitable to guarantee MPPT even under partial shadowed conditions, managed by an adaptive neuro fuzzy inference system trained by the training data derived from a particle swarm optimization (PSO–ANFIS) unit. The ISSBC is followed by a, single phase cascaded H bridge five-level inverter (CHI) driven by the individual DC outputs of the ISSBC, with selective harmonic elimination scheme to eliminate typically the seventh order harmonics. A comparison of different intelligent distributed maximum power point tracking (MPPT) algorithms for photovoltaic (PV) system under partial shadow conditions is carried out. The use of the ISSBC guarantees mitigation of ripple and it is meant to handle higher currents with minimal switching losses. Simulation was carried out in the Matlab Simulink environment and an experimental verification with a scaled down model validated the proposed scheme. It has been thus established, by both simulation and experimental verification, that the PSO–ANFIS model of distributed MPPT scheme of control outperforms other schemes of control for MPPT

Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

Directory of Open Access Journals (Sweden)

Luis Marchi

2012-01-01

Full Text Available The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6±10 y/o; 73.1% female; 27.4±3.4 BMI with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.. The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P<0.001 and was maintained through 24 months (7.1%, P<0.001. Segmental lordosis (P<0.001 and disc height (P<0.001 were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17% and 7/52 cases (13% spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis.

Is the radiographic subsidence of stand-alone cages associated with adverse clinical outcomes after cervical spine fusion? An observational cohort study with 2-year follow-up outcome scoring.

Science.gov (United States)

Zajonz, Dirk; Franke, Anne-Catherine; von der Höh, Nicolas; Voelker, Anna; Moche, Michael; Gulow, Jens; Heyde, Christoph-Eckhard

2014-01-01

The stand-alone treatment of degenerative cervical spine pathologies is a proven method in clinical practice. However, its impact on subsidence, the resulting changes to the profile of the cervical spine and the possible influence of clinical results compared to treatment with additive plate osteosynthesis remain under discussion until present. This study was designed as a retrospective observational cohort study to test the hypothesis that radiographic subsidence of cervical cages is not associated with adverse clinical outcomes. 33 cervical segments were treated surgically by ACDF with stand-alone cage in 17 patients (11 female, 6 male), mean age 56 years (33-82 years), and re-examined after eight and twenty-six months (mean) by means of radiology and score assessment (Medical Outcomes Study Short Form (MOS-SF 36), Oswestry Neck Disability Index (ONDI), painDETECT questionnaire and the visual analogue scale (VAS)). Subsidence was observed in 50.5% of segments (18/33) and 70.6% of patients (12/17). 36.3% of cases of subsidence (12/33) were observed after eight months during mean time of follow-up 1. After 26 months during mean time of follow-up 2, full radiographic fusion was seen in 100%. MOS-SF 36, ONDI and VAS did not show any significant difference between cases with and without subsidence in the two-sample t-test. Only in one type of scoring (painDETECT questionnaire) did a statistically significant difference in t-Test emerge between the two groups (p = 0.03; α = 0.05). However, preoperative painDETECT score differ significantly between patients with subsidence (13.3 falling to 12.6) and patients without subsidence (7.8 dropped to 6.3). The radiological findings indicated 100% healing after stand-alone treatment with ACDF. Subsidence occurred in 50% of the segments treated. No impact on the clinical results was detected in the medium-term study period.

Integration of hydrogen energy technologies in stand-alone power systems analysis of the current potential for applications

International Nuclear Information System (INIS)

Zoulias, E.I.; Lymberopoulos, N.; Tsoutsos, T.; Glockner, R.; Mydske, H.J.; Vosseler, I.; Gavalda, O.; Taylor, P.

2006-01-01

The European study entitled: 'Market Potential Analysis for Introduction of Hydrogen Energy Technology in Stand-Alone Power Systems (H-SAPS)' aimed to establish a broad understanding of the market potential for H-SAPS and provide a basis for promoting in wide scale new technological applications. The scope of the study was limited to small and medium installations, up to a few hundred kW power rating and based on RE as the primary energy source. The potential for hydrogen technology in SAPS was investigated through an assessment of the technical potential for hydrogen, the market analysis and the evaluation of external factors. The results are mostly directed towards action by governments and the research community but also industry involvement is identified. The results include targeted market research, establishment of individual cost targets, regulatory changes to facilitate alternative grid solutions, information and capacity building, focused technology research and bridging the technology gaps. (author)

Multi-Objective Optimal Design of Stand-Alone Hybrid Energy System Using Entropy Weight Method Based on HOMER

Directory of Open Access Journals (Sweden)

Jiaxin Lu

2017-10-01

Full Text Available Implementation of hybrid energy system (HES is generally considered as a promising way to satisfy the electrification requirements for remote areas. In the present study, a novel decision making methodology is proposed to identify the best compromise configuration of HES from a set of feasible combinations obtained from HOMER. For this purpose, a multi-objective function, which comprises four crucial and representative indices, is formulated by applying the weighted sum method. The entropy weight method is employed as a quantitative methodology for weighting factors calculation to enhance the objectivity of decision-making. Moreover, the optimal design of a stand-alone PV/wind/battery/diesel HES in Yongxing Island, China, is conducted as a case study to validate the effectiveness of the proposed method. Both the simulation and optimization results indicate that, the optimization method is able to identify the best trade-off configuration among system reliability, economy, practicability and environmental sustainability. Several useful conclusions are given by analyzing the operation of the best configuration.

Geriatric fall-related injuries.

Science.gov (United States)

Hefny, Ashraf F; Abbas, Alaa K; Abu-Zidan, Fikri M

2016-06-01

Falls are the leading cause of geriatric injury. We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.

A practical multi-objective design approach for optimum exhaust heat recovery from hybrid stand-alone PV-diesel power systems

International Nuclear Information System (INIS)

Yousefi, Moslem; Kim, Joong Hoon; Hooshyar, Danial; Yousefi, Milad; Sahari, Khairul Salleh Mohamed; Ahmad, Rodina Binti

2017-01-01

Highlights: • Heat recovery exchanger is designed based on practical conditions of a hybrid power system. • Off-the-grid electricity system modeling and analysis using micro-grid analysis software HOMER. • NSGA-II is used for the multi-objective design optimization task. • A new local search is proposed to incorporate the engineering knowledge in NSGA-II. • The proposed approach outperforms the existing ones. - Abstract: Integration of solar power and diesel generators (DGs) together with battery storage has proven to be an efficient choice for stand-alone power systems (SAPS). For higher energy efficiency, heat recovery from exhaust gas of the DG can also be employed to supply all or a portion of the thermal energy demand. Although the design of such heat recovery systems (HRSs) has been studied, the effect of solar power integration has not been taken into account. In this paper, a new approach for practical design of these systems based on varying engine loads is presented. Fast and elitist non-dominated sorting genetic algorithm (NSGA-II) equipped with a novel local search was used for the design process, considering conflicting objectives of annual energy recovery and total cost of the system, and six design variables. An integrated power system, designed for a remote SAPS, was used to evaluate the design approach. The optimum power supply system was first designed using the commercial software Hybrid Optimization of Multiple Energy Resources (HOMER), based on power demand and global solar energy in the region. Heat recovery design was based on the outcome of HOMER for DG hourly load, considering different power scenarios. The proposed approach improves the annual heat recovery of the PV/DG/battery system by 4%, PV/battery by 1.7%, and stand-alone DG by 1.8% when compared with a conventional design based on nominal DG load. The results prove that the proposed approach is effective and that load calculations should be taken into account prior to

Factors that can influence the economic feasibility of stand-alone and grid-connected photovoltaic systems: case studies using the software AVES-F

International Nuclear Information System (INIS)

Blasques, L.C.M.; Pinho, J.T.

2004-01-01

This paper presents case studies of economic feasibility of solar photovoltaic systems using the software AVES-F (Analysis of Economic Feasibility of Photovoltaic Systems), developed by the authors, considering cases of stand-alone and grid-connected systems. The software takes into account several factors that can influence the economic feasibility of these kind of systems, like load to be supplied, distance to the grid, the use regime of the system, applied subsidies and others. The main goal of this paper is to analyze some of these factors and to observe how they can affect the economics of PV systems for electricity generation. (authors)

International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Science.gov (United States)

Wildiers, Hans; Heeren, Pieter; Puts, Martine; Topinkova, Eva; Janssen-Heijnen, Maryska L.G.; Extermann, Martine; Falandry, Claire; Artz, Andrew; Brain, Etienne; Colloca, Giuseppe; Flamaing, Johan; Karnakis, Theodora; Kenis, Cindy; Audisio, Riccardo A.; Mohile, Supriya; Repetto, Lazzaro; Van Leeuwen, Barbara; Milisen, Koen; Hurria, Arti

2014-01-01

Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base. PMID:25071125

Financial gerontology and the rehabilitation nurse.

Science.gov (United States)

Mauk, Kristen L; Mauk, James M

2006-01-01

Rehabilitation nurses, particularly those who work in geriatrics, recognize that the elderly have become increasingly heterogeneous, with many remaining active well into their 80s and beyond. As the baby boomers enter older adulthood, the senior healthcare market will be greatly affected. The areas of finance, economics, and marketing are seeing new trends that combine the expertise of financial planners with healthcare advisors and advocates for seniors. One emerging specialty area is financial gerontology. This article defines financial gerontology, presents emerging trends and certifications related to the field, and discusses implications for the rehabilitation nurse.

Improving geriatric trauma outcomes: A small step toward a big problem.

Science.gov (United States)

Hammer, Peter M; Storey, Annika C; Bell, Teresa; Bayt, Demetria; Hockaday, Melissa S; Zarzaur, Ben L; Feliciano, David V; Rozycki, Grace S

2016-07-01

Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center. As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979). Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients. Therapeutic/care management study, level IV.

Developing positive attitudes toward geriatric nursing among Millennials and Generation Xers.

Science.gov (United States)

Heise, Barbara A; Johnsen, Vickie; Himes, Deborah; Wing, Debra

2012-01-01

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults.With the understanding that younger adults see a need to balance work and play, a baccalaureate nursing program provides examples of ways to accomplish this through integration of courses, simulations, positive images of aging, and learning activities that enhance empathy for both frail and healthy older adults.

Psychosocial Issues in Geriatric Rehabilitation.

Science.gov (United States)

Rodriguez, Ricardo M

2017-11-01

Geriatric patients present multiple age-related challenges and needs that must be taken into account during the rehabilitation process to achieve expected goals. This article examines the importance of identifying and managing psychosocial issues commonly observed in older adults and presents strategies to optimize their rehabilitation process. Depression, anxiety, fear of falling, adjustment issues, neurocognitive disorders, and caregiver support are discussed as a selection of factors that are relevant for geriatric patients undergoing rehabilitation. An argument is made for the importance of comprehensive geriatric assessment in older adults to identify salient issues that may impact rehabilitation and quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

Science.gov (United States)

Adelman, Ronald D.; Ansell, Pamela; Breckman, Risa; Snow, Caitlin E.; Ehrlich, Amy R.; Greene, Michele G.; Greenberg, Debra F.; Raik, Barrie L.; Raymond, Joshua J.; Clabby, John F.; Fields, Suzanne D.; Breznay, Jennifer B.

2011-01-01

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area…

Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome

DEFF Research Database (Denmark)

Beck, Anne Marie; Tolstrup Andersen, Ulla; Leedo, Eva

2015-01-01

(70 + years and at nutritional risk) at discharge. INTERVENTIONS: Participants were randomly allocated to receive discharge Liaison-Team vs. discharge Liaison-Team in cooperation with a dietician. The dietician performed a total of three home visits with the aim of developing and implementing......OBJECTIVES: The objective was to test whether adding a dietician to a discharge Liaison-Team after discharge of geriatric patients improves nutritional status, muscle strength and patient relevant outcomes. DESIGN: Twelve-week randomized controlled trial. SETTING AND SUBJECTS: Geriatric patients...... an individual nutritional care plan. The first visit took place at the day of discharge together with the discharge Liaison-Team while the remaining visits took place approximately three and eight weeks after discharge and were performed by a dietician alone. MAIN MEASURES: Nutritional status (weight...

The Technology Acceptance of a TV Platform for the Elderly Living Alone or in Public Nursing Homes.

Science.gov (United States)

Santana-Mancilla, Pedro C; Anido-Rifón, Luis E

2017-06-08

In Mexico, many seniors are alone for most of the day or live in public nursing homes. Simple interaction with computer systems is required for older people. This is why we propose the exploration of a medium well known by seniors, such as the television (TV). The primary objective of this study is to improve the quality of life of seniors through an easier reminder system, using the television set. A technological platform was designed based on interactive television, through which seniors and their caregivers can have a better way to track their daily activities. Finally, an evaluation of the technology adoption was performed with 50 seniors living in two public nursing homes. The evaluation found that the elderly perceived the system as useful, easy to use, and they had a positive attitude and good intention to use it. This helped to generate initial evidence that the system supported them in achieving a better quality of life, by reminding them to take their medications and increasing their rate of attendance to their medical appointments.

Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

Science.gov (United States)

Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F.; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L.; Bruce, Martha L.

2011-01-01

Abstract Objective The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Materials and Methods Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. Results An ethnically diverse sample of 48 English- and Spanish-only–speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the “markedly severe” range at baseline and in the “mild” range at follow-up. Conclusions Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed. PMID:21780942

PALLIATIVE CARE IN GERIATRICS: CURRENT ISSUES AND PROSPECTS

Directory of Open Access Journals (Sweden)

I. P. Рonomareva

2016-01-01

Full Text Available The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

"Candidatus Fokinia solitaria", a Novel "Stand-Alone" Symbiotic Lineage of Midichloriaceae (Rickettsiales.

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Franziska Szokoli

Full Text Available Recently, the family Midichloriaceae has been described within the bacterial order Rickettsiales. It includes a variety of bacterial endosymbionts detected in different metazoan host species belonging to Placozoa, Cnidaria, Arthropoda and Vertebrata. Representatives of Midichloriaceae are also considered possible etiological agents of certain animal diseases. Midichloriaceae have been found also in protists like ciliates and amoebae. The present work describes a new bacterial endosymbiont, "Candidatus Fokinia solitaria", retrieved from three different strains of a novel Paramecium species isolated from a wastewater treatment plant in Rio de Janeiro (Brazil. Symbionts were characterized through the full-cycle rRNA approach: SSU rRNA gene sequencing and fluorescence in situ hybridization (FISH with three species-specific oligonucleotide probes. In electron micrographs, the tiny rod-shaped endosymbionts (1.2 x 0.25-0.35 μm in size were not surrounded by a symbiontophorous vacuole and were located in the peripheral host cytoplasm, stratified in the host cortex in between the trichocysts or just below them. Frequently, they occurred inside autolysosomes. Phylogenetic analyses of Midichloriaceae apparently show different evolutionary pathways within the family. Some genera, such as "Ca. Midichloria" and "Ca. Lariskella", have been retrieved frequently and independently in different hosts and environmental surveys. On the contrary, others, such as Lyticum, "Ca. Anadelfobacter", "Ca. Defluviella" and the presently described "Ca. Fokinia solitaria", have been found only occasionally and associated to specific host species. These last are the only representatives in their own branches thus far. Present data do not allow to infer whether these genera, which we named "stand-alone lineages", are an indication of poorly sampled organisms, thus underrepresented in GenBank, or represent fast evolving, highly adapted evolutionary lineages.

