Simulation for ward processes of surgical care.

Science.gov (United States)

Pucher, Philip H; Darzi, Ara; Aggarwal, Rajesh

2013-07-01

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. Copyright © 2013 Elsevier Inc. All rights reserved.

Ward identities at finite temperature

International Nuclear Information System (INIS)

DOlivo, J.C.; Torres, M.; Tututi, E.

1996-01-01

The Ward identities for QED at finite temperature are derived using the functional real-time formalism. They are verified by an explicit one-loop calculation. An effective causal vertex is constructed which satisfy the Ward identity with the associated retarded self-energy. copyright 1996 American Institute of Physics

Superconformal Ward identities and the supertorus

International Nuclear Information System (INIS)

Grundberg, J.; Nakayama, R.

1987-12-01

We derive superconformal Ward identities in the context of superspace supergravity. From these Ward identities we extract operator product expansions and the case of a supertorus is studied in some detail. (orig.)

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

Science.gov (United States)

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

Coding Partitions

Directory of Open Access Journals (Sweden)

Fabio Burderi

2007-05-01

Full Text Available Motivated by the study of decipherability conditions for codes weaker than Unique Decipherability (UD, we introduce the notion of coding partition. Such a notion generalizes that of UD code and, for codes that are not UD, allows to recover the ``unique decipherability" at the level of the classes of the partition. By tacking into account the natural order between the partitions, we define the characteristic partition of a code X as the finest coding partition of X. This leads to introduce the canonical decomposition of a code in at most one unambiguouscomponent and other (if any totally ambiguouscomponents. In the case the code is finite, we give an algorithm for computing its canonical partition. This, in particular, allows to decide whether a given partition of a finite code X is a coding partition. This last problem is then approached in the case the code is a rational set. We prove its decidability under the hypothesis that the partition contains a finite number of classes and each class is a rational set. Moreover we conjecture that the canonical partition satisfies such a hypothesis. Finally we consider also some relationships between coding partitions and varieties of codes.

Performance of Multilevel Coding Schemes with Different Decoding Methods and Mapping Strategies in Mobile Fading Channels

Institute of Scientific and Technical Information of China (English)

YUAN Dongfeng; WANG Chengxiang; YAO Qi; CAO Zhigang

2001-01-01

Based on "capacity rule", the perfor-mance of multilevel coding (MLC) schemes with dif-ferent set partitioning strategies and decoding meth-ods in AWGN and Rayleigh fading channels is investi-gated, in which BCH codes are chosen as componentcodes and 8ASK modulation is used. Numerical re-sults indicate that MLC scheme with UP strategy canobtain optimal performance in AWGN channels andBP is the best mapping strategy for Rayleigh fadingchannels. BP strategy is of good robustness in bothkinds of channels to realize an optimum MLC system.Multistage decoding (MSD) is a sub-optimal decodingmethod of MLC for both channels. For Ungerboeckpartitioning (UP) and mixed partitioning (MP) strat-egy, MSD is strongly recommended to use for MLCsystem, while for BP strategy, PDL is suggested to useas a simple decoding method compared with MSD.

Ward identities for conformal models

International Nuclear Information System (INIS)

Lazzarini, S.; Stora, R.

1988-01-01

Ward identities which express the symmetry of conformal models are treated. Diffeomorphism invariance or locally holomorphic coordinate transformations are used. Diffeomorphism invariance is then understood in terms of Riemannian geometry. Two different sets of Ward identities expressing diffeomorphism invariance in a conformally invariant way are found for the free bosonic string. Using a geometrical argument, the correct invariance for a large class of conformal models is given

Anomalous N=2 superconformal Ward identities

International Nuclear Information System (INIS)

Ketov, Sergei V.

2000-01-01

The N=2 superconformal Ward identities and their anomalies are discussed in N=2 superspace (including N=2 harmonic superspace), at the level of the low-energy effective action (LEEA) in four-dimensional N=2 supersymmetric field theories. The (first) chiral N=2 supergravity compensator is related to the known N=2 anomalous Ward identity in the N=2 (abelian) vector mulitplet sector. As regards the hypermultiplet LEEA given by the N=2 non-linear sigma-model (NLSM), a new anomalous N=2 superconformal Ward identity is found, whose existence is related to the (second) analytic compensator in N=2 supergravity. The celebrated solution of Seiberg and Witten is known to obey the (first) anomalous Ward identity in the Coulomb branch. We find a few solutions to the new anomalous Ward identity, after making certain assumptions about unbroken internal symmetries. Amongst the N=2 NLSM target space metrics governing the hypermultiplet LEEA are the SU(2)-Yang-Mills-Higgs monopole moduli-space metrics that can be encoded in terms of the spectral curves (Riemann surfaces), similarly to the Seiberg-Witten-type solutions. After a dimensional reduction to three spacetime dimensions (3d), our results support the mirror symmetry between the Coulomb and Higgs branches in 3d, N=4 gauge theories

A multilevel adaptive reaction-splitting method for SRNs

KAUST Repository

Moraes, Alvaro

2015-01-07

In this work, we present a novel multilevel Monte Carlo method for kinetic simulation of stochastic reaction networks specifically designed for systems in which the set of reaction channels can be adaptively partitioned into two subsets characterized by either “high” or “low” activity. To estimate expected values of observables of the system, our method bounds the global computational error to be below a prescribed tolerance, within a given confidence level. This is achieved with a computational complexity of order O (TOL-2).We also present a novel control variate technique which may dramatically reduce the variance of the coarsest level at a negligible computational cost. Our numerical examples show substantial gains with respect to the standard Stochastic Simulation Algorithm (SSA) by Gillespie and also our previous hybrid Chernoff tau-leap method.

Multilevel modeling using R

CERN Document Server

Finch, W Holmes; Kelley, Ken

2014-01-01

A powerful tool for analyzing nested designs in a variety of fields, multilevel/hierarchical modeling allows researchers to account for data collected at multiple levels. Multilevel Modeling Using R provides you with a helpful guide to conducting multilevel data modeling using the R software environment.After reviewing standard linear models, the authors present the basics of multilevel models and explain how to fit these models using R. They then show how to employ multilevel modeling with longitudinal data and demonstrate the valuable graphical options in R. The book also describes models fo

Nursing Education Trial Using a Virtual Nightingale Ward.

Science.gov (United States)

Tsuji, Keiko; Iwata, Naomi; Kodama, Hiromi; Hagiwara, Tomoko; Takai, Kiyako; Sasaki, Yoko; Nagata, Yoshie; Matsumoto, Maki

2017-01-01

Nursing department students are expected to correctly grasp the entire concept of nursing through their education. The authors created a movie of a Nightingale ward (virtual ward, hereafter) with an architectural computer design software for education. The students' reaction to the virtual ward was categorized into three viewpoints: that of nurses, of patients, and of nurses and patients in common. Most of the reactions in each viewpoint were: "easy to observe patients" in the nurses' viewpoint; "no privacy" in the patients' viewpoint; and "wide room" in the common viewpoint, respectively. These reactions show the effectiveness of using a virtual ward in nursing education. Because these reactions are characteristics of a Nightingale ward, and even students, who have generally less experiences, recognized these characteristics from the both viewpoints of nurses and patients.

Delivery of pharmaceutical services at ward level in a teaching hospital.

Science.gov (United States)

Schellack, N; Martins, V; Botha, N; Meyer, J C

2009-03-01

Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are

Ward nurses' knowledge of computed tomography scanning.

Science.gov (United States)

Majeed, M A; Nayeemuddin, M; Christie, M

Patients benefit from and are reassured by advance information on procedures that they are to undergo. Ward nurses should have adequate knowledge of radiological investigations to ensure proper patient preparation and good interdepartmental communication to avoid delays and cancellations. This study was conducted to assess the ward nurses' knowledge of the process of computed tomography (CT) scanning. One hundred and twenty qualified nurses were asked to complete a questionnaire regarding CT scanning. The findings revealed a suboptimal level of awareness about the process. This is probably due to lack of formal teaching for nurses on the wards in regards the different radiological procedures and patient preparation. There is a strong case for better educational talks on rapidly changing radiological techniques for ward staff to ensure high-quality patient care.

The median hazard ratio: a useful measure of variance and general contextual effects in multilevel survival analysis.

Science.gov (United States)

Austin, Peter C; Wagner, Philippe; Merlo, Juan

2017-03-15

Multilevel data occurs frequently in many research areas like health services research and epidemiology. A suitable way to analyze such data is through the use of multilevel regression models (MLRM). MLRM incorporate cluster-specific random effects which allow one to partition the total individual variance into between-cluster variation and between-individual variation. Statistically, MLRM account for the dependency of the data within clusters and provide correct estimates of uncertainty around regression coefficients. Substantively, the magnitude of the effect of clustering provides a measure of the General Contextual Effect (GCE). When outcomes are binary, the GCE can also be quantified by measures of heterogeneity like the Median Odds Ratio (MOR) calculated from a multilevel logistic regression model. Time-to-event outcomes within a multilevel structure occur commonly in epidemiological and medical research. However, the Median Hazard Ratio (MHR) that corresponds to the MOR in multilevel (i.e., 'frailty') Cox proportional hazards regression is rarely used. Analogously to the MOR, the MHR is the median relative change in the hazard of the occurrence of the outcome when comparing identical subjects from two randomly selected different clusters that are ordered by risk. We illustrate the application and interpretation of the MHR in a case study analyzing the hazard of mortality in patients hospitalized for acute myocardial infarction at hospitals in Ontario, Canada. We provide R code for computing the MHR. The MHR is a useful and intuitive measure for expressing cluster heterogeneity in the outcome and, thereby, estimating general contextual effects in multilevel survival analysis. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Developing non-technical ward-round skills.

Science.gov (United States)

Harvey, Rachel; Mellanby, Edward; Dearden, Effie; Medjoub, Karima; Edgar, Simon

2015-10-01

Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an a priori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin et al. Ninety-seven per cent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum. © 2015 John Wiley & Sons Ltd.

W-infinity ward identities and correlation functions in the c = 1 matrix model

International Nuclear Information System (INIS)

Das, S.R.; Dhar, A.; Mandal, G.; Wadia, S.R.

1992-01-01

In this paper, the authors explore consequences of W-infinity symmetry in the fermionic field theory of the c = 1 matrix model. The authors derive exact Ward identities relating correlation functions of the bilocal operator. These identities can be expressed as equations satisfied by the effective action of a three-dimensional theory and contain non-perturbative information about the model. The authors use thee identities to calculate the two-point function of the bilocal operator in the double scaling limit. The authors extract the operator whose two-point correlator has a single pole at an (imaginary) integer value of the energy. The authors then rewrite the W-infinity charges in terms of operators in the matrix model and use this to derive constraints satisfied by the partition function of the matrix model with a general time dependent potential

A Novel Criterion for Optimum MultilevelCoding Systems in Mobile Fading Channels

Institute of Scientific and Technical Information of China (English)

YUAN Dongfeng; WANG Chengxiang; YAO Qi; CAO Zhigang

2001-01-01

A novel criterion that is "capac-ity rule" and "mapping rule" for the design of op-timum MLC scheme over mobile fading channels isproposed.According to this theory,the performanceof multilevel coding with multistage decoding schemes(MLC/MSD) in mobile fading channels is investi-gated,in which BCH codes are chosen as componentcodes,and three mapping strategies with 8ASK mod-ulation are used.Numerical results indicate that whencode rates of component codes in MLC scheme are de-signed based on "capacity rule",the performance ofthe system with block partitioning (BP) is optimumfor Rayleigh fading channels,while the performance ofthe system with Ungerboeck partioning (UP) is bestfor AWGN channels.

EUROPEAN INTEGRATION: A MULTILEVEL PROCESS THAT REQUIRES A MULTILEVEL STATISTICAL ANALYSIS

Directory of Open Access Journals (Sweden)

Roxana-Otilia-Sonia HRITCU

2015-11-01

Full Text Available A process of market regulation and a system of multi-level governance and several supranational, national and subnational levels of decision making, European integration subscribes to being a multilevel phenomenon. The individual characteristics of citizens, as well as the environment where the integration process takes place, are important. To understand the European integration and its consequences it is important to develop and test multi-level theories that consider individual-level characteristics, as well as the overall context where individuals act and express their characteristics. A central argument of this paper is that support for European integration is influenced by factors operating at different levels. We review and present theories and related research on the use of multilevel analysis in the European area. This paper draws insights on various aspects and consequences of the European integration to take stock of what we know about how and why to use multilevel modeling.

Reviving post-take surgical ward round teaching.

Science.gov (United States)

Force, Jade; Thomas, Ian; Buckley, Frances

2014-04-01

Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff. © 2014 John Wiley & Sons Ltd.

The Productive Ward program™: a longitudinal multilevel study of nurse perceived practice environment, burnout, and nurse-reported quality of care and job outcomes.

Science.gov (United States)

Van Bogaert, Peter; Van heusden, Danny; Somers, Annemie; Tegenbos, Muriel; Wouters, Kristien; Van der Straeten, Johnny; Van Aken, Paul; Havens, Donna Sullivan

2014-09-01

The objective of this study was to investigate the impact of The Productive Ward-Releasing Time to Care™ program implemented in a hospital transformation process on nurse perception related to practice environment, burnout, quality of care, and job outcomes. To address the continuously evolving complex challenges of patient care, high-performance nursing care is necessary. A longitudinal survey design was used to conduct a study in a 600-bed acute care university hospital with 3 measurement periods: T0: base line in 2006, T1 in 2011, and T2 in 2013. As part of the hospital transformation process, the productive ward program was introduced between T1 and T2. Relevant impact on nurse-physician relations, nurse management, hospital management-organizational support, nurse-reported quality of care, and job outcomes were identified. Hospital strategies and policies should be aligned with daily practices so that engaged and committed staff can promote excellent outcomes.

Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward.

Science.gov (United States)

Gregory, Linda Rosemary; Hopwood, Nick; Boud, David

2014-05-01

It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre's tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar's room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning.

The transition from staff nurse to ward leader.

Science.gov (United States)

Spencer, Caroline; Al-Sadoon, Tara; Hemmings, Laura; Jackson, Karen; Mulligan, Paul

Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it.

25 CFR 117.23 - Transactions between guardian and ward.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Transactions between guardian and ward. 117.23 Section... COMPETENCY § 117.23 Transactions between guardian and ward. Business dealings between the guardian and his ward involving the sale or purchase of any property, real or personal, by the guardian to or from the...

Developing skills in clinical leadership for ward sisters.

Science.gov (United States)

Fenton, Katherine; Phillips, Natasha

The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.

Testing Group Mean Differences of Latent Variables in Multilevel Data Using Multiple-Group Multilevel CFA and Multilevel MIMIC Modeling.

Science.gov (United States)

Kim, Eun Sook; Cao, Chunhua

2015-01-01

Considering that group comparisons are common in social science, we examined two latent group mean testing methods when groups of interest were either at the between or within level of multilevel data: multiple-group multilevel confirmatory factor analysis (MG ML CFA) and multilevel multiple-indicators multiple-causes modeling (ML MIMIC). The performance of these methods were investigated through three Monte Carlo studies. In Studies 1 and 2, either factor variances or residual variances were manipulated to be heterogeneous between groups. In Study 3, which focused on within-level multiple-group analysis, six different model specifications were considered depending on how to model the intra-class group correlation (i.e., correlation between random effect factors for groups within cluster). The results of simulations generally supported the adequacy of MG ML CFA and ML MIMIC for multiple-group analysis with multilevel data. The two methods did not show any notable difference in the latent group mean testing across three studies. Finally, a demonstration with real data and guidelines in selecting an appropriate approach to multilevel multiple-group analysis are provided.

Unique Path Partitions

DEFF Research Database (Denmark)

Bessenrodt, Christine; Olsson, Jørn Børling; Sellers, James A.

2013-01-01

We give a complete classification of the unique path partitions and study congruence properties of the function which enumerates such partitions.......We give a complete classification of the unique path partitions and study congruence properties of the function which enumerates such partitions....

Two-Stage n-PSK Partitioning Carrier Phase Recovery Scheme for Circular mQAM Coherent Optical Systems

DEFF Research Database (Denmark)

Rodrigo Navarro, Jaime; Kakkar, Aditya; Pang, Xiaodan

2016-01-01

(ΔνTs) tolerance is achieved compared to the single-stage n-PSK partitioning scheme. Superior performance in the ΔνTs tolerance compared to the blind phase search algorithm is also reported. The relative improvements with respect to other CPR schemes are also validated experimentally for a 28-Gbaud C......A novel two-stage n-PSK partitioning carrier phase recovery (CPR) scheme for circular multilevel quadrature amplitude modulation (C-mQAM) constellations is presented. The first stage of the algorithm provides an initial rough estimation of the received constellation, which is utilized in the second...... stage for CPR. The performance of the proposed algorithm is studied through extensive simulations at the forward error correction bit error rate targets of 3.8 × 10−3 and 1 × 10−2 and is compared with different CPR algorithms. A significant improvement in the combined linewidth symbol duration product...

The role of the ward manager in promoting patient safety.

Science.gov (United States)

Pinnock, David

In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.

Equations describing coherent and partially coherent multilevel molecular excitation induced by pulsed Raman transitions: III

International Nuclear Information System (INIS)

Shore, B.W.; Sacks, R.; Karr, T.

1987-01-01

This memo discusses the equations of motion used to describe multilevel molecular excitation induced by Raman transitions. These equations are based upon the time-dependent Schroedinger equation expressed in a basis of molecular energy states. A partition of these states is made into two sets, those that are far from resonance (and hence unpopulated) and those that are close to resonance, either by one-photon transition or two-photon (Raman) processes. By adiabatic elimination an effective Schroedinger equation is obtained for the resonance states alone. The effective Hamiltonian is expressible in terms of a polarizibility operator

Congenital cataract screening in maternity wards is effective

DEFF Research Database (Denmark)

Magnusson, Gunilla; Bizjajeva, Svetlana; Haargaard, Birgitte

2013-01-01

AIM: To study which eye-screening protocol prevails in Swedish maternity/neonatal wards, evaluate efficacy in a prospective study, and compare results with earlier Swedish retrospective results. METHODS: Surveys were sent in 2006 to maternity/neonatal and women's health departments regarding...... with earlier retrospective results was performed. RESULTS: Eye screening is routine protocol at a rate of 90% of Swedish maternity wards. Sixty-one children were included in the study. An increase was shown in case referrals from maternity wards compared to ten years ago (64% versus 50%). Detection...

The ward round--patient experiences and barriers to participation.

Science.gov (United States)

Swenne, Christine Leo; Skytt, Bernice

2014-06-01

Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication. The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care. The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis. The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University. The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process. Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved. © 2013 Nordic College of Caring Science.

Ergonomics in the psychiatric ward towards workers or patients?

Science.gov (United States)

Silvana, Salerno; Laura, Forcella; Ursula, Di Fabio; Irene, Figà Talamanca; Paolo, Boscolo

2012-01-01

Patient's aggressive behavior is one of the major problem in the psychiatric ward. Here we present the preliminary results of a psychiatric ward case-study, of a public hospital in the Chieti province, in order to plan ergonomic improvement. We applied the Method of Organizational Congruencies in the psychiatric ward in order to study the relationship between organized hospital work and nurses wellbeing in a 24 hour shifts. We observed 58 main phases in the three work shifts. The technical actions are mainly those of any hospital wards (shift briefing, preparing and administering drugs, recording data on clinical charts, etc.). We found important differences mainly due to the nurses overcontrol activities on the patients behavior (preventing suicides or self destructive behavior), the occurrence of restraint procedure towards patients, the pollution due to patient's cigarette smoke. The fear of patient's self destructive behavior or other aggressive behaviour are the main cognitive and social aspects of this hospital ward. Nurses working in this psychiatric ward have to accept: locked doors, poor and polluted environment, restraint procedure with high risk of aggression and no availability of mental health care programs. A new interdisciplinary concept for ergonomics in psychiatry setting may represent a challenge for both nurses and patients and the community.

Generalized ward identities for non-local transformation

International Nuclear Information System (INIS)

Li Ziping; Li Ruijie

2002-01-01

Based on the phase-space generating functional of Green function for a system with a singular higher-order Lagrangian, the generalized canonical Ward identities under the local and non-local transformation in phase space for such a system have been derived. Starting from the configuration-space generating functional for a gauge-invariant system, the generalized Ward identities were deduced under the local, non-local and global transformation, respectively. The applications to the non-Abelian Chern-Simons theories with higher derivatives were given. Some relationships among the proper vertices have been deduced, in which one does not need to carry out the integration over canonical momenta in phase-space generating functional. The Ward-Takahashi identities for BRS transformation are also obtained

Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

International Nuclear Information System (INIS)

Lurkittikul, N; Kittithreerapronchai, O

2014-01-01

The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients

Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

Science.gov (United States)

Lurkittikul, N.; Kittithreerapronchai, O.

2014-06-01

The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.

The chiral Ward-Takahashi identity in the ladder approximation

International Nuclear Information System (INIS)

Kugo, Taichiro; Mitchard, M.G.

1992-01-01

We show that the ladder approximation to the Schwinger-Dyson and Bethe-Salpeter equations preserves the Ward-Takahashi identity for the axial vector vertex if and only if we use the gluon momentum as the argument of the running coupling constant. However, in the usual Landau gauge this is inconsistent with the vector Ward identity. We propose a new method for making the ladder approximation scheme consistent with both vector and axial vector Ward identities. (orig.)

Optimizing Lighting Design for Hospital Wards by Defining User Zones

DEFF Research Database (Denmark)

Thuesen, Niels; Stidsen, Lone; Kirkegaard, Poul Henning

2011-01-01

of lighting design, so it has the ability to support the different users activity and behavior on the ward. By using RFID tracking and manual observations we have analyzed and evaluated the ward functionality as working environment for the staff. The method creates a higher understanding of the ward...... of lighting design in private and public settings are often not similar. The purpose of this article is therefore present a approach dividing the hospital ward in 3 user zones for patients, staff and visitors. The main user of the zone should be in control of the light scenario and thereby a refining...

Utilities of gossip across organizational levels : Multilevel selection, free-riders, and teams.

Science.gov (United States)

Kniffin, Kevin M; Wilson, David Sloan

2005-09-01

Gossip is a subject that has been studied by researchers from an array of disciplines with various foci and methods. We measured the content of language use by members of a competitive sports team across 18 months, integrating qualitative ethnographic methods with quantitative sampling and analysis. We hypothesized that the use of gossip will vary significantly depending on whether it is used for self-serving or group-serving purposes. Our results support a model of gossip derived from multilevel selection theory that expects gossip to serve group-beneficial rules when rewards are partitioned at the group level on a scale that permits mutual monitoring. We integrate our case study with earlier studies of gossip conducted by anthropologists, psychologists, and management researchers.

Patients' feelings about ward nursing regimes and involvement in rule construction.

Science.gov (United States)

Alexander, J

2006-10-01

This study compared two acute psychiatric ward nursing regimes, focusing on ward rules as a means of investigating the relationship between the flexibility/inflexibility of the regimes and patient outcomes. Previous studies identified an association between ward rules and patient aggression. A link between absconding and nurses' attitudes towards rule enforcement has also been explored. However, an in-depth exploration of ward rules from the perspective of nurses and patients had not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients' responses to the rules; to evaluate the impact of rules and rule enforcement on nurse-patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design. The relevance of sociological theory emerged from the data analysis. During this process, the results were moved up to another conceptual level to represent the meaning of lived experience at the level of theory. For example, nurses' descriptions of their feelings in relation to rule enforcement were merged as role ambivalence. This concept was supported by examples from the transcripts. Other possible explanations for the data and the connections between them were checked by returning to each text unit in the cluster and ensuring that it fitted with the emergent theory. The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non-participant observations provided a context for the interview data. Measures of the Ward Atmosphere Scale, the Hospital-Hostel Practices Profile, ward incidents and levels of as required (PRN) medication were obtained. The analysis of the quantitative data was assisted by spss, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data. A series of

Non-perturbative construction of the Luttinger-Ward functional

Directory of Open Access Journals (Sweden)

M.Potthoff

2006-01-01

Full Text Available For a system of correlated electrons, the Luttinger-Ward functional provides a link between static thermodynamic quantities on the one hand and single-particle excitations on the other. The functional is useful in deriving several general properties of the system as well as in formulating the thermodynamically consistent approximations. Its original construction, however, is perturbative as it is based on the weak-coupling skeleton-diagram expansion. Here, it is shown that the Luttinger-Ward functional can be derived within a general functional-integral approach. This alternative and non-perturbative approach stresses the fact that the Luttinger-Ward functional is universal for a large class of models.

Developing a general ward nursing dashboard.

Science.gov (United States)

Russell, Margot; Hogg, Maggie; Leach, Stuart; Penman, Mags; Friel, Susan

2014-12-15

The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice.

Conceptualising Multilevel Regulation in the EU: A Legal Translation of Multilevel Governance?

NARCIS (Netherlands)

Chowdhury, Nupur; Wessel, Ramses A.

2012-01-01

How should we conceive of regulation in the European context? This paper attempts to answer this by developing multilevel regulation as a theoretical concept. The basic aim of the paper is to explore the difference and convergence between regulation and governance and develop multilevel governance

Positioning and change in a hospital ward

DEFF Research Database (Denmark)

Kjærbeck, Susanne

2017-01-01

Purpose This paper focuses on communication about hygiene in a hospital ward and with the relevant infection control organization. The purpose of this paper is to examine the function of the hygiene coordinator as a key change agent and the communicative challenges and role conflicts implied in her...... practice. The author suggests strategies for improving communication on hygiene on ward level. Design/methodology/approach The empirical material consists of interviews and recordings of communicative events in relation to a breakout of dangerous bacteria in the ward. Change communication is used...... as a contextualizing frame of understanding, and positioning theory and analysis are applied to shed light upon the core challenges of communicating as a change agent when the coordinator's professional position and collegial relations do not support it. Findings It is shown how these challenges are connected...

Multilevel corporate environmental responsibility.

Science.gov (United States)

Karassin, Orr; Bar-Haim, Aviad

2016-12-01

The multilevel empirical study of the antecedents of corporate social responsibility (CSR) has been identified as "the first knowledge gap" in CSR research. Based on an extensive literature review, the present study outlines a conceptual multilevel model of CSR, then designs and empirically validates an operational multilevel model of the principal driving factors affecting corporate environmental responsibility (CER), as a measure of CSR. Both conceptual and operational models incorporate three levels of analysis: institutional, organizational, and individual. The multilevel nature of the design allows for the assessment of the relative importance of the levels and of their components in the achievement of CER. Unweighted least squares (ULS) regression analysis reveals that the institutional-level variables have medium relationships with CER, some variables having a negative effect. The organizational level is revealed as having strong and positive significant relationships with CER, with organizational culture and managers' attitudes and behaviors as significant driving forces. The study demonstrates the importance of multilevel analysis in improving the understanding of CSR drivers, relative to single level models, even if the significance of specific drivers and levels may vary by context. Copyright © 2016 Elsevier Ltd. All rights reserved.

Multilevel geometry optimization

Science.gov (United States)

Rodgers, Jocelyn M.; Fast, Patton L.; Truhlar, Donald G.

2000-02-01

Geometry optimization has been carried out for three test molecules using six multilevel electronic structure methods, in particular Gaussian-2, Gaussian-3, multicoefficient G2, multicoefficient G3, and two multicoefficient correlation methods based on correlation-consistent basis sets. In the Gaussian-2 and Gaussian-3 methods, various levels are added and subtracted with unit coefficients, whereas the multicoefficient Gaussian-x methods involve noninteger parameters as coefficients. The multilevel optimizations drop the average error in the geometry (averaged over the 18 cases) by a factor of about two when compared to the single most expensive component of a given multilevel calculation, and in all 18 cases the accuracy of the atomization energy for the three test molecules improves; with an average improvement of 16.7 kcal/mol.

Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

Science.gov (United States)

Gabbay, Uri; Bukchin, Michael

2009-01-01

Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity

Multilevel ensemble Kalman filtering

KAUST Repository

Hoel, Hakon

2016-06-14

This work embeds a multilevel Monte Carlo sampling strategy into the Monte Carlo step of the ensemble Kalman filter (EnKF) in the setting of finite dimensional signal evolution and noisy discrete-time observations. The signal dynamics is assumed to be governed by a stochastic differential equation (SDE), and a hierarchy of time grids is introduced for multilevel numerical integration of that SDE. The resulting multilevel EnKF is proved to asymptotically outperform EnKF in terms of computational cost versus approximation accuracy. The theoretical results are illustrated numerically.