Synchronized Pulsed dc - dc Converter as Maximum Power Position Tracker with Wide Load and Insolation Variation for Stand Alone PV System

International Nuclear Information System (INIS)

Hardik, P. Desai; Ranjan Maheshwari

2011-01-01

This paper investigates the interest focused on employing parallel connected dc-dc converter with high tracking effectiveness under wide variation in environmental conditions (Insolation) and wide load variation. dc-dc converter is an essential part of the stand alone PV system. Paper also presents an approach on how duty cycle for maximum power position (MPP) is adjusted by taking care of varying load conditions and without iterative steps. Synchronized PWM pulses are employed for the converter. High tracking efficiency is achieved with continuous input and inductor current. In this approach, the converter can he utilized in buck as well in boost mode. The PV system simulation was verified and experimental results were in agreement to the presented scheme. (authors)

Development of a Laser-Powered Dielectric Structure-Based Accelerator as a Stand-Alone Particle Source

International Nuclear Information System (INIS)

Yoder, R. B.; Travish, G.; Arab, E. R.; Fong, D.; Hoyer, Z.; Lacroix, U. H.; Vartanian, N.; Rosenzweig, J. B.

2010-01-01

An experimental program to develop and build a dielectric-based slab-symmetric structure (the micro-accelerator platform, or MAP) for generating and accelerating low-energy electrons is underway at UCLA and Manhattanville College. This optical acceleration structure is effectively a resonant cavity powered by a side-coupled laser, and has applications as a radiation source for medicine or industry. We present recent experimental and computational results on the accelerator, and progress toward its incorporation into a self-contained particle source. Such a particle source would incorporate a micron-scale electron emitter and a non-relativistic capture region to enable self-injection into the synchronous field within the accelerator. A prototype of the accelerator itself has been constructed from candidate dielectric materials using micromanufacturing techniques; the current status of the testing program is described. A novel electron emitter incorporating pyroelectric crystals with field-enhancing tips has been demonstrated to produce steady currents; the results are dependent on tip geometry, and appear suitable for injection into a microstructure. Extension of the MAP concept to non-relativistic velocities, as in the stand-alone source, requires a tapered structure that gives rise to numerous complications including beam defocusing and manufacturing challenges; approaches for addressing these complications are mentioned.

Effects of ozone as a stand-alone and coagulation-aid treatment on the reduction of trihalomethanes precursors from high DOC and hardness water.

Science.gov (United States)

Sadrnourmohamadi, Mehrnaz; Gorczyca, Beata

2015-04-15

This study investigates the effect of ozone as a stand-alone and coagulation aid on the removal of dissolved organic carbon (DOC) from the water with a high level of DOC (13.8 mgL(-1)) and calcium hardness (270 mgL(-1)) CaCO3. Natural water collected from the Assiniboine River (Manitoba, Canada) was used in this study. Effectiveness of ozone treatment was evaluated by measurement of DOC, DOC fractions, UV254, and trihalomethane formation potential (THMFP). Additionally, zeta potential and dissolved calcium concentration were measured to discern the mechanism of ozone reactions. Results indicated that 0.8 mg O3/mg DOC ozone stand-alone can cause up to 86% UV254 reduction and up to 27% DOC reduction. DOC fractionation results showed that ozone can change the composition of DOC in the water samples, converting the hydrophobic fractions into hydrophilic ones and resulting in the reduction of THMFP. Also, ozone caused a decrease in particle stability and dissolved calcium concentration. These simultaneous ozonation effects caused improved water flocculation and enhanced removal of DOC. This resulted in reduction of the coagulant dosage when ozone doses higher than 0.2 mg O3/mg DOC were applied prior to coagulation with ferric sulfate. Also, pre-ozonation-coagulation process achieved preferential THMFP removal for all of the ozone doses tested (0-0.8 mg O3/mg DOC), leading to a lower specific THMFP in pre-ozonated-coagulated waters than in the corresponding ozonated waters. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

OpenAIRE

Jennifer C. Reneker; Kyra Weems; Vincent Scaia

2016-01-01

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at th...

Prevalence and determinants for malnutrition in geriatric outpatients

NARCIS (Netherlands)

van Bokhorst-de van der Schueren, M.A.E.; Lonterman-Monasch, S.; de Vries, O.J.; Danner, S.A.; Kramer, M.H.H.; Muller, M.

2013-01-01

Background & aims: Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. Methods: From 2005 to

Health policy 2016: implications for geriatric urology.

Science.gov (United States)

Suskind, Anne M; Clemens, J Quentin

2016-03-01

The US healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore, will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. The Affordable Care Act has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination and risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues.

Predicting in-patient falls in a geriatric clinic: a clinical study combining assessment data and simple sensory gait measurements.

Science.gov (United States)

Marschollek, M; Nemitz, G; Gietzelt, M; Wolf, K H; Meyer Zu Schwabedissen, H; Haux, R

2009-08-01

Falls are among the predominant causes for morbidity and mortality in elderly persons and occur most often in geriatric clinics. Despite several studies that have identified parameters associated with elderly patients' fall risk, prediction models -- e.g., based on geriatric assessment data -- are currently not used on a regular basis. Furthermore, technical aids to objectively assess mobility-associated parameters are currently not used. To assess group differences in clinical as well as common geriatric assessment data and sensory gait measurements between fallers and non-fallers in a geriatric sample, and to derive and compare two prediction models based on assessment data alone (model #1) and added sensory measurement data (model #2). For a sample of n=110 geriatric in-patients (81 women, 29 men) the following fall risk-associated assessments were performed: Timed 'Up & Go' (TUG) test, STRATIFY score and Barthel index. During the TUG test the subjects wore a triaxial accelerometer, and sensory gait parameters were extracted from the data recorded. Group differences between fallers (n=26) and non-fallers (n=84) were compared using Student's t-test. Two classification tree prediction models were computed and compared. Significant differences between the two groups were found for the following parameters: time to complete the TUG test, transfer item (Barthel), recent falls (STRATIFY), pelvic sway while walking and step length. Prediction model #1 (using common assessment data only) showed a sensitivity of 38.5% and a specificity of 97.6%, prediction model #2 (assessment data plus sensory gait parameters) performed with 57.7% and 100%, respectively. Significant differences between fallers and non-fallers among geriatric in-patients can be detected for several assessment subscores as well as parameters recorded by simple accelerometric measurements during a common mobility test. Existing geriatric assessment data may be used for falls prediction on a regular basis

Evaluation of geriatric changes in dogs

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Soumyaranjan Pati

2015-03-01

Full Text Available Aim: The present study has been envisaged to ascertain the old age for critical management of geriatric dogs considering the parameters of externally visible changes, haemato-biochemical alterations and urine analysis in geriatric dogs approaching senility. Materials and Methods: The study was undertaken in the Department of Veterinary Pathology in collaboration with Teaching Veterinary Clinic complex spanning a period of 1 year. For screening of geriatric dogs, standard geriatric age chart of different breeds was followed. The external characteristics such as hair coat texture, dental wear and tear, skin texture and glaucoma were taken as a marker of old age. Haematology, serum biochemistry and urine analysis were also included in the study. Results: External visible changes like greying of hair, dull appearance of hair coat, glaucoma, osteoarthritis, dental wear and tear were commonly encountered in the aged dogs. The haemoglobin, total erythrocyte count and packed cell volume showed a decreasing trend in the geriatric groups. Biochemical values like total protein, albumin, calcium level showed a decreasing trend while urea level with an increasing trend in geriatric dogs without any much alteration in serum glutamicoxaloacetic transaminse, serum glutamic-pyruvate transaminase, cholesterol and creatinine. Physical examination of urine revealed yellow, amber, red, deep red color with turbidity and higher specific gravity. Chemical examination revealed presence of protein, glucose, ketone bodies, blood and bilirubin on some cases. The culture and sensitivity test of the urine samples revealed presence of bacteria with sensitive and resistance to some antibiotics. Conclusion: External visible changes are still the golden standard of determining the old age in dogs. Haemato-biochemical evaluation can be useful for correlating with the pathophysiological status of the animal. Biochemical analysis of urine can be employed rightly as kidney

Opportunities for emotional intelligence in the context of nursing

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Lubica Ilievová

2013-04-01

Full Text Available Introduction: Emotional intelligence is the ability to recognize and control one´s own emotions as well as emotions of other people. There are two orientations in studying emotional intelligence. They differ in whether they relate abilities and personal characteristic features or not. Emotional intelligence usage is currently being understood as a fundamental requirement of nursing in care provision to patients.Methods: In a research conducted with a group of nursing students (n = 86, we were examining emotional intelligence as an ability and as a feature. We used SIT-EMO (Situational Test of Emotional Understanding scales in order to fi nd out emotional intelligence as an ability, and SEIS (Schutte Emotional Intelligence Scale, measuring emotional intelligence as a feature. In the context of nursing, we were finding out emotional self-effi cacy in relation to geriatric patients (ESE-GP. TEIQue-SF (Trait Emotional Intelligence Questionnaire – short form method was used to set up our own questionnaire.Results: We were fi nding out the extent of emotional intelligence and we were analyzing it from the viewpoint of its grasping as a feature, ability and emotional self-effi cacy in relation to geriatric patients. We found out lower levels in social awareness, emotional management and stress management dimensions of the nursing students.Conclusion: Emotional intelligence as an ability of the nursing students can be enhanced through psychological and social trainings. Emotional intelligence has an impact on social and communication skills, which are a precondition of effective nursing care.

The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions

Science.gov (United States)

Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.

2016-01-01

OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

Search Improvement Process-Chaotic Optimization-Particle Swarm Optimization-Elite Retention Strategy and Improved Combined Cooling-Heating-Power Strategy Based Two-Time Scale Multi-Objective Optimization Model for Stand-Alone Microgrid Operation

Directory of Open Access Journals (Sweden)

Fei Wang

2017-11-01

Full Text Available The optimal dispatching model for a stand-alone microgrid (MG is of great importance to its operation reliability and economy. This paper aims at addressing the difficulties in improving the operational economy and maintaining the power balance under uncertain load demand and renewable generation, which could be even worse in such abnormal conditions as storms or abnormally low or high temperatures. A new two-time scale multi-objective optimization model, including day-ahead cursory scheduling and real-time scheduling for finer adjustments, is proposed to optimize the operational cost, load shedding compensation and environmental benefit of stand-alone MG through controllable load (CL and multi-distributed generations (DGs. The main novelty of the proposed model is that the synergetic response of CL and energy storage system (ESS in real-time scheduling offset the operation uncertainty quickly. And the improved dispatch strategy for combined cooling-heating-power (CCHP enhanced the system economy while the comfort is guaranteed. An improved algorithm, Search Improvement Process-Chaotic Optimization-Particle Swarm Optimization-Elite Retention Strategy (SIP-CO-PSO-ERS algorithm with strong searching capability and fast convergence speed, was presented to deal with the problem brought by the increased errors between actual renewable generation and load and prior predictions. Four typical scenarios are designed according to the combinations of day types (work day or weekend and weather categories (sunny or rainy to verify the performance of the presented dispatch strategy. The simulation results show that the proposed two-time scale model and SIP-CO-PSO-ERS algorithm exhibit better performance in adaptability, convergence speed and search ability than conventional methods for the stand-alone MG’s operation.

Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review.

Science.gov (United States)

Dwyer, Drew

2011-12-01

, Assessment and Review of Information package. As both reviewers were in agreement on all studies included, a third reviewer was not required. A final total of eight papers, qualitative in nature, were included in the review. The majority of papers examined the experiences of nurses' leadership styles and the management characteristics within their organisations. The qualitative papers were analysed using The Joanna Briggs Institute-Qualitative Assessment and Review Instrument.The process of meta-synthesis embodied in this programme involves the aggregation or synthesis of findings or conclusions. Five syntheses were derived with key themes related to education, professional nursing development, positive attitudes to aged care and the need for a supportive environment. Nurses that work in the aged care environment show a strong motivation to work in care and provide the best outcomes in nursing the elderly. Geriatric nursing is considered a specialised and complex area of healthcare by the nursing profession. Nurses experience a lack of professional support and collaboration from allied health and medical colleagues. There is a lack of specific education that is focused in clinical leadership and health team management. There is no current structured pathway of learning and development for nursing careers in aged care. Nurses identify with their leadership role in residential aged care, and experience paradoxical feelings of being valued by the clients and devalued by the system at the same time. Organisational barriers are strong in preventing continuing education and skills development for nurse leaders in aged care environments. Overall the themes presented in the review reported the negative experiences of nurses in residential aged care and geriatrics. Nurses will continue to be devalued if there is no professional identity and support for their roles and need to have a career pathway when making the decision to enter into aged and geriatric practice. Clinical leadership

Effect of State Feedback Coupling and System Delays on the Transient Performance of Stand-Alone VSI with LC Output Filter

DEFF Research Database (Denmark)

Federico, de Bosio; de Sousa Ribeiro, Luiz Antonio; Freijedo Fernandez, Francisco Daniel

2016-01-01

The influence of state feedback coupling in the dynamics performance of power converters for stand-alone microgrids is investigated. Computation and PWM delays are the main factors that limit the achievable bandwidth of current regulators in digital implementations. In particular, the performance...... of state feedback decoupling is degraded because of these delays. Two decoupling techniques to improve the transient response of the system are investigated, named non-ideal and ideal capacitor voltage decoupling respectively. In particular, the latter solution consists in leading the capacitor voltage...... on the state feedback decoupling path in order to compensate for system delays. Practical implementation issues are discussed with reference to both the decoupling techniques. A design methodology for the voltage loop, that considers the closed loop transfer functions developed for the inner loop, is also...

Dealing with the patient's body in nursing: nurses' ambiguous experience in clinical practice.

Science.gov (United States)

Picco, Elisa; Santoro, Roberto; Garrino, Lorenza

2010-03-01

The core of nursing in western countries is interaction with the patient and with his/her body in particular. As all nursing practices revolve around caring for the patient's body, nurses need to understand the frailty of the body, the intimacy surrounding it, the story it tells, as well as the discomfort and difficulties both illness and close contact can generate in the nurse-patient relationship. With this study, we wanted to explore the ward experiences of a small group of nurses in their day-to-day interaction with patients and their bodies, to highlight their perceptions and possible difficulties in providing care. We collected qualitative data from in-depth interviews with 14 nurses working in departments of general internal medicine, neurology, and geriatrics. The interviews were conducted between April and June 2006 and interpreted using an interpretive phenomenological approach. Analysis of the interview transcripts revealed that while the nurses recognize the centrality of the body in nursing, they also expressed a certain ambiguity toward it: being able to improve a patient's well-being through attentive care to the body is a major source of job satisfaction, but various coping and defense strategies are deployed to overcome care-giving situations that elicit avoidance or refusal reactions to the patient's body.

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

Science.gov (United States)

Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

2015-04-25

Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

Directory of Open Access Journals (Sweden)

Cokorda Istri Devi Larayanthi

2013-04-01

Full Text Available Sleep is an unconscious condition that is relatively more responsive to internal stimuli. Insomnia is a sleep disorder with characteristic difficulty of initiating sleep or difficulty in maintaining sleep. Insomnia is divided into 2 primary insomnia and secondary insomnia. Conection with age, the function of organs in the body decreases. So that geriatric patients are susceptible to illnesses, especially insomnia. Many of the causes of insomnia in geriatric mental disorders, psychiatric, general medical conditions, medications, certain substances, and others. Management of insomnia in geriatric patients were divided into 3 method: 1 manage underlying cause, 2 nonpharmacological therapies such as cognitive behavior therapy (CBT, and 3 pharmacological therapies such as benzodiazepine and non-benzodiazepine that eszopiclone and Ramelteon. Pharmacological treatment in geriatrics should follow the rule "start low, go slow", starting dose of ½ of the adult dose, and its use in the short term.

Abstracts from the 35th Annual Scientific Meeting of the Canadian Geriatrics Society, Montreal, April 2015

OpenAIRE

Cetin-Sahin, D.; McCusker, J.; Ciampi, A.; Vu, T.T.M.; Cossette, S.; Veillette, N.; Vadeboncoeur, A.; Belzile, E.; Ducharme, F.; Arvisais, K.; Bergeron-Wolff, S.; Bouffard, C.; Michaud, A.-S.; Bergeron, J.; Brazeau, S.

2015-01-01

Optimizing heath care services for seniors in emergency departments (ED) is a core component of the “Senior Friendly Hospital Approach” being implemented in Quebec. We measured the availability of geriatric expertise in Quebec EDs and its relationship with ED characteristics such as university affiliation, number of stretchers, and geographical location. We surveyed (2013–2014) head nurses and head physicians at 116 adult, non-psychiatric Quebec EDs. We defined high level of availability in t...

Analysis and Management of Geriatric Anxiety.

Science.gov (United States)

Sallis, James F.; Lichstein, Kenneth L.

1982-01-01

Reviews the prevalence, negative health implications, and clinical management of geriatric anxiety. Proposes an interactive model of geriatric anxiety whereby physical disease and anxiety processes enter into reciprocal stimulation as a function of diminished capacity to withstand stress and hypervigilance of stress symptomatology. Outlines…

Feasibility study and energy conversion analysis of stand-alone hybrid renewable energy system

International Nuclear Information System (INIS)

Baghdadi, Fazia; Mohammedi, Kamal; Diaf, Said; Behar, Omar

2015-01-01

Highlights: • Hybrid stand-alone wind–solar–fossil power system is analyzed. • Measurement data are used to evaluate system performance. • The proposed system can generate about 70% from renewables. • Such a hybrid plant is very promising for remote regions in Algeria. - Abstract: There is a great interest in the development of renewable power technologies in Algeria, and more particularly hybrid concept. The present paper has investigated the performance of hybrid PV–Wind–Diesel–Battery configuration based on hourly measurements of Adrar climate (southern Algeria). Data of global solar radiation, ambient temperature and wind speed for a period of one year have been used. Firstly, the proposed hybrid system has been optimized by means of HOMER software. The optimization process has been carried out taking into account renewable resources potential and energy demand; while maximizing renewable electricity use and fuel saving are the purpose. In the second step, a mathematical model has been developed to ensure efficient energy management on the basis of various operation strategies. The analysis has shown that renewable energy system (PV–Wind) is able to supply about 70% of the demand. Wind power has ranked first with 43% of the annual total electricity production followed by diesel generator (with 31%) while the remaining fraction is being to PV panels. In this context, 69% of the fossil fuel can be saved when using the proposed hybrid configuration instead of the diesel generators that are currently installed in most remote regions in Algeria. Such a concept is very promising to meet the focus of renewable energy program announced in 2011.

Teaching geriatric fellows how to teach: a needs assessment targeting geriatrics fellowship program directors.

Science.gov (United States)

Rivera, Veronica; Yukawa, Michi; Aronson, Louise; Widera, Eric

2014-12-01

The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

WATER AND SALT METABOLISM IN THE GERIATRIC SYNDROMES

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Carlos G. Musso

2010-01-01

Full Text Available Geriatrics has already described four syndromes of its own: confusional syndrome, incontinence (fecal and/or urinary, and gait disorders and immobility syndrome, naming them geriatric giants. This name reflects their prevalence and great importance in the elderly. Ageing process induces many changes in renal physiology such as a reduction in glomerular filtration rate (senile hyponatremia, and water and sodium reabsorbtion capability. Besides, there are particular water and salt metabolism alteration characteristics of the geriatric syndromes, such as dehydration and hypernatremia in psychiatric disturbances as well as hyponatremia in patients suffering from immobility syndrome. The geriatric giants and nephrogeriatric physiology changes, are a good example of feed-back between geriatric syndromes, clinical entities characteristics in the elderly that predispose and potentiate each other, leading to catastrophic clinical events.

Prison nursing and its training

Directory of Open Access Journals (Sweden)

M. Sánchez-Roig

Full Text Available The main task of nurses is to take care of sick and healthy people and evaluate changes in their health conditions. The goal is to take the appropriate measures to help their recovery or guarantee a dignified death, and if possible, help them regain autonomy and independence. Nursing is present in different areas: primary health, mental health, accident and emergencies, intensive and coronary care, surgical care, paediatrics, geriatrics, public health, occupational health, teaching, etc. In our case, prison nursing, one of the least known branches of the profession, we wanted to investigate more deeply the work of nurses in prisons, which aspect of health care they are responsible for and to what type of population they are geared towards, as well as the necessary training to be able to work in such a particular environment. To conclude, we have seen that university degrees in general nursing do not include knowledge in this area, and that authors from different countries support the specialization of prison nursing and the need for nurses to be trained according to the health conditions of inmates and the characteristics of prisons.

Prison nursing and its training.

Science.gov (United States)

Sánchez-Roig, M; Coll-Cámara, A

2016-12-01

The main task of nurses is to take care of sick and healthy people and evaluate changes in their health conditions. The goal is to take the appropriate measures to help their recovery or guarantee a dignified death, and if possible, help them regain autonomy and independence. Nursing is present in different areas: primary health, mental health, accident and emergencies, intensive and coronary care, surgical care, paediatrics, geriatrics, public health, occupational health, teaching, etc. In our case, prison nursing, one of the least known branches of the profession, we wanted to investigate more deeply the work of nurses in prisons, which aspect of health care they are responsible for and to what type of population they are geared towards, as well as the necessary training to be able to work in such a particular environment. To conclude, we have seen that university degrees in general nursing do not include knowledge in this area, and that authors from different countries support the specialization of prison nursing and the need for nurses to be trained according to the health conditions of inmates and the characteristics of prisons.

Effects of inpatient geriatric interventions in a German geriatric hospital: Impact on ADL, mobility and cognitive status.

Science.gov (United States)

Bordne, S; Schulz, R-J; Zank, S

2015-06-01

Given the demographic changes, the need for effective geriatric intervention is obvious. Geriatric care aims to maintain the highest possible level of independence and quality of life and to reduce the risk of need for care. This study investigated the benefits of geriatric care on functional performance, mobility and cognition. This study involved a retrospective analysis of clinical data from 646 patients. At hospital admission and discharge functional status was assessed using the Barthel index. Mobility was evaluated by means of the Tinetti test and cognition by the mini-mental state examination (MMSE). A follow-up was conducted on 112 patients 2-5 months after hospital discharge. Statistical analysis included t-tests including Cohen's d for effect size and multivariate regression analysis. The mean age of the study population was 81.1 ± 7.1 years including 439 women (68%) and 207 men (32%). There were significant average improvements for activities of daily living (ADL), mobility and cognition comparing discharge and admission scores. For functional and mobility status, effect sizes were medium to high. Regression analyses showed that ADL improvement was predicted by functional, mobile and cognitive status at admission. Follow-up analyses revealed a high percentage of former patients still living at home and an overall maintenance of ADL levels. Geriatric patients seem to experience long-term improvements during geriatric treatment, which appears to fulfill its aim of recovering independence. For a better understanding of relevant factors for the recreation of geriatric patients, further research is needed, e.g. with respect to the impact of the nutritional status.

The Magnitude of Atherogenic Dyslipidaemia among Geriatric ...

African Journals Online (AJOL)

The Magnitude of Atherogenic Dyslipidaemia among Geriatric Nigerians with ... June 2011 on 122 consecutive geriatric patients with systemic hypertension ... of dyslipidaemia and a marker of dyslipidaemic cardiometabolic risk among them.

[Remaining a caregiver in the face of a refusal of nursing care].

Science.gov (United States)

Blanchard, Karine; Ménard, Rachel; Corvol, Aline

2016-10-01

Caregivers working with elderly people often find themselves in a difficult position when faced with the refusal of nursing care, whether or not the patient presents cognitive disorders. The nurses from the mobile geriatrics team of Rennes university hospital are regularly asked to help the caregiving teams in such situations. Refusals may concern washing, medication, eating, moving to an armchair, the organisation of physical aids or human assistance after discharge or transfer to a nursing home. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Endoprostheses in geriatric traumatology].

Science.gov (United States)

Buecking, B; Eschbach, D; Bliemel, C; Knobe, M; Aigner, R; Ruchholtz, S

2017-01-01

Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.

Geriatric and Student Perceptions following Student-led Educational Sessions

Directory of Open Access Journals (Sweden)

Kristin Janzen

2018-01-01

Full Text Available Objective: The objective of this study was to measure the effect of student-led educational events on geriatric patient and student participant perceptions in a community setting. Methods: Students led three events at a senior community center, focusing on learning and memory, sleep hygiene, and arthritis pain. The participants were geriatric patients who themselves were providers of support to homebound peers (“clients” through an independently organized program. Geriatric participants completed pre- and post-event surveys to measure changes in familiarity with the topics. Student participants also completed pre- and post-event surveys that tracked changes in their comfort in working with the geriatric population. Results: Each event demonstrated at least one positive finding for geriatric patients and/or their clients. Students reported increased comfort in working with and teaching the geriatric population following the first and third events, but not the second. Conclusion: Student-led educational sessions can improve perceived health-related knowledge of geriatric participants while simultaneously exposing students to the geriatric patient population. Overall, both students and geriatric participants benefited from these events. Practice Implications: Incorporation of single, student-led educational events could be mutually beneficial to students and the elderly population in the community and easily incorporated into any healthcare curriculum. Funding:This work was supported by a Butler University Innovation Fund Grant. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Research

Depression And Loneliness Levels Among the Older People, a Comparison Between Living Alone, Living with Family or Living at Nursing Home

Directory of Open Access Journals (Sweden)

Ege Agirman

2017-09-01

CONCLUSION: In the study, we found out that, rate of depression in older people is higher than the level in entire society, the same is true for the sense of loneliness, loneliness becomes more fierce, as depression becomes stronger, The older people living alone are more exposed to depression compared to the ones living with family or being nursed, and loneliness becomes a more important problem for these people, [J Contemp Med 2017; 7(3.000: 234-240

Cumulated Ambulation Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, Morten Tange; Jakobsen, Thomas Linding; Nielsen, Jesper Westphal

2012-01-01

Regaining basic mobility independence is considered important for elderly hospitalised patients. The Cumulated Ambulation Score (CAS) is a valid tool for evaluating these patients' basic mobility (getting in and out of bed, sit-to-stand from a chair and walking) in orthopaedic wards, and its use ...... is recommended in Denmark for patients with hip fracture. The aims of the present study were to evaluate the feasibility of the CAS in a geriatric ward and to describe its use after hip fracture in Denmark....

Factors associated with the 6-minute walk test in nursing home residents and community-dwelling older adults

Science.gov (United States)

Caballer, Vicent-Benavent; Lisón, Juan Francisco; Rosado-Calatayud, Pedro; Amer-Cuenca, Juan José; Segura-Orti, Eva

2015-01-01

[Purpose] The main objective of this study was to determine the contributions and extent to which certain physical measurements explain performance in the 6-minute walk test in healthy older adults living in a geriatric nursing home and for older adults dwelling in the community. [Subjects] The subjects were 122 adults aged 65 and older with no cognitive impairment who were independent in their daily activities. [Methods] The 6-minute walk test, age, body mass index, walking speed, chair stand test, Berg Balance Scale, Timed Up-and-Go test, rectus femoris cross-sectional area, Short Physical Performance Battery, and hand-grip strength were examined. [Results] Strong significant associations were found between mobility, lower-limb function, balance, and the 6-minute walk test. A stepwise multiple regression on the entire sample showed that lower-limb function was a significant and independent predictor for the 6-minute walk test. Additionally, lower-limb function was a strong predictor for the 6-minute walk test in our nursing home group, whereas mobility was found to be the best predictor in our community-dwelling group. [Conclusion] Better lower-limb function, balance, and mobility result in a higher distance covered by healthy older adults. Lower-limb function and mobility appeared to best determine walking performance in the nursing home and community-dwelling groups, respectively. PMID:26696740

The Impact of Course Delivery Systems on Student Achievement and Sense of Community: A Comparison of Learning Community versus Stand-Alone Classroom Settings in an Open-Enrollment Inner City Public Community College

Science.gov (United States)

Bandyopadhyay, Pamela

2010-01-01

This study examined the effects of two types of course delivery systems (learning community classroom environments versus stand-alone classroom environments) on the achievement of students who were simultaneously enrolled in remedial and college-level social science courses at an inner city open-enrollment public community college. This study was…

Attachment and coping of dementia care staff: The role of staff attachment style, geriatric nursing self-efficacy, and approaches to dementia in burnout.

Science.gov (United States)

Kokkonen, Taru-Maija; Cheston, Richard I L; Dallos, Rudi; Smart, Cordet A

2014-07-01

Past research suggests that dementia care staff are vulnerable to the development of burnout, which has implications for staff well-being and hence the quality of care for people with dementia. Studying personal vulnerability factors in burnout is important as it can guide staff training and support. Attachment theory suggests that adult attachment styles affect caregiving relationships and individuals' responses to stress, providing a framework for understanding caregivers' styles of coping. This cross-sectional survey study examined relationships between staff attachment styles, geriatric nursing self-efficacy, and approaches to dementia in burnout. Seventy-seven members of dementia care staff working on inpatient wards for older people completed self-report questionnaires. Insecure attachment, lower levels of self-efficacy, and more optimistic attitudes in staff were related to higher levels of burnout. Staff training on the role of attachment in dementia care is recommended. Further research is required to explore mediating factors between adult attachment styles and burnout. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The geriatric polytrauma: Risk profile and prognostic factors.

Science.gov (United States)

Rupprecht, Holger; Heppner, Hans Jürgen; Wohlfart, Kristina; Türkoglu, Alp

2017-03-01

In the German population, the percentage of elderly patients is increasing, and consequently there are more elderly patients among trauma cases, and particularly cases of polytrauma. The aim of this study was to present clinical results and a risk profile for geriatric polytrauma patients. Review of 140 geriatric (over 65 years of age) polytrauma patients who received prehospital treatment was performed. Severity of trauma was retrospectively assessed with Hannover Polytrauma Score (HPTS). Age, hemoglobin (Hb) level, systolic blood pressure (BP), Glasgow Coma Scale (GCS) score, timing of and necessity for intubation were analyzed in relation to mortality and in comparison with younger patients. Geriatric polytrauma patients (n=140) had overall mortality rate of 65%, whereas younger patients (n=1468) had mortality rate of 15.9%. Despite equivalent severity of injury (HPTS less age points) in geriatric and non-geriatric groups, mortality rate was 4 times higher in geriatric group. Major blood loss with Hb polytrauma patients. Additional risk factors include very low GCS score and systolic BP <80 mm Hg, for instance, as potential clinical indicators of massive bleeding and traumatic brain injury. Such parameters demand early and rapid treatment at prehospital stage and on admission.