Multilevel ensemble Kalman filtering

KAUST Repository

Hoel, Hakon; Law, Kody J. H.; Tempone, Raul

2016-01-01

This work embeds a multilevel Monte Carlo sampling strategy into the Monte Carlo step of the ensemble Kalman filter (EnKF) in the setting of finite dimensional signal evolution and noisy discrete-time observations. The signal dynamics is assumed to be governed by a stochastic differential equation (SDE), and a hierarchy of time grids is introduced for multilevel numerical integration of that SDE. The resulting multilevel EnKF is proved to asymptotically outperform EnKF in terms of computational cost versus approximation accuracy. The theoretical results are illustrated numerically.

Multilevel Models: Conceptual Framework and Applicability

Directory of Open Access Journals (Sweden)

Roxana-Otilia-Sonia Hrițcu

2015-10-01

Full Text Available Individuals and the social or organizational groups they belong to can be viewed as a hierarchical system situated on different levels. Individuals are situated on the first level of the hierarchy and they are nested together on the higher levels. Individuals interact with the social groups they belong to and are influenced by these groups. Traditional methods that study the relationships between data, like simple regression, do not take into account the hierarchical structure of the data and the effects of a group membership and, hence, results may be invalidated. Unlike standard regression modelling, the multilevel approach takes into account the individuals as well as the groups to which they belong. To take advantage of the multilevel analysis it is important that we recognize the multilevel characteristics of the data. In this article we introduce the outlines of multilevel data and we describe the models that work with such data. We introduce the basic multilevel model, the two-level model: students can be nested into classes, individuals into countries and the general two-level model can be extended very easily to several levels. Multilevel analysis has begun to be extensively used in many research areas. We present the most frequent study areas where multilevel models are used, such as sociological studies, education, psychological research, health studies, demography, epidemiology, biology, environmental studies and entrepreneurship. We support the idea that since hierarchies exist everywhere, multilevel data should be recognized and analyzed properly by using multilevel modelling.

The relationship between substance use and exit security on psychiatric wards

NARCIS (Netherlands)

Simpson, A.; Bowers, L.; Allan, T.; Haglund, K.; Muir-Cochrane, E.; Nijman, H.L.I.; Merwe, M. van der

2011-01-01

Aim.  In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Background.  Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming

Postoperative pneumonia-prevention program for the inpatient surgical ward.

Science.gov (United States)

Wren, Sherry M; Martin, Molinda; Yoon, Jung K; Bech, Fritz

2010-04-01

Postoperative pneumonia can lead to increased morbidity, length of hospital stay, and costs. Pneumonia-prevention programs have been successfully implemented in ICU settings, but no program exists for surgical ward patients. A pilot prevention program was designed and implemented based on literature review. The program consisted of education of physicians and ward staff and a standardized postoperative electronic order set consisting of incentive spirometer, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation. Quarterly staff meetings discussed the results of and compliance with the program. The intervention commenced in April 2007. Baseline incidence of inpatient ward pneumonia was calculated from the National Surgical Quality Improvement Program database for fiscal year (FY) 2006 and FY 2007. Postintervention incidence was calculated in the same manner from FY 2007 through FY 2008. Any patient who contracted pneumonia in the ICU was excluded from analysis. There was a significant decrease in ward pneumonia incidence from 0.78% in the preintervention group compared with 0.18% in the postintervention group (p = 0.006), representing an 81% decrease in incidence from 2006 to 2008. The pneumonia-prevention program was very successful in diminishing postoperative pneumonia on the surgical ward. There was a highly statistically significant 4-fold decrease in pneumonia incidence after program implementation. The interventions were not costly but did require ongoing communication and cooperation between physician and nursing leadership to achieve compliance with the measures. This program has great potential for dissemination to hospital surgical wards and could decrease inpatient postoperative pneumonias. Published by Elsevier Inc.

Multilevel geometry optimization

Energy Technology Data Exchange (ETDEWEB)

Rodgers, Jocelyn M. [Department of Chemistry and Supercomputer Institute, University of Minnesota, Minneapolis, Minnesota 55455-0431 (United States); Fast, Patton L. [Department of Chemistry and Supercomputer Institute, University of Minnesota, Minneapolis, Minnesota 55455-0431 (United States); Truhlar, Donald G. [Department of Chemistry and Supercomputer Institute, University of Minnesota, Minneapolis, Minnesota 55455-0431 (United States)

2000-02-15

Geometry optimization has been carried out for three test molecules using six multilevel electronic structure methods, in particular Gaussian-2, Gaussian-3, multicoefficient G2, multicoefficient G3, and two multicoefficient correlation methods based on correlation-consistent basis sets. In the Gaussian-2 and Gaussian-3 methods, various levels are added and subtracted with unit coefficients, whereas the multicoefficient Gaussian-x methods involve noninteger parameters as coefficients. The multilevel optimizations drop the average error in the geometry (averaged over the 18 cases) by a factor of about two when compared to the single most expensive component of a given multilevel calculation, and in all 18 cases the accuracy of the atomization energy for the three test molecules improves; with an average improvement of 16.7 kcal/mol. (c) 2000 American Institute of Physics.

Holomorphic Vector Bundles Corresponding to some Soliton Solutions of the Ward Equation

Energy Technology Data Exchange (ETDEWEB)

Zhu, Xiujuan, E-mail: yzzhuxiujuan@sina.com [Jiangsu Second Normal University, School of Mathematics and Information Technology (China)

2015-12-15

Holomorphic vector bundles corresponding to the static soliton solution of the Ward equation were explicitly presented by Ward in terms of a meromorphic framing. Bundles (for simplicity, “bundle” is to be taken throughout to mean “holomorphic vector bundle”) corresponding to all Ward k-soliton solutions whose extended solutions have only simple poles, and some Ward 2-soliton solutions whose extended solutions have only a second-order pole, were explicitly described by us in a previous paper. In this paper, we go on to present some bundles corresponding to soliton-antisoliton solutions of the Ward equation, and Ward 3-soliton solutions whose extended solutions have a simple pole and a double pole. To give some more interpretation of the bundles, we study the second Chern number of the corresponded bundles and find that it can be obtained directly from the patching matrices. We also point out some information about bundles corresponding to Ward soliton solutions whose extended solutions have general pole data at the end of the paper.

Multilevel models applications using SAS

CERN Document Server

Wang, Jichuan; Fisher, James F

2011-01-01

This book covers a broad range of topics about multilevel modeling. The goal is to help readers to understand the basic concepts, theoretical frameworks, and application methods of multilevel modeling. It is at a level also accessible to non-mathematicians, focusing on the methods and applications of various multilevel models and using the widely used statistical software SAS®. Examples are drawn from analysis of real-world research data.

Quantity and quality of interaction between staff and older patients in UK hospital wards: A descriptive study.

Science.gov (United States)

Barker, Hannah Ruth; Griffiths, Peter; Mesa-Eguiagaray, Ines; Pickering, Ruth; Gould, Lisa; Bridges, Jackie

2016-10-01

The quality of staff-patient interactions underpins the overall quality of patient experience and can affect other important outcomes. However no studies have been identified that comprehensively explore both the quality and quantity of interactions in general hospital settings. To quantify and characterise the quality of staff-patient interactions and to identify factors associated with negative interaction ratings. Data were gathered at two acute English NHS hospitals between March and April 2015. Six wards for adult patients participated including medicine for older people (n=4), urology (n=1) and orthopaedics (n=1). Eligible patients on participating wards were randomly selected for observation. Staff-patient interactions were observed using the Quality of Interactions Schedule. 120h of care were observed with each 2h observation session determined from a balanced random schedule (Monday-Friday, 08:00-22:00h). Multilevel logistic regression models were used to determine factors associated with negative interactions. 1554 interactions involving 133 patients were observed. The median length of interaction was 36s with a mean of 6 interactions per patient per hour. Seventy three percent of interactions were categorized as positive, 17% neutral and 10% negative. Forty percent of patients had at least one negative interaction (95% confidence interval 32% to 49%). Interactions initiated by the patient (adjusted Odds Ratio [OR] 5.30), one way communication (adjusted OR 10.70), involving two or more staff (adjusted OR 5.86 for 2 staff, 6.46 for 3+ staff), having a higher total number of interactions (adjusted OR 1.09 per unit increase), and specific types of interaction content were associated with increased odds of negative interaction (pinteraction was associated with increased odds of negative interaction in a reduced model. There was no significant association with gender, age or cognitive impairment. There was substantially more variation at ward level (variance

Multilevel models for longitudinal data

OpenAIRE

Fiona Steele

2008-01-01

Repeated measures and repeated events data have a hierarchical structure which can be analysed by using multilevel models. A growth curve model is an example of a multilevel random-coefficients model, whereas a discrete time event history model for recurrent events can be fitted as a multilevel logistic regression model. The paper describes extensions to the basic growth curve model to handle auto-correlated residuals, multiple-indicator latent variables and correlated growth processes, and e...

Multilevel ensemble Kalman filter

KAUST Repository

Chernov, Alexey; Hoel, Haakon; Law, Kody; Nobile, Fabio; Tempone, Raul

2016-01-01

This work embeds a multilevel Monte Carlo (MLMC) sampling strategy into the Monte Carlo step of the ensemble Kalman filter (EnKF). In terms of computational cost vs. approximation error the asymptotic performance of the multilevel ensemble Kalman filter (MLEnKF) is superior to the EnKF s.

Multilevel ensemble Kalman filter

KAUST Repository

Chernov, Alexey

2016-01-06

This work embeds a multilevel Monte Carlo (MLMC) sampling strategy into the Monte Carlo step of the ensemble Kalman filter (EnKF). In terms of computational cost vs. approximation error the asymptotic performance of the multilevel ensemble Kalman filter (MLEnKF) is superior to the EnKF s.

Behavior observation of major noise sources in critical care wards.

Science.gov (United States)

Xie, Hui; Kang, Jian; Mills, Gary H

2013-12-01

This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises. © 2013 Elsevier Inc. All rights reserved.

Team Ward Rounds for Quality Improvement in Patient-Centred ...

African Journals Online (AJOL)

In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of ...

Strengthening the role of the ward manager: a review of the literature.

Science.gov (United States)

Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

2014-09-01

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

Handing over patients from the ICU to the general ward

DEFF Research Database (Denmark)

Bunkenborg, Gitte; Bitsch Hansen, Tina; Hølge-Hazelton, Bibi

2017-01-01

AIM: To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards. BACKGROUND: Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing...... focused ethnography was applied to the study. METHODS: Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU...... towards patient status and the handing over process" emerged from observation notes. From transcribed focus group interviews, the theme "Balancing and negotiating when passing on, consuming and adapting knowledge" was identified. CONCLUSION: A lack of shared goals regarding handing over patients from...

Generalized on-shell ward identities in string theory

International Nuclear Information System (INIS)

Lee, Jen-Chi

1994-01-01

It is demonstrated that an infinite set of string-tree level on-shell Ward identities, which are valid to all σ-model loop orders, can be systematically constructed without referring to the string field theory. As examples, bosonic massive scattering amplitudes are calculated explicitly up to the second massive excited states. Ward identities satisfied by these amplitudes are derived by using zero-norm states in the spectrum. In particular, the inter-particle Ward identity generated by the D 2 xD 2' zero-norm state at the second massive level is demonstrated. The four physical propagating states of this mass level are then shown to form a large gauge multiplet. This result justifies our previous consideration on higher inter-spin symmetry from the generalized worldsheet σ-model point of view. (author)

Characterization of indoor bioaerosols from a hospital ward in a ...

African Journals Online (AJOL)

Characterization of indoor bioaerosols from a hospital ward in a tropical ... assessment of indoor air quality and determine pathogenic microorganisms due to particle fall-out. Key words: Indoor air, bioaerosols, hospital ward, tropical setting ...

Analysis of Ward identities in supersymmetric Yang-Mills theory

Science.gov (United States)

Ali, Sajid; Bergner, Georg; Gerber, Henning; Montvay, Istvan; Münster, Gernot; Piemonte, Stefano; Scior, Philipp

2018-05-01

In numerical investigations of supersymmetric Yang-Mills theory on a lattice, the supersymmetric Ward identities are valuable for finding the critical value of the hopping parameter and for examining the size of supersymmetry breaking by the lattice discretisation. In this article we present an improved method for the numerical analysis of supersymmetric Ward identities, which takes into account the correlations between the various observables involved. We present the first complete analysis of supersymmetric Ward identities in N=1 supersymmetric Yang-Mills theory with gauge group SU(3). The results indicate that lattice artefacts scale to zero as O(a^2) towards the continuum limit in agreement with theoretical expectations.

Becoming 'ward smart' medical students.

Science.gov (United States)

Walker, Beth; Wallace, Deirdre; Mangera, Zaheer; Gill, Deborah

2017-10-01

A small number of medical students elect to work as health care assistants (HCAs) during or prior to their undergraduate training. There is a significant body of evidence in the literature regarding the impact of HCA experience on student nurses; however, little research has examined the effects of such experience on medical students. All fourth-year medical students with self-declared experience as HCAs from a single UK medical school were invited to participate in focus groups to explore their experiences and perceptions. Ten students from the year group took part. Participants felt that their experience as HCAs enhanced their learning in the workplace through becoming 'ward smart', helping them to become socialised into the world of health care, providing early meaningful and humanised patient interaction, and increasing their understanding of multidisciplinary team (MDT) members' roles. Little research has examined the effects of [HCA] experience on medical students DISCUSSION: Becoming 'ward smart' and developing a sense of belonging are central to maximising learning in, from and through work on the ward. Experience as a HCA provides a range of learning and social opportunities for medical students, and legitimises their participation within clinical communities. HCA experience also seems to benefit in the 'hard to reach' dimensions of medical training: empathy; humanisation of patient care; professional socialisation; and providing a sense of belonging within health care environments. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Microbiological assessment of indoor air of teaching hospital wards ...

African Journals Online (AJOL)

Thus, the objective of this study is to provide fundamental data related to the microbial quality of indoor air of Jimma University Specialized Hospital wards, to estimate the health hazard and to create standards for indoor air quality control. METHODS: The microbial quality of indoor air of seven wards of Jimma University ...

Ward Identities for the 2PI effective action in QED

International Nuclear Information System (INIS)

Reinosa, Urko; Serreau, Julien

2007-01-01

We study the issue of symmetries and associated Ward-like identities in the context of two-particle-irreducible (2PI) functional techniques for abelian gauge theories. In the 2PI framework, the n-point proper vertices of the theory can be obtained in various different ways which, although equivalent in the exact theory, differ in general at finite approximation order. We derive generalized (2PI) Ward identities for these various n-point functions and show that such identities are exactly satisfied at any approximation order in 2PI QED. In particular, we show that 2PI-resummed vertex functions, i.e. field-derivatives of the so-called 2PI-resummed effective action, exactly satisfy standard Ward identities. We identify another set of n-point functions in the 2PI framework which exactly satisfy the standard Ward identities at any approximation order. These are obtained as field-derivatives of the two-point function φ, which defines the extremum of the 2PI effective action. We point out that the latter is not constrained by the underlying symmetry. As a consequence, the well-known fact that the corresponding gauge-field polarization tensor is not transverse in momentum space for generic approximations does not constitute a violation of (2PI) Ward identities. More generally, our analysis demonstrates that approximation schemes based on 2PI functional techniques respect all the Ward identities associated with the underlying abelian gauge symmetry. Our results apply to arbitrary linearly realized global symmetries as well

Ward identities of higher order Virasoro algebra

International Nuclear Information System (INIS)

Zha Chaozeng; Dolate, S.

1994-11-01

The general formulations of primary fields versus quasi-primary ones in the context of high order Virasoro algebra (HOVA) and the corresponding Ward identity are explored. The primary fields of conformal spins up to 8 are given in terms of quasi-primary fields, and the general features of the higher order expressions are also discussed. It is observed that the local fields, either primary of quasi-primary, carry the same numbers of central charges, and not all the primary fields contribute to the anomalies in the Ward identities. (author). 6 refs

Summative Evaluation on the Hospital Wards. What Do Faculty Say to Learners?

Science.gov (United States)

Hasley, Peggy B.; Arnold, Robert M.

2009-01-01

No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…

Advancing multilevel thinking and methods in HRM research

NARCIS (Netherlands)

Renkema, Maarten; Meijerink, Jeroen Gerard; Bondarouk, Tatiana

2016-01-01

Purpose Despite the growing belief that multilevel research is necessary to advance HRM understanding, there remains a lack of multilevel thinking – the application of principles for multilevel theory building. The purpose of this paper is to propose a systematic approach for multilevel HRM

Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventililation System

DEFF Research Database (Denmark)

Qian, H.; Nielsen, Peter Vilhelm; Li, Y.

2004-01-01

Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventilalation System. The 2nd International Conference on Build Environment and Public Health, BEPH 2004, Shenzhen , China . ABSTRACT Displacement ventilation has not been considered to be an applicable system for hospital...... to accurately predict three-dimensional distribution of air velocity, temperature, and contaminant concentration in the ward. Indoor airflow in a displacement ventilation system involves a combination of different flow streams such as the gravity currents and thermal plumes. It is important to choose...... ventilation system in hospital wards. It is for this purpose that we study the performance of displacement ventilation in hospital wards as one of the steps to optimize the ventilation design. When the prospect of applying displacement ventilation system in a hospital ward is examined, it should be necessary...

Doctor Ward's Accidental Terrarium.

Science.gov (United States)

Hershey, David R.

1996-01-01

Presents the story of the accidental invention of the Wardian case, or terrarium, by Nathaniel Bagshaw Ward. Advocates the use of this story in teaching precollege biology as an illustration of how a chance event can lead to a major scientific advancement and as an example of the common occurrence of multiple discovery in botany. Contains 34…

Correlation between levels of conflict and containment on acute psychiatric wards: the city-128 study.

Science.gov (United States)

Bowers, Len; Stewart, Duncan; Papadopoulos, Chris; Iennaco, Joanne DeSanto

2013-05-01

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

Nurses caring for ENT patients in a district general hospital without a dedicated ENT ward score significantly less in a test of knowledge than nurses caring for ENT patients in a dedicated ENT ward in a comparable district general hospital.

Science.gov (United States)

Foxton, C R; Black, D; Muhlschlegel, J; Jardine, A

2014-12-01

To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training. © 2014 John Wiley & Sons Ltd.

Anatomy of the ward round.

LENUS (Irish Health Repository)

O'Hare, James A

2008-07-01

The ward round has been a central activity of hospital life for hundreds of years. It is hardly mentioned in textbooks. The ward round is a parade through the hospital of professionals where most decision making concerning patient care is made. However the traditional format may be intimidating for patients and inadequate for communication. The round provides an opportunity for the multi-disciplinary team to listen to the patient\\'s narrative and jointly interpret his concerns. From this unfolds diagnosis, management plans, prognosis formation and the opportunity to explore social, psychological, rehabilitation and placement issues. Physical examination of the patient at the bedside still remains important. It has been a tradition to discuss the patient at the bedside but sensitive matters especially of uncertainty may better be discussed elsewhere. The senior doctor as round leader must seek the input of nursing whose observations may be under-appreciated due to traditional professional hierarchy. Reductions in the working hours of junior doctors and shortened length of stay have reduced continuity of patient care. This increases the importance of senior staff in ensuring continuity of care and the need for the joint round as the focus of optimal decision making. The traditional round incorporates teaching but patient\\'s right to privacy and their preferences must be respected. The quality and form of the clinical note is underreported but the electronic record is slow to being accepted. The traditional multi-disciplinary round is disappearing in some centres. This may be regrettable. The anatomy and optimal functioning of the ward round deserves scientific scrutiny and experimentation.

Leadership support for ward managers in acute mental health inpatient settings.

Science.gov (United States)

Bonner, Gwen; McLaughlin, Sue

2014-05-01

This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

Views of pharmacists on involvement in ward rounds in selected ...

African Journals Online (AJOL)

Background: Pharmacist participation in ward rounds is of increasing interest for better pharmaceutical care, yet most pharmacists do not engage in this activity. Objective: The objective was to obtain public sector pharmacistsf views and perceptions on their involvement in ward rounds. Method: A rapid assessment was ...

Safety-Critical Partitioned Software Architecture: A Partitioned Software Architecture for Robotic

Science.gov (United States)

Horvath, Greg; Chung, Seung H.; Cilloniz-Bicchi, Ferner

2011-01-01

The flight software on virtually every mission currently managed by JPL has several major flaws that make it vulnerable to potentially fatal software defects. Many of these problems can be addressed by recently developed partitioned operating systems (OS). JPL has avoided adopting a partitioned operating system on its flight missions, primarily because doing so would require significant changes in flight software design, and the risks associated with changes of that magnitude cannot be accepted by an active flight project. The choice of a partitioned OS can have a dramatic effect on the overall system and software architecture, allowing for realization of benefits far beyond the concerns typically associated with the choice of OS. Specifically, we believe that a partitioned operating system, when coupled with an appropriate architecture, can provide a strong infrastructure for developing systems for which reusability, modifiability, testability, and reliability are essential qualities. By adopting a partitioned OS, projects can gain benefits throughout the entire development lifecycle, from requirements and design, all the way to implementation, testing, and operations.

Multilevel marketing společnosti Amway

OpenAIRE

Drozdková, Markéta

2010-01-01

This thesis analyses effectiveness and principles of multilevel marketing as a possible way of selling products and services. Theoretical part describes basis of marketing and direct selling, which is the basis of multilevel marketing. The thesis also states illegal forms of selling that misuse the advantages of multilevel marketing. Pracical part applies gained knowledge on Amway corporation and it atteds to operation of the company, which is evaluated by SWOT analysis.

A Container-based Trusted Multi-level Security Mechanism

Directory of Open Access Journals (Sweden)

Li Xiao-Yong

2017-01-01

Full Text Available Multi-level security mechanism has been widely applied in the military, government, defense and other domains in which information is required to be divided by security-level. Through this type of security mechanism, users at different security levels are provided with information at corresponding security levels. Traditional multi-level security mechanism which depends on the safety of operating system finally proved to be not practical. We propose a container-based trusted multi-level security mechanism in this paper to improve the applicability of the multi-level mechanism. It guarantees multi-level security of the system through a set of multi-level security policy rules and trusted techniques. The technical feasibility and application scenarios are also discussed. The ease of realization, strong practical significance and low cost of our method will largely expand the application of multi-level security mechanism in real life.

Frequency of nursing tasks in medical and surgical wards.

Science.gov (United States)

Farquharson, Barbara; Bell, Cheryl; Johnston, Derek; Jones, Martyn; Schofield, Pat; Allan, Julia; Ricketts, Ian; Morrison, Kenny; Johnston, Marie

2013-09-01

To explore the frequency of different nursing tasks in medical and surgical wards. The time nurses spend on direct patient care is important for both patients and nurses. However, little is known about the time nurses spend on various nursing tasks. A real-time, repeated measures design conducted amongst 67 (n = 39 medical, n = 28 surgical) UK hospital nurses. Between September 2011 and August 2012 participants completed an electronic diary version of a classification of nursing tasks (WOMBAT) during shifts. A total of 961 real-time measures of nursing task were obtained. Direct patient care [median = 37.5%, interquartile range = 27.8], indirect care (median = 11.1%, interquartile range = 19.4) and medication (median = 11.1%, interquartile range = 18.8) were most commonly reported. Participants were interrupted in 62% of entries (interquartile range = 35), reported adequate time in 78% (interquartile range = 31) and adequate resources in 89% (interquartile range = 36). Ward-related tasks were significantly more frequent on medical wards than surgical wards but otherwise there were no significant differences. Nurses spend the highest proportion of time in direct patient care and majority of this on core nursing activities. Interruptions to tasks are common. Nurses tend to report adequate time/resources. The frequency of nursing tasks is similar in medical and surgical wards. Nurse managers should review the level of interruptions to nurses' work and ensure appropriate levels of supervision. © 2013 John Wiley & Sons Ltd.

Polymers as reference partitioning phase: polymer calibration for an analytically operational approach to quantify multimedia phase partitioning

DEFF Research Database (Denmark)

Gilbert, Dorothea; Witt, Gesine; Smedes, Foppe

2016-01-01

Polymers are increasingly applied for the enrichment of hydrophobic organic chemicals (HOCs) from various types of samples and media in many analytical partitioning-based measuring techniques. We propose using polymers as a reference partitioning phase and introduce polymer-polymer partitioning......-air) and multimedia partition coefficients (lipid-water, air-water) were calculated by applying the new concept of a polymer as reference partitioning phase and by using polymer-polymer partition coefficients as conversion factors. The present study encourages the use of polymer-polymer partition coefficients...

Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India.

Science.gov (United States)

Levesque, Jean-Frédéric; Haddad, Slim; Narayana, Delampady; Fournier, Pierre

2007-07-01

To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access. We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units. Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations. The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.

HIV infection, tuberculosis and workload in a general paediatric ward

African Journals Online (AJOL)

South African Journal of Child Health ... To describe the impact of HIV infection and tuberculosis on the workload of a general paediatric ward at Red Cross War Memorial Children's Hospital in 2007. Methods. Prospective descriptive surveillance of the patient composition of a general paediatric ward over a 1-year period.

Service audit of a forensic rehabilitation ward.

Science.gov (United States)

Young, Susan; Gudjonsson, Gisli H; Needham-Bennett, Humphrey; Chick, Kay

2009-10-01

An open forensic rehabilitation ward provides an important link bridging the gap between secure and community provisions. This paper provides an audit of such a service by examining the records of an open forensic rehabilitation ward over a five-year period from 1 June 2000 until 31 May 2005. During the audit period there were 51 admissions, involving 45 different patients, and 50 discharges. The majority of the patients came from secure unit facilities, acute psychiatric wards or home. Thirty-nine patients were discharged either into hostels (66%) or their home (12%). The majority of patients (80%) had on admission a primary diagnosis of either schizophrenia or schizoaffective disorder. Most had an extensive forensic history. The focus of their admission was to assess and treat their mental illness/disorder and offending behaviour and this was successful as the majority of patients were transferred to a community placement after a mean of 15 months. It is essential that there is a well-integrated care pathway for forensic patients, involving constructive liaison with generic services and a well-structured treatment programme which integrates the key principles of the 'recovery model' approach to care.

What scares patients to get admitted in a psychiatry ward? An exploratory study

Directory of Open Access Journals (Sweden)

Sushmita Bhattacharya

2018-01-01

Full Text Available Background: There has been very little focus on understanding the experiences of people suffering from mental illness during their treatment in the outpatient and inpatient treatment facilities. Majority of the decisions regarding their treatment are taken by the mental health professionals in consultation with the caregivers, and the patient remains a passive recipient of the services. It is commonly seen that patients refuse admission in the psychiatry ward even when clinical needs warrant admission. Aim: The aim of the current study was to explore the perception of patients regarding admission in the psychiatry ward and the fears associated with indoor treatment facility. Methodology: A semistructured interview schedule was administered to 110 patients undergoing treatment from outpatient services to study their attitude toward treatment in psychiatry ward. Results: A large number of patients perceived psychiatry ward as a hostile place with unfriendly atmosphere and dark and unsupportive environment. However, the patients who had been admitted in the past found it less scary and appreciated good and friendly behavior of the staff in the ward. Conclusion: Negative perception of inpatient treatment and psychiatry wards is still highly prevalent among the patients. With growing focus on reducing stigma about psychiatric illnesses, dispelling the myths related to treatment in wards is the need of the hour.

Recommendations for the safety preparation of sterile medicines in medical wards

Directory of Open Access Journals (Sweden)

Ana M.ª Martín de Rosales Cabrera

2014-01-01

Full Text Available Objective: To develop a recommendations guide about the preparation of sterile medicines in medical wards, and to figure out the current situation of different Spanish hospitals, regarding the preparation of sterile medicines outside the pharmacy. Methods: The autors reviewed the available international guidelines in order to summarize the main quality recommendations. To know about the current situation in Spanish hospitals, a 30 questions survey was designed and spread to 500 different hospitals. Answers were analysed with Survey monkey® platform in the period February-July 2012. Results: Based on the literature review, the authors agreed a recommendations list for the safe preparation of sterile medicines in medical wards, which was structured in 8 sections. Regarding the survey results, 8.4% of the hospitals answered, showing a great variability among centres in the quality requirements for sterile compounding outside the pharmacy. It should be pointed out the lack of assigned areas for drug preparation in wards, the lack of protocols to discern which kind of medicines can be compounded in wards as well as the poor recommendations about garment and aseptic technique. Conclusions: The authors confirm the absence of qualified practice standards to be applied in the preparation of sterile medicines in medical wards, as well as the great variability of diary practice. The implementation of quality and safety recommendations in the preparation of sterile medicines in medical wards may contribute to improve patient safety.

[Airborne Fungal Aerosol Concentration and Distribution Characteristics in Air- Conditioned Wards].

Science.gov (United States)

Zhang, Hua-ling; Feng, He-hua; Fang, Zi-liang; Wang, Ben-dong; Li, Dan

2015-04-01

The effects of airborne fungus on human health in the hospital environment are related to not only their genera and concentrations, but also their particle sizes and distribution characteristics. Moreover, the mechanisms of aerosols with different particle sizes on human health are different. Fungal samples were obtained in medicine wards of Chongqing using a six-stage sampler. The airborne fungal concentrations, genera and size distributions of all the sampling wards were investigated and identified in detail. Results showed that airborne fungal concentrations were not correlated to the diseases or personnel density, but were related to seasons, temperature, and relative humidity. The size distribution rule had roughly the same for testing wards in winter and summer. The size distributions were not related with diseases and seasons, the percentage of airborne fungal concentrations increased gradually from stage I to stage III, and then decreased dramatically from stage V to stage VI, in general, the size of airborne fungi was a normal distribution. There was no markedly difference for median diameter of airborne fungi which was less 3.19 μm in these wards. There were similar dominant genera in all wards. They were Aspergillus spp, Penicillium spp and Alternaria spp. Therefore, attention should be paid to improve the filtration efficiency of particle size of 1.1-4.7 μm for air conditioning system of wards. It also should be targeted to choose appropriate antibacterial methods and equipment for daily hygiene and air conditioning system operation management.

Multi-Level Secure Local Area Network

OpenAIRE

Naval Postgraduate School (U.S.); Center for Information Systems Studies Security and Research (CISR)

2011-01-01

Multi-Level Secure Local Area Network is a cost effective, multi-level, easy to use office environment leveraging existing high assurance technology. The Department of Defense and U.S. Government have an identified need to securely share information classified at differing security levels. Because there exist no commercial solutions to this problem, NPS is developing a MLS LAN. The MLS LAN extends high assurance capabilities of an evaluated multi-level secure system to commercial personal com...

Polyacrylate–water partitioning of biocidal compounds: Enhancing the understanding of biocide partitioning between render and water

DEFF Research Database (Denmark)

Bollmann, Ulla E.; Ou, Yi; Mayer, Philipp

2014-01-01

-N-octylisothiazolinone). The correlation of the polyacrylate-water partition constants with the octanol-water partition constants is significant, but the polyacrylate-water partition constants were predominantly below octanol-water partition constants (Kow). The comparison with render-water distribution constants showed that estimating...

The labour ward analgesic service at King Edward VIII Hospital ...

African Journals Online (AJOL)

The labour ward analgesic service at King Edward VIII. Hospital, Durban. D. A. ROCKE, C. C. ROUT, H. D. RUSSELL, S. SINGH. Abstract The provision of analgesic services to the labour ward at King Edward VIII Hospital was studied during a I-week period. Of249 patients, 113 (45%) received no analgesia whatsoever.

Urinary catheterization in medical wards

Directory of Open Access Journals (Sweden)

Nirmanmoh Bhatia

2010-01-01

Full Text Available Aims : The study aims to determine the: 1. frequency of inappropriate catheterization in medical wards and the reasons for doing it. 2. various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections (CAUTI and bacterial colonization on Foley′s catheters (BCFC. Settings and Design: Hospital-based prospective study. Materials and Methods: One hundred and twenty five patients admitted consecutively in the medical wards of a tertiary care hospital, who underwent catheterization with a Foley′s catheter, at admission, have been included in the study. Patient profiles were evaluated using the following parameters: age, sex, diagnosis, functional status, mental status, indication, duration and place of catheterization, development of BCFC and CAUTI. Statistical tests used: Chi-square test. Results: Thirty-six out of 125 (28.8% patients included were inappropriately catheterized. BCFC developed in 52.8% and 22.4% were diagnosed with a CAUTI. The most frequent indication for inappropriate catheterization was urinary incontinence without significant skin breakdown (27.8%. The risk factors for inappropriate catheterization were female sex (RR=1.29, 95% CI=0.99, 1.69, P60 years (RR=0.65, 95% CI=0.48, 0.89, P3 days (RR=0.62, 95% CI=0.43, 0.89, P60 years (RR=0.47, 95% CI=0.25, 0.90, P3 days (RR=0.24, 95% CI=0.10, 0.58, P< 0.01. Conclusions : Inappropriate catheterization is highly prevalent in medical wards, especially in patients with urinary incontinence. The patients catheterized in the medical emergency and female patients in particular are at high risk. Careful attention to these factors can reduce the frequency of inappropriate catheterization and unnecessary morbidity.

Modeling Multi-Level Systems

CERN Document Server

Iordache, Octavian

2011-01-01

This book is devoted to modeling of multi-level complex systems, a challenging domain for engineers, researchers and entrepreneurs, confronted with the transition from learning and adaptability to evolvability and autonomy for technologies, devices and problem solving methods. Chapter 1 introduces the multi-scale and multi-level systems and highlights their presence in different domains of science and technology. Methodologies as, random systems, non-Archimedean analysis, category theory and specific techniques as model categorification and integrative closure, are presented in chapter 2. Chapters 3 and 4 describe polystochastic models, PSM, and their developments. Categorical formulation of integrative closure offers the general PSM framework which serves as a flexible guideline for a large variety of multi-level modeling problems. Focusing on chemical engineering, pharmaceutical and environmental case studies, the chapters 5 to 8 analyze mixing, turbulent dispersion and entropy production for multi-scale sy...

An outbreak of Burkholderia stabilis colonization in a nasal ward.

Science.gov (United States)

Wang, Lijun; Wang, Mei; Zhang, Junyi; Wu, Wei; Lu, Yuan; Fan, Yanyan

2015-04-01

The aim of this study was to describe an outbreak of Burkholderia stabilis colonization among patients in a nasal ward. Multilocus sequence typing (MLST) was used for the molecular typing of B. stabilis isolates. Microbiological records were reviewed to delineate the colonization outbreak period. One hundred seventy-one cultures of environment and equipment samples from the nasal ward were performed to trace the source of contamination. Infection control measures were taken in order to end the outbreak. All B. stabilis isolates were identified as a new MLST type, ST821. A total of 53 patients carried this B. stabilis in the nasal ward between March and September 2013, which was defined as the outbreak period. The source of the colonization was not determined because all environment cultures were negative for Burkholderia cepacia complex. No further B. stabilis carriers have been found in the ward since the implementation of interventions. Attention must be paid to asymptomatic colonization in order to identify outbreaks early. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Ward Identity and Scattering Amplitudes for Nonlinear Sigma Models

Science.gov (United States)

Low, Ian; Yin, Zhewei

2018-02-01

We present a Ward identity for nonlinear sigma models using generalized nonlinear shift symmetries, without introducing current algebra or coset space. The Ward identity constrains correlation functions of the sigma model such that the Adler's zero is guaranteed for S -matrix elements, and gives rise to a subleading single soft theorem that is valid at the quantum level and to all orders in the Goldstone decay constant. For tree amplitudes, the Ward identity leads to a novel Berends-Giele recursion relation as well as an explicit form of the subleading single soft factor. Furthermore, interactions of the cubic biadjoint scalar theory associated with the single soft limit, which was previously discovered using the Cachazo-He-Yuan representation of tree amplitudes, can be seen to emerge from matrix elements of conserved currents corresponding to the generalized shift symmetry.

The complex formation-partition and partition-association models of solvent extraction of ions

International Nuclear Information System (INIS)

Siekierski, S.

1976-01-01

Two models of the extraction process have been proposed. In the first model it is assumed that the partitioning neutral species is at first formed in the aqueous phase and then transferred into the organic phase. The second model is based on the assumption that equivalent amounts of cations are at first transferred from the aqueous into the organic phase and then associated to form a neutral molecule. The role of the solubility parameter in extraction and the relation between the solubility of liquid organic substances in water and the partition of complexes have been discussed. The extraction of simple complexes and complexes with organic ligands has been discussed using the first model. Partition coefficients have been calculated theoretically and compared with experimental values in some very simple cases. The extraction of ion pairs has been discussed using the partition-association model and the concept of single-ion partition coefficients. (author)

Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh.

Science.gov (United States)

Zaman, Shahaduz

2004-11-01

An ethnographic exploration was done in an orthopaedic ward of a government teaching hospital in Bangladesh to understand the nature of hospital culture in the context of Bangladeshi society at large. Life and work in the ward result in a culture that is simultaneously created by its inhabitants and the conditions in which they are situated. The study shows that biomedicine is a product of particular social conditions and that the hospital reflects features of its society. Behind the injuries and broken limbs in the ward are stories of violence, crime, and intolerance occurring in a society where masses of people fight over limited resources. In the ward people interact in an extremely hierarchical manner. The patients, who are mainly from poor economic backgrounds, remain at the bottom of the hierarchy. Doctors and other staff members are often professionally frustrated. Strikes related to hospital staff's various professional demands hamper the regular flow of work in the ward. Family members are engaged in nursing and provide various kinds of support to their hospitalized relatives. Patients give small bribes to ward boys and cleaners to obtain their day-to-day necessities. Patients joke with each other and mock senior doctors. Thus, they neutralize their powerlessness and drive away the monotony of their stay. Doctors develop 'indigenous' solutions to orthopaedic problems. Instead of using high-tech devices, they employ instruments made of bamboo, bricks, and razor blades. This study shows how medical practice takes shape in an understaffed, under-resourced and poorly financed hospital operating in a low-income country.

Prevalence of Nosocomial Infection in Different Wards of Ghaem Hospital, Mashhad

Directory of Open Access Journals (Sweden)

Jamal Falahi

2017-04-01

Full Text Available Background The CDC defines a nosocomial infection as a localized or systemic condition caused by an adverse reaction to the presence of an infectious agent(s or its toxin(s. It is an infection that occurs between 48 to 72 hours after admission of patients in the hospital or as soon after the hospital discharge and on the admission time, patients don't have this infection. Objectives This study aimed to characterize the prevalence of nosocomial infection in Ghaem hospital, Mashhad, Iran. Methods This retrospective study was conducted in all wards of the Ghaem hospital, Mashhad during the 1 year period (2013; the data were collected from the wards records and HIS system and analyzed by the SPSS software (version16. Results In the present study, of total 35979 hospitalized patients in different wards of the Ghaem hospital was reported 1.1% of nosocomial infection. In the meantime, overall, the most prevalent organism was Acinetobacter baumannii with a prevalence of 37.2% and the minimum was linked to the Bacillus species with a prevalence 0.3%. The highest and lowest prevalence of the nosocomial infection was in the ICU and CCU with 49.9% and 0.3%, respectively. In general, among all wards of the mentioned hospital, the most frequent nosocomial infection was pneumonia (47.4% and the lowest belonged to CSF (2.3%. Conclusions In our study, the ICU ward was accounted for the highest rate of nosocomial infection, due to the critical importance of this ward. Preventive measures and survivelance system for reduction of nosocomial infections is needed.

COMPUTING VERTICES OF INTEGER PARTITION POLYTOPES

Directory of Open Access Journals (Sweden)

A. S. Vroublevski

2015-01-01

Full Text Available The paper describes a method of generating vertices of the polytopes of integer partitions that was used by the authors to calculate all vertices and support vertices of the partition polytopes for all n ≤ 105 and all knapsack partitions of n ≤ 165. The method avoids generating all partitions of n. The vertices are determined with the help of sufficient and necessary conditions; in the hard cases, the well-known program Polymake is used. Some computational aspects are exposed in more detail. These are the algorithm for checking the criterion that characterizes partitions that are convex combinations of two other partitions; the way of using two combinatorial operations that transform the known vertices to the new ones; and employing the Polymake to recognize a limited number (for small n of partitions that need three or more other partitions for being convexly expressed. We discuss the computational results on the numbers of vertices and support vertices of the partition polytopes and some appealing problems these results give rise to.

Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium

NARCIS (Netherlands)

Gendt, de C.; Bilsen, J.J.; Stichele, van der R.; Lambert, M.; Noortgate, N. Den; Deliens, L.H.J.

2005-01-01

OBJECTIVES: To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. DESIGN: Structured mail questionnaires. SETTING: All 94 acute geriatric wards in hospitals in Flanders

78 FR 14543 - Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement

Science.gov (United States)

2013-03-06

... ENVIRONMENTAL PROTECTION AGENCY [FRL 9788-2; CERCLA-04-2013-3754] Ward Transformer Superfund Site... Ward Transformer Superfund Site located in Raleigh, Wake County, North Carolina. Under the terms of the.... Submit your comments by Site name Ward Transformer Superfund Site by one of the following methods: [[Page...

The impact on the workload of the Ward Manager with the introduction of administrative assistants.

Science.gov (United States)

Locke, Rachel; Leach, Camilla; Kitsell, Fleur; Griffith, Jacki

2011-03-01

To evaluate the impact on the workload of the Ward Manager (WM) with the introduction of administrative assistants into eight trusts in the South of England in a year-long pilot. Ward Managers are nurse leaders who are responsible for ward management and delivering expert clinical care to patients. They have traditionally been expected to achieve this role without administrative assistance. Meeting the workload demands of multiple roles and overload has meant the leadership and clinical role has suffered, presenting issues of low morale among existing WMs and issues of recruiting the next generation of WMs. Sixty qualitative interviews were carried out with 16 WMs, 12 Ward Manager Assistants (WMAs), and six senior nurse executives about the impact of the introduction of the WMA post. Quantitative data to measure change in WM workload and ward activity was supplied by 24 wards. Ward Managers reported spending reduced time on administrative tasks and having increased time available to spend on the ward with patients and leading staff. With the introduction of WMAs, there was also improvement in key performance measures (the maintenance of quality under service pressures) and increased staff motivation. There was overwhelming support for the introduction of administrative assistants from participating WMs. The WMAs enabled WMs to spend more time with patients and, more widely, to provide greater support to ward teams. The success of the pilot is reflected in wards working hard to be able to extend contracts of WMAs. The extent of the success is reflected in wards that were not participants in the pilot, observing the benefits of the post, having worked to secure funding to recruit their own WMAs. The widespread introduction of administrative assistance could increase ward productivity and provide support for clinical leaders. Continuing professional development for WMs needs to incorporate training about management responsibilities and how to best use administrative

The locked psychiatric ward: hotel or detention camp for people with dual diagnosis.

Science.gov (United States)

Terkelsen, Toril Borch; Larsen, Inger Beate

2013-10-01

The concepts of autonomy and liberty are established goals in mental health care; however, involuntary commitment is used towards people with mental health and substance abuse problems (dual diagnosis). To explore how patients and staff act in the context of involuntary commitment, how interactions are described and how they might be interpreted. Ethnographic methodology in a locked psychiatric ward in Norway. Two parallel images emerged: (a) The ward as a hotel. Several patients wanted a locked ward for rest and safety, even when admission was classified as involuntary. The staff was concerned about using the ward for real treatment of motivated people, rather than merely as a comfortable hotel for the unmotivated. (b) The ward as a detention camp. Other patients found involuntary commitment and restrictions in the ward as a kind of punishment, offending them as individuals. Contrary, the staff understood people with dual diagnoses more like a generalized group in need of their control and care. Patients and staff have different perceptions of involuntary commitment. Based on the patients' points of view, mental health care ought to be characterized by inclusion and recognition, treating patients as equal citizens comparable to guests in a hotel.

Experiences of psychiatric nurses exposed to hostility from patients in a forensic ward.

Science.gov (United States)

Tema, T R; Poggenpoel, M; Myburgh, C P H

2011-10-01

Hostile behaviour is becoming a way of life in South Africa. Hostility prevails at all settings, including in the health sector. In a forensic ward psychiatric nurses are subjected to hostile behaviour by the patients. The aim of the present study was to explore and describe the psychiatric nurses' experiences of hostile behaviour by patients in a forensic ward and make recommendations for nurse managers to empower these psychiatric nurses to cope with the patients' aggression. Qualitative, in-depth, phenomenological interviews were conducted with nine psychiatric nurses exposed to hostility from patients in a forensic ward. Recommendations were derived from the results from nurse managers to assist psychiatric nurses. It became apparent from the findings that psychiatric nurses in a forensic ward work in a stressful environment. Hostile behaviour in the forensic ward is consistently experienced by the psychiatric nurses as hindering therapeutic relationships. The psychiatric nurses experienced being disempowered. Psychiatric nurses experience hostile behaviour by patients in a forensic ward as disempowering. IMPLICATIONS FOR NURSE MANAGEMENT: Nurse managers can facilitate psychiatric nurses' empowerment by providing them access to: information, support, resources, opportunity and growth. © 2011 Blackwell Publishing Ltd.

Multilevel Modulation formats for Optical Communication

DEFF Research Database (Denmark)

Jensen, Jesper Bevensee

2008-01-01

This thesis studies the use of multilevel modulation formats for optical communication systems. Multilevel modulation is an attractive method of increasing the spectral efficiency of optical communication systems. Various modulation formats employing phase modulation, amplitude modulation...... or a combination of the two have been studied. The use of polarization multiplexing (PolMux) to double the bit rate has also been investigated. The impact of transmission impairments such as chromatic dispersion, self phase modulation and cross phase modulation has been investigated. The feasibility of multilevel...... modulation for network oriented scenarios has been demonstrated....

One-Level or Multilevel Interbody Fusion for Multilevel Lumbar Degenerative Diseases: A Prospective Randomized Control Study with a 4-Year Follow-Up.

Science.gov (United States)

Li, Tiefeng; Shi, Lei; Luo, Yibin; Chen, Deyu; Chen, Yu

2018-02-01

The treatment of multilevel lumbar degenerative disease (LDD) is complicated and challenging, and the optimal surgical strategy remains controversial. To compare the differences in clinical and radiologic outcomes and in complications after 1-level interbody fusion versus multilevel interbody fusion for the treatment of multilevel LDD. A total of 100 patients with multilevel LDD were randomized in a 1:1 ratio into the 1-level interbody fusion group or the multilevel interbody fusion group. Clinical and radiologic results and major complications in the 2 groups were analyzed. Clinical outcomes were assessed using the Visual Analog Scale for radicular and back pain, the Oswestry Disability Index, and the short-form 36 physical score. Clinical status was assessed by the Whitecloud classification. Radiologic evaluation included assessment of lumbar lordosis, pelvic incidence, and sacral slope. There were no significant differences in clinical and radiologic results between the 2 groups. Procedure duration and intraoperative blood loss were significantly greater in the multilevel interbody fusion group than in the 1-level interbody fusion group; the multilevel interbody fusion group also had greater incidences of temporary nerve root palsy, wound infection, and adjacent segment disease. A hybrid technique including 1-level interbody fusion and multilevel posterolateral fusion is recommended for patients with multilevel LDD. Copyright © 2017 Elsevier Inc. All rights reserved.

Pain in the nursing home: assessment and treatment on different types of care wards

NARCIS (Netherlands)

Achterberg, W.P.; Pot, A.M.; Scherder, E.J.A.; Ribbe, M.W.

2007-01-01

). Patients on psychogeriatric wards who had pain received less pain medication, adjusted for frequency and intensity of pain (OR 0.37 [95% CI = 0.23–0.59]), compared to patients on somatic wards. We conclude that admission to a psychogeriatric care ward, independent of cognition, is associated with

Multilevel index decomposition analysis: Approaches and application

International Nuclear Information System (INIS)

Xu, X.Y.; Ang, B.W.

2014-01-01

With the growing interest in using the technique of index decomposition analysis (IDA) in energy and energy-related emission studies, such as to analyze the impacts of activity structure change or to track economy-wide energy efficiency trends, the conventional single-level IDA may not be able to meet certain needs in policy analysis. In this paper, some limitations of single-level IDA studies which can be addressed through applying multilevel decomposition analysis are discussed. We then introduce and compare two multilevel decomposition procedures, which are referred to as the multilevel-parallel (M-P) model and the multilevel-hierarchical (M-H) model. The former uses a similar decomposition procedure as in the single-level IDA, while the latter uses a stepwise decomposition procedure. Since the stepwise decomposition procedure is new in the IDA literature, the applicability of the popular IDA methods in the M-H model is discussed and cases where modifications are needed are explained. Numerical examples and application studies using the energy consumption data of the US and China are presented. - Highlights: • We discuss the limitations of single-level decomposition in IDA applied to energy study. • We introduce two multilevel decomposition models, study their features and discuss how they can address the limitations. • To extend from single-level to multilevel analysis, necessary modifications to some popular IDA methods are discussed. • We further discuss the practical significance of the multilevel models and present examples and cases to illustrate

The survival time of chocolates on hospital wards: covert observational study.

Science.gov (United States)

Gajendragadkar, Parag R; Moualed, Daniel J; Nicolson, Phillip L R; Adjei, Felicia D; Cakebread, Holly E; Duehmke, Rudolf M; Martin, Claire A

2013-12-14

To quantify the consumption of chocolates in a hospital ward environment. Multicentre, prospective, covert observational study. Four wards at three hospitals (where the authors worked) within the United Kingdom. Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates. Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten. Median survival time of a chocolate. 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R(2)=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%). From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed.

75 FR 81269 - Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements

Science.gov (United States)

2010-12-27

... ENVIRONMENTAL PROTECTION AGENCY [Docket EPA-RO4-SFUND-2010-1053, FRL-9243-2] Ward Transformer... entered into a five settlements for reimbursement of past response costs concerning the Ward Transformer... Docket ID No. EPA-RO4- SFUND-2010-1053 or Site name Ward Transformer Superfund Site by one of the...

Light-front Ward-Takahashi identity for two-fermion systems

International Nuclear Information System (INIS)

Marinho, J. A. O.; Frederico, T.; Pace, E.; Salme, G.; Sauer, P. U.

2008-01-01

We propose a three-dimensional electromagnetic current operator within light-front dynamics that satisfies a light-front Ward-Takahashi identity for two-fermion systems. The light-front current operator is obtained by a quasipotential reduction of the four-dimensional current operator and acts on the light-front valence component of bound or scattering states. A relation between the light-front valence wave function and the four-dimensional Bethe-Salpeter amplitude both for bound or scattering states is also derived, such that the matrix elements of the four-dimensional current operator can be fully recovered from the corresponding light-front ones. The light-front current operator can be perturbatively calculated through a quasipotential expansion, and the divergence of the proposed current satisfies a Ward-Takahashi identity at any given order of the expansion. In the quasipotential expansion the instantaneous terms of the fermion propagator are accounted for by the effective interaction and two-body currents. We exemplify our theoretical construction in the Yukawa model in the ladder approximation, investigating in detail the current operator at the lowest nontrivial order of the quasipotential expansion of the Bethe-Salpeter equation. The explicit realization of the light-front form of the Ward-Takahashi identity is verified. We also show the relevance of instantaneous terms and of the pair contribution to the two-body current and the Ward-Takahashi identity

Multilevel sequential Monte-Carlo samplers

KAUST Repository

Jasra, Ajay

2016-01-01

Multilevel Monte-Carlo methods provide a powerful computational technique for reducing the computational cost of estimating expectations for a given computational effort. They are particularly relevant for computational problems when approximate distributions are determined via a resolution parameter h, with h=0 giving the theoretical exact distribution (e.g. SDEs or inverse problems with PDEs). The method provides a benefit by coupling samples from successive resolutions, and estimating differences of successive expectations. We develop a methodology that brings Sequential Monte-Carlo (SMC) algorithms within the framework of the Multilevel idea, as SMC provides a natural set-up for coupling samples over different resolutions. We prove that the new algorithm indeed preserves the benefits of the multilevel principle, even if samples at all resolutions are now correlated.

Multilevel sequential Monte-Carlo samplers

KAUST Repository

Jasra, Ajay

2016-01-05

Multilevel Monte-Carlo methods provide a powerful computational technique for reducing the computational cost of estimating expectations for a given computational effort. They are particularly relevant for computational problems when approximate distributions are determined via a resolution parameter h, with h=0 giving the theoretical exact distribution (e.g. SDEs or inverse problems with PDEs). The method provides a benefit by coupling samples from successive resolutions, and estimating differences of successive expectations. We develop a methodology that brings Sequential Monte-Carlo (SMC) algorithms within the framework of the Multilevel idea, as SMC provides a natural set-up for coupling samples over different resolutions. We prove that the new algorithm indeed preserves the benefits of the multilevel principle, even if samples at all resolutions are now correlated.

Rolling out Productive Ward foundation modules across a hospital trust.

Science.gov (United States)

Foster, Sam; Gordon, Pete; McSherry, Wilfred

The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

Door locking and exit security measures on acute psychiatric admission wards

NARCIS (Netherlands)

Nijman, H.L.I.; Bowers, L.; Haglund, K.; Muir-Cochrane, E.; Simpson, A.; Merwe, M. van der

2011-01-01

Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping

Space-partition method for the variance-based sensitivity analysis: Optimal partition scheme and comparative study

International Nuclear Information System (INIS)

Zhai, Qingqing; Yang, Jun; Zhao, Yu

2014-01-01

Variance-based sensitivity analysis has been widely studied and asserted itself among practitioners. Monte Carlo simulation methods are well developed in the calculation of variance-based sensitivity indices but they do not make full use of each model run. Recently, several works mentioned a scatter-plot partitioning method to estimate the variance-based sensitivity indices from given data, where a single bunch of samples is sufficient to estimate all the sensitivity indices. This paper focuses on the space-partition method in the estimation of variance-based sensitivity indices, and its convergence and other performances are investigated. Since the method heavily depends on the partition scheme, the influence of the partition scheme is discussed and the optimal partition scheme is proposed based on the minimized estimator's variance. A decomposition and integration procedure is proposed to improve the estimation quality for higher order sensitivity indices. The proposed space-partition method is compared with the more traditional method and test cases show that it outperforms the traditional one

A systematic literature review of Releasing Time to Care: The Productive Ward.

Science.gov (United States)

Wright, Stella; McSherry, Wilfred

2013-05-01

This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. A systematic literature review. The terms 'Releasing Time to Care' and 'Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, ProQuest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. © 2013 Blackwell Publishing Ltd.

Multilevel modelling: Beyond the basic applications.

Science.gov (United States)

Wright, Daniel B; London, Kamala

2009-05-01

Over the last 30 years statistical algorithms have been developed to analyse datasets that have a hierarchical/multilevel structure. Particularly within developmental and educational psychology these techniques have become common where the sample has an obvious hierarchical structure, like pupils nested within a classroom. We describe two areas beyond the basic applications of multilevel modelling that are important to psychology: modelling the covariance structure in longitudinal designs and using generalized linear multilevel modelling as an alternative to methods from signal detection theory (SDT). Detailed code for all analyses is described using packages for the freeware R.

Light-front zero-mode contribution to the Ward Identity

International Nuclear Information System (INIS)

Sales, J.H.O.; Suzuki, A.T.

2010-01-01

In a covariant gauge we implicitly assume that the Green's function propagates information from one point of the space-time to another, so that the Green's function is responsible for the dynamics of the relativistic particle. In the light front form one would naively expect that this feature would be preserved. In this manner, the fermionic field propagator can be split into a propagating piece and a non-propagating ('contact') term. Since the latter ('contact') one does not propagate information, and therefore, supposedly can be discarded with no harm to the field dynamics we wanted to know what would be the impact of dropping it off. To do that, we investigated its role in the Ward identity in the light front. Here we use the terminology Ward identity to identify the limiting case of photon's zero momentum transfer in the vertex from the more general Ward-Takahashi identity with nonzero momentum transfer.

Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods.

Science.gov (United States)

Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

2016-01-01

Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.

The prediction of blood-tissue partitions, water-skin partitions and skin permeation for agrochemicals.