Approaches for developing a sizing method for stand-alone PV systems with variable demand

Energy Technology Data Exchange (ETDEWEB)

Posadillo, R. [Grupo de Investigacion en Energias y Recursos Renovables, Dpto. de Fisica Aplicada, E.P.S., Universidad de Cordoba, Avda. Menendez Pidal s/n, 14004 Cordoba (Spain); Lopez Luque, R. [Grupo de Investigacion de Fisica para las Energias y Recursos Renovables, Dpto. de Fisica Aplicada. Edificio C2 Campus de Rabanales, 14071 Cordoba (Spain)

2008-05-15

Accurate sizing is one of the most important aspects to take into consideration when designing a stand-alone photovoltaic system (SAPV). Various methods, which differ in terms of their simplicity or reliability, have been developed for this purpose. Analytical methods, which seek functional relationships between variables of interest to the sizing problem, are one of these approaches. A series of rational considerations are presented in this paper with the aim of shedding light upon the basic principles and results of various sizing methods proposed by different authors. These considerations set the basis for a new analytical method that has been designed for systems with variable monthly energy demands. Following previous approaches, the method proposed is based on the concept of loss of load probability (LLP) - a parameter that is used to characterize system design. The method includes information on the standard deviation of loss of load probability ({sigma}{sub LLP}) and on two new parameters: annual number of system failures (f) and standard deviation of annual number of failures ({sigma}{sub f}). The method proves useful for sizing a PV system in a reliable manner and serves to explain the discrepancies found in the research on systems with LLP<10{sup -2}. We demonstrate that reliability depends not only on the sizing variables and on the distribution function of solar radiation, but on the minimum value as well, which in a given location and with a monthly average clearness index, achieves total solar radiation on the receiver surface. (author)

Intellectual function, activities of daily living and computerized tomography of the brain in geriatric demented patients

Energy Technology Data Exchange (ETDEWEB)

Omura, Fumiaki; Ogura, Chikara; Kishimoto, Akira; Okubo, Masayo; Imamoto, Atsushi [Tottori Univ., Yonago (Japan). School of Medicine; Tsuchie, Harutaka; Sugihara, Kanichiro; Fujii, Shozo

1984-09-01

Thirty eight patients of geriatric dementia (mean age 74.9 years) were examined by computerized tomography (CT) and their intellectual functions and activities of daily living (ADL) were evaluated. CT was evaluated by both visual assessment method and direct measuring method. Intellectual function was evaluated by Jikei University dementia rating scale. ADL was evaluated by both Hasegawa's rating scale and Sengoku's rating scale. Results were as follows: significant influence by age was observed in intellectual functions and ADL of subjects above 75 years old. There were good correlations between the higher intellectual function, the better grooming and hygiene, and less needs of nursing care. The severe brain atrophy evaluated by the visual assessment method was correlated with the depressed level of intellectual function. When brain atrophy is mild despite high degree of dementia, reexamination should be made to explore somatic diseases inducing depression of mental activity. It also should be noted that sex and age difference is important in studying geriatric patients.

Intellectual function, activities of daily living and computerized tomography of the brain in geriatric demented patients

International Nuclear Information System (INIS)

Omura, Fumiaki; Ogura, Chikara; Kishimoto, Akira; Okubo, Masayo; Imamoto, Atsushi; Tsuchie, Harutaka; Sugihara, Kanichiro; Fujii, Shozo.

1984-01-01

Thirty eight patients of geriatric dementia (mean age 74.9 years) were examined by computerized tomography (CT) and their intellectual functions and activities of daily living (ADL) were evaluated. CT was evaluated by both visual assessment method and direct measuring method. Intellectual function was evaluated by Jikei University dementia rating scale. ADL was evaluated by both Hasegawa's rating scale and Sengoku's rating scale. Results were as follows: significant influence by age was observed in intellectual functions and ADL of subjects above 75 years old. There were good correlations between the higher intellectual function, the better grooming and hygiene, and less needs of nursing care. The severe brain atrophy evaluated by the visual assessment method was correlated with the depressed level of intellectual function. When brain atrophy is mild despite high degree of dementia, reexamination should be made to explore somatic diseases inducing depression of mental activity. It also should be noted that sex and age difference is important in studying geriatric patients. (author)

[Encouragement and training of ethical competence in geriatric nursing. A pre-condition of high quality in professional caring process].

Science.gov (United States)

Dettmann, Ulf

2006-02-01

The article makes a case for the necessity of more intensive training in the ethics of geriatric care. It confronts the bias against too much ethical behaviour in daily practice, while also arguing for the liberating and enriching aspects of giving ethical care to the aged. Based on a differentiation between morals and ethics, the essay recognizes the endeavors to achieve moral behaviour in geriatric care, but questions whether in every case the caregivers have sufficient ethical core competence to determine either the appropriateness or the righteousness of their moral actions. The essay discusses what should be understood under "ethical competence" and how ethical competence can be acquired and advanced by schooling.

A stand alone computer system to aid the development of mirror fusion test facility RF heating systems

International Nuclear Information System (INIS)

Thomas, R.A.

1983-01-01

The Mirror Fusion Test Facility (MFTF-B) control system architecture requires the Supervisory Control and Diagnostic System (SCDS) to communicate with a LSI-11 Local Control Computer (LCC) that in turn communicates via a fiber optic link to CAMAC based control hardware located near the machine. In many cases, the control hardware is very complex and requires a sizable development effort prior to being integrated into the overall MFTF-B system. One such effort was the development of the Electron Cyclotron Resonance Heating (ECRH) system. It became clear that a stand alone computer system was needed to simulate the functions of SCDS. This paper describes the hardware and software necessary to implement the SCDS Simulation Computer (SSC). It consists of a Digital Equipment Corporation (DEC) LSI-11 computer and a Winchester/Floppy disk operating under the DEC RT-11 operating system. All application software for MFTF-B is programmed in PASCAL, which allowed us to adapt procedures originally written for SCDS to the SSC. This nearly identical software interface means that software written during the equipment development will be useful to the SCDS programmers in the integration phase

Optimum capacity determination of stand-alone hybrid generation system considering cost and reliability

International Nuclear Information System (INIS)

Chen, Hung-Cheng

2013-01-01

Highlights: ► This paper presents a methodology for the installation capacity optimization. ► Hybrid generation system is optimized by application of adaptive genetic algorithm. ► A cost investigation is made under various conditions and component characteristics. ► The optimization scheme is validated to meet the annual power load demand. -- Abstract: The aim of this work is to present an optimization methodology for the installation capacity of a stand-alone hybrid generation system, taking into consideration the cost and reliability. Firstly, on the basis of derived steady state models of a wind generator (WG), a photovoltaic array (PV), a battery and an inverter, the hybrid generation system is modeled for the purpose of capacity optimization. Secondly, the power system is analyzed for determining both the system structure and the operation control strategy. Thirdly, according to hourly weather database of wind speed, temperature and solar irradiation, annual power generation capacity is estimated for the system match design in order that an annual power load demand can be met. The capacity determination of a hybrid generation system becomes complicated as a result of the uncertainty in the renewable energy together with load demand and the nonlinearity of system components. Aimed at the power system reliability and the cost minimization, the capacity of a hybrid generation system is optimized by application of an adaptive genetic algorithm (AGA) to individual power generation units. A total cost investigation is made under various conditions, such as wind generator power curves, battery discharge depth and the loss of load probability (LOLP). At the end of this work, the capacity of a hybrid generation system is optimized at two installation sites, namely the offshore Orchid Island and Wuchi in Taiwan. The optimization scheme is validated to optimize power capacities of a photovoltaic array, a battery and a wind turbine generator with a relative

Modeling and control design of a stand alone wind energy conversion system based on functional model predictive control

Energy Technology Data Exchange (ETDEWEB)

Kassem, Ahmed M. [Beni-Suef University, Electrical Dept., Beni Suef (Egypt)

2012-09-15

This paper investigates the application of the model predictive control (MPC) approach to control the voltage and frequency of a stand alone wind generation system. This scheme consists of a wind turbine which drives an induction generator feeding an isolated load. A static VAR compensator is connected at the induction generator terminals to regulate the load voltage. The rotor speed, and thereby the load frequency are controlled via adjusting the mechanical power input using the blade pitch-angle. The MPC is used to calculate the optimal control actions including system constraints. To alleviate computational effort and to reduce numerical problems, particularly in large prediction horizon, an exponentially weighted functional model predictive control (FMPC) is employed. Digital simulations have been carried out in order to validate the effectiveness of the proposed scheme. The proposed controller has been tested through step changes in the wind speed and the load impedance. Simulation results show that adequate performance of the proposed wind energy scheme has been achieved. Moreover, this scheme is robust against the parameters variation and eliminates the influence of modeling and measurement errors. (orig.)

Hierachy of needs of geriatric patients.

Science.gov (United States)

Majercsik, E

2005-01-01

The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique based on a motivational approach. The process was based on the method of paired comparisons, and a duly composed questionnaire was administered to the geriatric patients who were proven to have consistent thinking and surpassed a pre-established threshold in the Mini Mental State Examination. The evaluation of the responds leads to a numerical derivation (on an interval scale) of the hierarchy of needs. The received hierarchy of needs proved to oppose the general hypothesis of Maslow's motivation theory. This may induce a necessary shift in the approach to the care of the elderly, and accentuate the self-actualization and esteem needs beside the overtly emphasized physiological care. Copyright (c) 2005 S. Karger AG, Basel

Malignancies of gastrointestinal tract in geriatric patients

International Nuclear Information System (INIS)

Bystricky, B.

2017-01-01

Incidence of gastrointestinal cancer rises with age. In spite of this fact, older patients are underrepresented in clinical trials. We need to take into account several variables prior to selection of therapy in these patients. These are physiologic aging processes, comorbidities, functional and cognitive status. There are several assessment tools in geriatric population – the most used is comprehensive geriatric assessment (CGA). A close cooperation with geriatrician is useful before starting cancer treatment. This article reviews treatment algorithms in selected malignancies of GI tract in geriatric patients. (author)

The international phase 4 validation study of the EORTC QLQ-SWB32: a stand-alone measure of spiritual wellbeing (SWB) for people receiving palliative care for cancer

OpenAIRE

Vivat, B.; Young, T.; Winstanley, J.; Arraras, J.; Black, K.; Boyle, F.; Brédart, A.; Costantini, A.; Guo, J.; Irarrazaval, M. E.; Kobayashi, K.; Kruizinga, R.; Navarro, M.; Omidvari, S.; Rohde, G. E.

2017-01-01

The EORTC Quality of Life (QL) Group has just completed the final phase (field-testing and validation) of an international project to develop a stand-alone measure of spiritual wellbeing (SWB) for palliative cancer patients. Participants (n= 451) - from 14 countries on four continents; 54% female; 188 Christian, 50 Muslim, 156 with no religion - completed a provisional 36-item measure of SWB plus the EORTC QLQ-C15-PAL (PAL), then took part in a structured debriefing interview. All items showe...

Geriatric Family Support and Diabetic Type-2 Glycemic Control

Directory of Open Access Journals (Sweden)

Shiva Heidari

2008-07-01

Full Text Available Objectives: As the most part of geriatric (65 years and older diabetic care is given at home, family support has an important role in their blood sugar level control care. This study aimed to assess the relationship between family support and blood sugar level control in such elderly suffering type-2 diabetes. Methods & Materials: Via descriptive-correlative study, one hundred fifty geriatric patients with type-2 diabetes, who referred to Institute of Endocrinology and Metabolism in Iran University of Medical Sciences were selected. Samplings based on nonrandomized and convenience. The questionnaire consisted of three sections: demographic data glucose-labeled hemoglobin (HbA1C and received-perceived family support by applying the standard questionnaire of "Diabetes Social Support-Family Version" format. Data were analyzed by SPSS version 15 by using Chi-square and Pierson Tests. Results: Results showed a significant relationship between family support and glycemic control (r=-0.56, P<0.0001. Also there were significant relationships between family support, gender and marital status (P<0.0001. There were also significant relationships between glycemic control and marital status (P=0.02, financial status (P=0.04 and educational level (P=0.05. Conclusion: Findings of this research added further evidence about the impact of family support on the health of older adults with diabetes. These findings suggest using family centered nursing interventions and collaboration of family members in care of the elderly with type-2 diabetes.

Health Policy 2016 – Implications for Geriatric Urology

Science.gov (United States)

Suskind, Anne M.; Clemens, J. Quentin

2016-01-01

Purpose of Review The U.S. healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. Recent Findings The Affordable Care Act (ACA) has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Summary Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination, risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues. PMID:26765043

Development of a nursing practice based competency model for the Flemish master of nursing and obstetrics degree.

Science.gov (United States)

De Clercq, Gerlinde; Goelen, Guido; Danschutter, Dirk; Vermeulen, Joeri; Huyghens, Luc

2011-01-01

The aim was to identify a set of competences for the Flemish academic Master of Nursing and Obstetrics degree that answer perceived needs in health care. The competency model was to demonstrate a degree of consensus among key nurses. The study was conducted in all Flemish hospitals registered to have 400 beds or more. Head nurses of surgery, geriatrics and intensive care units were eligible to participate, as well as one nurse from administration per hospital. A two round Delphi process allowed participants to comment on items identified in an analysis of existing international competency profiles of master level nurses and adapted to the Flemish context. Competences agreed to by 90% of the respondents were considered to have consensus. Fifteen out of 19 eligible hospitals were recruited in the study, 45 nurses participated in the Delphi panel. Consensus was reached on 31 competences that can be assigned to 5 nurse's roles: nursing expert, innovator, researcher, educator and manager. The resulting competency profile is in accordance with published profiles for similar programs. The reported study demonstrates a practical method to develop a consensus competency model for an academic master program based on the input of key individuals in mainstream nursing. 2010 Elsevier Ltd. All rights reserved.

American Geriatrics Society

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... Learn More Social Media Facebook Twitter LinkedIn Instagram Social Media Bar Right Menu Annual Meeting Donate to our Foundation Contact Us American Geriatrics Society 40 Fulton St., 18th Floor New York, NY ...

Comprehensive geriatric assessment

African Journals Online (AJOL)

2007-09-14

Sep 14, 2007 ... i.e. difficulty performing simple physical and mental tasks necessary for daily life. ... Definition. Comprehensive geriatric assessment (CGA) is a multidimensional .... The formation of a programme of therapy is decided on.

Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals.

Science.gov (United States)

Girard, R; Gaujard, S; Pergay, V; Pornon, P; Martin Gaujard, G; Vieux, C; Bourguignon, L

2015-07-01

Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric patients. After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group implemented and evaluated corrective measures. In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and indications for catheter drainage; limit available medical devices; and improve prescription and traceability procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was repeated in 2012 to assess the impact of the programme. Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%. The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P = 0.1013) which contradicts the literature. In 2010, the 269 responses to the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff had poor knowledge of the recommended indications and techniques, and the equipment varied widely between units. Following implementation of the programme, the study was repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature. Multi-modal programmes are an effective means to control UTI. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Quality of life in older individuals with joint contractures in geriatric care settings.

Science.gov (United States)

Heise, Marco; Müller, Martin; Fischer, Uli; Grill, Eva

2016-09-01

The purpose of this study was to analyze the association between functioning and disability and quality of life (QoL) in older individuals with joint contractures in the geriatric care setting. More specifically, this study aimed to identify determinants of QoL out of a defined set of contracture-related categories of the International Classification of Functioning, Disability and Health (ICF). Participants for this multicenter cross-sectional survey were recruited from acute geriatric rehabilitation hospitals, nursing homes, and community nursing facilities in Germany between February and October 2013. QoL was assessed using the validated German version of the EQ-5D index score and the EQ-5D visual analog scale (VAS). Manual and automatic variable selection methods were used to identify the most relevant variables out of 125 contracture-related ICF categories. A total of 241 eligible participants (34.9 % male, mean age 80.1 years) were included. The final models contained 14 ICF categories as predictors of the EQ-5D index score and 15 categories as predictors of the EQ-5D VAS. The statistically significant ICF categories from both models were 'muscle power functions (b730),' 'memory functions (b144),' 'taking care of plants (d6505),' 'recreation and leisure (d920),' 'religion and spirituality (d930),' 'drugs (e1101),' and 'products and technology for personal use in daily living (e115).' We identified the most relevant ICF categories for older individuals with joint contractures and their health-related quality of life. These items describe potential determinants of QoL which may provide the basis for future health interventions aiming to improve QoL for the patients with joint contractures.