Science.gov (United States)

Abraham, Michael H; Gola, Joelle M R; Ibrahim, Adam; Acree, William E; Liu, Xiangli

2014-07-01

There is considerable interest in the blood-tissue distribution of agrochemicals, and a number of researchers have developed experimental methods for in vitro distribution. These methods involve the determination of saline-blood and saline-tissue partitions; not only are they indirect, but they do not yield the required in vivo distribution. The authors set out equations for gas-tissue and blood-tissue distribution, for partition from water into skin and for permeation from water through human skin. Together with Abraham descriptors for the agrochemicals, these equations can be used to predict values for all of these processes. The present predictions compare favourably with experimental in vivo blood-tissue distribution where available. The predictions require no more than simple arithmetic. The present method represents a much easier and much more economic way of estimating blood-tissue partitions than the method that uses saline-blood and saline-tissue partitions. It has the added advantages of yielding the required in vivo partitions and being easily extended to the prediction of partition of agrochemicals from water into skin and permeation from water through skin. © 2013 Society of Chemical Industry.

Dynamic isolation technologies in negative pressure isolation wards

CERN Document Server

Xu, Zhonglin

2017-01-01

This book presents novel design principles and technologies for dynamic isolation based on experimental studies. These approaches have now become the local standard in Beijing and are currently being promoted for use nationwide. Further, the book provides details of measures and guidelines for the design process. Departing from the traditional understanding that isolation wards should be designed with high negative pressure, airtight doors and fresh air, it establishes the basis for designing biological clean rooms, including isolation wards, using a simple and convenient scientific approach. This book is intended for designers, engineers, researchers, hospital management staff and graduate students in heating ventilation air conditioning (HVAC), air cleaning technologies and related areas.

Partitioning in P-T concept

International Nuclear Information System (INIS)

Zhang Peilu; Qi Zhanshun; Zhu Zhixuan

2000-01-01

Comparison of dry- and water-method for partitioning fission products and minor actinides from the spent fuels, and description of advance of dry-method were done. Partitioning process, some typical concept and some results of dry-method were described. The problems fond in dry-method up to now were pointed out. The partitioning study program was suggested

Severe psychosomatic illness in children: effect on a pediatric ward's staff.

Science.gov (United States)

Fialkov, M J; Miller, J A

1981-12-01

Observations of a pediatric ward's response to the repeated hospitalization of an asthmatic child revealed a close parallel to the transactional patterns described in families of children with psychosomatic illnesses. Characteristics of such families include enmeshment, overprotectiveness, rigidity and resistance to change, lack of conflict resolution, and use of the child's sick role to relieve tension and discomfort within the family. In this article we have attempted to demonstrate the similarity of responses between these families and groups of hospital ward personnel. Resolution of the ward personnel's internal conflict was followed by changes in the coping abilities of the staff, with a successful outcome for a second child with a similar clinical condition.

Ward identities for scale and special conformal transformations in inflation

International Nuclear Information System (INIS)

Kundu, Nilay; Shukla, Ashish; Trivedi, Sandip P.

2016-01-01

We derive the general Ward identities for scale and special conformal transformations in theories of single field inflation. Our analysis is model independent and based on symmetry considerations alone. The identities we obtain are valid to all orders in the slow roll expansion. For special conformal transformations, the Ward identities include a term which is non-linear in the fields that arises due to a compensating spatial reparametrization. Some observational consequences are also discussed.

Comparison of student learning in the out-patient clinic and ward round.

Science.gov (United States)

Davis, M H; Dent, J A

1994-05-01

In undergraduate medical education there is a trend away from ward-based teaching towards out-patient and community-based teaching. To study the potential effects of this altered emphasis on student learning, a pilot group of final-year medical students at the University of Dundee was asked to keep individual structured log-books. These contained details of patients seen during their 3-week orthopaedic attachment in both a ward and out-patient setting. A comparison of perceived learning in the two settings showed that students learned more from attending an out-patient clinic than a ward round, but did not make full use of the learning potential of either. The setting did not particularly influence the balance of learning as categorized here but only the ward round supplied experience of surgical complications. The amount of learning taking place in an out-patient clinic was influenced by student ability, measured by examination performance, but not by clinic work-load. The implications of increased use of out-patient clinics and the advantages and disadvantages of the approach employed are discussed. It is concluded that in the situation studied student learning in the outpatient setting is as good as or superior to the ward setting but should not totally replace it.

Splitting Ward identity

Energy Technology Data Exchange (ETDEWEB)

Safari, Mahmoud [Institute for Research in Fundamental Sciences (IPM), School of Particles and Accelerators, P.O. Box 19395-5531, Tehran (Iran, Islamic Republic of)

2016-04-15

Within the background-field framework we present a path integral derivation of the splitting Ward identity for the one-particle irreducible effective action in the presence of an infrared regulator, and make connection with earlier works on the subject. The approach is general in the sense that it does not rely on how the splitting is performed. This identity is then used to address the problem of background dependence of the effective action at an arbitrary energy scale. We next introduce the modified master equation and emphasize its role in constraining the effective action. Finally, application to general gauge theories within the geometric approach is discussed. (orig.)

Splitting Ward identity

International Nuclear Information System (INIS)

Safari, Mahmoud

2016-01-01

Within the background-field framework we present a path integral derivation of the splitting Ward identity for the one-particle irreducible effective action in the presence of an infrared regulator, and make connection with earlier works on the subject. The approach is general in the sense that it does not rely on how the splitting is performed. This identity is then used to address the problem of background dependence of the effective action at an arbitrary energy scale. We next introduce the modified master equation and emphasize its role in constraining the effective action. Finally, application to general gauge theories within the geometric approach is discussed. (orig.)

Two-Stage n-PSK Partitioning Carrier Phase Recovery Scheme for Circular mQAM Coherent Optical Systems

Directory of Open Access Journals (Sweden)

Jaime Rodrigo Navarro

2016-06-01

Full Text Available A novel two-stage n-PSK partitioning carrier phase recovery (CPR scheme for circular multilevel quadrature amplitude modulation (C-mQAM constellations is presented. The first stage of the algorithm provides an initial rough estimation of the received constellation, which is utilized in the second stage for CPR. The performance of the proposed algorithm is studied through extensive simulations at the forward error correction bit error rate targets of 3.8 × 10−3 and 1 × 10−2 and is compared with different CPR algorithms. A significant improvement in the combined linewidth symbol duration product (ΔνTs tolerance is achieved compared to the single-stage n-PSK partitioning scheme. Superior performance in the ΔνTs tolerance compared to the blind phase search algorithm is also reported. The relative improvements with respect to other CPR schemes are also validated experimentally for a 28-Gbaud C-16QAM back-to-back transmission system. The computational complexity of the proposed CPR scheme is studied, and reduction factors of 24.5 | 30.1 and 59.1 | 63.3 are achieved for C-16QAM and C-64QAM, respectively, compared to single-stage BPS in the form of multipliers | adders.

Multilevel particle filter

KAUST Repository

Law, Kody

2016-01-06

This talk will pertain to the filtering of partially observed diffusions, with discrete-time observations. It is assumed that only biased approximations of the diffusion can be obtained, for choice of an accuracy parameter indexed by l. A multilevel estimator is proposed, consisting of a telescopic sum of increment estimators associated to the successive levels. The work associated to O( 2) mean-square error between the multilevel estimator and average with respect to the filtering distribution is shown to scale optimally, for example as O( 2) for optimal rates of convergence of the underlying diffusion approximation. The method is illustrated on some toy examples as well as estimation of interest rate based on real S&P 500 stock price data.

Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis.

Science.gov (United States)

Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph

2014-01-01

Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors. A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor-student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians.

Partitioning planning studies: Preliminary evaluation of metal and radionuclide partitioning the high-temperature thermal treatment systems

International Nuclear Information System (INIS)

Liekhus, K.; Grandy, J.; Chambers, A.

1997-03-01

A preliminary study of toxic metals and radionuclide partitioning during high-temperature processing of mixed waste has been conducted during Fiscal Year 1996 within the Environmental Management Technology Evaluation Project. The study included: (a) identification of relevant partitioning mechanisms that cause feed material to be distributed between the solid, molten, and gas phases within a thermal treatment system; (b) evaluations of existing test data from applicable demonstration test programs as a means to identify and understand elemental and species partitioning; and, (c) evaluation of theoretical or empirical partitioning models for use in predicting elemental or species partitioning in a thermal treatment system. This preliminary study was conducted to identify the need for and the viability of developing the tools capable of describing and predicting toxic metals and radionuclide partitioning in the most applicable mixed waste thermal treatment processes. This document presents the results and recommendations resulting from this study that may serve as an impetus for developing and implementing these predictive tools

Partitioning planning studies: Preliminary evaluation of metal and radionuclide partitioning the high-temperature thermal treatment systems

Energy Technology Data Exchange (ETDEWEB)

Liekhus, K.; Grandy, J.; Chambers, A. [and others

1997-03-01

A preliminary study of toxic metals and radionuclide partitioning during high-temperature processing of mixed waste has been conducted during Fiscal Year 1996 within the Environmental Management Technology Evaluation Project. The study included: (a) identification of relevant partitioning mechanisms that cause feed material to be distributed between the solid, molten, and gas phases within a thermal treatment system; (b) evaluations of existing test data from applicable demonstration test programs as a means to identify and understand elemental and species partitioning; and, (c) evaluation of theoretical or empirical partitioning models for use in predicting elemental or species partitioning in a thermal treatment system. This preliminary study was conducted to identify the need for and the viability of developing the tools capable of describing and predicting toxic metals and radionuclide partitioning in the most applicable mixed waste thermal treatment processes. This document presents the results and recommendations resulting from this study that may serve as an impetus for developing and implementing these predictive tools.

Food hygiene on the wards.

Science.gov (United States)

Steuer, Walter

2007-09-13

A PROBLEM THAT IS OFTEN OVERLOOKED OR SIMPLY NOT GIVEN ENOUGH ATTENTION: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient's room and often eaten only hours later can pose a risk of infection.In summary, the following principles of food hygiene must be observed on the wards:Maintenance of the cold-hot chainNot only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitorsCleanliness and minimal contamination of kitchen worktopsCleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food

Robot Assisted Surgical Ward Rounds: Virtually Always There

Directory of Open Access Journals (Sweden)

Stefanie M. Croghan

2018-05-01

Full Text Available Background:  While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates ‘human’ interaction by swiveling and adjusting height to patients’ eye-level.     Methods: Robot-assisted ward rounds(RASWR were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA.  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard rounds, acting as control group. Data were paired, and non-parametric analysis performed.     Results: RASWRs are feasible (>90% completed without technical difficulty. The RASWR(n=52 observations demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05 between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25 agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11 willing to regularly partake in RASWR.    Conclusion: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds

Robot Assisted Surgical Ward Rounds: Virtually Always There.

Science.gov (United States)

Croghan, Stefanie M; Carroll, Paul; Reade, Sarah; Gillis, Amy E; Ridgway, Paul F

2018-05-02

 While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates 'human' interaction by swiveling and adjusting height to patients' eye-level.   METHODS: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  RESULTS: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  CONCLUSION: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be

Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

LENUS (Irish Health Repository)

Tan, T

2012-02-01

BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

Opening the black box in nursing work and management practice: the role of ward managers.

Science.gov (United States)

Townsend, Keith; Wilkinson, Adrian; Kellner, Ashlea

2015-03-01

This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. © 2013 John Wiley & Sons Ltd.

Dispersion approach to anomalies in the axial-vector Ward-Takahashi identities

Energy Technology Data Exchange (ETDEWEB)

Nishijima, K. Sasaki, R. (Tokyo Univ. (Japan). Dept. of Physic)

1975-01-01

On the basis of dispersion relations and unitarity anomalous Ward-Takahashi identities for the axial-vector current are derived in quantum electrodynamics. In this derivation use of divergent unrenormalized expressions is intentionally avoided, and only finite renormalized expressions are employed from the start. The origin of the anormalies is attributed to a mismatch of the subtraction conditions present in the naive Ward-Takahashi identities. The resulting anomalous Ward-Takahashi identities are valid in every order of the perturbation expansion and can be cast in the form of an operator equation. In the course of this derivation we encounter the problem of how to regularize operator products and a possible solution of this problem is provided in terms of subtraction conditions.

Dispersion approach to anomalies in the axial-vector Ward-Takahashi identities

International Nuclear Information System (INIS)

Nishijima, Kazuhiko; Sasaki, Ryu

1975-01-01

On the basis of dispersion relations and unitarity anomalous Ward-Takahashi identities for the axial-vector current are derived in quantum electrodynamics. In this derivation use of divergent unrenormalized expressions is intentionally avoided, and only finite renormalized expressions are employed from the start. The origin of the anormalies is attributed to a mismatch of the subtraction conditions present in the naive Ward-Takahashi identities. The resulting anomalous Ward-Takahashi identities are valid in every order of the perturbation expansion and can be cast in the form of an operator equation. In the course of this derivation we encounter the problem of how to regularize operator products and a possible solution of this problem is provided in terms of subtraction conditions. (auth.)

Medical academia clinical experiences of Ward Round Teaching curriculum.

Science.gov (United States)

Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

2014-01-01

Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

Medical academia clinical experiences of Ward Round Teaching curriculum

Directory of Open Access Journals (Sweden)

Fariba Haghani

2014-01-01

Full Text Available Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members′ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9. Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation.Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability were employed (Guba and Lincoln. Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1 tangible teachings (analytic intelligence, technical intelligence, legal duties and (2 implied teachings (professionalism, professional discipline, professional difficulties. Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

The Euler–Riemann gases, and partition identities

International Nuclear Information System (INIS)

Chair, Noureddine

2013-01-01

The Euler theorem in partition theory and its generalization are derived from a non-interacting quantum field theory in which each bosonic mode with a given frequency is equivalent to a sum of bosonic mode whose frequency is twice (s-times) as much, and a fermionic (parafermionic) mode with the same frequency. Explicit formulas for the graded parafermionic partition functions are obtained, and the inverse of the graded partition function (IGPPF), turns out to be bosonic (fermionic) partition function depending on the parity of the order s of the parafermions. It is also shown that these partition functions are generating functions of partitions of integers with restrictions, the Euler generating function is identified with the inverse of the graded parafermionic partition function of order 2. As a result we obtain new sequences of partitions of integers with given restrictions. If the parity of the order s is even, then mixing a system of parafermions with a system whose partition function is (IGPPF), results in a system of fermions and bosons. On the other hand, if the parity of s is odd, then, the system we obtain is still a mixture of fermions and bosons but the corresponding Fock space of states is truncated. It turns out that these partition functions are given in terms of the Jacobi theta function θ 4 , and generate sequences in partition theory. Our partition functions coincide with the overpartitions of Corteel and Lovejoy, and jagged partitions in conformal field theory. Also, the partition functions obtained are related to the Ramond characters of the superconformal minimal models, and in the counting of the Moore–Read edge spectra that appear in the fractional quantum Hall effect. The different partition functions for the Riemann gas that are the counter parts of the Euler gas are obtained by a simple change of variables. In particular the counter part of the Jacobi theta function is (ζ(2t))/(ζ(t) 2 ) . Finally, we propose two formulas which brings

Drug dispensing errors in a ward stock system

DEFF Research Database (Denmark)

Andersen, Stig Ejdrup

2010-01-01

. Multivariable analysis showed that surgical and psychiatric settings were more susceptible to involvement in dispensing errors and that polypharmacy was a risk factor. In this ward stock system, dispensing errors are relatively common, they depend on speciality and are associated with polypharmacy......The aim of this study was to determine the frequency of drug dispensing errors in a traditional ward stock system operated by nurses and to investigate the effect of potential contributing factors. This was a descriptive study conducted in a teaching hospital from January 2005 to June 2007. In five....... These results indicate that strategies to reduce dispensing errors should address polypharmacy and focus on high-risk units. This should, however, be substantiated by a future trial....

Hawk: A Runtime System for Partitioned Objects

NARCIS (Netherlands)

Ben Hassen, S.; Bal, H.E.; Tanenbaum, A.S.

1997-01-01

Hawk is a language-independent runtime system for writing data-parallel programs using partitioned objects. A partitioned object is a multidimensional array of elements that can be partitioned and distributed by the programmer. The Hawk runtime system uses the user-defined partitioning of objects

Respiratory support in oncology ward setting: a prospective descriptive study.

Science.gov (United States)

Mishra, Seema; Bhatnagar, Sushma; Gupta, Deepak; Goyal, Gaurav Nirvani; Agrawal, Ravi; Jain, Roopesh; Chauhan, Himanshu

2009-01-01

Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes. Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation. Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively. Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

Comorbid depression in dementia on psychogeriatric nursing home wards: which symptoms are prominent?

NARCIS (Netherlands)

Verkaik, R.; Francke, A.L.; Meijel, B. van; Ribbe, M.W.; Bensing, J.M.

2009-01-01

OBJECTIVE: To provide insight into the prevalence and clinically relevant symptoms of comorbid depression among dementia patients in psychogeriatric nursing home wards, to enhance depression recognition. DESIGN: Cross-sectional analyses of multicenter diagnostic data. SETTING: Psychogeriatric wards

Factors impacting perceived safety among staff working on mental health wards.

Science.gov (United States)

Haines, Alina; Brown, Andrew; McCabe, Rhiannah; Rogerson, Michelle; Whittington, Richard

2017-09-01

Safety at work is a core issue for mental health staff working on in-patient units. At present, there is a limited theoretical base regarding which factors may affect staff perceptions of safety. This study attempted to identify which factors affect perceived staff safety working on in-patient mental health wards. A cross-sectional design was employed across 101 forensic and non-forensic mental health wards, over seven National Health Service trusts nationally. Measures included an online staff survey, Ward Features Checklist and recorded incident data. Data were analysed using categorical principal components analysis and ordinal regression. Perceptions of staff safety were increased by ward brightness, higher number of patient beds, lower staff to patient ratios, less dayroom space and more urban views. The findings from this study do not represent common-sense assumptions. Results are discussed in the context of the literature and may have implications for current initiatives aimed at managing in-patient violence and aggression. None. © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license.

[On the partition of acupuncture academic schools].

Science.gov (United States)

Yang, Pengyan; Luo, Xi; Xia, Youbing

2016-05-01

Nowadays extensive attention has been paid on the research of acupuncture academic schools, however, a widely accepted method of partition of acupuncture academic schools is still in need. In this paper, the methods of partition of acupuncture academic schools in the history have been arranged, and three typical methods of"partition of five schools" "partition of eighteen schools" and "two-stage based partition" are summarized. After adeep analysis on the disadvantages and advantages of these three methods, a new method of partition of acupuncture academic schools that is called "three-stage based partition" is proposed. In this method, after the overall acupuncture academic schools are divided into an ancient stage, a modern stage and a contemporary stage, each schoolis divided into its sub-school category. It is believed that this method of partition can remedy the weaknesses ofcurrent methods, but also explore a new model of inheritance and development under a different aspect through thedifferentiation and interaction of acupuncture academic schools at three stages.

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses.

Science.gov (United States)

Zhang, Aihua; Tao, Hong; Ellenbecker, Carol Hall; Liu, Xiaohong

2013-08-01

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. A cross-sectional design was selected for this descriptive correlation study. Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse. © 2012 Blackwell Publishing Ltd.

Active learning on the ward: outcomes from a comparative trial with traditional methods.

Science.gov (United States)

Melo Prado, Hegla; Hannois Falbo, Gilliatt; Rodrigues Falbo, Ana; Natal Figueirôa, José

2011-03-01

Academic activity during internship is essentially practical and ward rounds are traditionally considered the cornerstone of clinical education. However, the efficacy and effectiveness of ward rounds for learning purposes have been under-investigated and it is necessary to assess alternative educational paradigms for this activity. This study aimed to compare the educational effectiveness of ward rounds conducted with two different learning methodologies. Student subjects were first tested on 30 true/false questions to assess their initial degree of knowledge on pneumonia and diarrhoea. Afterwards, they attended ward rounds conducted using an active and a traditional learning methodology. The participants were submitted to a second test 48hours later in order to assess knowledge acquisition and were asked to answer two questions about self-directed learning and their opinions on the two learning methodologies used. Seventy-two medical students taking part in a paediatric clinic rotation were enrolled. The active methodology proved to be more effective than the traditional methodology for the three outcomes considered: knowledge acquisition (33 students [45.8%] versus 21 students [29.2%]; p=0.03); self-directed learning (38 students [52.8%] versus 11 students [15.3%]; pmethods (61 students [84.7%] versus 38 students [52.8%]; ptraditional methodology in a ward-based context. This study seems to be valuable in terms of the new evidence it demonstrates on learning methodologies in the context of the ward round. © Blackwell Publishing Ltd 2011.

Analysis of load balance in hybrid partitioning | Talib | Botswana ...

African Journals Online (AJOL)

In information retrieval systems, there are three types of index partitioning schemes - term partitioning, document partitioning, and hybrid partitioning. The hybrid-partitioning scheme combines both term and document partitioning schemes. Term partitioning provides high concurrency, which means that queries can be ...

Identifying the nontechnical skills required of nurses in general surgical wards.

Science.gov (United States)

Marshall, Dianne C; Finlayson, Mary P

2018-04-01

To identify the nontechnical skills (NTS) required of nurses in general surgical wards for safe and effective care. As the largest occupational group, nurses are in an ideal position to block the vulnerabilities of patient adverse events in a surgical ward. Previous studies in the surgical environment have identified the NTS required of nurses for safe care in operating rooms; however, these skills have not been identified for nurses in general surgical wards. A nonparticipant observational descriptive design was used. A purposive sample of 15 registered nurses was recruited from four surgical wards and observed for a full shift on a morning, afternoon or night shift. Nonparticipant observations were conducted using field notes to collect data. A coding frame was developed, and an inductive process was used to analyse the data. A taxonomy comprising seven NTS required of nurses in their roles in surgical ward teams emerged from the data analysis. They are communication, leadership and management, planning, decision-making, situation awareness, teamwork and patient advocacy. Patient care provided by general surgical nurses involved the seven identified key NTS. These particular NTS are an important component of safe nursing practice as they underpin the provision of safe and effective care for general surgical patients. Nurses block the trajectory of error by using NTS to address the vulnerabilities in the system that can lead to adverse patient events. Identifying general surgical nurses' NTS enables the development of teaching strategies that target the learning of those skills to achieve successful work outcomes and improve patient safety. © 2018 John Wiley & Sons Ltd.

Holographic Ward identities for symmetry breaking in two dimensions

Energy Technology Data Exchange (ETDEWEB)

Argurio, Riccardo [Physique Théorique et Mathématique and International Solvay Institutes,Université Libre de Bruxelles,C.P. 231, 1050 Brussels (Belgium); Giribet, Gaston [Martin Fisher School of Physics, Brandeis University,Waltham, Massachusetts 02453 (United States); Physics Department, University of Buenos Aires FCEN-UBA and IFIBA-CONICET,Ciudad Universitaria, Pabellón I, 1428, Buenos Aires (Argentina); Marzolla, Andrea; Naegels, Daniel [Physique Théorique et Mathématique and International Solvay Institutes,Université Libre de Bruxelles,C.P. 231, 1050 Brussels (Belgium); Sierra-Garcia, J. Anibal [Department of Particle Physics and IGFAE, University of Santiago de Compostela,E-15782 Santiago de Compostela (Spain)

2017-04-03

We investigate symmetry breaking in two-dimensional field theories which have a holographic gravity dual. Being at large N, the Coleman theorem does not hold and Goldstone bosons are expected. We consider the minimal setup to describe a conserved current and a charged operator, and we perform holographic renormalization in order to find the correct Ward identities describing symmetry breaking. This involves some subtleties related to the different boundary conditions that a vector can have in the three-dimensional bulk. We establish which is the correct prescription that yields, after renormalization, the same Ward identities as in higher dimensions.

The management pattern carried out in a cataract surgery day ward.

Science.gov (United States)

Lin, Jing; Fang, Xiaoqun; Wu, Suhong

2013-06-01

To evaluate the management practice and process of a cataract surgery day ward. From January to December in 2012, a portion of the cataract patients were evaluated for the pattern of day ward management. Methods were as follows: 1) Establish the cataract day ward. 2) Enroll the patients who met the following criteria: voluntary, local residents or outsiders who stayed in a hotel near the hospital, accompanied by family, and who had simple senile cataract without any systemic major diseases. 3) Establish the hospitalization process. 4) Analyze the nursing process. After cataract day surgery, the patients were followed for 2 hours and completed a questionnaire about their needs and sentiments. A total of 3971 cases were observed in this study; 49 cases were switched to a normal pattern of hospitalization because of operative complications, 1 case had a strong desire to switch to a normal pattern of hospitalization because of ocular discomfort, 8 cases went back to the hospital for treatment because of ocular pain, and 52 cases called on the phone to seek help. Overall, 3820 cases(96.2%) returned on time the next day to visit the doctor. No patients showed severe postoperative complications and 98% expressed great satisfaction with the day ward process. Only 200 cases expressed great concern about not knowing how to deal with postoperative pain, the changes in condition outside the hospital, the therapeutic effects, and the problem of expense reimburse-ment. Day ward cataract surgery is an efficient and safe mode, and has the potential to relieve the demand for inpatient beds and to ensure timely treatment of the patients. In addition, it helps the patients enjoy health care at public expense, reserving reimbursement for those who need to be hospitalized. Nurses should pay more attention to systemic evaluation of the patients, health education, and psychological guidance, and keep in close communication with doctors, which is the key to ensure the safety of day ward

The multilevel governance of migration and integration

NARCIS (Netherlands)

Scholten, P.; Penninx, R.; Garcés–Mascareñas, B.; Penninx, R.

2016-01-01

This chapter focuses on migration and integration as multilevel policy issues and explores the consequences in terms of multilevel governance. Immigration policymaking has been characterized by continued struggle between national governments and the EU about the amount of discretion states have in

Participatory Action Research in clinical nursing practice in a medical ward

DEFF Research Database (Denmark)

Kjerholt, Mette; Wagner, Lis; Lindhardt, Tove

2016-01-01

Background: Action research with a participatory approach (PAR) was used as research design in a medical ward but stopped midway because of lack of active actor participation in the actions. Aim: To describe challenges and barriers influencing lack of participation. Setting: A medical hospital ward......, Denmark. Participants were healthcare staff. Methods: Field observations, interviews, logbook. Data were analysed using content analysis methods. Findings: Multiple factors influenced lack of actor participation. The causes were complex and included: organizational framework, significance/meaning, actor...... roles, responsibility. Conclusion: Before using PAR it is crucial to investigate if the organization and the participants at all levels are suited and agree to participate actively. The findings indicate, that to carry out PAR in a busy medical ward, it is necessary to evaluate whether the necessary...

Multilevel security for relational databases

CERN Document Server

Faragallah, Osama S; El-Samie, Fathi E Abd

2014-01-01

Concepts of Database Security Database Concepts Relational Database Security Concepts Access Control in Relational Databases      Discretionary Access Control      Mandatory Access Control      Role-Based Access Control Work Objectives Book Organization Basic Concept of Multilevel Database Security IntroductionMultilevel Database Relations Polyinstantiation      Invisible Polyinstantiation      Visible Polyinstantiation      Types of Polyinstantiation      Architectural Consideration

The evaluation of a hostel ward. A controlled study using modified cost-benefit analysis.

Science.gov (United States)

Hyde, C; Bridges, K; Goldberg, D; Lowson, K; Sterling, C; Faragher, B

1987-12-01

A controlled modified cost-benefit evaluation of a hostel ward caring for new long-stay patients is described and results are presented for the first two years. In some respects the residents of the hostel ward had fewer psychotic impairments than those remaining on the wards of the district general hospital, mainly because the latter seem to continue to acquire such defects, while the former have remained relatively unchanged. The hostel ward residents also develop superior domestic skills, use more facilities in the community, and are more likely to be engaged in constructive activities than controls. These advantages were not purchased at a price, since the cost of providing this form of care for these patients has cost less than care provided by the district general hospital.

Partitioning sparse rectangular matrices for parallel processing

Energy Technology Data Exchange (ETDEWEB)

Kolda, T.G.

1998-05-01

The authors are interested in partitioning sparse rectangular matrices for parallel processing. The partitioning problem has been well-studied in the square symmetric case, but the rectangular problem has received very little attention. They will formalize the rectangular matrix partitioning problem and discuss several methods for solving it. They will extend the spectral partitioning method for symmetric matrices to the rectangular case and compare this method to three new methods -- the alternating partitioning method and two hybrid methods. The hybrid methods will be shown to be best.