Academic detailing to teach aging and geriatrics.

Science.gov (United States)

Duckett, Ashley; Cuoco, Theresa; Pride, Pamela; Wiley, Kathy; Iverson, Patty J; Marsden, Justin; Moran, William; Caton, Cathryn

2015-01-01

Geriatric education is a required component of internal medicine training. Work hour rules and hectic schedules have challenged residency training programs to develop and utilize innovative teaching methods. In this study, the authors examined the use of academic detailing as a teaching intervention in their residents' clinic and on the general medicine inpatient wards to improve clinical knowledge and skills in geriatric care. The authors found that this teaching method enables efficient, directed education without disrupting patient care. We were able to show improvements in medical knowledge as well as self-efficacy across multiple geriatric topics.

Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

Science.gov (United States)

Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

2018-02-01

The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

Techno-economic assessment of FT unit for synthetic diesel production in existing stand-alone biomass gasification plant using process simulation tool

DEFF Research Database (Denmark)

Hunpinyo, Piyapong; Narataruksa, Phavanee; Tungkamani, Sabaithip

2014-01-01

For alternative thermo-chemical conversion process route via gasification, biomass can be gasified to produce syngas (mainly CO and H2). On more applications of utilization, syngas can be used to synthesize fuels through the catalytic process option for producing synthetic liquid fuels...... such as Fischer-Tropsch (FT) diesel. The embedding of the FT plant into the stand-alone based on power mode plants for production of a synthetic fuel is a promising practice, which requires an extensive adaptation of conventional techniques to the special chemical needs found in a gasified biomass. Because...... there are currently no plans to engage the FT process in Thailand, the authors have targeted that this work focus on improving the FT configurations in existing biomass gasification facilities (10 MWth). A process simulation model for calculating extended unit operations in a demonstrative context is designed...

Factors associated with end-of-life by home-visit nursing-care providers in Japan.

Science.gov (United States)

Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi

2017-06-01

Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.

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

Science.gov (United States)

Borowiak, Ewa; Kostka, Tomasz

2013-06-01

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

The effect of working position on trunk posture and exertion for routine nursing tasks: an experimental study.

Science.gov (United States)

Freitag, Sonja; Seddouki, Rachida; Dulon, Madeleine; Kersten, Jan Felix; Larsson, Tore J; Nienhaus, Albert

2014-04-01

To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion. Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for 'computer-assisted recording and long-term analysis of musculoskeletal loads') measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion). If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-adjustable beds are provided in healthcare institutions.

Adaptive Artificial intelligence based fuzzy logic MPPTcontrol for stande-alone photovoltaic system under different atmospheric conditions

Directory of Open Access Journals (Sweden)

Zaghba Layachi

2015-08-01

Full Text Available there is an increased need for analysing the effect of atmospheric variables on photovoltaic (PV production and performance. The outputs from the different PV cells in different atmospheric conditions, such as irradiation and temperature , differ from each other evidencing knowledge deficiency in PV systems [14]. Maximum power point tracking (MPPT methods are used to maximize the PV array output power by tracking continuously the maximum power point (MPP. Among all MPPT methods existing in the literature, perturb and observe (P&O is the most commonly used for its simplicity and ease of implementation; however, it presents drawbacks such as slow response speed, oscillation around the MPP in steady state, and even tracking in wrong way under rapidly changing atmospheric conditions. In order to allow a functioning around the optimal point Mopt, we have inserted a DC-DC converter (Buck–Boost for a better matching between the PV and the load. This paper, we study the Maximum power point tracking using adaptive Intelligent fuzzy logic and conventional (P&O control for stande-alone photovoltaic Array system .In particular, the performances of the controllers are analyzed under variation weather conditions with are constant temperature and variable irradiation. The proposed system is simulated by using MATLAB-SIMULINK. According to the results, fuzzy logic controller has shown better performance during the optimization.

Barriers in implementing research among registered nurses working in the care of the elderly: a multicenter study in Spain.

Science.gov (United States)

Sarabia-Cobo, C M; Sarabia-Cobo, A B; Pérez, V; Hermosilla, C; Nuñez, M J; de Lorena, P

2015-11-01

This study identified barriers to the utilization of research results perceived by nurses who work in nursing homes in Spain. An observational, cross-sectional, descriptive, and multicentre study was conducted in 126 nursing homes in different Spanish cities. The BARRIERS to Research Utilization Scale (BARRIERS scale) was used to identify barriers. A total of 756 nurses responded (92.48%). BARRIERS scale variables with the highest scores included Characteristics of the organization (mean=24.89, SD=4.37), followed by Professional features (mean=21.87, SD=4.85). The specific barriers that were rated the highest included "not enough time on the job to implement new ideas" (mean=3.89, SD=0.98), followed by "unknown nursing research" (mean=2.75; SD=1.22) and "Doctors do not cooperate in the implementation" (mean=3.01, SD=1.85). Geriatric nurses perceive time as the main barrier to implementing the results of research in practice. The number and nature of the barriers are consistent with studies from other countries. Knowledge of the barriers is crucial for institutions and educators to instigate measures that improve the implementation of nursing research, especially in an area like elderly care. To our knowledge, this is the first study conducted among geriatric nurses in Spain. Copyright © 2015 Elsevier Inc. All rights reserved.

Social network analysis: Presenting an underused method for nursing research.

Science.gov (United States)

Parnell, James Michael; Robinson, Jennifer C

2018-06-01

This paper introduces social network analysis as a versatile method with many applications in nursing research. Social networks have been studied for years in many social science fields. The methods continue to advance but remain unknown to most nursing scholars. Discussion paper. English language and interpreted literature was searched from Ovid Healthstar, CINAHL, PubMed Central, Scopus and hard copy texts from 1965 - 2017. Social network analysis first emerged in nursing literature in 1995 and appears minimally through present day. To convey the versatility and applicability of social network analysis in nursing, hypothetical scenarios are presented. The scenarios are illustrative of three approaches to social network analysis and include key elements of social network research design. The methods of social network analysis are underused in nursing research, primarily because they are unknown to most scholars. However, there is methodological flexibility and epistemological versatility capable of supporting quantitative and qualitative research. The analytic techniques of social network analysis can add new insight into many areas of nursing inquiry, especially those influenced by cultural norms. Furthermore, visualization techniques associated with social network analysis can be used to generate new hypotheses. Social network analysis can potentially uncover findings not accessible through methods commonly used in nursing research. Social networks can be analysed based on individual-level attributes, whole networks and subgroups within networks. Computations derived from social network analysis may stand alone to answer a research question or incorporated as variables into robust statistical models. © 2018 John Wiley & Sons Ltd.

Nutritional status assessment in geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group.

Science.gov (United States)

Camina-Martín, M Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, J Antonio; Redondo-del-Río, M Paz

2015-07-01

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, because elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología, SEGG) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories seeks to aid in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment associated to laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is to further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 Elsevier Ireland Ltd. All rights

[Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology NutritionWork Group].

Science.gov (United States)

Camina-Martín, María Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, José Antonio; Redondo-Del-Río, María Paz

2016-01-01

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 SEGG. Published by Elsevier

Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.

Science.gov (United States)

Boogaard, Jannie A; Werner, Perla; Zisberg, Anna; van der Steen, Jenny T

2017-12-01

In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden. A cross-sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers' trust. A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses' aides at a moderate-to-high level. Approximately half to one-third reported moderate-to-low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician-family communication. The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers' trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; 17: 2466-2471. © 2017 Japan Geriatrics Society.

Predictive validity of the Hendrich fall risk model II in an acute geriatric unit.

Science.gov (United States)

Ivziku, Dhurata; Matarese, Maria; Pedone, Claudio

2011-04-01

Falls are the most common adverse events reported in acute care hospitals, and older patients are the most likely to fall. The risk of falling cannot be completely eliminated, but it can be reduced through the implementation of a fall prevention program. A major evidence-based intervention to prevent falls has been the use of fall-risk assessment tools. Many tools have been increasingly developed in recent years, but most instruments have not been investigated regarding reliability, validity and clinical usefulness. This study intends to evaluate the predictive validity and inter-rater reliability of Hendrich fall risk model II (HFRM II) in order to identify older patients at risk of falling in geriatric units and recommend its use in clinical practice. A prospective descriptive design was used. The study was carried out in a geriatric acute care unit of an Italian University hospital. All over 65 years old patients consecutively admitted to a geriatric acute care unit of an Italian University hospital over 8-month period were enrolled. The patients enrolled were screened for the falls risk by nurses with the HFRM II within 24h of admission. The falls occurring during the patient's hospital stay were registered. Inter-rater reliability, area under the ROC curve, sensitivity, specificity, positive and negative predictive values and time for the administration were evaluated. 179 elderly patients were included. The inter-rater reliability was 0.87 (95% CI 0.71-1.00). The administration time was about 1min. The most frequently reported risk factors were depression, incontinence, vertigo. Sensitivity and specificity were respectively 86% and 43%. The optimal cut-off score for screening at risk patients was 5 with an area under the ROC curve of 0.72. The risk factors more strongly associated with falls were confusion and depression. As falls of older patients are a common problem in acute care settings it is necessary that the nurses use specific validate and reliable

An Overview of Otorhinolaryngeal Problems in Geriatrics

Directory of Open Access Journals (Sweden)

Girija Shankar Mohanta

2018-06-01

Full Text Available Summary: Background: The increase of geriatric population, as well as their age-related problems, is of great concern for the society and for the governments all over the world and also in India. The main objectives were to overview and find the prevalence of Oto-rhino-laryngological problems in the geriatric population. Method: A prospective study of geriatric patients was undertaken in ENT & HNS Department, S.C.B Medical College & Hospital, Cuttack, India, from November 2014 to August 2016.Inclusion criteria –The patients of age 60 yrs & above who attended ENT outpatient department were studied. Among 3563 patients studied, 363 patients were admitted. The patients were segregated according to sex (male/female, ages (60–64 yr group, 65–69 yr group, 70 yr & above, disease ratio, and prevalence of diseases, associated co-morbidities, and socio-economic aspects. Results: Total patients studied were 3563. The otological problems were being prevalent in geriatrics among study population (51.77% in which presbycusis was the highest with 17.71% of total and 34.21% of otological problems. The problems related to nose were 13.03%, among which epistaxis was 4.98% of total and 37.60% of nasal problems. The neck and throat problems were 35.20%. The problems were more in males (63.65% than in females (36.35%. Conclusion: The hearing loss is the most prevalent diagnosis amongst all otologic problems and epistaxis amongst nasal symptoms. The emergence of head & neck cancers among the geriatric population is a great concern in a developing country like India. Keywords: Oto-rhino-laryngological problems, geriatric populations

The oncologic and the geriatric patient

International Nuclear Information System (INIS)

Philotheou, Geraldine M

2002-01-01

The oncologic and the geriatric patient have special needs in the nuclear medicine department. The nuclear medicine technologists must be knowledgeable and compassionate when dealing with these patients. The diagnosis of cancer will have a sociological and psychological impact on the patient, to which the technologist must relate in an empathetic way. Furthermore, the technologist should take cognisance of the patient's physical condition and be able to modify the examination accordingly. Dealing with the geriatric patient should be correctly placed on the continuum between a gerontological and geriatric approach taking into consideration normal changes due to aging. The patient experience when undergoing the high technology nuclear medicine diagnostic procedure is unique and all effort must be made to ensure the success of the examination and the satisfaction of the patient (Au)

Predoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools.

Science.gov (United States)

Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2017-08-01

The aim of this study was to assess the current teaching of geriatric dentistry in U.S. dental schools and compare the findings to previous reports. Academic deans at all 67 U.S. dental schools were contacted in November 2015 via email, asking them to complete a questionnaire about the teaching of geriatric dentistry or gerodontology at their institution. Questionnaires were received from 56 of the 67 schools (84% response rate). The results showed that geriatric dentistry was taught in all responding schools; for 92.8% of the respondents, the instruction was compulsory. Among the responding schools, 62.5% were teaching it as an independent course, 25% as an organized series of lectures, and 8.9% as occasional lectures in parts of other courses. In addition, 57.1% had some form of compulsory clinical education in geriatric dentistry. Public schools, as opposed to private schools, were marginally associated with an increased interest in expanding geriatric dentistry teaching (p=0.078). No differences were found between any teaching variables and school location. This study found that the form of education in geriatric dentistry in U.S. dental schools differed in many ways, but the teaching of geriatric dentistry had increased among all respondents and had been increasing for over 30 years. Future research is needed to determine the impact of this teaching on services to the geriatric community.

Working Environment In Nursing: Needs Improvement?

Directory of Open Access Journals (Sweden)

Alicia Hanzeliková Pogrányivá

2012-08-01

Full Text Available Background: Knowing the quality of life of professionals is important because it is related to job performance, better results, and greater productivity, which results in better patient care. Objective: To know the Professional Quality of Life perceived by the nurses at the Geriatric Hospital of Toledo (Spain. Method: A descriptive cross-section study was employed to measure the Professional Quality of Life of all healthcare nurses (69 in total at the Geriatric Hospital of Toledo. The questionnaire used as a measuring instrument was the Professional Quality of Life - 35. The data obtained was analyzed by means of: descriptive statistics, single-factor ANOVA variance analysis, T Student tests, and simple and multiple regression analysis. The study was approved by both the research commission and the ethics commission at the Hospital Complex of Toledo. Participation in the study on behalf of the nursing staff was voluntary. Results: In total, 45 responses were obtained (65.2%. The overall mean score measured the perceived Professional Quality of Life to be low. In relation to the three dimensions evaluated in the study, the highest average found was in “intrinsic motivation,” followed by “workload”, and then “management support.” In the multivariate analysis, “management support” was shown as the most influential factor in the Professional Quality of Life with a 23% influence (P<0.001, followed by workload with 9% (P = 0.01. Conclusions: The professionals at the participating center perceive their workplace as having an elevated degree of responsibility, a large quantity of work, a high occurrence of rushes and fatigue, and all this with little support on behalf of management. Promotions are scarce or the policies for receiving a promotion are inadequate. The perception of Professional Quality of Life in nursing is low. The obtained results indicate a need for an organizing cultural change based on participation, motivation, and

Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial.

Science.gov (United States)

Hoogendijk, Emiel O; van der Horst, Henriëtte E; van de Ven, Peter M; Twisk, Jos W R; Deeg, Dorly J H; Frijters, Dinnus H M; van Leeuwen, Karen M; van Campen, Jos P C M; Nijpels, Giel; Jansen, Aaltje P D; van Hout, Hein P J

2016-03-01

Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults. A 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations. Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months (B=-0.25, 95%CI=-0.43 to -0.06, p=0.007), but this effect was not statistically significant after correction for multiple comparisons. The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population. The Netherlands National Trial Register NTR2160. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Comparison of plate-cage construct and stand-alone anchored spacer in the surgical treatment of three-level cervical spondylotic myelopathy: a preliminary clinical study.