A brief history of partitions of numbers, partition functions and their modern applications

Science.gov (United States)

Debnath, Lokenath

2016-04-01

'Number rules the universe.' The Pythagoras 'If you wish to forsee the future of mathematics our course is to study the history and present conditions of the science.' Henri Poincaré 'The primary source (Urqell) of all mathematics are integers.' Hermann Minkowski This paper is written to commemorate the centennial anniversary of the Mathematical Association of America. It deals with a short history of different kinds of natural numbers including triangular, square, pentagonal, hexagonal and k-gonal numbers, and their simple properties and their geometrical representations. Included are Euclid's and Pythagorean's main contributions to elementary number theory with the main contents of the Euclid Elements of the 13-volume masterpiece of mathematical work. This is followed by Euler's new discovery of the additive number theory based on partitions of numbers. Special attention is given to many examples, Euler's theorems on partitions of numbers with geometrical representations of Ferrers' graphs, Young's diagrams, Lagrange's four-square theorem and the celebrated Waring problem. Included are Euler's generating functions for the partitions of numbers, Euler's pentagonal number theorem, Gauss' triangular and square number theorems and the Jacobi triple product identity. Applications of the theory of partitions of numbers to different statistics such as the Bose- Einstein, Fermi- Dirac, Gentile, and Maxwell- Boltzmann statistics are briefly discussed. Special attention is given to pedagogical information through historical approach to number theory so that students and teachers at the school, college and university levels can become familiar with the basic concepts of partitions of numbers, partition functions and their modern applications, and can pursue advanced study and research in analytical and computational number theory.

Multilevel optimization algorithms and applications

CERN Document Server

Pardalos, Panos; Värbrand, Peter

1998-01-01

Researchers working with nonlinear programming often claim "the word is non­ linear" indicating that real applications require nonlinear modeling. The same is true for other areas such as multi-objective programming (there are always several goals in a real application), stochastic programming (all data is uncer­ tain and therefore stochastic models should be used), and so forth. In this spirit we claim: The word is multilevel. In many decision processes there is a hierarchy of decision makers, and decisions are made at different levels in this hierarchy. One way to handle such hierar­ chies is to focus on one level and include other levels' behaviors as assumptions. Multilevel programming is the research area that focuses on the whole hierar­ chy structure. In terms of modeling, the constraint domain associated with a multilevel programming problem is implicitly determined by a series of opti­ mization problems which must be solved in a predetermined sequence. If only two levels are considered, we have ...

Situations of Agitation and Violence: the Reality in an Acute Inpatient Ward

Directory of Open Access Journals (Sweden)

Fátima Honrado Ferreira

2013-11-01

Full Text Available Although aggressiveness/violence is present in all individuals and societies, it may have different manifestations. Even though, on one hand, it is considered innate to Man, on the other it is viewed as a social phenomenon with a cultural, social and historical frames. Violent behaviour in a psychiatric inpatient ward cannot, and should no,t be solely at-tributed to factors that are directly linked to the patient; there is a set of factors that may contribute to a hostile environment within the inpatient ward. The environment in the ward as well as the role of the mental health care professionals, and in particular the role of the nurse, should be taken into account.

Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden.

Science.gov (United States)

Sjölander, Maria; Gustafsson, Maria; Gallego, Gisselle

2017-08-01

Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists' skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.

[Project to improve abdominal obesity in day care ward psychiatric patients].

Science.gov (United States)

Liu, Yu-Chieh; Wang, Hui-Yu; Huang, Hui-Ling; Chen, Min-Li

2011-06-01

Over half (57.14%) of patients in our ward suffer from abdominal obesity. This rate is on a continuing upward trend. Reasons for such obesity include lack of physical activity classes, inadequate physical activity, high calorie diets and unhealthy eating habits, chronic diseases and drug side effects, poor motivation to reduce weight, and lack of crisis awareness of abdominal obesity. This project was designed to lessen the problem of abdominal obesity among psychiatric day care inpatients. Resolution measures implemented included: (1) arranging aerobic exercise classes; (2) scheduling classes to teach patients healthy diet habits and knowledge regarding diseases and drugs; (3) holding a waistline reduction competition; (4) displaying health education bulletin boards; (5) holding a quiz contest with prizes for correct answers. The eight abdominally obese patients in the ward achieved an average waist circumference reduction of 2.9 cm and the overall abdominal obesity rate in the ward fell to 35.7%. BMI, eating habits, and awareness of weight loss importance and motivation all improved. The outcome achieved targeted project objectives. We recommend the integration of obesity prevention into routine ward activities and quality control indicators. Nurses should provide patients with weight loss concepts, regularly monitor risk factors, and encourage patient family cooperation to maintain medical care quality.

Application of the MIT two-channel model to predict flow recirculation in WARD 61-pin blanket tests

International Nuclear Information System (INIS)

Huang, T.T.; Todreas, N.E.

1983-01-01

The preliminary application of MIT two-channel model to WARD sodium blanket tests was presented in this report. The criterion was employed to predict the recirculation for selected completed (transient and steady state) and proposed (transient only) tests. The heat loss was correlated from the results of the WARD zero power tests. The calculational results show that the criterion agrees with the WARD tests except for WARD RUN 718 for which the criterion predicts a different result from WARD data under bundle heat loss condition. However, if the test assembly is adiabatic, the calculations predict an operating point which is marginally close to the mixed-to-recirculation transition regime

Application of the MIT two-channel model to predict flow recirculation in WARD 61-pin blanket tests

International Nuclear Information System (INIS)

Huang, T.T.; Todreas, N.E.

1983-01-01

The preliminary application of MIT TWO-CHANNEL MODEL to WARD sodium blanket tests was presented in this report. Our criterion was employed to predict the recirculation for selected completed (transient and steady state) and proposed (transient only) tests. The heat loss was correlated from the results of the WARD zero power tests. The calculational results show that our criterion agrees with the WARD tests except for WARD RUN 718 for which the criterion predicts a different result from WARD data under bundle heat loss condition. However, if the test assembly is adiabatic, the calculations predict an operating point which is marginally close to the mixed-to-recirculation transition regime

New Linear Partitioning Models Based on Experimental Water: Supercritical CO2 Partitioning Data of Selected Organic Compounds.

Science.gov (United States)

Burant, Aniela; Thompson, Christopher; Lowry, Gregory V; Karamalidis, Athanasios K

2016-05-17

Partitioning coefficients of organic compounds between water and supercritical CO2 (sc-CO2) are necessary to assess the risk of migration of these chemicals from subsurface CO2 storage sites. Despite the large number of potential organic contaminants, the current data set of published water-sc-CO2 partitioning coefficients is very limited. Here, the partitioning coefficients of thiophene, pyrrole, and anisole were measured in situ over a range of temperatures and pressures using a novel pressurized batch-reactor system with dual spectroscopic detectors: a near-infrared spectrometer for measuring the organic analyte in the CO2 phase and a UV detector for quantifying the analyte in the aqueous phase. Our measured partitioning coefficients followed expected trends based on volatility and aqueous solubility. The partitioning coefficients and literature data were then used to update a published poly parameter linear free-energy relationship and to develop five new linear free-energy relationships for predicting water-sc-CO2 partitioning coefficients. A total of four of the models targeted a single class of organic compounds. Unlike models that utilize Abraham solvation parameters, the new relationships use vapor pressure and aqueous solubility of the organic compound at 25 °C and CO2 density to predict partitioning coefficients over a range of temperature and pressure conditions. The compound class models provide better estimates of partitioning behavior for compounds in that class than does the model built for the entire data set.

Auditing Safety of Compounding and Reconstituting of Intravenous Medicines on Hospital Wards in Finland.

Science.gov (United States)

Suvikas-Peltonen, Eeva; Palmgren, Joni; Häggman, Verner; Celikkayalar, Ercan; Manninen, Raija; Airaksinen, Marja

2017-01-01

On the hospital wards in Finland, nurses generally reconstitute intravenous medicines, such as antibiotics, analgesics, and antiemetics prescribed by doctors. Medicine reconstitution is prone to many errors. Therefore, it is important to identify incorrect practices in the reconstitution of medicine to improve patient safety in hospitals. The aim of this study was to audit the compounding and reconstituting of intravenous medicines on hospital wards in a secondary-care hospital in Finland by using an assessment tool and microbiological testing for identifying issues posing patient safety risks. A hospital pharmacist conducted an external audit by using a validated 65-item assessment tool for safe-medicine compounding practices on 20 wards of the selected hospital. Also, three different microbiological samples were collected to assure the aseptics. Practices were evaluated using a four-point rating scale of "never performed," "rarely performed," "often performed," and "always performed," and were based on observation and interviews with nurses or ward pharmacists. In addition, glove-, settle plate-, and media fill-tests were collected. Associations between microbial sample results and audit-tool results were discussed. Altogether, only six out of the 65 items were fully implemented in all wards; these were related to logistic practices and quality assurance. More than half of the wards used incorrect practices ("rarely performed" or "never performed") for five items. Most of these obviated practices related to aseptic practices. All media-fill tests were clean but the number of colony forming units in glove samples and settle- plate samples varied from 0 to >100. More contamination was found in wards where environmental conditions were inadequate or the use of gloves was incorrect. Compounding practices were [mostly] quite well adapted, but the aseptic practices needed improvement. Attention should have been directed particularly to good aseptic techniques and

Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study.

Science.gov (United States)

Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

2014-08-15

An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards.

Science.gov (United States)

Muir-Cochrane, Eimear; van der Merwe, Marie; Nijman, Henk; Haglund, Kristina; Simpson, Alan; Bowers, Len

2012-02-01

There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Is Ward Experience in Resuscitation Effort Related to the Prognosis of Unexpected Cardiac Arrest?

Directory of Open Access Journals (Sweden)

Sen-Kuang Hou

2007-09-01

Conclusion: Hospital wards with more than 5 cardiac arrests per year have a better patient survival rate than those with fewer arrests. This is despite all ward staff receiving the same level of training.

Comparison of the training status of medical students of pediatric ward based on their logbooks

Directory of Open Access Journals (Sweden)

MOZHGHAN ZAHMATKESHAN

2013-04-01

Full Text Available Introduction: Logbooks show whether medical students have been exposed to a particular disease and whether they are able to perform particular practices or not. To evaluate the training status of the medical students in the pediatric ward of Shiraz University of Medical Sciences, the data about the students’ knowledge of different diseases in different parts of the pediatric ward in 2011 was collected based on their logbooks and compared with similar data in 2005. Methods: In this descriptive study, medical students’ electronic notes were designed and completed by 90 medical students trained in the pediatric ward in 2011. Then the information was compared with the data of the previous study conducted in 2005. Results: In the pediatric outpatient clinic, neonatal emergency room, pediatric emergency room, and general pediatric ward, 50% of the diseases listed in the diaries were observed by the students. However, 19% of the patients were observed by the students in subspecialty wards. Conclusion: Using daily notes (logbooks is a useful method for educational evaluation of the students. It can show the education acquired by the students, and clarify the defects and inadequacies in education. It seems that using electronic diaries in data collection increases the students’ participation and facilitates training. In general, expansion and development of new wards facilitate the exposure of medical students to more diseases and this fact has been shown about pediatric neurology ward in the present study.

Costs of terminal patients who receive palliative care or usual care in different hospital wards.

Science.gov (United States)

Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

2010-11-01

In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

Scalable Adaptive Multilevel Solvers for Multiphysics Problems

Energy Technology Data Exchange (ETDEWEB)

Xu, Jinchao [Pennsylvania State Univ., University Park, PA (United States). Dept. of Mathematics

2014-11-26

In this project, we carried out many studies on adaptive and parallel multilevel methods for numerical modeling for various applications, including Magnetohydrodynamics (MHD) and complex fluids. We have made significant efforts and advances in adaptive multilevel methods of the multiphysics problems: multigrid methods, adaptive finite element methods, and applications.

Medical and surgical ward rounds in teaching hospitals of Kuwait University: students’ perceptions

Directory of Open Access Journals (Sweden)

AlMutar S

2013-09-01

Full Text Available Sara AlMutar,1 Lulwa AlTourah,1 Hussain Sadeq,2 Jumanah Karim,2 Yousef Marwan3 1Department of Medicine, 2Department of Pediatrics, Mubarak Al-Kabeer Hospital, 3Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait Background: Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students’ perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. Methods: A pretested questionnaire was used to collect data from 141 medical students during the 2012–2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest to 5 (highest. Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. Results: Only 17 students (12.1% declined to participate in the study. The students' current competency scores (for competencies taught within both disciplines – medical and surgical were significantly lower than the scores indicating students’ expectations (P < 0.001. The best-taught competency was bedside examination, in both medical (mean: 3.45 and surgical (mean: 3.05 ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001. Conclusion: Both medical and surgical ward rounds were deficient in meeting the students’ expectations. Medical educators should utilize the available literature to improve the bedside

Learning from positively deviant wards to improve patient safety: an observational study protocol.

Science.gov (United States)

Baxter, Ruth; Taylor, Natalie; Kellar, Ian; Lawton, Rebecca

2015-12-11

Positive deviance is an asset-based approach to improvement which has recently been adopted to improve quality and safety within healthcare. The approach assumes that solutions to problems already exist within communities. Certain groups or individuals identify these solutions and succeed despite having the same resources as others. Within healthcare, positive deviance has previously been applied at individual or organisational levels to improve specific clinical outcomes or processes of care. This study explores whether the positive deviance approach can be applied to multidisciplinary ward teams to address the broad issue of patient safety among elderly patients. Preliminary work analysed National Health Service (NHS) Safety Thermometer data from 34 elderly medical wards to identify 5 'positively deviant' and 5 matched 'comparison' wards. Researchers are blinded to ward status. This protocol describes a multimethod, observational study which will (1) assess the concurrent validity of identifying positively deviant elderly medical wards using NHS Safety Thermometer data and (2) generate hypotheses about how positively deviant wards succeed. Patient and staff perceptions of safety will be assessed on each ward using validated surveys. Correlation and ranking analyses will explore whether this survey data aligns with the routinely collected NHS Safety Thermometer data. Staff focus groups and researcher fieldwork diaries will be completed and qualitative thematic content analysis will be used to generate hypotheses about the strategies, behaviours, team cultures and dynamics that facilitate the delivery of safe patient care. The acceptability and sustainability of strategies identified will also be explored. The South East Scotland Research Ethics Committee 01 approved this study (reference: 14/SS/1085) and NHS Permissions were granted from all trusts. Findings will be published in peer-reviewed, scientific journals, and presented at academic conferences. This study

Development of partitioning method : cold experiment with partitioning test facility in NUCEF (I)

International Nuclear Information System (INIS)

Yamaguchi, Isoo; Morita, Yasuji; Kondo, Yasuo

1996-03-01

A test facility in which about 1.85 x 10 14 Bq of high-level liquid waste can be treated has been completed in 1994 at Nuclear Fuel Cycle Safety Engineering Research Facility (NUCEF) for research and development of Partitioning Method. The outline of the partitioning test facility and support equipments for it which were design terms, constructions, arrangements, functions and inspections were given in JAERI-Tech 94-030. The present report describes the results of the water transfer test and partitioning tests, which are methods of precipitation by denitration, oxalate precipitation, solvent extraction, and adsorption with inorganic ion exchanger, using nitric acid to master operation method of the test facility. As often as issues related to equipments occurred during the tests, they were improved. As to issues related to processes such as being stopped up of columns, their measures of solution were found by testing in laboratories. They were reflected in operation of the Partitioning Test Facility. Their particulars and improving points were described in this report. (author)

Purification of biomaterials by phase partitioning

Science.gov (United States)

Harris, J. M.

1984-01-01

A technique which is particularly suited to microgravity environments and which is potentially more powerful than electrophoresis is phase partitioning. Phase partitioning is purification by partitioning between the two immiscible aqueous layers formed by solution of the polymers poly(ethylene glycol) and dextran in water. This technique proved to be very useful for separations in one-g but is limited for cells because the cells are more dense than the phase solutions thus tend to sediment to the bottom of the container before reaching equilibrium with the preferred phase. There are three phases to work in this area: synthesis of new polymers for affinity phase partitioning; development of automated apparatus for ground-based separations; and design of apparatus for performing simple phase partitioning space experiments, including examination of mechanisms for separating phases in the absence of gravity.

Multilevel ensemble Kalman filtering

KAUST Repository

Hoel, Haakon

2016-01-08

The ensemble Kalman filter (EnKF) is a sequential filtering method that uses an ensemble of particle paths to estimate the means and covariances required by the Kalman filter by the use of sample moments, i.e., the Monte Carlo method. EnKF is often both robust and efficient, but its performance may suffer in settings where the computational cost of accurate simulations of particles is high. The multilevel Monte Carlo method (MLMC) is an extension of classical Monte Carlo methods which by sampling stochastic realizations on a hierarchy of resolutions may reduce the computational cost of moment approximations by orders of magnitude. In this work we have combined the ideas of MLMC and EnKF to construct the multilevel ensemble Kalman filter (MLEnKF) for the setting of finite dimensional state and observation spaces. The main ideas of this method is to compute particle paths on a hierarchy of resolutions and to apply multilevel estimators on the ensemble hierarchy of particles to compute Kalman filter means and covariances. Theoretical results and a numerical study of the performance gains of MLEnKF over EnKF will be presented. Some ideas on the extension of MLEnKF to settings with infinite dimensional state spaces will also be presented.

Multilevel ensemble Kalman filtering

KAUST Repository

Hoel, Haakon; Chernov, Alexey; Law, Kody; Nobile, Fabio; Tempone, Raul

2016-01-01

The ensemble Kalman filter (EnKF) is a sequential filtering method that uses an ensemble of particle paths to estimate the means and covariances required by the Kalman filter by the use of sample moments, i.e., the Monte Carlo method. EnKF is often both robust and efficient, but its performance may suffer in settings where the computational cost of accurate simulations of particles is high. The multilevel Monte Carlo method (MLMC) is an extension of classical Monte Carlo methods which by sampling stochastic realizations on a hierarchy of resolutions may reduce the computational cost of moment approximations by orders of magnitude. In this work we have combined the ideas of MLMC and EnKF to construct the multilevel ensemble Kalman filter (MLEnKF) for the setting of finite dimensional state and observation spaces. The main ideas of this method is to compute particle paths on a hierarchy of resolutions and to apply multilevel estimators on the ensemble hierarchy of particles to compute Kalman filter means and covariances. Theoretical results and a numerical study of the performance gains of MLEnKF over EnKF will be presented. Some ideas on the extension of MLEnKF to settings with infinite dimensional state spaces will also be presented.

Teaching Multilevel Adult ESL Classes. ERIC Digest.

Science.gov (United States)

Shank, Cathy C.; Terrill, Lynda R.

Teachers in multilevel adult English-as-a-Second-Language classes are challenged to use a variety of materials, activities, and techniques to engage the interest of the learners and assist them in their educational goals. This digest recommends ways to choose and organize content for multilevel classes, explains grouping strategies, discusses a…

Multilevel Higher-Order Item Response Theory Models

Science.gov (United States)

Huang, Hung-Yu; Wang, Wen-Chung

2014-01-01

In the social sciences, latent traits often have a hierarchical structure, and data can be sampled from multiple levels. Both hierarchical latent traits and multilevel data can occur simultaneously. In this study, we developed a general class of item response theory models to accommodate both hierarchical latent traits and multilevel data. The…

Theory of mind in schizophrenia: correlation with clinical symptomatology, emotional recognition and ward behavior.

Science.gov (United States)

Lee, Woo Kyeong; Kim, Yong Kyu

2013-09-01

Several studies have suggested the presence of a theory of mind (ToM) deficit in schizophrenic disorders. This study examined the relationship of emotion recognition, theory of mind, and ward behavior in patients with schizophrenia. Fifty-five patients with chronic schizophrenia completed measures of emotion recognition, ToM, intelligence, Positive and Negative Syndrome Scale (PANSS) and Nurse's Observation Scale for Inpatient Evaluation (NOSIE). Theory of mind sum score correlated significantly with IQ, emotion recognition, and ward behavior. Ward behavior was linked to the duration of the illness, and even more so to theory of mind deficits. Theory of mind contributed a significant proportion of the amount of variance to explain social behavior on the ward. Considering our study results, impaired theory of mind contributes significantly to the understanding of social competence in patients with schizophrenia. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

Canonical symmetry of a constrained Hamiltonian system and canonical Ward identity

International Nuclear Information System (INIS)

Li, Zi-ping

1995-01-01

An algorithm for the construction of the generators of the gauge transformation of a constrained Hamiltonian system is given. The relationships among the coefficients connecting the first constraints in the generator are made clear. Starting from the phase space generating function of the Green function, the Ward identity in canonical formalism is deduced. We point out that the quantum equations of motion in canonical form for a system with singular Lagrangian differ from the classical ones whether Dirac's conjecture holds true or not. Applications of the present formulation to the Abelian and non-Abelian gauge theories are given. The expressions for PCAC and generalized PCAC of the AVV vertex are derived exactly from another point of view. A new form of the Ward identity for gauge-ghost proper vertices is obtained which differs from the usual Ward-Takahashi identity arising from the BRS invariance

Shielding estimation for nuclear medicine therapy ward: our experience

International Nuclear Information System (INIS)

Skopljak-Beganovic, A.; Kucukalic-Selimovic, E.; Beganovic, A.; Drljevic, A.

2008-01-01

Full text: The aim of this study was to calculate and estimate the shielding thickness for a new Nuclear Medicine Therapy Ward. Parameters available for shielding calculation were: ground plan of the ward, radionuclides planned for use, maximum administered activity of I-131, maximum delivered activity of I-131 to the ward per week, average time spent in the hospital after the treatment. The most hazardous and most commonly used radioisotope is I-131. The target dose that needs to be met for occupationally exposed workers is 0.3 mSv per year. There are several factors that could be changed in order to achieve this value: distance from the source, shielding thickness, angle of incidence, occupational and usage factors. The maximum dose rate at 1 meter from the thyroid gland of the patient was considered to be 100 mSv/h. The distances and incidence angles could not be changed since these vales were predetermined in the ground plan. Different usage and occupational factors were used for different rooms in the ward. We used occupational factor 1 for the bed and 1/6 for the bathroom, and usage factor 1 for nurses' room and patient room and 1/6 for the corridors, etc. The easiest way of calculating dose attenuation in material was by introducing the HVL and TVL for broad beams. TVL and HVL were taken from the graph.The results show that shielding thickness should be in the range of 3 mmPb for room doors to 30 mmPb for the wall adjacent to the nurse's office. Most of the walls are 20 mmPb thick. These values were calculated using conservative assumptions and are more then enough to protect staff, patients and public from external radiation. If the construction cannot support the weight of lead some rearrangements regarding patient positions could be made. (author)

The Design and Simulation of Natural Personalised Ventilation (NPV System for Multi-Bed Hospital Wards

Directory of Open Access Journals (Sweden)

Zulfikar A. Adamu

2015-05-01

Full Text Available Adequate ventilation is necessary for thermal comfort and reducing risks from infectious bio-aerosols in hospital wards, but achieving this with mechanical ventilation has carbon and energy implications. Natural ventilation is often limited to window-based designs whose dilution/mixing effectiveness are subject to constraints of wind speed, cross ventilation, and in the case of hospital wards, proximity of patients to external walls. A buoyancy-driven natural ventilation system capable of achieving dilution/mixing was shown to be feasible in a preceding study of novel system called natural personalised ventilation (NPV. This system combined both architecture and airflow engineering principles of space design and buoyancy and was tested and validated (salt-bath experiment for a single bed ward. This research extends the previous work and is proof-of-concept on the feasibility of NPV system for multi-bed wards. Two different four-bed ward types were investigated of using computational fluid dynamics (CFD simulations under wind-neutral conditions. Results predict that NPV system could deliver fresh air to multiple patients, including those located 10 m away from external wall, with absolute flow rates of between 32 L·s−1 and 54 L·s−1 for each patient/bed. Compared to same wards simulated using window design, ingress of airborne contaminants into patients’ breathing zone and summer overheating potential were minimised, while overall ward dilution was maximised. Findings suggest the NPV has potentials for enabling architects and building service engineers to decouple airflow delivery from the visualisation and illumination responsibilities placed upon windows.

Barriers to Nurse-Patient Communication in Cardiac Surgery Wards: A Qualitative Study

Science.gov (United States)

Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

2014-01-01

Background: An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. Objectives: The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. Design and Methods: This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Results: Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Conclusions: Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care. PMID:25363126

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.

Plane partition vesicles

International Nuclear Information System (INIS)

Rensburg, E J Janse van; Ma, J

2006-01-01

We examine partitions and their natural three-dimensional generalizations, plane partitions, as models of vesicles undergoing an inflation-deflation transition. The phase diagrams of these models include a critical point corresponding to an inflation-deflation transition, and exhibits multicritical scaling in the vicinity of a multicritical point located elsewhere on the critical curve. We determine the locations of the multicritical points by analysing the generating functions using analytic and numerical means. In addition, we determine the numerical values of the multicritical scaling exponents associated with the multicritical scaling regimes in these models

The importance of applying an appropriate data partitioning

CERN Document Server

Dimitrov, Gancho; The ATLAS collaboration

2015-01-01

In this presentation are described specific technical solutions put in place in various database applications of the ATLAS experiment at LHC where we make use of several partitioning techniques available in Oracle 11g. With the broadly used range partitioning and its option of automatic interval partitioning we add our own logic in PLSQL procedures and scheduler jobs to sustain data sliding windows in order to enforce various data retention policies. We also make use of the new Oracle 11g reference partitioning in the ATLAS Nightly Build System to achieve uniform data segmentation. However the most challenging was to segment the data of the new ATLAS Distributed Data Management system, which resulted in tens of thousands list type partitions and sub-partitions. Partition and sub-partition management, index strategy, statistics gathering and queries execution plan stability are important factors when choosing an appropriate physical model for the application data management. The so-far accumulated knowledge wi...

[Specificity of the anaerobic bacterial infections in the surgical and orthopedic wards].

Science.gov (United States)

Kierzkowska, Marta; Majewska, Anna; Sawicka-Grzelak, Anna; Młynarczyk, Andrzej; Ładomirska-Pestkowska, Katarzvna; Młynarczyk, Grazyna

2012-01-01

The aim of this study was to estimate the contribution strictly anaerobic bacteria in the etiology of infections in patients on surgery and orthopedic wards. We examined 159 samples taken from patients hospitalized in surgical wards and 179 clinical specimens taken from orthopedic patients. Clinical strains of obligate anaerobes were identified by API 20A biochemical tests (ATB Expression, bioMerieux S.A., France). Susceptibility of the clinical strains was examined by ATB ANA (bioMerieux S.A., France) system. The MIC values were determined by the gradient diffusion method, Etest (AB BIODISK, Sweden i bioMerieux S.A., France). Gram-negative bacteria predominant in the samples taken from surgical patients, Most frequently we isolated rods of the genus Bacteroides (26%): B. fragilis, B. ovatus/B. thetaiotaomicron, and B. distasonis. In 44 samples (28%) we identified only anaerobic bacteria. Multibacterial isolations, with the participation of anaerobic and aerobic flora, dominated among patients in the study. Overall 238 strictly anaerobic bacteria were cultured from patients hospitalized in orthopedic wards. Gram-positive bacteria accounted for 78%. The most frequently were isolated Peptostreptococcus (56%), Propionibacterium (10%) species. In this study all Bacteroides strains were resistant to penicillin G. Some species were resistant to clindamycin, as well. Overall 40% of Bacteroides strains taken from surgical and 50% isolated from orthopedic wards showed no sensitivity to this antibiotic. A similar phenomenon was observed among bacteria of the genus Prevotella. In samples taken from orthopedic patients we observed the predominance of Gram-positive anaerobic bacteria. Some of them were part of the normal flora but they should not be excluded as an etiology agents of infection. The specimens taken from patients treated in surgical wards showed the presence of a mixed microflora, which included aerobic and anaerobic bacteria, primarily Gram-negative rods

Multilevel Cultural Issues

NARCIS (Netherlands)

van Herk, H.; Fischer, Ronald; van Herk, Hester; Torelli, Carlos J.

2017-01-01

Multi-level structures are omnipresent. Consumers live in geographical locations, shop in specific stores, or are members of clubs. Consumers who belong to the same group share characteristics and are expected to be more similar than consumers belonging to another group. In data analysis this

Establishing female-only areas in psychiatry wards to improve safety and quality of care for women.

Science.gov (United States)

Kulkarni, Jayashri; Gavrilidis, Emmy; Lee, Stuart; Van Rheenen, Tamsyn E; Grigg, Jasmin; Hayes, Emily; Lee, Adeline; Ong, Roy; Seeary, Amy; Andersen, Shelley; Worsley, Rosie; Keppich-Arnold, Sandra; Stafrace, Simon

2014-12-01

Our aim was to assess the impact of creating a female-only area within a mixed-gender inpatient psychiatry service, on female patient safety and experience of care. The Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area. Documented incidents compromising the safety of women on each ward in the 6 months following the refurbishment were compared. Further, a questionnaire assessing perceived safety and experience of care was administered to female inpatients on both wards, and staff feedback was also obtained. The occurrence of documented incidents compromising females' safety was found to be significantly lower on the ward containing a female-only area. Women staying on this ward rated their perceived safety and experience of care significantly more positively than women staying where no such gender segregation was available. Further, the female-only area was identified by the majority of surveyed staff to provide a safer environment for female patients. Establishing female-only areas in psychiatry wards is an effective way to improve the safety and experience of care for female patients. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Post natal use of analgesics: comparisons between conventional postnatal wards and a maternity hotel.

Science.gov (United States)

Nordeng, Hedvig; Eskild, Anne; Nesheim, Britt-Ingjerd

2010-04-01

To investigate factors related to analgesic use after delivery, and especially whether rates of analgesic use were different in a midwife-managed maternity hotel as compared to conventional postnatal wards. One maternity hotel and two conventional postnatal wards at Ullevål University Hospital in Oslo, Norway. Data were obtained from hospital records for 804 women with vaginal deliveries. Postnatal analgesic use. Overall, approximately half the women used analgesics after vaginal delivery in both conventional postnatal wards and maternity hotel. The factors that were significantly associated with use of analgesics postnatally in multivariate analysis were multiparity, having a non-Western ethnicity, smoking in pregnancy, younger age, instrumental delivery, analgesic use during labour, maternal complications post partum, and duration of postnatal stay 4 days or more. The use of analgesics is determined by socio-demographic and obstetric factors rather than the organisation of the ward.

Present status of partitioning developments

International Nuclear Information System (INIS)

Nakamura, Haruto; Kubota, Masumitsu; Tachimori, Shoichi

1978-09-01

Evolution and development of the concept of partitioning of high-level liquid wastes (HLLW) in nuclear fuel reprocessing are reviewed historically from the early phase of separating useful radioisotopes from HLLW to the recent phase of eliminating hazardous nuclides such as transuranium elements for safe waste disposal. Since the criteria in determining the nuclides for elimination and the respective decontamination factors are important in the strategy of partitioning, current views on the criteria are summarized. As elimination of the transuranium is most significant in the partitioning, various methods available of separating them from fission products are evaluated. (auth.)

Evaluation of bio-aerosols concentration in the different wards of three educational hospitals in Iran

Directory of Open Access Journals (Sweden)

Heshmatollah Nourmoradi

2012-01-01

Full Text Available Aims: The aim of this study was to evaluate the bioaerosols level in the various parts of three educational hospitals of Isfahan, Iran. Materials and Methods: The collection of bioaerosols (including bacterial and fungal microorganisms was carried out with one-stage Anderson sampler. The sampling was carried out at the height of 1.5 m from the floor of various hospitals wards (infectious, surgery, urology wards, and operating room. The volume of each sample was determined based on pre-tests carried and was about 50 L. After sampling, the samples were incubated and analyzed. The effect of various environmental conditions including humidity, temperature, and outdoor bioaerosol levels was also investigated. Results: The lowest numbers of fungal and bacterial concentration were obtained in operating rooms of the hospitals and the highest concentration was observed in infectious disease wards of hospital 1 and 2 and surgery ward of hospital 3. The bacterial concentration was observed to be higher in hospital wards than outdoor, except hospitals′ operating rooms. Conclusion: The findings showed that the bioaerosols level in the hospitals was relatively high. The higher levels of indoor bacteria than outdoor might be associated with the presence of patients, their activity, unsuitable ventilation, and disinfection. Therefore, environmental monitoring and control measures are required to improve hospital environmental quality especially in the wards with immune deficiency patients.

Classification algorithms using adaptive partitioning

KAUST Repository

Binev, Peter; Cohen, Albert; Dahmen, Wolfgang; DeVore, Ronald

2014-01-01

© 2014 Institute of Mathematical Statistics. Algorithms for binary classification based on adaptive tree partitioning are formulated and analyzed for both their risk performance and their friendliness to numerical implementation. The algorithms can be viewed as generating a set approximation to the Bayes set and thus fall into the general category of set estimators. In contrast with the most studied tree-based algorithms, which utilize piecewise constant approximation on the generated partition [IEEE Trans. Inform. Theory 52 (2006) 1335.1353; Mach. Learn. 66 (2007) 209.242], we consider decorated trees, which allow us to derive higher order methods. Convergence rates for these methods are derived in terms the parameter - of margin conditions and a rate s of best approximation of the Bayes set by decorated adaptive partitions. They can also be expressed in terms of the Besov smoothness β of the regression function that governs its approximability by piecewise polynomials on adaptive partition. The execution of the algorithms does not require knowledge of the smoothness or margin conditions. Besov smoothness conditions are weaker than the commonly used Holder conditions, which govern approximation by nonadaptive partitions, and therefore for a given regression function can result in a higher rate of convergence. This in turn mitigates the compatibility conflict between smoothness and margin parameters.

Classification algorithms using adaptive partitioning

KAUST Repository

Binev, Peter

2014-12-01

© 2014 Institute of Mathematical Statistics. Algorithms for binary classification based on adaptive tree partitioning are formulated and analyzed for both their risk performance and their friendliness to numerical implementation. The algorithms can be viewed as generating a set approximation to the Bayes set and thus fall into the general category of set estimators. In contrast with the most studied tree-based algorithms, which utilize piecewise constant approximation on the generated partition [IEEE Trans. Inform. Theory 52 (2006) 1335.1353; Mach. Learn. 66 (2007) 209.242], we consider decorated trees, which allow us to derive higher order methods. Convergence rates for these methods are derived in terms the parameter - of margin conditions and a rate s of best approximation of the Bayes set by decorated adaptive partitions. They can also be expressed in terms of the Besov smoothness β of the regression function that governs its approximability by piecewise polynomials on adaptive partition. The execution of the algorithms does not require knowledge of the smoothness or margin conditions. Besov smoothness conditions are weaker than the commonly used Holder conditions, which govern approximation by nonadaptive partitions, and therefore for a given regression function can result in a higher rate of convergence. This in turn mitigates the compatibility conflict between smoothness and margin parameters.

Occurrence of airborne vancomycin- and gentamicin-resistant bacteria in various hospital wards in Isfahan, Iran.

Science.gov (United States)

Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmad, Hossein; Hassanzadeh, Akbar

2016-01-01

Airborne transmission of pathogenic resistant bacteria is well recognized as an important route for the acquisition of a wide range of nosocomial infections in hospitals. The aim of this study was to determine the prevalence of airborne vancomycin and gentamicin (VM and GM) resistant bacteria in different wards of four educational hospitals. A total of 64 air samples were collected from operating theater (OT), Intensive Care Unit (ICU), surgery ward, and internal medicine ward of four educational hospitals in Isfahan, Iran. Airborne culturable bacteria were collected using all glass impingers. Samples were analyzed for the detection of VM- and GM-resistant bacteria. The average level of bacteria ranged from 99 to 1079 CFU/m(3). The highest level of airborne bacteria was observed in hospital 4 (628 CFU/m(3)) and the highest average concentration of GM- and VM-resistant airborne bacteria were found in hospital 3 (22 CFU/m(3)). The mean concentration of airborne bacteria was the lowest in OT wards and GM- and VM-resistant airborne bacteria were not detected in this ward of hospitals. The highest prevalence of antibiotic-resistant airborne bacteria was observed in ICU ward. There was a statistically significant difference for the prevalence of VM-resistant bacteria between hospital wards (P = 0.012). Our finding showed that the relatively high prevalence of VM- and GM-resistant airborne bacteria in ICUs could be a great concern from the point of view of patients' health. These results confirm the necessity of application of effective control measures which significantly decrease the exposure of high-risk patients to potentially airborne nosocomial infections.

Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis

Directory of Open Access Journals (Sweden)

Krautter M

2014-09-01

Full Text Available Markus Krautter,1 Sven Andreesen,2 Nadja Köhl-Hackert,2 Katja Hoffmann,3 Wolfgang Herzog,2 Christoph Nikendei2 1Department of Nephrology, University of Heidelberg, 2Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, 3Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany Background: Peer-assisted learning (PAL has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective.Purpose: To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors.Methods: A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80. The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants. The discussions were analyzed using content analysis.Results: The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available.Conclusion: On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor–student working alliance

Limits of Freedom: The Ward Churchill Case

Science.gov (United States)

O'Nell, Robert M.

2006-01-01

The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…

Numerical investigation of airborne infection in naturally ventilated hospital wards with central-corridor type

DEFF Research Database (Denmark)

Zhou, Qi; Qian, Hua; Liu, Li

2018-01-01

Natural ventilation is believed to control airborne infection due to high ventilation rates while an undesired flow pattern may cause infection transmission in hospital wards. A computational fluid dynamics simulation was carried out in this study to investigate the impact of airflow pattern....... The results not only give direct evidence to strongly support World Health Organization’s recommendation but also suggest required amendment of the Chinese standard GB 51039-2014 to improve ventilation arrangement in general hospital wards in China. Our findings are useful for improving the future design...... of general hospital wards for airborne infection control....

Nurses' personal and ward accountability and missed nursing care: A cross-sectional study.

Science.gov (United States)

Srulovici, Einav; Drach-Zahavy, Anat

2017-10-01

Missed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses' values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses' socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods. This study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses' assessments of missed nursing care. A cross-sectional design, where nurses were nested in wards. A total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals. Missed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses' socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy. Focal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean=1.87, SD=0.71 and Mean=2.09, SD=0.84, respectively; r=0.55, ppersonal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β=-0.29, p0.05). The interaction effect was significant (β=-0.31, ppersonal accountability and missed nursing care. Similar patterns were obtained for the incoming nurses' assessment of focal nurse's missed care. Use of focal and incoming nurses' missed nursing care assessments limited the common source bias and strengthened our findings. Personal and ward accountability are significant values, which are associated with

Multi-level converter with auxiliary resonant-commutated pole

NARCIS (Netherlands)

Dijkhuizen, F.R.; Duarte, J.L.; Groningen, van W.D.H.

1998-01-01

The family of multi-level power converters offers advantages for high-power, high-voltage systems. A multi-level nested-cell structure has the attractive feature of static and dynamic voltage sharing among the switches. This is achieved by using clamping capacitors (floating capacitors) rather than

The Benefits of Adaptive Partitioning for Parallel AMR Applications

Energy Technology Data Exchange (ETDEWEB)

Steensland, Johan [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Advanced Software Research and Development

2008-07-01

Parallel adaptive mesh refinement methods potentially lead to realistic modeling of complex three-dimensional physical phenomena. However, the dynamics inherent in these methods present significant challenges in data partitioning and load balancing. Significant human resources, including time, effort, experience, and knowledge, are required for determining the optimal partitioning technique for each new simulation. In reality, scientists resort to using the on-board partitioner of the computational framework, or to using the partitioning industry standard, ParMetis. Adaptive partitioning refers to repeatedly selecting, configuring and invoking the optimal partitioning technique at run-time, based on the current state of the computer and application. In theory, adaptive partitioning automatically delivers superior performance and eliminates the need for repeatedly spending valuable human resources for determining the optimal static partitioning technique. In practice, however, enabling frameworks are non-existent due to the inherent significant inter-disciplinary research challenges. This paper presents a study of a simple implementation of adaptive partitioning and discusses implied potential benefits from the perspective of common groups of users within computational science. The study is based on a large set of data derived from experiments including six real-life, multi-time-step adaptive applications from various scientific domains, five complementing and fundamentally different partitioning techniques, a large set of parameters corresponding to a wide spectrum of computing environments, and a flexible cost function that considers the relative impact of multiple partitioning metrics and diverse partitioning objectives. The results show that even a simple implementation of adaptive partitioning can automatically generate results statistically equivalent to the best static partitioning. Thus, it is possible to effectively eliminate the problem of determining the

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

NARCIS (Netherlands)

Bowers, L.; Jeffery, D.; Simpson, A.; Daly, C.; Warren, J.; Nijman, H.L.I.

2007-01-01

Aim. This paper reports in examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week oil acute Psychiatric wards. Background. Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and

Ward-Takahashi identities in quantum electrodynamics

Energy Technology Data Exchange (ETDEWEB)

Nishijima, K; Sasaki, R [Tokyo Univ. (Japan). Dept. of Physics

1975-03-01

The Ward-Takahashi identities are derived for connected Green's functions in quantum electrodynamics without recourse to equal-time commutation relations, field equations and the Feynman-Dyson perturbation expansions. The argument is based on the dispersion formulation of field theories and only finite expressions are used throughout this derivation. These identities are shown to be consequences of the subtraction conditions imposed upon the 2-, 3- and 4-point Green's functions.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care.

Science.gov (United States)

Tuvesson, Hanna; Wann-Hansson, Christine; Eklund, Mona

2011-06-16

The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

Directory of Open Access Journals (Sweden)

Wann-Hansson Christine

2011-06-01

Full Text Available Abstract Background The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. Methods 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. Results The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. Conclusions The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

Validation of a checklist to assess ward round performance in internal medicine

DEFF Research Database (Denmark)

Nørgaard, Kirsten; Ringsted, Charlotte; Dolmans, Diana

2004-01-01

and construct validity of the task-specific checklist. METHODS: To determine content validity, a questionnaire was mailed to 295 internists. They were requested to give their opinion on the relevance of each item included on the checklist and to indicate the comprehensiveness of the checklist. To determine...... construct validity, an observer assessed 4 groups of doctors during performance of a complete ward round (n = 32). The nurse who accompanied the doctor on rounds made a global assessment of the performance. RESULTS: The response rate to the questionnaire was 80.7%. The respondents found that all 10 items......BACKGROUND: Ward rounds are an essential responsibility for doctors in hospital settings. Tools for guiding and assessing trainees' performance of ward rounds are needed. A checklist was developed for that purpose for use with trainees in internal medicine. OBJECTIVE: To assess the content...

Clinical leadership for high-quality care: developing future ward leaders.

Science.gov (United States)

Enterkin, Judith; Robb, Elizabeth; McLaren, Susan

2013-03-01

This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention. © 2012 Blackwell Publishing Ltd.

A multilevel evolutionary framework for sustainability analysis

Directory of Open Access Journals (Sweden)

Timothy M. Waring

2015-06-01

Full Text Available Sustainability theory can help achieve desirable social-ecological states by generalizing lessons across contexts and improving the design of sustainability interventions. To accomplish these goals, we argue that theory in sustainability science must (1 explain the emergence and persistence of social-ecological states, (2 account for endogenous cultural change, (3 incorporate cooperation dynamics, and (4 address the complexities of multilevel social-ecological interactions. We suggest that cultural evolutionary theory broadly, and cultural multilevel selection in particular, can improve on these fronts. We outline a multilevel evolutionary framework for describing social-ecological change and detail how multilevel cooperative dynamics can determine outcomes in environmental dilemmas. We show how this framework complements existing sustainability frameworks with a description of the emergence and persistence of sustainable institutions and behavior, a means to generalize causal patterns across social-ecological contexts, and a heuristic for designing and evaluating effective sustainability interventions. We support these assertions with case examples from developed and developing countries in which we track cooperative change at multiple levels of social organization as they impact social-ecological outcomes. Finally, we make suggestions for further theoretical development, empirical testing, and application.

Modelling of coughed droplets in a hospital ward

DEFF Research Database (Denmark)

Sadrizadeh, Sasan; Nielsen, Peter Vilhelm

2016-01-01

Coughing and its importance for spreading respiratory infectious diseases has been confirmed in many previous studies. The dispersion process of respiratory droplets released by the coughing of a patient in a hospital ward was studied using computational fluid dynamics simulation. Two relatively ...

Characteristics of aggression among psychiatric inpatients by ward type in Japan: Using the Staff Observation Aggression Scale - Revised (SOAS-R).

Science.gov (United States)

Sato, Makiko; Noda, Toshie; Sugiyama, Naoya; Yoshihama, Fumihiro; Miyake, Michi; Ito, Hiroto

2017-12-01

Aggressive behaviour by psychiatric patients is a serious issue in clinical practice, and adequate management of such behaviour is required, with careful evaluation of the factors causing the aggression. To examine the characteristics of aggressive incidents by ward type, a cross-sectional descriptive study was conducted for 6 months between April 2012 and June 2013 using the Staff Observation Aggression Scale - Revised, Japanese version (SOAS-R) in 30 wards across 20 Japanese psychiatric hospitals. Participating wards were categorized into three types based on the Japanese medical reimbursement system: emergency psychiatric, acute psychiatric, and standard wards (common in Japan, mostly treating non-acute patients). On analyzing the 443 incidents reported, results showed significant differences in SOAS-R responses by ward type. In acute and emergency psychiatric wards, staff members were the most common target of aggression. In acute psychiatric wards, staff requiring patients to take medication was the most common provocation, and verbal aggression was the most commonly used means. In emergency psychiatric wards, victims felt threatened. In contrast, in standard wards, both the target and provocation of aggression were most commonly other patients, hands were used, victims reported experiencing physical pain, and seclusion was applied to stop their behaviour. These findings suggest that ward environment was an important factor influencing aggressive behaviour. Ensuring the quality and safety of psychiatric care requires understanding the characteristics of incidents that staff are likely to encounter in each ward type, as well as implementing efforts to deal with the incidents adequately and improve the treatment environment. © 2016 Australian College of Mental Health Nurses Inc.

Multilevel sparse functional principal component analysis.

Science.gov (United States)

Di, Chongzhi; Crainiceanu, Ciprian M; Jank, Wolfgang S

2014-01-29

We consider analysis of sparsely sampled multilevel functional data, where the basic observational unit is a function and data have a natural hierarchy of basic units. An example is when functions are recorded at multiple visits for each subject. Multilevel functional principal component analysis (MFPCA; Di et al. 2009) was proposed for such data when functions are densely recorded. Here we consider the case when functions are sparsely sampled and may contain only a few observations per function. We exploit the multilevel structure of covariance operators and achieve data reduction by principal component decompositions at both between and within subject levels. We address inherent methodological differences in the sparse sampling context to: 1) estimate the covariance operators; 2) estimate the functional principal component scores; 3) predict the underlying curves. Through simulations the proposed method is able to discover dominating modes of variations and reconstruct underlying curves well even in sparse settings. Our approach is illustrated by two applications, the Sleep Heart Health Study and eBay auctions.

Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward.

Science.gov (United States)

Angelhoff, Charlotte; Edéll-Gustafsson, Ulla; Mörelius, Evalotte

2018-02-01

To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge. Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child. This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood. The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family. © 2017 John Wiley & Sons Ltd.

Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital.

Science.gov (United States)

Hung, Man Yui; Wright, David John; Blacklock, Jeanette; Needle, Richard John

2017-01-01

A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs) in order to inform future innovations of a similar nature. Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance. Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months. It was believed that by locating pharmacists on the ward full time and allowing them to undertake medicines administration and medicines reconciliation, the nursing time would be saved and medicines safety improved. There was however significant learning to be derived from the implementation

Proposed Novel Multiphase-Multilevel Inverter Configuration for Open-End Winding Loads

DEFF Research Database (Denmark)

Padamanaban, Sanjeevi Kumar; Wheeler, Patrick; Blaabjerg, Frede

2016-01-01

This paper presents a new multiphase-multilevel inverter configuration for open-winding loads and suitable for medium power (low-voltage/high-current) applications such as `More Electric Aircraft'. Modular structure comprised of standard dual three-phase voltage source inverter (VSI) along with one...... is developed in this work and overcomes the complexity of standard space vector modulations, easy for real implementation purposes in digital processors. Proposed six-phase multilevel inverter configuration generates multilevel outputs with benefit in comprises with standard multilevel inverter topologies...

Ward identity for non-equilibrium Fermi systems

Czech Academy of Sciences Publication Activity Database

Velický, B.; Kalvová, Anděla; Špička, Václav

2008-01-01

Roč. 77, č. 4 (2008), 041201/1-041201/4 ISSN 1098-0121 R&D Projects: GA ČR GC202/07/J051 Institutional research plan: CEZ:AV0Z10100520; CEZ:AV0Z10100521 Keywords : non-equilibrium * Green’s functions * quantum transport equations * Ward identity Subject RIV: BE - Theoretical Physics Impact factor: 3.322, year: 2008

Gentile statistics and restricted partitions

Indian Academy of Sciences (India)

The partition function of Gentile statistics also has the property that it nicely interpolates between the ... We now construct the partition function for such a system which also incorporates the property of interpolation ... As in [4], we however keep s arbitrary even though for s > 2 there are no quadratic. Hamiltonian systems.

The importance of having an appropriate data segmentation (partitioning)

CERN Document Server

Dimitrov, Gancho; The ATLAS collaboration

2014-01-01

In this presentation will be shown real life examples from database applications in the ATLAS experiment @ LHC where we make use of many Oracle partitioning techniques available in Oracle 11g. With the broadly used range partitioning and its option of automatic interval partitioning we add our own logic in PLSQL for sustaining data sliding windows in order to enforce various data retention policies. We also make use of the reference partitioning in some use cases, however the most challenging was to segment the data of a large bookkeeping system which resulted in tens of thousands list partitions and list sub-partitions. Partition and sub-partition management, index strategy, statistics gathering and queries execution plan stability are important factors when choosing an appropriate for the use case data management model. The gained experience with all of those will be shared with the audience.

Long bone reconstruction using multilevel lengthening of bone defect fragments.

Science.gov (United States)

Borzunov, Dmitry Y

2012-08-01

This paper presents experimental findings to substantiate the use of multilevel bone fragment lengthening for managing extensive long bone defects caused by diverse aetiologies and shows its clinical introduction which could provide a solution for the problem of reducing the total treatment time. Both experimental and clinical multilevel lengthening to bridge bone defect gaps was performed with the use of the Ilizarov method only. The experimental findings and clinical outcomes showed that multilevel defect fragment lengthening could provide sufficient bone formation and reduction of the total osteosynthesis time in one stage as compared to traditional Ilizarov bone transport. The method of multilevel regeneration enabled management of critical-size defects that measured on average 13.5 ± 0.7 cm in 78 patients. The experimental and clinical results proved the efficiency of the Ilizarov non-free multilevel bone plasty that can be recommended for practical use.

Synchronous Control of Modular Multilevel Converters

DEFF Research Database (Denmark)

Oleschuk, Valentin; Blaabjerg, Frede; Bose, Bimal K.

2002-01-01

A novel method of direct synchronous pulsewidth modulation (PWM) is applied for control of modular multilevel converters consisting from three standard triphase inverter modules along with an 0.33 p.u. output transformer. The proposed method provides synchronisation of the voltage waveforms...... for each module and the composed voltage at the output of the converter. Multilevel output voltage of the converter has quarter-wave symmetry during the whole range including the zone of overmodulation. Both continuous and discontinuous versions of synchronous PWM, based on vector approach...

Generating Milton Babbitt's all-partition arrays

OpenAIRE

Bemman, Brian; Meredith, David

2016-01-01

In most of Milton Babbitt's (1916–2011) works written since the early 1960s, both the pitch and rhythmic content is organized according to a highly constrained structure known as the all-partition array. The all-partition array provides a framework that ensures that as many different forms of a tone row as possible (generated by any combination of transposition, inversion or reversal) are expressed 'horizontally' and that each integer partition of 12 whose cardinality is no greater than the n...

Lift of dilogarithm to partition identities

International Nuclear Information System (INIS)

Terhoeven, M.

1992-11-01

For the whole set of dilogarithm identities found recently using the thermodynamic Bethe-Ansatz for the ADET series of purely elastic scattering theories we give partition identities which involve characters of those conformal field theories which correspond to the UV-limits of the scattering theories. These partition identities in turn allow to derive the dilogarithm identities using modular invariance and a saddle point approximation. We conjecture on possible generalizations of this correspondance, namely, a lift from dilogarithm to partition identities. (orig.)

Evaluation of Pharmacists' Participation in Post-Admission Ward ...

African Journals Online (AJOL)

Objective: The study evaluates pharmacist's perception of and participation in post-admission ward rounds, at the Lagos University Teaching Hospital (LUTH). Method: All the 60 pharmacists covering various units of pharmaceutical services were administered a forty-two element structured questionnaire. Fifty (83.3%) ...

Towards the development of multilevel-multiagent diagnostic aids

International Nuclear Information System (INIS)

Stratton, R.C.; Jarrell, D.B.

1991-10-01

Presented here is our methodology for developing automated aids for diagnosing faults in complex systems. We have designed these aids as multilevel-multiagent diagnostic aids based on principles that should be generally applicable to any complex system. In this methodology, ''multilevel'' refers to information models described at successful levels of abstraction that are tied together in such a way that reasoning is directed to the appropriate level as determined by the problem solving requirements. The concept of ''multiagent'' refers to the method of information processing within the multilevel model network; each model in the network is an independent information processor, i.e., an intelligent agent. 19 refs., 15 figs., 9 tabs

Hand decontamination practices in paediatric wards

Directory of Open Access Journals (Sweden)

S Jelly

2003-09-01

Full Text Available The purpose of this study was to determine and describe hand decontamination practices of health care professionals in the paediatric wards of an academic hospital in Johannesburg. The purpose was addressed within a survey design and through the use of descriptive and comparative methods. Data were collected through direct observation conducted with the use of a researcher-administered checklist. A sample of sixtysix health professionals was obtained through convenience sampling.

Social influence on 5-year survival in a longitudinal chemotherapy ward co-presence network.

Science.gov (United States)

Lienert, Jeffrey; Marcum, Christopher Steven; Finney, John; Reed-Tsochas, Felix; Koehly, Laura

2017-09-01

Chemotherapy is often administered in openly designed hospital wards, where the possibility of patient-patient social influence on health exists. Previous research found that social relationships influence cancer patient's health; however, we have yet to understand social influence among patients receiving chemotherapy in the hospital. We investigate the influence of co-presence in a chemotherapy ward. We use data on 4,691 cancer patients undergoing chemotherapy in Oxfordshire, United Kingdom who average 59.8 years of age, and 44% are Male. We construct a network of patients where edges exist when patients are co-present in the ward, weighted by both patients' time in the ward. Social influence is based on total weighted co-presence with focal patients' immediate neighbors, considering neighbors' 5-year mortality. Generalized estimating equations evaluated the effect of neighbors' 5-year mortality on focal patient's 5-year mortality. Each 1,000-unit increase in weighted co-presence with a patient who dies within 5 years increases a patient's mortality odds by 42% ( β = 0.357, CI:0.204,0.510). Each 1,000-unit increase in co-presence with a patient surviving 5 years reduces a patient's odds of dying by 30% ( β = -0.344, CI:-0.538,0.149). Our results suggest that social influence occurs in chemotherapy wards, and thus may need to be considered in chemotherapy delivery.

Bayesian Optimal Experimental Design Using Multilevel Monte Carlo

KAUST Repository

Ben Issaid, Chaouki; Long, Quan; Scavino, Marco; Tempone, Raul

2015-01-01

Experimental design is very important since experiments are often resource-exhaustive and time-consuming. We carry out experimental design in the Bayesian framework. To measure the amount of information, which can be extracted from the data in an experiment, we use the expected information gain as the utility function, which specifically is the expected logarithmic ratio between the posterior and prior distributions. Optimizing this utility function enables us to design experiments that yield the most informative data for our purpose. One of the major difficulties in evaluating the expected information gain is that the integral is nested and can be high dimensional. We propose using Multilevel Monte Carlo techniques to accelerate the computation of the nested high dimensional integral. The advantages are twofold. First, the Multilevel Monte Carlo can significantly reduce the cost of the nested integral for a given tolerance, by using an optimal sample distribution among different sample averages of the inner integrals. Second, the Multilevel Monte Carlo method imposes less assumptions, such as the concentration of measures, required by Laplace method. We test our Multilevel Monte Carlo technique using a numerical example on the design of sensor deployment for a Darcy flow problem governed by one dimensional Laplace equation. We also compare the performance of the Multilevel Monte Carlo, Laplace approximation and direct double loop Monte Carlo.