Science.gov (United States)

Shi, Sheng; Liu, Zu-De; Li, Xin-Feng; Qian, Lie; Zhong, Gui-Bin; Chen, Fang-Jing

2015-09-01

Although stand-alone cages were advocated to be superior to plate-cage construct (PCC) because of comparable clinical outcomes and fewer plate-related complications, cage dislocation and subsidence were frequently mentioned in multilevel fusion. There are some concerns about whether these issues can be effectively prevented in multilevel anterior cervical discectomy and fusion (ACDF) by stand-alone anchored spacer (SAAS). The aim was to compare clinical outcomes, radiologic parameters, and complications of PCC and SAAS in the treatment of three-level cervical spondylotic myelopathy (CSM). This was a retrospective comparative study. A total of 38 consecutive patients with three-level CSM (ACDF with PCC, 20 patients; ACDF with SAAS, 18 patients) were reviewed. Clinical outcomes were assessed using Japanese Orthopaedic Association and Neck Disability Index. The radiologic evaluations included cervical alignment (CA), segmental angle (SA), postoperative curvature loss (PCL), and incidence of subsidence. All the aforementioned parameters were compared before and after surgery between two groups. Besides, the aforementioned results were also compared between the two groups. The complications were also recorded. The mean follow-up period was 30.3 months. No significant differences were observed in clinical outcomes between the two groups (p>.05). Additionally, no significant differences existed in fusion rate between the two groups. There were significant differences in PCL of SA and CA and correction of SA between the two groups (pSAAS group, and the potential of SAAS to reduce the incidence of postoperative dysphagia was not proven. No other complications were observed in this study. In the surgical treatment of three-level CSM, PCC is superior to SAAS in correction and maintenance of SA and avoiding cage subsidence, although the technique of ACDF with SAAS yielded encouraging clinical outcomes and high fusion rate. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparison of Turkey’s Geographical Regions in terms of Stand-Alone PV System Design and Cost Parameters

Directory of Open Access Journals (Sweden)

Nevzat Onat

2017-01-01

Full Text Available Stand-alone photovoltaic (SAPV systems are widely used in rural areas where there is no national grid or as a precaution against power outages. In this study, technical and economic analysis of a SAPV system was carried out using meteorological data for 75 province centers in seven geographical regions of Turkey. Obtained results for each province center were separated by geographical area. The averages of the centers for each region are taken as output. A calculation algorithm based on MsExcel has been established for these operations. The analyses made with the developed algorithm are repeated for five different scenarios that they cover periods of time when a constant strong load is active for all seasons (winter, spring, summer, and autumn and all year round. The developed algorithm calculates the life-cycle cost, the unit energy cost, the electrical capacity utilization rate, the amount of generated/excess energy per month, the initial investment/replacement, and operating and maintenance (O&M costs of each element. As a result, geographical regions of Turkey are compared in terms of these outputs graphically. Further investigations may include the sale of excess energy generated, small-scale PV system cost factors parallel to the grid, and the effects of government incentives.

Power fluctuations suppression of stand-alone hybrid generation combining solar photovoltaic/wind turbine and fuel cell systems

International Nuclear Information System (INIS)

Ahmed, Nabil A.; Miyatake, Masafumi; Al-Othman, A.K.

2008-01-01

In this paper a hybrid energy system combining variable speed wind turbine, solar photovoltaic and fuel cell generation systems is presented to supply continuous power to residential power applications as stand-alone loads. The wind and photovoltaic systems are used as main energy sources while the fuel cell is used as secondary or back-up energy source. Three individual dc-dc boost converters are used to control the power flow to the load. A simple and cost effective control with dc-dc converters is used for maximum power point tracking and hence maximum power extracting from the wind turbine and the solar photovoltaic systems. The hybrid system is sized to power a typical 2 kW/150 V dc load as telecommunication power plants or ac residential power applications in isolated islands continuously throughout the year. The results show that even when the sun and wind are not available; the system is reliable and available and it can supply high-quality power to the load. The simulation results which proved the accuracy of the proposed controllers are given to demonstrate the availability of the proposed system in this paper. Also, a complete description of the management and control system is presented

Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge

DEFF Research Database (Denmark)

Beck, Anne Marie; Kjær, Stine; Hansen, Birthe Stenbæk

2013-01-01

Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.Design:Twelv......Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.......Design:Twelve-week single-blind randomized controlled study.Setting and subjects:Geriatric medical patients (65+ years) at nutritional risk.Interventions:Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented......, rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality.Results:One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks...

Validation of the NOSCA - nurses' observation scale of cognitive abilities.

Science.gov (United States)

Persoon, Anke; Schoonhoven, Lisette; Melis, Rene J F; van Achterberg, Theo; Kessels, Roy P C; Rikkert, Marcel G M Olde

2012-11-01

To examine the psychometric properties of the Nurses' Observation Scale for Cognitive Abilities. Nurses' Observation Scale for Cognitive Abilities is a behavioural rating scale comprising eight subscales that represent different cognitive domains. It is based on observations during contact between nurse and patient. Observational study. A total of 50 patients from two geriatric wards in acute care hospitals participated in this study. Reliability was examined via internal consistency and inter-rater reliability. Construct validity of the Nurses' Observation Scale for Cognitive Abilities and its subscales were explored by means of convergent and divergent validity and post hoc analyses for group differences. Cronbach's αs of the total Nurses' Observation Scale for Cognitive Abilities and its subscales were 0·98 and 0·66-0·93, respectively. The item-total correlations were satisfactory (overall > 0·4). The intra-class coefficients were good (37 of 39 items > 0·4). The convergent validity of the Nurses' Observation Scale for Cognitive Abilities against cognitive ratings (MMSE, NOSGER) and severity of dementia (Clinical Dementia Rating) demonstrated satisfactory correlations (0·59-0·70, p 0·05). The divergent validity of the Nurses' Observation Scale for Cognitive Abilities against depressive symptoms was low (0·12, p > 0·05). The construct validity of the Nurses' Observation Scale for Cognitive Abilities subscales against 13 specific neuropsychological tests showed correlations varying from poor to fair (0·18-0·74; 10 of 13 correlations p Validity and reliability of the total Nurses' Observation Scale for Cognitive Abilities are excellent. The correlations between the Nurses' Observation Scale for Cognitive Abilities subscales and standard neuropsychological tests were moderate. More conclusive results may be found if the Nurses' Observation Scale for Cognitive Abilities subscales were to be validated using more ecologically valid tests and in a patient

Approach to the pressure sores in geriatric patients

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Emre İnözü

2012-09-01

Full Text Available Objectives: The aim of this study was to evaluate the follow-up results of nutritionally supported geriatric patientswho were admitted for their pressure sores then plannedtheir treatment.Materials and methods: In this study, we analyzed thehospitalized geriatric pressure sore patients in our clinicwho were admitted between 2006 and 2011. We calculatedBody Mass Index and the blood albumin levels of allhospitalized geriatric patients. In this patient group proteinenergy malnutrition and deficiency were analyzed andproper nutrition support was provided accordingly. Afterrecovering from malnutrition further treatment surpassed.Results: The mean albumin levels of the hospitalized patientswas 2,53 ± 0,25 g/dL after nutritional support thoselevels increased to mean 3,95 ± 0,42 g/dL . Of all thosepatients 75% were operated when their general conditionallowed us for a surgery. Due to their high risk wedid not perform any surgical operation to the remaining25%.. Post operative mean hospitalization period was 12(8-21 days. Majority of the patients (78.6% were treatedsuccessfully either with surgical or conservative treatmentmodalities.Conclusions: The success of the geriatric pressure soretreatment is highly related with the proper nutritional supportfor the ongoing malnutrition-like pathologies. Beforeoperation nutritional support not only makes a healthygranulation tissue but also yields fast and reliable woundhealing. Despite their chronic health problems many ofour geriatric patients were treated surgically for their pressuresores.Key words: Pressure sore, geriatric medicine, malnutrition,nutritional support

Graduate and Undergraduate Geriatric Dentistry Education in a Selected Dental School in Japan

Science.gov (United States)

Kitagawa, Noboru; Sato, Yuji; Komabayashi, Takashi

2010-01-01

Geriatric dentistry and its instruction are critical in a rapidly aging population. Japan is the world’s fastest-aging society, and thus geriatric dentistry education in Japan can serve as a global model for other countries that will soon encounter the issues that Japan has already confronted. This study aimed to evaluate geriatric dental education with respect to the overall dental education system, undergraduate geriatric dentistry curricula, mandatory internships, and graduate geriatric education of a selected dental school in Japan. Bibliographic data and local information were collected. Descriptive and statistical analyses (Fisher and Chi-square test) were conducted. Japanese dental schools teach geriatric dentistry in 10 geriatric dentistry departments as well as in prosthodontic departments. There was no significant differences found between the number of public and private dental schools with geriatric dentistry departments (p = 0.615). At Showa University School of Dentistry, there are more didactic hours than practical training hours; however, there is no significant didactic/practical hour distribution difference between the overall dental curriculum and fourth-year dental students’ geriatric dental education curriculum (p=0.077). Graduate geriatric education is unique because it is a four-year Ph.D. course of study; there is neither a Master’s degree program nor a certificate program in Geriatric Dentistry. Overall, both undergraduate and graduate geriatric dentistry curricula are multidisciplinary. This study contributes to a better understanding of geriatric dental education in Japan; the implications of this study include developing a clinical/didactic curriculum, designing new national/international dental public health policies, and calibrating the competency of dentists in geriatric dentistry. PMID:21985207

Energetic and financial investigation of a stand-alone solar-thermal Organic Rankine Cycle power plant

International Nuclear Information System (INIS)

Tzivanidis, Christos; Bellos, Evangelos; Antonopoulos, Kimon A.

2016-01-01

Highlights: • A stand-alone solar driven Organic Rankine Cycle is optimized parametrically. • The system is optimized energetically and financially. • Nine working fluids are tested with cyclohexane to be the most suitable. • A collecting area of 25,000 m"2 parabolic trough collectors is the optimum solution. • The maximum IRR is 13.46% and the payback period is about 9 years. - Abstract: The use of solar thermal energy for electricity production is a clean and sustainable way to cover the increasing energy needs of our society. The most mature technology for capturing solar energy in high temperature levels is the parabolic trough collectors (PTC). In this study, an Organic Rankine Cycle (ORC) coupled with PTC is analyzed parametrically in order to be optimized financially and energetically. The first step is the thermodynamic investigation of the ORC by using various working fluids. The second step is the energetic and financial investigation of the total system which includes the solar field, the storage tank and the ORC module. By testing many combinations of collecting areas and storage tank volumes, finally cyclohexane proved to be the most suitable working fluid for producing 1 MW_e_l with PTC. Specifically, in the optimum situation a solar field of 25,000 m"2 with storage tank of about 300 m"3 leads to a payback period of 9 years and to an internal rate of return (IRR) equal to 13.46%. Moreover, an economic comparison for different commercial collectors is presented, with Eurotrough ET-150 being the financially optimum solution for this case study.

Stand-Alone Solar Organic Rankine Cycle Water Pumping System and Its Economic Viability in Nepal

Directory of Open Access Journals (Sweden)

Suresh Baral

2015-12-01

Full Text Available The current study presents the concept of a stand-alone solar organic Rankine cycle (ORC water pumping system for rural Nepalese areas. Experimental results for this technology are presented based on a prototype. The economic viability of the system was assessed based on solar radiation data of different Nepalese geographic locations. The mechanical power produced by the solar ORC is coupled with a water pumping system for various applications, such as drinking and irrigation. The thermal efficiency of the system was found to be 8% with an operating temperature of 120 °C. The hot water produced by the unit has a temperature of 40 °C. Economic assessment was done for 1-kW and 5-kW solar ORC water pumping systems. These systems use different types of solar collectors: a parabolic trough collector (PTC and an evacuated tube collector (ETC. The economic analysis showed that the costs of water are $2.47/m3 (highest and $1.86/m3 (lowest for the 1-kW system and a 150-m pumping head. In addition, the cost of water is reduced when the size of the system is increased and the pumping head is reduced. The minimum volumes of water pumped are 2190 m3 and 11,100 m3 yearly for 1 kW and 5 kW, respectively. The payback period is eight years with a profitability index of 1.6. The system is highly feasible and promising in the context of Nepal.

Fried frailty phenotype assessment components as applied to geriatric inpatients

Directory of Open Access Journals (Sweden)

Bieniek J

2016-04-01

Full Text Available Joanna Bieniek, Krzysztof Wilczynski, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in elderly patients presenting with relatively good health status. Objective: The aim of this article was to assess the usefulness and limitations of Fried frailty phenotype criteria in geriatric inpatients, characterized by comorbidity and functional impairments, and to estimate the frailty phenotype prevalence in this group. Patients and methods: Five hundred consecutive patients of the university hospital subacute geriatric ward, aged 79.0±8.4 years (67% women and 33% men, participated in this cross-sectional study. Comprehensive geriatric assessment and Fried frailty phenotype component evaluation were performed in all patients. Results: Multimorbidity (6.0±2.8 diseases characterized our study group, with a wide range of clinical conditions and functional states (Barthel Index of Activities of Daily Living 72.2±28.2 and Mini-Mental State Examination 23.6±7.1 scores. All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8–69.2 (diagnostic group. One or more components were not feasible to be assessed in 35% of the remaining patients (nondiagnostic group because of lack of past patient’s body mass control and/or cognitive or physical impairment. Patients from the nondiagnostic group, as compared to patients from the diagnostic group, presented with more advanced age, higher prevalence of dementia, lower prevalence of hypertension, lower systolic and diastolic blood pressure, body mass index, Mini

[Challenges of implementing a geriatric trauma network : A regional structure].

Science.gov (United States)

Schoeneberg, Carsten; Hussmann, Bjoern; Wesemann, Thomas; Pientka, Ludger; Vollmar, Marie-Christin; Bienek, Christine; Steinmann, Markus; Buecking, Benjamin; Lendemans, Sven

2018-04-01

At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics. In 2015, a geriatric trauma center certification in the form of a conglomerate network structure was agreed upon for the first time in Germany. For this purpose, the requirements for certification were observed. Both structure and organization were defined in a manual according to DIN EN ISO 9001:2015. Between 2008 and 2016, an increase of 70% was seen in geriatric trauma cases in our hospital, with a rise of up to 360% in specific diagnoses. The necessary standards and regulations were compiled and evaluated from our hospitals. After successful certification, improvements were necessary, followed by a planned re-audit. These were prepared by multiprofessional interdisciplinary teams and implemented at all locations. A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.

Geriatric fall-related injuries | Hefny | African Health Sciences

African Journals Online (AJOL)

Background: Falls are the leading cause of geriatric injury. ... and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. Methods: All injured patients with an age ≥ 60 years who were admitted to ...

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

OpenAIRE

Cokorda Istri Devi Larayanthi

2013-01-01

Sleep is an unconscious condition that is relatively more responsive to internal stimuli. Insomnia is a sleep disorder with characteristic difficulty of initiating sleep or difficulty in maintaining sleep. Insomnia is divided into 2 primary insomnia and secondary insomnia. Conection with age, the function of organs in the body decreases. So that geriatric patients are susceptible to illnesses, especially insomnia. Many of the causes of insomnia in geriatric mental disorders, psychiatric, gene...

Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?

Science.gov (United States)

Maes, Frédéric; Dalleur, Olivia; Henrard, Séverine; Wouters, Dominique; Scavée, Christophe; Spinewine, Anne; Boland, Benoit

2014-01-01

Anticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse. A cross-sectional study of consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication (CHADS₂ [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] ≥2) upon hospital admission. All patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using CHADS₂ and HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older (age >75 years), Reduced platelet count or function, Rebleed risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, and Stroke) scores, respectively. Anticoagulation underuse was observed in 384 (50%) of 773 geriatric patients with AF (median age 85 years; female 57%, cognitive disorder 33%, nursing home 20%). No geriatric characteristic was found to be associated with anticoagulation underuse. Conversely, anticoagulation underuse was markedly increased in the patients treated with aspirin (odds ratio [OR] [95% confidence interval]: 5.3 [3.8; 7.5]). Other independent predictors of anticoagulation underuse were ethanol abuse (OR: 4.0 [1.4; 13.3]) and age ≥90 years (OR: 2.0 [1.2; 3.4]). Anticoagulation underuse was not inferior in patients with a lower bleeding risk and/or a higher stroke risk and underuse was surprisingly not inferior either in the AF patients who had previously had a stroke. Half of this geriatric population did not receive any anticoagulation despite a clear indication, regardless of their individual bleeding or stroke risks. Aspirin use is the main characteristic associated with anticoagulation underuse.