Bayesian Optimal Experimental Design Using Multilevel Monte Carlo

KAUST Repository

Ben Issaid, Chaouki

2015-01-07

Experimental design is very important since experiments are often resource-exhaustive and time-consuming. We carry out experimental design in the Bayesian framework. To measure the amount of information, which can be extracted from the data in an experiment, we use the expected information gain as the utility function, which specifically is the expected logarithmic ratio between the posterior and prior distributions. Optimizing this utility function enables us to design experiments that yield the most informative data for our purpose. One of the major difficulties in evaluating the expected information gain is that the integral is nested and can be high dimensional. We propose using Multilevel Monte Carlo techniques to accelerate the computation of the nested high dimensional integral. The advantages are twofold. First, the Multilevel Monte Carlo can significantly reduce the cost of the nested integral for a given tolerance, by using an optimal sample distribution among different sample averages of the inner integrals. Second, the Multilevel Monte Carlo method imposes less assumptions, such as the concentration of measures, required by Laplace method. We test our Multilevel Monte Carlo technique using a numerical example on the design of sensor deployment for a Darcy flow problem governed by one dimensional Laplace equation. We also compare the performance of the Multilevel Monte Carlo, Laplace approximation and direct double loop Monte Carlo.

Data Partitioning Technique for Improved Video Prioritization

Directory of Open Access Journals (Sweden)

Ismail Amin Ali

2017-07-01

Full Text Available A compressed video bitstream can be partitioned according to the coding priority of the data, allowing prioritized wireless communication or selective dropping in a congested channel. Known as data partitioning in the H.264/Advanced Video Coding (AVC codec, this paper introduces a further sub-partition of one of the H.264/AVC codec’s three data-partitions. Results show a 5 dB improvement in Peak Signal-to-Noise Ratio (PSNR through this innovation. In particular, the data partition containing intra-coded residuals is sub-divided into data from: those macroblocks (MBs naturally intra-coded, and those MBs forcibly inserted for non-periodic intra-refresh. Interactive user-to-user video streaming can benefit, as then HTTP adaptive streaming is inappropriate and the High Efficiency Video Coding (HEVC codec is too energy demanding.

External equivalent type Ward aiming optimization studies in power systems; Equivalentes externos tipo Ward visando estudos de otimizacao em sistemas de potencia

Energy Technology Data Exchange (ETDEWEB)

Nepomuceno, Leonardo

1993-07-01

The execution of functions such as contingency analysis, optimization, reactive dispatch, etc, at the control centers requires appropriate models representing the non-observable parts (external system). The classical external equivalents have been developed considering basically the contingency analysis. This work points out the performance of the Extended Ward Equivalent (W.E.), which currently represents the state of art concerning reduced circuit based models. the work analyzes the W.E. response to changes occurred in optimization studied. Moreover, a new model, named INTERNAL REACTIVE WARD (WRINT), resulting from an adaptation of the W.E. is proposed focusing on the improvement of the equivalent in case of changes occurs in optimization studies. The model's general idea is to reflect the equivalent's capacity of reactive response into the internal system. Comparative computational test results are shown. The details of routines implementation are also pointed out. (author)

EXTENSION OF FORMULAS FOR PARTITION FUNCTIONS

African Journals Online (AJOL)

Ladan et al.

2Department of Mathematics, Ahmadu Bello University, Zaria. ... 2 + 1 + 1. = 1 + 1 + 1 + 1. Partition function ( ). Andrew and Erikson (2004) stated that the ..... Andrews, G.E., 1984, The Theory of Partitions, Cambridge ... Pure Appl. Math.

The partition dimension of cycle books graph

Science.gov (United States)

Santoso, Jaya; Darmaji

2018-03-01

Let G be a nontrivial and connected graph with vertex set V(G), edge set E(G) and S ⊆ V(G) with v ∈ V(G), the distance between v and S is d(v,S) = min{d(v,x)|x ∈ S}. For an ordered partition ∏ = {S 1, S 2, S 3,…, Sk } of V(G), the representation of v with respect to ∏ is defined by r(v|∏) = (d(v, S 1), d(v, S 2),…, d(v, Sk )). The partition ∏ is called a resolving partition of G if all representations of vertices are distinct. The partition dimension pd(G) is the smallest integer k such that G has a resolving partition set with k members. In this research, we will determine the partition dimension of Cycle Books {B}{Cr,m}. Cycle books graph {B}{Cr,m} is a graph consisting of m copies cycle Cr with the common path P 2. It is shown that the partition dimension of cycle books graph, pd({B}{C3,m}) is 3 for m = 2, 3, and m for m ≥ 4. pd({B}{C4,m}) is 3 + 2k for m = 3k + 2, 4 + 2(k ‑ 1) for m = 3k + 1, and 3 + 2(k ‑ 1) for m = 3k. pd({B}{C5,m}) is m + 1.

Quantum Dilogarithms and Partition q-Series

Science.gov (United States)

Kato, Akishi; Terashima, Yuji

2015-08-01

In our previous work (Kato and Terashima, Commun Math Phys. arXiv:1403.6569, 2014), we introduced the partition q-series for mutation loop γ—a loop in exchange quiver. In this paper, we show that for a certain class of mutation sequences, called reddening sequences, the graded version of partition q-series essentially coincides with the ordered product of quantum dilogarithm associated with each mutation; the partition q-series provides a state-sum description of combinatorial Donaldson-Thomas invariants introduced by Keller.

Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals.

Science.gov (United States)

Haug, Jon B; Myhr, Randi; Reikvam, Asmund

2011-12-13

Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics--that is second- and third-generation cephalosporins, carbapenems, and quinolones--in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval. There is a need for caution in

Federalism and multilevel governance

NARCIS (Netherlands)

van der Wusten, H.; Agnew, J.; Mamadouh, V.; Secor, A.J.; Sharp, J.

2015-01-01

Federalism and multilevel governance both emphasize polycentricity in governing arrangements. With their different intellectual pedigrees, these concepts are discussed in two separate sections. Fragments are now increasingly mixed up in hybrid forms of governance that also encompass originally

Enhancing the Leadership of Ward Councillors through Emotional ...

African Journals Online (AJOL)

This article focuses on how emotional intelligence could be utilised to enhance the leadership skill of ward councillors in the Buffalo City Metropolitan Municipality. In this article, the concept of emotional intelligence is considered to include aspects such as self-awareness, motivation, self-management, social awareness, ...

Exploring ward nurses' perceptions of continuing education in clinical settings.

Science.gov (United States)

Govranos, Melissa; Newton, Jennifer M

2014-04-01

Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. A case study approach was utilized. A major teaching hospital in Melbourne, Australia. A range of clinical nursing staff (n=23). Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong

Multilevel Image Segmentation Based on an Improved Firefly Algorithm

Directory of Open Access Journals (Sweden)

Kai Chen

2016-01-01

Full Text Available Multilevel image segmentation is time-consuming and involves large computation. The firefly algorithm has been applied to enhancing the efficiency of multilevel image segmentation. However, in some cases, firefly algorithm is easily trapped into local optima. In this paper, an improved firefly algorithm (IFA is proposed to search multilevel thresholds. In IFA, in order to help fireflies escape from local optima and accelerate the convergence, two strategies (i.e., diversity enhancing strategy with Cauchy mutation and neighborhood strategy are proposed and adaptively chosen according to different stagnation stations. The proposed IFA is compared with three benchmark optimal algorithms, that is, Darwinian particle swarm optimization, hybrid differential evolution optimization, and firefly algorithm. The experimental results show that the proposed method can efficiently segment multilevel images and obtain better performance than the other three methods.

Care practices of older people with dementia in the surgical ward: A questionnaire survey

Directory of Open Access Journals (Sweden)

Nina Hynninen

2016-11-01

Full Text Available Objectives: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. Methods: The data were collected from nursing staff (n = 191 working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items, specific characteristics of older people with dementia in a surgical ward (24 of items, specific characteristics of their care in a surgical ward (66 of items and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items. Results: The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. Conclusion: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

Integrity Based Access Control Model for Multilevel XML Document

Institute of Scientific and Technical Information of China (English)

HONG Fan; FENG Xue-bin; HUANO Zhi; ZHENG Ming-hui

2008-01-01

XML's increasing popularity highlights the security demand for XML documents. A mandatory access control model for XML document is presented on the basis of investigation of the function dependency of XML documents and discussion of the integrity properties of multilevel XML document. Then, the algorithms for decomposition/recovery multilevel XML document into/from single level document are given, and the manipulation rules for typical operations of XQuery and XUpdate: QUERY, INSERT,UPDATE, and REMOVE, are elaborated. The multilevel XML document access model can meet the requirement of sensitive information processing application.

Controlled Confrontation: The Ward Grievance Procedure of the California Youth Authority. An Exemplary Project.

Science.gov (United States)

National Inst. of Law Enforcement and Criminal Justice (Dept. of Justice/LEAA), Washington, DC.

The Ward Grievance Procedure of the California Youth Authority is one of 17 programs that earned the National Institute's "Exemplary" label. This brochure provides the requisite practical information for those who wish to test or consider testing the ward grievance procedure. The program was developed as a way of dealing with the questions raised…

A statistical mechanical approach to restricted integer partition functions

Science.gov (United States)

Zhou, Chi-Chun; Dai, Wu-Sheng

2018-05-01

The main aim of this paper is twofold: (1) suggesting a statistical mechanical approach to the calculation of the generating function of restricted integer partition functions which count the number of partitions—a way of writing an integer as a sum of other integers under certain restrictions. In this approach, the generating function of restricted integer partition functions is constructed from the canonical partition functions of various quantum gases. (2) Introducing a new type of restricted integer partition functions corresponding to general statistics which is a generalization of Gentile statistics in statistical mechanics; many kinds of restricted integer partition functions are special cases of this restricted integer partition function. Moreover, with statistical mechanics as a bridge, we reveal a mathematical fact: the generating function of restricted integer partition function is just the symmetric function which is a class of functions being invariant under the action of permutation groups. Using this approach, we provide some expressions of restricted integer partition functions as examples.

Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study.

Science.gov (United States)

Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Mitchell, Deb; O'Brien, Lisa; May, Kerry; Ghaly, Marcelle; Ho, Melissa; Haines, Terry P

2016-10-01

The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety

The N=2 supersymmetric Ward-identities on harmonic superspace

International Nuclear Information System (INIS)

Lhallabi, T.

1986-09-01

The quantization of N=2 supersymmetric Yang-Mills theory coupled to matter hypermultiplet has been done in the harmonic superspace, by requiring BRS and anti-BRS invariance. Also the corresponding Ward-identities have been derived. (author)

Ward identities for amplitudes with reggeized gluons

International Nuclear Information System (INIS)

Bartles, J.; Vacca, G.P.

2012-05-01

Starting from the effective action of high energy QCD we derive Ward identities for Green's functions of reggeized gluons. They follow from the gauge invariance of the effective action, and allow to derive new representations of amplitudes containing physical particles as well as reggeized gluons. We explicitly demonstrate their validity for the BFKL kernel, and we present a new derivation of the kernel.

Multilevel- marketing v České republice

OpenAIRE

Prudičová, Petra

2009-01-01

Graduation Theses concerns an analysis and evaluation, of how a multi-level marketing, functions in the Czech Republic. Explaining its ideals and principals, while it theoretically applies on a specific company, which is involved with multi-level marketing. The target is to introduce such system in an objective way and evaluate it in practice.

Infection control as a topic for ward-based nursing education.

Science.gov (United States)

Gould, D; Chamberlain, A

1994-08-01

The link between nursing theory and practice remains a topic of ongoing debate. Related to this issue is the best place to effectively combine the two. The solution may be ward-based teaching programmes as part of formal continuing staff development, involving collaboration between college-based lecturers and acknowledged clinical experts. Using infection control as an example of a topic in need of regular and continual updating for qualified practitioners, it is argued that such programmes would be desirable because they would afford sufficient flexibility to fulfil individual learning needs and could be assessed to indicate whether nursing practice had been enhanced. Participants could be accredited for successful completion of ward-based programmes.

Spatially Partitioned Embedded Runge--Kutta Methods

KAUST Repository

Ketcheson, David I.

2013-10-30

We study spatially partitioned embedded Runge--Kutta (SPERK) schemes for partial differential equations (PDEs), in which each of the component schemes is applied over a different part of the spatial domain. Such methods may be convenient for problems in which the smoothness of the solution or the magnitudes of the PDE coefficients vary strongly in space. We focus on embedded partitioned methods as they offer greater efficiency and avoid the order reduction that may occur in nonembedded schemes. We demonstrate that the lack of conservation in partitioned schemes can lead to nonphysical effects and propose conservative additive schemes based on partitioning the fluxes rather than the ordinary differential equations. A variety of SPERK schemes are presented, including an embedded pair suitable for the time evolution of fifth-order weighted nonoscillatory spatial discretizations. Numerical experiments are provided to support the theory.

Spatially Partitioned Embedded Runge--Kutta Methods

KAUST Repository

Ketcheson, David I.; MacDonald, Colin B.; Ruuth, Steven J.

2013-01-01

We study spatially partitioned embedded Runge--Kutta (SPERK) schemes for partial differential equations (PDEs), in which each of the component schemes is applied over a different part of the spatial domain. Such methods may be convenient for problems in which the smoothness of the solution or the magnitudes of the PDE coefficients vary strongly in space. We focus on embedded partitioned methods as they offer greater efficiency and avoid the order reduction that may occur in nonembedded schemes. We demonstrate that the lack of conservation in partitioned schemes can lead to nonphysical effects and propose conservative additive schemes based on partitioning the fluxes rather than the ordinary differential equations. A variety of SPERK schemes are presented, including an embedded pair suitable for the time evolution of fifth-order weighted nonoscillatory spatial discretizations. Numerical experiments are provided to support the theory.

Nurses experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng South Africa

Directory of Open Access Journals (Sweden)

Moloko Malatji

2017-12-01

Purpose: The purpose of this study was to explore and describe nurses' experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng in order to develop recommendations for staffing patterns in these wards. Methodology: A qualitative, exploratory, descriptive and contextual research design was used. Data was collected by means of in-depth semi structured individual interviews from a purposive sample of professional nurses working in the surgical wards of this hospital. Data was analysed using Tesch's method of qualitative thematic analysis. Principles of trustworthiness and ethical principles to ensure the protection of human rights were applied throughout the study. Results: The findings of the study revealed one central theme which reflected that participants experienced the staffing patterns of the surgical wards negatively. Two main themes emerged as, nurses had negative experiences in the surgical wards as well as negative emotional experiences related to the staffing patterns. Conclusion: It is evident from the findings of the study that nurses are experiencing staffing patterns negatively.

Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital

Directory of Open Access Journals (Sweden)

Hung MY

2017-11-01

Full Text Available Man Yui Hung,1 David John Wright,2 Jeanette Blacklock,2 Richard John Needle1,2 1Pharmacy Department, Colchester Hospital University NHS Foundation Trust, Colchester, 2School of Pharmacy, University of East Anglia, Norwich, UK Introduction: A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs in order to inform future innovations of a similar nature.Methods: Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance.Results: Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months.Discussion: It was

Measuring dynamic social contacts in a rehabilitation hospital: effect of wards, patient and staff characteristics.

Science.gov (United States)

Duval, Audrey; Obadia, Thomas; Martinet, Lucie; Boëlle, Pierre-Yves; Fleury, Eric; Guillemot, Didier; Opatowski, Lulla; Temime, Laura

2018-01-26

Understanding transmission routes of hospital-acquired infections (HAI) is key to improve their control. In this context, describing and analyzing dynamic inter-individual contact patterns in hospitals is essential. In this study, we used wearable sensors to detect Close Proximity Interactions (CPIs) among patients and hospital staff in a 200-bed long-term care facility over 4 months. First, the dynamic CPI data was described in terms of contact frequency and duration per individual status or activity and per ward. Second, we investigated the individual factors associated with high contact frequency or duration using generalized linear mixed-effect models to account for inter-ward heterogeneity. Hospital porters and physicians had the highest daily number of distinct contacts, making them more likely to disseminate HAI among individuals. Conversely, contact duration was highest between patients, with potential implications in terms of HAI acquisition risk. Contact patterns differed among hospital wards, reflecting varying care patterns depending on reason for hospitalization, with more frequent contacts in neurologic wards and fewer, longer contacts in geriatric wards. This study is the first to report proximity-sensing data informing on inter-individual contacts in long-term care settings. Our results should help better understand HAI spread, parameterize future mathematical models, and propose efficient control strategies.

Ward Valley transfer stalled by Babbitt

International Nuclear Information System (INIS)

Anon.

1994-01-01

Interior Secretary Bruce Babbitt announced on November 24 that he would not authorize the land transfer for the proposed low-level waste disposal site at Ward Valley, California, until a legal challenge to the facility's license and environmental impact statement is resolved. Even if the matter is resolved quickly, there exists the possibility that yet another hearing will be held on the project, even though state courts in California have stated flatly that no such hearings are required

Particle Removal Efficiency of the Portable HEPA Air Cleaner in a Simulated Hospital Ward

DEFF Research Database (Denmark)

Qian, Hua; Li, Yuguo; Sun, Hequan

2010-01-01

of beds in an isolation ward is insufficient. An experiment was conducted in a full scale experimental ward with a dimension of 6.7 m × 6 m × 2.7 m and 6 beds to test these hypotheses for a portable HEPA filter. The removal efficiency for different size particles was measured at different locations...

Multiscale Multilevel Approach to Solution of Nanotechnology Problems

Directory of Open Access Journals (Sweden)

Polyakov Sergey

2018-01-01

Full Text Available The paper is devoted to a multiscale multilevel approach for the solution of nanotechnology problems on supercomputer systems. The approach uses the combination of continuum mechanics models and the Newton dynamics for individual particles. This combination includes three scale levels: macroscopic, mesoscopic and microscopic. For gas–metal technical systems the following models are used. The quasihydrodynamic system of equations is used as a mathematical model at the macrolevel for gas and solid states. The system of Newton equations is used as a mathematical model at the mesoand microlevels; it is written for nanoparticles of the medium and larger particles moving in the medium. The numerical implementation of the approach is based on the method of splitting into physical processes. The quasihydrodynamic equations are solved by the finite volume method on grids of different types. The Newton equations of motion are solved by Verlet integration in each cell of the grid independently or in groups of connected cells. In the framework of the general methodology, four classes of algorithms and methods of their parallelization are provided. The parallelization uses the principles of geometric parallelism and the efficient partitioning of the computational domain. A special dynamic algorithm is used for load balancing the solvers. The testing of the developed approach was made by the example of the nitrogen outflow from a balloon with high pressure to a vacuum chamber through a micronozzle and a microchannel. The obtained results confirm the high efficiency of the developed methodology.

Multiscale Multilevel Approach to Solution of Nanotechnology Problems

Science.gov (United States)

Polyakov, Sergey; Podryga, Viktoriia

2018-02-01

The paper is devoted to a multiscale multilevel approach for the solution of nanotechnology problems on supercomputer systems. The approach uses the combination of continuum mechanics models and the Newton dynamics for individual particles. This combination includes three scale levels: macroscopic, mesoscopic and microscopic. For gas-metal technical systems the following models are used. The quasihydrodynamic system of equations is used as a mathematical model at the macrolevel for gas and solid states. The system of Newton equations is used as a mathematical model at the mesoand microlevels; it is written for nanoparticles of the medium and larger particles moving in the medium. The numerical implementation of the approach is based on the method of splitting into physical processes. The quasihydrodynamic equations are solved by the finite volume method on grids of different types. The Newton equations of motion are solved by Verlet integration in each cell of the grid independently or in groups of connected cells. In the framework of the general methodology, four classes of algorithms and methods of their parallelization are provided. The parallelization uses the principles of geometric parallelism and the efficient partitioning of the computational domain. A special dynamic algorithm is used for load balancing the solvers. The testing of the developed approach was made by the example of the nitrogen outflow from a balloon with high pressure to a vacuum chamber through a micronozzle and a microchannel. The obtained results confirm the high efficiency of the developed methodology.

iPad use at the bedside: a tool for engaging patients in care processes during ward rounds?

Science.gov (United States)

Baysari, M T; Adams, K; Lehnbom, E C; Westbrook, J I; Day, R O

2014-10-01

Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

My Ward: The Story of St Thomas', Guy's and the Evelina Children's Hospitals and their Ward Names Wendy Mathews My Ward: The Story of St Thomas', Guy's and the Evelina Children's Hospitals and their Ward Names | Walpole House Publishing £5 I 135pp | 9780956394200 0956394205 [Formula: see text].

Science.gov (United States)

2011-05-01

This is a fascinating record of the stories behind the names of wards at three London hospitals and of the hospitals themselves. Made possible by a grant from Guy's and st Thomas' Charity, it is beautifully produced and illustrated and is a great historical read.

[Comment on “Ward Off?”] Ward Valley Report deserves better coverage

Science.gov (United States)

Thompson, George A.

Eos, Transactions, AGU, which is bannered as “The Newspaper of the Geophysical Sciences,” carried an “In Brief” article in the issue of May 23 that does a serious disservice to the geophysical sciences. It was written in a flip editorial style that questioned the usefulness of the Ward Valley report (Secretary Babbitt found it useful enough to act decisively) and the integrity of the NAS/NRC committee members who wrote it.The 17 committee members, most of whom are AGU members, studied the issues as a public service at the request of the NAS in response to Babbitt's request. They documented the evidence and conclusions thoroughly in a report of over 200 pages. Surely, scientific input is needed for decisions about complex issues in our society.

Occupational genetic risks for nurses at radiotherapy oncology wards

Energy Technology Data Exchange (ETDEWEB)

Srb, V; Kubzova, E

1985-05-31

A lymphocyte chromosome analysis of short-term cultured whole peripheral blood of 14 nurses in the radiotherapy/oncology ward of the radiological clinic (working in health risk conditions for an average of 14 years) classified them into a high risk genetic group. They were found to have 4.7% cells with chromosomal aberrations as compared with 1.5% such cells in the control group. The said difference had a high statistical significance (p<0.001). Only aberrations of the structural type were evaluated.The mitotic activity of peripheral blood lymphocytes in the study group was also adversely affected (MI=1.8) compared with the control group (MI=2.9). Cytogenetic peripheral lymphocyte analysis used as a collective biological exposure test is being considered for incorporation in the system of preventive medical chec-kups of nurses working in radiotherapy/oncology wards.

Occupational genetic risks for nurses at radiotherapy oncology wards

International Nuclear Information System (INIS)

Srb, V.; Kubzova, E.

1985-01-01

A lymphocyte chromosome analysis of short-term cultured whole peripheral blood of 14 nurses in the radiotherapy/oncology ward of the radiological clinic (working in health risk conditions for an average of 14 years) classified them into a high risk genetic group. They were found to have 4.7% cells with chromosomal aberrations as compared with 1.5% such cells in the control group. The said difference had a high statistical significance (p<0.001). Only aberrations of the structural type were evaluated.The mitotic activity of peripheral blood lymphocytes in the study group was also adversely affected (MI=1.8) compared with the control group (MI=2.9). Cytogenetic peripheral lymphocyte analysis used as a collective biological exposure test is being considered for incorporation in the system of preventive medical chec-kups of nurses working in radiotherapy/oncology wards. (author)

External equivalent type Ward aiming optimization studies in power systems; Equivalentes externos tipo Ward visando estudos de otimizacao em sistemas de potencia

Energy Technology Data Exchange (ETDEWEB)

Nepomuceno, Leonardo

1993-07-01

The execution of functions such as contingency analysis, optimization, reactive dispatch, etc, at the control centers requires appropriate models representing the non-observable parts (external system). The classical external equivalents have been developed considering basically the contingency analysis. This work points out the performance of the Extended Ward Equivalent (W.E.), which currently represents the state of art concerning reduced circuit based models. the work analyzes the W.E. response to changes occurred in optimization studied. Moreover, a new model, named INTERNAL REACTIVE WARD (WRINT), resulting from an adaptation of the W.E. is proposed focusing on the improvement of the equivalent in case of changes occurs in optimization studies. The model's general idea is to reflect the equivalent's capacity of reactive response into the internal system. Comparative computational test results are shown. The details of routines implementation are also pointed out. (author)

Inappropriate use of urinary catheters and its common complications in different hospital wards

Directory of Open Access Journals (Sweden)

Parivash Davoodian

2012-01-01

Full Text Available Inappropriate use of indwelling urinary catheters (IUCs and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6% had IUCs used appropriately while 42 of them (20.6% were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%, 16 (19.0% and 14 patients (24.6%, respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2% and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

Self-balanced modulation and magnetic rebalancing method for parallel multilevel inverters

Science.gov (United States)

Li, Hui; Shi, Yanjun

2017-11-28

A self-balanced modulation method and a closed-loop magnetic flux rebalancing control method for parallel multilevel inverters. The combination of the two methods provides for balancing of the magnetic flux of the inter-cell transformers (ICTs) of the parallel multilevel inverters without deteriorating the quality of the output voltage. In various embodiments a parallel multi-level inverter modulator is provide including a multi-channel comparator to generate a multiplexed digitized ideal waveform for a parallel multi-level inverter and a finite state machine (FSM) module coupled to the parallel multi-channel comparator, the FSM module to receive the multiplexed digitized ideal waveform and to generate a pulse width modulated gate-drive signal for each switching device of the parallel multi-level inverter. The system and method provides for optimization of the output voltage spectrum without influence the magnetic balancing.

Dynamics of vacuum-sealed, double-leaf partitions

Science.gov (United States)

Kavanaugh, Joshua Stephen

The goal of this research is to investigate the feasibility and potential effectiveness of using vacuum-sealed, double-leaf partitions for applications in noise control. Substantial work has been done previously on double-leaf partitions where the acoustics of the inner chamber and mechanical vibrations of structural supports are passively and actively controlled. The work presented here is unique in that the proposed system aims to eliminate the need for active acoustic control of transmitted acoustic energy by removing all the air between the two panels of the double partition. Therefore, the only remaining energy paths would be along the boundary and at the points where there are intermediate structural supports connecting the two panels. The eventual goal of the research is to develop a high-loss double-leaf partition that simplifies active control by removing the need for control of the air cavity and channeling all the energy into discrete structural paths. The work presented here is a first step towards the goal of designing a high-loss, actively-controlled double-leaf partition with an air-evacuated inner chamber. One experiment is conducted to investigate the effects of various levels of vacuum on the response of a double-leaf partition whose panels are mechanically coupled only at the boundary. Another experiment is conducted which investigates the effect of changing the stiffness of an intermediate support coupling the two panels of a double-leaf partition in which a vacuum has been applied to the inner cavity. The available equipment was able to maintain a 99% vacuum between the panels. Both experiments are accompanied by analytical models used to investigate the importance of various dynamic parameters. Results show that the vacuum-sealed system shows some potential for increased transmission loss, primarily by the changing the natural frequencies of the double-leaf partition.

Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA infection control policies differs by ward specialty.

Directory of Open Access Journals (Sweden)

Rosemarie Sadsad

Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

Partitions in languages and parallel computations

Energy Technology Data Exchange (ETDEWEB)

Burgin, M S; Burgina, E S

1982-05-01

Partitions of entries (linguistic structures) are studied that are intended for parallel data processing. The representations of formal languages with the aid of such structures is examined, and the relationships are considered between partitions of entries and abstract families of languages and automata. 18 references.

Ward Valley transfer stalled by Babbitt

Energy Technology Data Exchange (ETDEWEB)

1994-01-01

Interior Secretary Bruce Babbitt announced on November 24 that he would not authorize the land transfer for the proposed low-level waste disposal site at Ward Valley, California, until a legal challenge to the facility's license and environmental impact statement is resolved. Even if the matter is resolved quickly, there exists the possibility that yet another hearing will be held on the project, even though state courts in California have stated flatly that no such hearings are required.

Multiple imputation by chained equations for systematically and sporadically missing multilevel data.