Geriatric consultation services-are wards more effective than teams?

Science.gov (United States)

Cameron, Ian D; Kurrle, Susan

2013-02-22

Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment.

Medical students' recognition and application of geriatrics principles in a new curriculum.

Science.gov (United States)

Nanda, Aman; Farrell, Timothy W; Shield, Renée R; Tomas, Maria; Campbell, Susan E; Wetle, Terrie

2013-03-01

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

A Low-Power Wearable Stand-Alone Tongue Drive System for People With Severe Disabilities.

Science.gov (United States)

Jafari, Ali; Buswell, Nathanael; Ghovanloo, Maysam; Mohsenin, Tinoosh

2018-02-01

This paper presents a low-power stand-alone tongue drive system (sTDS) used for individuals with severe disabilities to potentially control their environment such as computer, smartphone, and wheelchair using their voluntary tongue movements. A low-power local processor is proposed, which can perform signal processing to convert raw magnetic sensor signals to user-defined commands, on the sTDS wearable headset, rather than sending all raw data out to a PC or smartphone. The proposed sTDS significantly reduces the transmitter power consumption and subsequently increases the battery life. Assuming the sTDS user issues one command every 20 ms, the proposed local processor reduces the data volume that needs to be wirelessly transmitted by a factor of 64, from 9.6 to 0.15 kb/s. The proposed processor consists of three main blocks: serial peripheral interface bus for receiving raw data from magnetic sensors, external magnetic interference attenuation to attenuate external magnetic field from the raw magnetic signal, and a machine learning classifier for command detection. A proof-of-concept prototype sTDS has been implemented with a low-power IGLOO-nano field programmable gate array (FPGA), bluetooth low energy, battery and magnetic sensors on a headset, and tested. At clock frequency of 20 MHz, the processor takes 6.6 s and consumes 27 nJ for detecting a command with a detection accuracy of 96.9%. To further reduce power consumption, an application-specified integrated circuit processor for the sTDS is implemented at the postlayout level in 65-nm CMOS technology with 1-V power supply, and it consumes 0.43 mW, which is 10 lower than FPGA power consumption and occupies an area of only 0.016 mm.

Identifying and evaluating electronic learning resources for use in adult-gerontology nurse practitioner education.

Science.gov (United States)

Thompson, Hilaire J; Belza, Basia; Baker, Margaret; Christianson, Phyllis; Doorenbos, Ardith; Nguyen, Huong

2014-01-01

Enhancing existing curricula to meet newly published adult-gerontology advanced practice registered nurse (APRN) competencies in an efficient manner presents a challenge to nurse educators. Incorporating shared, published electronic learning resources (ELRs) in existing or new courses may be appropriate in order to assist students in achieving competencies. The purposes of this project were to (a) identify relevant available ELR for use in enhancing geriatric APRN education and (b) to evaluate the educational utility of identified ELRs based on established criteria. A multilevel search strategy was used. Two independent team members reviewed identified ELR against established criteria to ensure utility. Only resources meeting all criteria were retained. Resources were found for each of the competency areas and included formats such as podcasts, Web casts, case studies, and teaching videos. In many cases, resources were identified using supplemental strategies and not through traditional search or search of existing geriatric repositories. Resources identified have been useful to advanced practice educators in improving lecture and seminar content in a particular topic area and providing students and preceptors with additional self-learning resources. Addressing sustainability within geriatric APRN education is critical for sharing of best practices among educators and for sustainability of teaching and related resources. © 2014.

Lean business model and implementation of a geriatric fracture center.

Science.gov (United States)

Kates, Stephen L

2014-05-01

Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Factors Influencing Depression among Elderly Patients in Geriatric Hospitals

OpenAIRE

Jee, Young Ju; Lee, Yun Bok

2013-01-01

[Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem ...

Geriatric syndromes in patients with chronic kidney disease

Directory of Open Access Journals (Sweden)

Tomasz Gołębiowski

2016-06-01

Full Text Available The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than among general population. The causes of higher prevalence of those syndromes are not well known, but uremic environment and overall renal replacement therapy may have an important impact on its progress. The patient with geriatric syndrome require comprehensive treatment as well as physical rehabilitation, psychiatric cure and support in everyday activities.Herein below we would like to review recent literature regarding to particular features of main geriatric syndromes in a group of nephrological patients.

PR2ALIGN: a stand-alone software program and a web-server for protein sequence alignment using weighted biochemical properties of amino acids.

Science.gov (United States)

Kuznetsov, Igor B; McDuffie, Michael

2015-05-07

Alignment of amino acid sequences is the main sequence comparison method used in computational molecular biology. The selection of the amino acid substitution matrix best suitable for a given alignment problem is one of the most important decisions the user has to make. In a conventional amino acid substitution matrix all elements are fixed and their values cannot be easily adjusted. Moreover, most existing amino acid substitution matrices account for the average (dis)similarities between amino acid types and do not distinguish the contribution of a specific biochemical property to these (dis)similarities. PR2ALIGN is a stand-alone software program and a web-server that provide the functionality for implementing flexible user-specified alignment scoring functions and aligning pairs of amino acid sequences based on the comparison of the profiles of biochemical properties of these sequences. Unlike the conventional sequence alignment methods that use 20x20 fixed amino acid substitution matrices, PR2ALIGN uses a set of weighted biochemical properties of amino acids to measure the distance between pairs of aligned residues and to find an optimal minimal distance global alignment. The user can provide any number of amino acid properties and specify a weight for each property. The higher the weight for a given property, the more this property affects the final alignment. We show that in many cases the approach implemented in PR2ALIGN produces better quality pair-wise alignments than the conventional matrix-based approach. PR2ALIGN will be helpful for researchers who wish to align amino acid sequences by using flexible user-specified alignment scoring functions based on the biochemical properties of amino acids instead of the amino acid substitution matrix. To the best of the authors' knowledge, there are no existing stand-alone software programs or web-servers analogous to PR2ALIGN. The software is freely available from http://pr2align.rit.albany.edu.

Altered Synchronizations among Neural Networks in Geriatric Depression.

Science.gov (United States)

Wang, Lihong; Chou, Ying-Hui; Potter, Guy G; Steffens, David C

2015-01-01

Although major depression has been considered as a manifestation of discoordinated activity between affective and cognitive neural networks, only a few studies have examined the relationships among neural networks directly. Because of the known disconnection theory, geriatric depression could be a useful model in studying the interactions among different networks. In the present study, using independent component analysis to identify intrinsically connected neural networks, we investigated the alterations in synchronizations among neural networks in geriatric depression to better understand the underlying neural mechanisms. Resting-state fMRI data was collected from thirty-two patients with geriatric depression and thirty-two age-matched never-depressed controls. We compared the resting-state activities between the two groups in the default-mode, central executive, attention, salience, and affective networks as well as correlations among these networks. The depression group showed stronger activity than the controls in an affective network, specifically within the orbitofrontal region. However, unlike the never-depressed controls, geriatric depression group lacked synchronized/antisynchronized activity between the affective network and the other networks. Those depressed patients with lower executive function has greater synchronization between the salience network with the executive and affective networks. Our results demonstrate the effectiveness of the between-network analyses in examining neural models for geriatric depression.

76 FR 54536 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-09-01

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

78 FR 55778 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2013-09-11

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting.... App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

77 FR 49865 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-08-17

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

A prospective study assessing agreement and reliability of a geriatric evaluation

OpenAIRE

Locatelli, Isabella; Monod, St?fanie; Cornuz, Jacques; B?la, Christophe J.; Senn, Nicolas

2017-01-01

Background The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. Method...

76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-03-31

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 14... pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities...

75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-09-03

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities...

77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-03-13

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 11... matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care...

75 FR 11638 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-03-11

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 22... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2013-01-30

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting.... App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 10... matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care...

Development of statewide geriatric patients trauma triage criteria.

Science.gov (United States)

Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia

2011-06-01

The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the

Home hospitalization in the spectrum of community geriatric care.

Science.gov (United States)

Stessman, J; Hammerman-Rozenberg, R; Cohen, A

1997-04-01

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

Stand-alone power systems for the future: Optimal design, operation and control of solar-hydrogen energy systems

Energy Technology Data Exchange (ETDEWEB)

Ulleberg, Oeystein

1998-12-31

This thesis gives a systematic review of the fundamentals of energy systems, the governing physical and chemical laws related to energy, inherent characteristics of energy system, and the availability of the earth`s energy. It shows clearly why solar-hydrogen systems are one of the most viable options for the future. The main subject discussed is the modelling of SAPS (Stand-Alone Power Systems), with focus on photovoltaic-hydrogen energy systems. Simulation models for a transient simulation program are developed for PV-H{sub 2} components, including models for photovoltaics, water electrolysis, hydrogen storage, fuel cells, and secondary batteries. A PV-H{sub 2} demonstration plant in Juelich, Germany, is studied as a reference plant and the models validated against data from this plant. Most of the models developed were found to be sufficiently accurate to perform short-term system simulations, while all were more than accurate enough to perform long-term simulations. Finally, the verified simulation models are used to find the optimal operation and control strategies of an existing PV-H{sub 2} system. The main conclusion is that the simulation methods can be successfully used to find optimal operation and control strategies for a system with fixed design, and similar methods could be used to find alternative system designs. 148 refs., 78 figs., 31 tabs.

Stand-alone power systems for the future: Optimal design, operation and control of solar-hydrogen energy systems

Energy Technology Data Exchange (ETDEWEB)

Ulleberg, Oeystein

1999-12-31

This thesis gives a systematic review of the fundamentals of energy systems, the governing physical and chemical laws related to energy, inherent characteristics of energy system, and the availability of the earth`s energy. It shows clearly why solar-hydrogen systems are one of the most viable options for the future. The main subject discussed is the modelling of SAPS (Stand-Alone Power Systems), with focus on photovoltaic-hydrogen energy systems. Simulation models for a transient simulation program are developed for PV-H{sub 2} components, including models for photovoltaics, water electrolysis, hydrogen storage, fuel cells, and secondary batteries. A PV-H{sub 2} demonstration plant in Juelich, Germany, is studied as a reference plant and the models validated against data from this plant. Most of the models developed were found to be sufficiently accurate to perform short-term system simulations, while all were more than accurate enough to perform long-term simulations. Finally, the verified simulation models are used to find the optimal operation and control strategies of an existing PV-H{sub 2} system. The main conclusion is that the simulation methods can be successfully used to find optimal operation and control strategies for a system with fixed design, and similar methods could be used to find alternative system designs. 148 refs., 78 figs., 31 tabs.

IEA PVPS Task 3. Use of photovoltaic systems in stand-alone and island applications. 'Swiss participation'; IEA PVPS Task 3. Use of photovoltaic systems in stand-alone and island applications. 'Participation Suisse'

Energy Technology Data Exchange (ETDEWEB)

Villoz, M. [Dynatex SA, Morges (Switzerland)

2004-07-01

This report describes the work done during five years of the second phase of Task 3 of the photovoltaic power systems programme of the International Energy Agency (IEA-PVPS). Task 3 activities were concentrated on stand-alone photovoltaic systems with the main effort on improving the quality and reducing the cost of these systems. The work was divided in 2 sub-tasks whose first one was concentrated on quality insurance schemes and second one on technical recommendations coming from practical experience. Twelve original reports have been published covering topics that can be sorted in 4 categories: the first one is dedicated on quality issues with a review of existing standards in the participating countries and a double paper giving quality assurance recommendations on project management and examples of applying these rules in practical cases. The second category dwelled on photovoltaic systems with papers on charge controllers, on lightning protection and monitoring of systems. The third category presents interesting studies on the storage of energy which remains the main subject where improvements should be made in order to lower the cost of energy; four papers describe the management and the test procedures of lead-acid batteries, how to choose a lead-acid battery and finally are there alternatives to lead-acid batteries for the storage of photovoltaic electricity. The last category worked on loads and users of renewable energy and gives a large amount of experience with loads, how to choose them and how the energy can be better used through demand side management. (author)

Fried frailty phenotype assessment components as applied to geriatric inpatients

OpenAIRE

Bieniek, Joanna; Wilczy?ski, Krzysztof; Szewieczek, Jan

2016-01-01

Joanna Bieniek, Krzysztof Wilczynski, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in ...

Comparison of quality of sleep, depression, and life satisfaction between older adults in nursing homes and long-term care hospitals in Korea.

Science.gov (United States)

Kim, Kon Hee; Hwang, Eun Hee

2017-01-01

The purpose of the present study was to identify the sleep quality, depression, and life satisfaction between nursing home and long-term care hospital residents. Data was collected through a structured questionnaire survey of 61 nursing home residents and 74 long-term care hospital residents. Descriptive statistics, t-test, χ 2 -test, anova, Pearson's correlation were used to analyze the data. The residents living in a nursing home showed higher subjective health status and sleep quality than long-term care hospital residents. Depression did not show a significant difference between them. However, there was a significant difference in depression score by subjective health status. Sleep quality and depression showed a significant negative correlation for both residents. In terms of depression and life satisfaction, nursing home residents showed a significant negative correlation, and long-term care hospital residents showed a significant positive correlation. These results show that environmental management is essential to enhance sleep quality, thus depression and subjective health status will be improved. Geriatr Gerontol Int 2017; 17: 142-149. © 2015 Japan Geriatrics Society.

Direct Flux Control for Stand-Alone Operation Brushless Doubly Fed Induction Generators Using a Resonant-Based Sliding-Mode Control Approach

Directory of Open Access Journals (Sweden)

Kai Ji

2018-04-01

Full Text Available In this paper, a novel voltage control strategy for stand-alone operation brushless doubly fed induction generators for variable speed constant frequency wind energy conversion systems was presented and discussed. Based on the model of the power generation system, the proposed direct flux control strategy employs a nonlinear reduced-order generalized integrator-based resonant sliding-mode control approach to directly calculate and regulate the output value of converter which the control winding stator requires so as to eliminate its instantaneous errors, without involving any synchronous rotating coordinate transformations. The stability, robustness and convergence capability of the proposed control strategy were described and analyzed. Owing to the fact no additional current control inner loops are involved, the system configuration is therefore simplified and the dynamic performance enhanced. A constant converter switching frequency was achieved by using space vector pulse width modulation, which reduces the harmonics of the generator terminal voltage. In addition, the feasibility and validity of the proposed scheme is verified by experiments, and excellent steady and transient performance is achieved.

Spirituality in Nursing: Filipino Elderly's Concept of, Distance from, and Involvement with God

Science.gov (United States)

de Guzman, Allan B.; Dalay, Naihra Jae Z.; De Guzman, Anthony Joe M.; de Jesus, Luigi Lauren E.; de Mesa, Jacqueline Barbara C.; Flores, Jan Derick D.

2009-01-01

Spirituality is an aspect of holistic care delivery by health team members. However, despite the established relationship of spirituality and health, there had been little evidence of ways of assessing spirituality for nurses' clinical practice in Asia, particularly in regard to geriatric patients. This study aimed to establish an eiditic…

Dental Students' Self-Assessed Competence in Geriatric Dentistry.

Science.gov (United States)

Kiyak, H. Asuman; Brudvik, James

1992-01-01

A study of four classes of dental students (n=172) exposed to both didactic and clinical geriatric dental training found that the students perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, notably treatment planning, preventive dentistry, referrals, and providing care in alternative settings.…

Psychological background of prevention and treatment in geriatrics

Directory of Open Access Journals (Sweden)

Nazarov M.l.

2015-03-01

Full Text Available Confidentiality as the component of an interpersonal "patient — medical practitioner" contact formation can be considered as a corner stone of geriatric practice. Major psychological pitfalls of geriatric practice have been reviewed. The main issue of the paper is psychological substantiation of treatment and prevention of elderly.

"You're being paged!" outcomes of a nursing home on-call role-playing and longitudinal curriculum.

Science.gov (United States)

Yuasa, Misuzu; Bell, Christina L; Inaba, Michiko; Tamura, Bruce K; Ahsan, Samina; Saunders, Valisa; Masaki, Kamal

2013-11-01

Effectively handling telephone calls about nursing home (NH) residents is an important skill for healthcare professionals, but little formal training is typically provided. The objective of the current study was to describe and evaluate the effectiveness of a novel structured role-playing didactic session followed by an on-call NH longitudinal clinical experience. The effectiveness of the structured role-playing didactic session was compared in different learners, including geriatric medicine fellows (n = 10), family medicine residents and faculty (n = 14), nurse practitioner students (n = 31), and other learners (n = 7). The curriculum focused on common problems encountered while caring for NH residents during on-call periods. Learners rated themselves using an 18-item pre/post questionnaire including five attitude and 13 skills questions, using a 1-to-5 Likert scale. T-tests were used to compare means before and after sessions. Significant improvements were found in overall mean attitudes and skills scores. For all learners, the greatest improvements were seen in "comfort in managing residents at the NH," "managing feeding or gastrostomy tube dislodgement," "identifying different availability of medications, laboratory studies, and procedures in NH," and "describing steps to send NH residents to the emergency department." Geriatric medicine fellows' attitudes and skills improved significantly after the longitudinal clinical experience. The faculty survey demonstrated improved documentation, communication, and fellows' management of on-call problems after curriculum implementation. This novel curriculum used role-playing to provide training for on-call management of NH residents. This curriculum has been successfully disseminated on a national geriatrics educational resource website (POGOe) and is applicable to geriatric medicine fellowships, internal medicine and family medicine residency programs, and other training programs. © 2013, Copyright the Authors

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.

Science.gov (United States)

Mohile, Supriya Gupta; Velarde, Carla; Hurria, Arti; Magnuson, Allison; Lowenstein, Lisa; Pandya, Chintan; O'Donovan, Anita; Gorawara-Bhat, Rita; Dale, William

2015-09-01

Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes. Copyright © 2015 by the National Comprehensive Cancer Network.

Challenges for Nurses Caring for Individuals with Peripherally Inserted Central Catheters in Skilled Nursing Facilities.

Science.gov (United States)

Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet

2016-10-01

To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. Exploratory, qualitative pilot study. Two community based SNFs. Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Optimal Sizing of a Stand-Alone Hybrid Power System Based on Battery/Hydrogen with an Improved Ant Colony Optimization

Directory of Open Access Journals (Sweden)

Weiqiang Dong

2016-09-01

Full Text Available A distributed power system with renewable energy sources is very popular in recent years due to the rapid depletion of conventional sources of energy. Reasonable sizing for such power systems could improve the power supply reliability and reduce the annual system cost. The goal of this work is to optimize the size of a stand-alone hybrid photovoltaic (PV/wind turbine (WT/battery (B/hydrogen system (a hybrid system based on battery and hydrogen (HS-BH for reliable and economic supply. Two objectives that take the minimum annual system cost and maximum system reliability described as the loss of power supply probability (LPSP have been addressed for sizing HS-BH from a more comprehensive perspective, considering the basic demand of load, the profit from hydrogen, which is produced by HS-BH, and an effective energy storage strategy. An improved ant colony optimization (ACO algorithm has been presented to solve the sizing problem of HS-BH. Finally, a simulation experiment has been done to demonstrate the developed results, in which some comparisons have been done to emphasize the advantage of HS-BH with the aid of data from an island of Zhejiang, China.

Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (OGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013

DEFF Research Database (Denmark)

Singler, K.; Stuck, A. E.; Masud, T.

2014-01-01

using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end...... at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties...

Differences in lumbopelvic control and occupational behaviours in female nurses with and without a recent history of low back pain due to back injury.

Science.gov (United States)

Babiolakis, Corinne S; Kuk, Jennifer L; Drake, Janessa D M

2015-01-01

Low back pain is highly prevalent in nurses. This study aimed to determine which physical fitness, physical activity (PA) and biomechanical characteristics most clearly distinguish between nurses with [recently injured (RInj)] and without [not recently injured (NRInj)] a recent back injury. Twenty-seven (8 RInj, 19 NRInj) female nurses completed questionnaires (pain, work, PA), physical fitness, biomechanical and low back discomfort measures, and wore an accelerometer for one work shift. Relative to NRInj nurses, RInj nurses exhibited reduced lumbopelvic control (41.4% more displayed a moderate loss of frontal plane position), less active occupational behaviours (less moderate PA; less patient lifts performed alone; more sitting and less standing time) and more than two times higher low back discomfort scores. Despite no physical fitness differences, the lumbopelvic control, occupational behaviours and discomfort measures differed between nurses with and without recent back injuries. It is unclear whether poor lumbopelvic control is causal or adaptive in RInj nurses and may require further investigation. Practitioner Summary: It is unclear which personal modifiable factors are most clearly associated with low back pain in nurses. Lumbopelvic control was the only performance-based measure to distinguish between nurses with and without recent back injuries. Future research may investigate whether reduced lumbopelvic control is causal or adaptive in recently injured nurses.

Curriculum content in geriatric dentistry in USA dental schools.

Science.gov (United States)

Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2018-03-01

The aim of this study was to re-examine the teaching of geriatric dentistry in the USA dental schools, to identify curriculum content and compare the findings to previous reports. All dental schools in the United States were contacted via email with a questionnaire to assess the teaching of geriatric dentistry. Non-responding schools were sent a minimum of three reminder emails to complete the survey. A statistical analysis was performed. Descriptive statistics were conducted to profile the variables of interest. Bivariate analysis was performed to explore if any of the variables were related using Fisher's exact test, non-parametric Wilcoxon rank-sum test and the Kruskal-Wallis test. Fifty-six of the 67 dental schools completed the questionnaire. Geriatric dentistry was taught in all dental schools; for 92.8%, the course was compulsory. We found that 62.5% were teaching it as an independent course, 25% as an organised series of lectures and 8.9% as occasional lectures in parts of other courses. Clinically, 84.2% have some form of compulsory education in geriatric dentistry. Public schools were marginally associated with an increased interest in expanding the geriatric dentistry curriculum (P = .078). No differences were found between these variables and school location. Geriatric dentistry is now required in 92.8% of dental schools. The teaching of traditional topics has not changed much; however, the number of gerontological topics has increased. Clinical teaching needs to be expanded, as in only 57.1% of schools was it a requirement. The ageing imperative will require research to determine the impact of teaching on services to the geriatric community. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

[Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine].

Science.gov (United States)

Müller-Werdan, U; Heppner, H-J; Michels, G

2018-04-18

Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process.

System dynamic model and charging control of lead-acid battery for stand-alone solar PV system

KAUST Repository

Huang, B.J.

2010-05-01

The lead-acid battery which is widely used in stand-alone solar system is easily damaged by a poor charging control which causes overcharging. The battery charging control is thus usually designed to stop charging after the overcharge point. This will reduce the storage energy capacity and reduce the service time in electricity supply. The design of charging control system however requires a good understanding of the system dynamic behaviour of the battery first. In the present study, a first-order system dynamics model of lead-acid battery at different operating points near the overcharge voltage was derived experimentally, from which a charging control system based on PI algorithm was developed using PWM charging technique. The feedback control system for battery charging after the overcharge point (14 V) was designed to compromise between the set-point response and the disturbance rejection. The experimental results show that the control system can suppress the battery voltage overshoot within 0.1 V when the solar irradiation is suddenly changed from 337 to 843 W/m2. A long-term outdoor test for a solar LED lighting system shows that the battery voltage never exceeded 14.1 V for the set point 14 V and the control system can prevent the battery from overcharging. The test result also indicates that the control system is able to increase the charged energy by 78%, as compared to the case that the charging stops after the overcharge point (14 V). © 2010 Elsevier Ltd. All rights reserved.

Techno-economic analysis of stand-alone photovoltaic/wind/battery/hydrogen systems for very small-scale applications

Directory of Open Access Journals (Sweden)

Stojković Saša M.

2016-01-01

Full Text Available The paper presents the results of a technical and economic analysis of three stand-alone hybrid power systems based on renewable energy sources which supply a specific group of low-power consumers. This particular case includes measuring sensors and obstacle lights on a meteorological mast for wind measurements requiring an uninterrupted power supply in cold climate conditions. Although these low-power (100 W measuring sensors and obstacle lights use little energy, their energy consumption is not the same as the available solar energy obtained on a daily or seasonal basis. In the paper, complementarity of renewable energy sources was analysed, as well as one of short-term lead-acid battery-based storage and seasonal, hydrogen-based (electrolyser, H2 tank, and fuel cells storage. These relatively complex power systems were proposed earlier for high-power consumers only, while this study specifically highlights the role of the hydrogen system for supplying low-power consumers. The analysis employed a numerical simulation method using the HOMER software tool. The results of the analysis suggest that solar and wind-solar systems, which involve meteorological conditions as referred to in this paper, include a relatively large number of lead-acid batteries. Additionally, the analysis suggests that the use of hydrogen power systems for supplying low power-consumers is entirely justifiable, as it significantly reduces the number of batteries (two at minimum in this particular case. It was shown that the increase in costs induced by the hydrogen system is acceptable.

A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience.

Science.gov (United States)

Chong, Mei Sian; Empensando, Esmiller F; Ding, Yew Yoong; Tan, Thai Lian

2012-08-01

The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance. We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods. Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period. We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.

Exercise Promotion in Geriatric Oncology.

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Burhenn, Peggy S; Bryant, Ashley Leak; Mustian, Karen M

2016-09-01

Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals.

Positive and negative volume-outcome relationships in the geriatric trauma population.

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Matsushima, Kazuhide; Schaefer, Eric W; Won, Eugene J; Armen, Scott B; Indeck, Matthew C; Soybel, David I

2014-04-01

In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly, or to the case volume among all trauma patients treated by an institution. To test the hypothesis that outcomes of trauma care for geriatric patients are affected differently by the volume of geriatric cases and nongeriatric cases of an institution. This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39 431 eligible geriatric trauma patients (aged >65 years) in the Pennsylvania Trauma Outcomes Study. In-hospital mortality, major complications, and mortality after major complications (failure to rescue). Between 2001 and 2010, 39 431 geriatric trauma patients and 105 046 nongeriatric patients were captured in a review of outcomes in 20 state-designated levels 1 and 2 trauma centers. Larger volumes of geriatric trauma patients were significantly associated with lower odds of in-hospital mortality, major complications, and failure to rescue. In contrast, larger nongeriatric trauma volumes were significantly associated with higher odds of major complications in geriatric patients. Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients. These findings offer the possibility that outcomes might be improved with differentiated pathways of care for geriatric trauma patients.

[The mobile geriatrics team, global patient management].

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Bach, Fréderiue; Bloch, Frédéric

2013-01-01

The mobile geriatric team of Cochin hospital in Paris is responsible for the management and orientation of fragile elderly patients over the age of 75 admitted to emergency departments. It carries out a multi-disciplinary assessment, contributes to the creation of the care project and life project of geriatric patients and is involved in organising the patient's return home. This article focuses on the role of the social assistant through two clinical cases.

78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment

Science.gov (United States)

2013-02-25

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting....S.C. App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee has been... and the Under Secretary for Health on all matters pertaining to geriatrics and gerontology. The...

Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test?

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Aydin, Ali Ekrem; Soysal, Pinar; Isik, Ahmet Turan

2017-01-01

Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults. Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients. The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher ( P 0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT ( P 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT. The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice.

Older adults in jail: high rates and early onset of geriatric conditions.

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Greene, Meredith; Ahalt, Cyrus; Stijacic-Cenzer, Irena; Metzger, Lia; Williams, Brie

2018-02-17

The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults. This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth. All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older. Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

The Use of Artificial Neural Networks for Forecasting the Electric Demand of Stand-Alone Consumers

Science.gov (United States)

Ivanin, O. A.; Direktor, L. B.

2018-05-01

The problem of short-term forecasting of electric power demand of stand-alone consumers (small inhabited localities) situated outside centralized power supply areas is considered. The basic approaches to modeling the electric power demand depending on the forecasting time frame and the problems set, as well as the specific features of such modeling, are described. The advantages and disadvantages of the methods used for the short-term forecast of the electric demand are indicated, and difficulties involved in the solution of the problem are outlined. The basic principles of arranging artificial neural networks are set forth; it is also shown that the proposed method is preferable when the input information necessary for prediction is lacking or incomplete. The selection of the parameters that should be included into the list of the input data for modeling the electric power demand of residential areas using artificial neural networks is validated. The structure of a neural network is proposed for solving the problem of modeling the electric power demand of residential areas. The specific features of generation of the training dataset are outlined. The results of test modeling of daily electric demand curves for some settlements of Kamchatka and Yakutia based on known actual electric demand curves are provided. The reliability of the test modeling has been validated. A high value of the deviation of the modeled curve from the reference curve obtained in one of the four reference calculations is explained. The input data and the predicted power demand curves for the rural settlement of Kuokuiskii Nasleg are provided. The power demand curves were modeled for four characteristic days of the year, and they can be used in the future for designing a power supply system for the settlement. To enhance the accuracy of the method, a series of measures based on specific features of a neural network's functioning are proposed.

Stand-alone front-end system for high- frequency, high-frame-rate coded excitation ultrasonic imaging.

Science.gov (United States)

Park, Jinhyoung; Hu, Changhong; Shung, K Kirk

2011-12-01

A stand-alone front-end system for high-frequency coded excitation imaging was implemented to achieve a wider dynamic range. The system included an arbitrary waveform amplifier, an arbitrary waveform generator, an analog receiver, a motor position interpreter, a motor controller and power supplies. The digitized arbitrary waveforms at a sampling rate of 150 MHz could be programmed and converted to an analog signal. The pulse was subsequently amplified to excite an ultrasound transducer, and the maximum output voltage level achieved was 120 V(pp). The bandwidth of the arbitrary waveform amplifier was from 1 to 70 MHz. The noise figure of the preamplifier was less than 7.7 dB and the bandwidth was 95 MHz. Phantoms and biological tissues were imaged at a frame rate as high as 68 frames per second (fps) to evaluate the performance of the system. During the measurement, 40-MHz lithium niobate (LiNbO(3)) single-element lightweight (<;0.28 g) transducers were utilized. The wire target measure- ment showed that the -6-dB axial resolution of a chirp-coded excitation was 50 μm and lateral resolution was 120 μm. The echo signal-to-noise ratios were found to be 54 and 65 dB for the short burst and coded excitation, respectively. The contrast resolution in a sphere phantom study was estimated to be 24 dB for the chirp-coded excitation and 15 dB for the short burst modes. In an in vivo study, zebrafish and mouse hearts were imaged. Boundaries of the zebrafish heart in the image could be differentiated because of the low-noise operation of the implemented system. In mouse heart images, valves and chambers could be readily visualized with the coded excitation.

[Ten years of early complex geriatric rehabilitation therapy in the DRG system].

Science.gov (United States)