Science.gov (United States)

Resche-Rigon, Matthieu; White, Ian R

2018-06-01

In multilevel settings such as individual participant data meta-analysis, a variable is 'systematically missing' if it is wholly missing in some clusters and 'sporadically missing' if it is partly missing in some clusters. Previously proposed methods to impute incomplete multilevel data handle either systematically or sporadically missing data, but frequently both patterns are observed. We describe a new multiple imputation by chained equations (MICE) algorithm for multilevel data with arbitrary patterns of systematically and sporadically missing variables. The algorithm is described for multilevel normal data but can easily be extended for other variable types. We first propose two methods for imputing a single incomplete variable: an extension of an existing method and a new two-stage method which conveniently allows for heteroscedastic data. We then discuss the difficulties of imputing missing values in several variables in multilevel data using MICE, and show that even the simplest joint multilevel model implies conditional models which involve cluster means and heteroscedasticity. However, a simulation study finds that the proposed methods can be successfully combined in a multilevel MICE procedure, even when cluster means are not included in the imputation models.

Supporting Information Access in a Hospital Ward by a Context-Aware Mobile Electronic Patient Record

DEFF Research Database (Denmark)

Skov, Mikael B.; Høegh, Rune Thaarup

2006-01-01

Context-awareness holds promise for improving the utility of software products. Context-aware mobile systems encompass the ability to automatically discover and react to changes in an environment. Most contemporary context-aware mobile systems aim to support users in private situations, for example......Ward is to support nurses in conducting morning procedures in a hospital ward. MobileWard is context-aware as it is able to discover and react autonomously according to changes in the environment and since it integrates the ability to provide information and services to the user where the relevancy depends....... Implications and limitations of the proposed solution are further discussed....

Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals

Science.gov (United States)

2011-01-01

Background Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. Methods During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics - that is second- and third-generation cephalosporins, carbapenems, and quinolones - in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Results Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval

Medication Prescribing Pattern at a Pediatric Ward of an Ethiopian Hospital

Directory of Open Access Journals (Sweden)

Fitsum Sebsibe Teni

2014-11-01

Full Text Available Introduction: drug use in pediatric patients is a unique dilemma in the management and monitoring of disease. This study aimed at assessing medication prescribing in a pediatric ward of an  Ethiopian hospital. Materials and Methods: a retrospective cross-sectional study was done by reviewing the medical records of 249 patients among those admitted in the period between 11th of September 2007 and 10th of September 2008 to the pediatric ward of Gondar University Referral Hospital, Northwest Ethiopia. Data on characteristics like age, sex and weight; the diagnoses for which patients were admitted and medications prescribed to them during their stay in the ward was collected from the medical records of the patients. Results: an average of 3 diagnoses per patient with the most frequently diagnosed being malnutrition (29.23%, severe community acquired pneumonia (12.96% and underweight (8.86% were reported. A mean of 4.5 medications per patient with the most commonly prescribed being antibacterials namely penicillins which constituted 25.42%, other antibacterials making up 19.61% and medications used for correcting water, electrolyte and acid-base disturbances accounting for 17.19% of the total number of medications prescribed in the ward. The most common individual medications prescribed to the patients included crystalline penicillin, gentamicin and maintenance fluid constituting 9.22, 7.52 and 6.45 percentages respectively most of them in solution forms which were administered dominantly intravenously. Conclusion In this study the common prescription of antibacterials and those used for correcting water, electrolyte and acid-base disturbances was observed which went with the common diagnoses of malnutrition and pneumonia. 

Ward based community road safety performance benchmarking, monitoring and intervention programmes in the City of Johannesburg

CSIR Research Space (South Africa)

Ribbens, H

2008-07-01

Full Text Available benchmarking, monitoring and intervention programme. Community road safety needs in the respective wards are articulated through the ward councillor. The rationale is that the community exactly knows where these problem areas are, because they suffer as a...

Scheduling Driven Partitioning of Heterogeneous Embedded Systems

DEFF Research Database (Denmark)

Pop, Paul; Eles, Petru; Peng, Zebo

1998-01-01

In this paper we present an algorithm for system level hardware/software partitioning of heterogeneous embedded systems. The system is represented as an abstract graph which captures both data-flow and the flow of control. Given an architecture consisting of several processors, ASICs and shared...... busses, our partitioning algorithm finds the partitioning with the smallest hardware cost and is able to predict and guarantee the performance of the system in terms of worst case delay....

Drinking Water Quality Surveillance in a Vulnerable Urban Ward of Ahmedabad.

Science.gov (United States)

Iyer, Veena; Choudhury, Nandini; Azhar, Gulrez Shah; Somvanshi, Bhushan

2014-05-01

The World Bank estimates that 21% of all communicable diseases in India are related to unsafe water with diarrhoea alone causing more than 0.1 million deaths annually. The WHO drinking water surveillance parameters of quality, quantity, accessibility, affordability and continuity were assessed in one vulnerable ward of Ahmedabad-a fast growing city in Western India. Interviews with key informants of the ward office, health centre and water supply department, secondary analysis and mapping of field test reports and a questionnaire-based survey of different household types were conducted. We found that Ahmedabad Municipal Corporation (AMC) supplies water to the ward intermittently for two hours during the day. Housing society clusters supplement their AMC water supply with untested bore-well water. The water quality surveillance system is designed for a twenty-four-hour piped distribution of treated surface water. However, in order to maintain surveillance over an intermittent supply that includes ground water, the sampling process should include periodic surveys of water actually consumed by the citizens. The laboratory capacity of the Central Water Testing Laboratory should expand to include more refined tests for microbial and chemical contamination.

Gauge fixing, BRS invariance and Ward identities for randomly stirred flows

International Nuclear Information System (INIS)

Berera, Arjun; Hochberg, David

2009-01-01

The Galilean invariance of the Navier-Stokes equation is shown to be akin to a global gauge symmetry familiar from quantum field theory. This symmetry leads to a multiple counting of infinitely many inertial reference frames in the path integral approach to randomly stirred fluids. This problem is solved by fixing the gauge, i.e., singling out one reference frame. The gauge fixed theory has an underlying Becchi-Rouet-Stora (BRS) symmetry which leads to the Ward identity relating the exact inverse response and vertex functions. This identification of Galilean invariance as a gauge symmetry is explored in detail, for different gauge choices and by performing a rigorous examination of a discretized version of the theory. The Navier-Stokes equation is also invariant under arbitrary rectilinear frame accelerations, known as extended Galilean invariance (EGI). We gauge fix this extended symmetry and derive the generalized Ward identity that follows from the BRS invariance of the gauge-fixed theory. This new Ward identity reduces to the standard one in the limit of zero acceleration. This gauge-fixing approach unambiguously shows that Galilean invariance and EGI constrain only the zero mode of the vertex but none of the higher wavenumber modes.

Gauge fixing, BRS invariance and Ward identities for randomly stirred flows

Energy Technology Data Exchange (ETDEWEB)

Berera, Arjun [School of Physics and Astronomy, University of Edinburgh, Edinburgh, EH9 3JZ (United Kingdom)], E-mail: ab@ph.ed.ac.uk; Hochberg, David [Centro de Astrobiologia (CSIC-INTA), Ctra. Ajalvir Km. 4, 28850 Torrejon de Ardoz, Madrid (Spain)], E-mail: hochbergd@inta.es

2009-06-21

The Galilean invariance of the Navier-Stokes equation is shown to be akin to a global gauge symmetry familiar from quantum field theory. This symmetry leads to a multiple counting of infinitely many inertial reference frames in the path integral approach to randomly stirred fluids. This problem is solved by fixing the gauge, i.e., singling out one reference frame. The gauge fixed theory has an underlying Becchi-Rouet-Stora (BRS) symmetry which leads to the Ward identity relating the exact inverse response and vertex functions. This identification of Galilean invariance as a gauge symmetry is explored in detail, for different gauge choices and by performing a rigorous examination of a discretized version of the theory. The Navier-Stokes equation is also invariant under arbitrary rectilinear frame accelerations, known as extended Galilean invariance (EGI). We gauge fix this extended symmetry and derive the generalized Ward identity that follows from the BRS invariance of the gauge-fixed theory. This new Ward identity reduces to the standard one in the limit of zero acceleration. This gauge-fixing approach unambiguously shows that Galilean invariance and EGI constrain only the zero mode of the vertex but none of the higher wavenumber modes.

Multilevel structural equation models for assessing moderation within and across levels of analysis.

Science.gov (United States)

Preacher, Kristopher J; Zhang, Zhen; Zyphur, Michael J

2016-06-01

Social scientists are increasingly interested in multilevel hypotheses, data, and statistical models as well as moderation or interactions among predictors. The result is a focus on hypotheses and tests of multilevel moderation within and across levels of analysis. Unfortunately, existing approaches to multilevel moderation have a variety of shortcomings, including conflated effects across levels of analysis and bias due to using observed cluster averages instead of latent variables (i.e., "random intercepts") to represent higher-level constructs. To overcome these problems and elucidate the nature of multilevel moderation effects, we introduce a multilevel structural equation modeling (MSEM) logic that clarifies the nature of the problems with existing practices and remedies them with latent variable interactions. This remedy uses random coefficients and/or latent moderated structural equations (LMS) for unbiased tests of multilevel moderation. We describe our approach and provide an example using the publicly available High School and Beyond data with Mplus syntax in Appendix. Our MSEM method eliminates problems of conflated multilevel effects and reduces bias in parameter estimates while offering a coherent framework for conceptualizing and testing multilevel moderation effects. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Partition functions for supersymmetric black holes

NARCIS (Netherlands)

Manschot, J.

2008-01-01

This thesis presents a number of results on partition functions for four-dimensional supersymmetric black holes. These partition functions are important tools to explain the entropy of black holes from a microscopic point of view. Such a microscopic explanation was desired after the association of a

Mini outbreak of Kaposi′s varicelliform eruption in skin ward: A study of five cases

Directory of Open Access Journals (Sweden)

Rao GRR

2007-01-01

Full Text Available Background: Kaposi`s varicelliform eruption (KVE represents widespread cutaneous herpes simplex virus (HSV infection in patients with preexisting dermatoses. Occasionally, this infection can present as a nosocomial infection in skin wards, if adequate bed-spacing and barrier nursing methods are not followed. We are reporting five cases of KVE; four cases acquired the infection in a makeshift ward after admission of the first case in May 2005, due to the renovation work of the regular skin ward. Aim: The purpose of this study is to create clinical awareness about this uncommon dermatologic entity and to stress upon the importance of bed-spacing and barrier nursing in skin wards. Methods: Five cases of KVE, three females and two males with different primary dermatoses (pemphigus foliaceus - one, pemphigus vulgaris - two, paraneoplastic pemphigus - one and toxic epidemal necrolysis - one were included in this study. Diagnosis was made clinically and supported with Tzanck smear and HSV serology. All the cases were treated with oral acyclovir. Results: Four out of five cases of KVE recovered with treatment, one case of extensive pemphigus vulgaris with KVE succumbed to death. Conclusion: Mini outbreaks of KVE can occur in skin wards with inadequate bed-spacing and overcrowding of patients. Therefore adequate bed-spacing, barrier nursing and isolation of suspected cases are mandatory to prevent such life-threatening infections.

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation

Directory of Open Access Journals (Sweden)

Paul Moli

2011-04-01

Full Text Available Abstract Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.

Aspects of system modelling in Hardware/Software partitioning

DEFF Research Database (Denmark)

Knudsen, Peter Voigt; Madsen, Jan

1996-01-01

This paper addresses fundamental aspects of system modelling and partitioning algorithms in the area of Hardware/Software Codesign. Three basic system models for partitioning are presented and the consequences of partitioning according to each of these are analyzed. The analysis shows...... the importance of making a clear distinction between the model used for partitioning and the model used for evaluation It also illustrates the importance of having a realistic hardware model such that hardware sharing can be taken into account. Finally, the importance of integrating scheduling and allocation...

Medical ward round competence in internal medicine - an interview study towards an interprofessional development of an Entrustable Professional Activity (EPA).

Science.gov (United States)

Wölfel, Teresa; Beltermann, Esther; Lottspeich, Christian; Vietz, Elisa; Fischer, Martin R; Schmidmaier, Ralf

2016-07-11

The medical ward round is a central but complex activity that is of relevance from the first day of work. However, difficulties for young doctors have been reported. Instruction of ward round competence in medical curricula is hampered by the lack of a standardized description of the procedure. This paper aims to identify and describe physicians' tasks and relevant competences for conducting a medical ward round on the first day of professional work. A review of recent literature revealed known important aspects of medical ward rounds. These were used for the development of a semi-structured interview schedule. Medical ward round experts working at different hospitals were interviewed. The sample consisted of 14 ward physicians (M = 8.82 years of work experience) and 12 nurses (M = 14.55 years of work experience) working in different specializations of internal medicine. All interviews were audiotaped, fully transcribed, and analyzed using an inductive-deductive coding scheme. Nine fields of competences with 18 related sub-competences and 62 observable tasks were identified as relevant for conducting a medical ward round. Over 70 % of the experts named communication, collaborative clinical reasoning and organization as essential competences. Deeper analysis further unveiled the importance of self-management, management of difficult situations, error management and teamwork. The study is the first to picture ward round competences and related tasks in detail and to define an EPA "Conducting an internal medicine ward round" based on systematic interprofessional expert interviews. It thus provides a basis for integration of ward round competences in the medical curricula in an evidence based manner and gives a framework for the development of instructional intervention studies and comparative studies in other medical fields.

Generating Milton Babbitt's all-partition arrays

DEFF Research Database (Denmark)

Bemman, Brian; Meredith, David

2016-01-01

In most of Milton Babbitt's (1916–2011) works written since the early 1960s, both the pitch and rhythmic content is organized according to a highly constrained structure known as the all-partition array. The all-partition array provides a framework that ensures that as many different forms...

Accounting for Inpatient Wards when developing Master Surgical Schedules

NARCIS (Netherlands)

Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, W.A.M.; van Harten, Willem H.; van Harten, Wim H.

BACKGROUND: As the demand for health care services increases, the need to improve patient flow between departments has likewise increased. Understanding how the master surgical schedule (MSS) affects the inpatient wards and exploiting this relationship can lead to a decrease in surgery

Health Service Quality Based On Dabholkar Dimension At Ward Room Of Internal Disease

OpenAIRE

Supriyanto, Stefanus; Rahmawati, Alfi Febriana

2013-01-01

The NDR average at ward room of internal disease of Bojonegoro General Hospital during 2009-2011 was 58,6 ‰ (more than standard < 25 ‰). This research was aimed to analyze the importance and satisfaction rating of health service quality based on Dabholkar dimension. It used observational approach with cross sectional design. Interview was conducted to 37 patients in internal disease ward room of Bojonegoro General Hospital which selected by simple random sampling. This study found some issues...

audit of blood transfusion practices in the paediatric medical ward

African Journals Online (AJOL)

2013-01-01

Jan 1, 2013 ... AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY ..... services and even where available, beneficiaries have ... due to lack of existence of quality assurance protocol.

Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle.

Science.gov (United States)

Johnston, Maximilian J; Arora, Sonal; King, Dominic; Darzi, Ara

2018-01-01

This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety. A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards. Twenty-seven junior and senior surgeons completed validated questionnaires assessing supervision, escalation of care, and safety culture pre and post-intervention along with interviews to further explore the impact of the intervention. Patient outcomes pre and postintervention were also analyzed. Questionnaires revealed significant improvements in supervision postintervention (senior median pre 5 vs post 7, P = 0.002 and junior 4 vs 6, P = 0.039) and senior surgeon approachability (junior 5 vs 6, P = 0.047). Both groups agreed that they would feel safer as a patient in their hospital postintervention (senior 3 vs 4.5, P = 0.021 and junior 3 vs 4, P = 0.034). The interviews confirmed that the safety culture of the department had improved. There were no differences in inpatient mortality, cardiac arrest, reoperation, or readmission rates pre and postintervention. Improving supervision and introducing clear protocols can improve safety culture on the surgical ward. Future work should evaluate the effect these measures have on patient outcomes in multiple institutions.

Improving the communication between teams managing boarded patients on a surgical specialty ward.

Science.gov (United States)

Puvaneswaralingam, Shobitha; Ross, Daniella

2016-01-01

Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope

Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014.

Science.gov (United States)

Dunn, Angela C; Walker, Tiffany A; Redd, John; Sugerman, David; McFadden, Jevon; Singh, Tushar; Jasperse, Joseph; Kamara, Brima Osaio; Sesay, Tom; McAuley, James; Kilmarx, Peter H

2016-03-01

In the largest Ebola virus disease (EVD) outbreak in history, nosocomial transmission of EVD increased spread of the disease. We report on 2 instances in Sierra Leone where patients unknowingly infected with EVD were admitted to a general hospital ward (1 pediatric ward and 1 maternity ward), exposing health care workers, caregivers, and other patients to EVD. Both patients died on the general wards, and were later confirmed as being infected with EVD. We initiated contact tracing and assessed risk factors for secondary infections to guide containment recommendations. We reviewed medical records to establish the index patients' symptom onset. Health care workers, patients, and caregivers were interviewed to determine exposures and personal protective equipment (PPE) use. Contacts were monitored daily for EVD symptoms. Those who experienced EVD symptoms were isolated and tested. Eighty-two contacts were identified: 64 health care workers, 7 caregivers, 4 patients, 4 newborns, and 3 children of patients. Seven contacts became symptomatic and tested positive for EVD: 2 health care workers (1 nurse and 1 hospital cleaner), 2 caregivers, 2 newborns, and 1 patient. The infected nurse placed an intravenous catheter in the pediatric index patient with only short gloves PPE and the hospital cleaner cleaned the operating room of the maternity ward index patient wearing short gloves PPE. The maternity ward index patient's caregiver and newborn were exposed to her body fluids. The infected patient and her newborn shared the ward and latrine with the maternity ward index patient. Hospital staff members did not use adequate PPE. Caregivers were not offered PPE. Delayed recognition of EVD and inadequate PPE likely led to exposures and secondary infections. Earlier recognition of EVD and adequate PPE might have reduced direct contact with body fluids. Limiting nonhealth-care worker contact, improving access to PPE, and enhancing screening methods for pregnant women, children

On multi-level thinking and scientific understanding

Science.gov (United States)

McIntyre, Michael Edgeworth

2017-10-01

Professor Duzheng YE's name has been familiar to me ever since my postdoctoral years at MIT with Professors Jule CHARNEY and Norman PHILLIPS, back in the late 1960s. I had the enormous pleasure of meeting Professor YE personally in 1992 in Beijing. His concern to promote the very best science and to use it well, and his thinking on multi-level orderly human activities, reminds me not only of the communication skills we need as scientists but also of the multi-level nature of science itself. Here I want to say something (a) about what science is; (b) about why multi-level thinking—and taking more than one viewpoint—is so important for scientific as well as for other forms of understanding; and (c) about what is meant, at a deep level, by "scientific understanding" and trying to communicate it, not only with lay persons but also across professional disciplines. I hope that Professor YE would approve.

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*

Science.gov (United States)

Almeida, Luiz Maurício Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

2013-01-01

BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. PMID:24173179

Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study.

Science.gov (United States)

Cowman, Seamus; Bowers, Len

2009-05-01

The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses. Violence is a serious problem in psychiatric services and staff experience significant psychological reactions to being assaulted. Health and Safety Authorities in the UK and Ireland have expressed concern about violence and assault in healthcare, however, there remains a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. A descriptive survey research design was employed. Questionnaires were circulated to all acute wards in London and in Ireland and the resulting data compared. A total of 124 psychiatric wards from London and 43 wards from Ireland were included in this study and response rates of 70% (London) and 86% (Ireland) were obtained. Differences and similarities in safety and security practices were identified between London and Ireland, with Irish wards having generally higher and more intensive levels of security. There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and London. Given the trends in European Union (EU) regulation, there is a strong argument for the publication of acceptable minimum guidelines for safety and security in mental health services across the EU. There must be a concerted effort to ensure that all policy and procedure in safety and security is founded on evidence and best practice. Mental health managers must establish a review of work safety and security procedures and practices. Risk assessment and environmental audits of all mental health clinical environments should be mandatory.

Does doctors’ workload impact supervision and ward activities of final-year students? A prospective study

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Celebi Nora

2012-06-01

Full Text Available Abstract Background Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students. Methods A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1 only watched, (2 assisted the ward resident, (3 performed the activity themselves under supervision of the ward resident, or (4 performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL, and the number of admissions and discharges. Both students and ward residents were blinded to the study question. Results A total of 32 diaries (59 %, 442 recorded working days were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p  Conclusions There was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.

77 FR 10960 - Security Zone, East River and Bronx Kill; Randalls and Wards Islands, NY

Science.gov (United States)

2012-02-24

...'' W (Port Morris Stacks), and all waters of the Bronx Kill southeast of the Bronx Kill Rail Road...-AA87 Security Zone, East River and Bronx Kill; Randalls and Wards Islands, NY AGENCY: Coast Guard, DHS... waters of the East River and Bronx Kill, in the vicinity of Randalls and Wards Islands, New York. This...

Space Vector Pulse Width Modulation of a Multi-Level Diode ...

African Journals Online (AJOL)

Space Vector Pulse Width Modulation of a Multi-Level Diode Clamped ... of MATLAB /SIMULINK modeling of the space vector pulse-width modulation and the ... two adjacent active vectors in determining the switching process of the multilevel ...

Implementation and Evaluation of a Ward-Based eLearning Program for Trauma Patient Management.

Science.gov (United States)

Curtis, Kate; Wiseman, Taneal; Kennedy, Belinda; Kourouche, Sarah; Goldsmith, Helen

2016-01-01

The majority of trauma nursing education is focused on the emergency phases of care. We describe the development and evaluation of a trauma eLearning module for the ward environment. The module was developed using adult learning principles and implemented in 2 surgical wards. There were 3 phases of evaluation: (1) self-efficacy of nurses; (2) relevance and usability of the module and; (3) application of knowledge learnt. The majority indicated they had applied new knowledge, particularly when performing a physical assessment (85.7%), communicating (91.4%), and identifying risk of serious illness (90.4%). Self-efficacy relating to confidence in caring for patients, communication, and escalating clinical deterioration improved (p = .023). An eLearning trauma patient assessment module for ward nursing staff improves nursing knowledge and self-efficacy.

Light Atmosphere in Hospital Wards

DEFF Research Database (Denmark)

Stidsen, Lone Mandrup

by the patients in the ward. The project is based on the Danish Regulation for light in hospitals (DS703), which is a supplement to the regulation of artificial lighting in workplaces (DS700). The kick-off to the project was reading the DS703, second paragraph, chapter 2 about general requirements for lighting...... group has quite diverse needs and preferences, while the staff needs task lighting and the patient a space experienced as homely and pleasant. Categories such as ‘pleasure’ and ‘activities’ are also a part of the user aspect. The space is divided into subcategories as ‘location of the space...

Matrix string partition function

CERN Document Server

Kostov, Ivan K; Kostov, Ivan K.; Vanhove, Pierre

1998-01-01

We evaluate quasiclassically the Ramond partition function of Euclidean D=10 U(N) super Yang-Mills theory reduced to a two-dimensional torus. The result can be interpreted in terms of free strings wrapping the space-time torus, as expected from the point of view of Matrix string theory. We demonstrate that, when extrapolated to the ultraviolet limit (small area of the torus), the quasiclassical expressions reproduce exactly the recently obtained expression for the partition of the completely reduced SYM theory, including the overall numerical factor. This is an evidence that our quasiclassical calculation might be exact.

Multilevel and Multi-index Monte Carlo methods for the McKean–Vlasov equation

KAUST Repository

Haji-Ali, Abdul-Lateef

2017-09-12

We address the approximation of functionals depending on a system of particles, described by stochastic differential equations (SDEs), in the mean-field limit when the number of particles approaches infinity. This problem is equivalent to estimating the weak solution of the limiting McKean–Vlasov SDE. To that end, our approach uses systems with finite numbers of particles and a time-stepping scheme. In this case, there are two discretization parameters: the number of time steps and the number of particles. Based on these two parameters, we consider different variants of the Monte Carlo and Multilevel Monte Carlo (MLMC) methods and show that, in the best case, the optimal work complexity of MLMC, to estimate the functional in one typical setting with an error tolerance of $$\\\\mathrm {TOL}$$TOL, is when using the partitioning estimator and the Milstein time-stepping scheme. We also consider a method that uses the recent Multi-index Monte Carlo method and show an improved work complexity in the same typical setting of . Our numerical experiments are carried out on the so-called Kuramoto model, a system of coupled oscillators.

Multilevel techniques for Reservoir Simulation

DEFF Research Database (Denmark)

Christensen, Max la Cour

The subject of this thesis is the development, application and study of novel multilevel methods for the acceleration and improvement of reservoir simulation techniques. The motivation for addressing this topic is a need for more accurate predictions of porous media flow and the ability to carry...... Full Approximation Scheme) • Variational (Galerkin) upscaling • Linear solvers and preconditioners First, a nonlinear multigrid scheme in the form of the Full Approximation Scheme (FAS) is implemented and studied for a 3D three-phase compressible rock/fluids immiscible reservoir simulator...... is extended to include a hybrid strategy, where FAS is combined with Newton’s method to construct a multilevel nonlinear preconditioner. This method demonstrates high efficiency and robustness. Second, an improved IMPES formulated reservoir simulator is implemented using a novel variational upscaling approach...

An Association-Oriented Partitioning Approach for Streaming Graph Query

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Yun Hao

2017-01-01

Full Text Available The volumes of real-world graphs like knowledge graph are increasing rapidly, which makes streaming graph processing a hot research area. Processing graphs in streaming setting poses significant challenges from different perspectives, among which graph partitioning method plays a key role. Regarding graph query, a well-designed partitioning method is essential for achieving better performance. Existing offline graph partitioning methods often require full knowledge of the graph, which is not possible during streaming graph processing. In order to handle this problem, we propose an association-oriented streaming graph partitioning method named Assc. This approach first computes the rank values of vertices with a hybrid approximate PageRank algorithm. After splitting these vertices with an adapted variant affinity propagation algorithm, the process order on vertices in the sliding window can be determined. Finally, according to the level of these vertices and their association, the partition where the vertices should be distributed is decided. We compare its performance with a set of streaming graph partition methods and METIS, a widely adopted offline approach. The results show that our solution can partition graphs with hundreds of millions of vertices in streaming setting on a large collection of graph datasets and our approach outperforms other graph partitioning methods.

Development of Geospatial Map Based Portal for Delimitation of Mcd Wards

Science.gov (United States)

Gupta, A. Kumar Chandra; Kumar, P.; Sharma, P. Kumar

2017-09-01

The Geospatial Delhi Limited (GSDL), a Govt. of NCT of Delhi Company formed in order to provide the geospatial information of National Capital Territory of Delhi (NCTD) to the Government of National Capital Territory of Delhi (GNCTD) and its organs such as DDA, MCD, DJB, State Election Department, DMRC etc., for the benefit of all citizens of Government of National Capital Territory of Delhi (GNCTD). This paper describes the development of Geospatial Map based Portal for Delimitation of MCD Wards (GMPDW) and election of 3 Municipal Corporations of NCT of Delhi. The portal has been developed as a map based spatial decision support system (SDSS) for delimitation of MCD Wards and draw of peripheral wards boundaries to planning and management of MCD Election process of State Election Commission, and as an MCD election related information searching tools (Polling Station, MCD Wards and Assembly constituency etc.,) for the citizens of NCTD. The GMPDW is based on Client-Server architecture model. It has been developed using Arc GIS Server 10.0 with .NET (pronounced dot net) technology. The GMPDW is scalable to enterprise SDSS with enterprise Geo Database & Virtual Private Network (VPN) connectivity. Spatial data to GMPDW includes Enumeration Block (EB) and Enumeration Blocks Group (EBG) boundaries of Citizens of Delhi, Assembly Constituency, Parliamentary Constituency, Election District, Landmark locations of Polling Stations & basic amenities (Police Stations, Hospitals, Schools and Fire Stations etc.). GMPDW could help achieve not only the desired transparency and easiness in planning process but also facilitates through efficient & effective tools for management of MCD election. It enables a faster response to the changing ground realities in the development planning, owing to its in-built scientific approach and open-ended design.

Supervisors' pedagogical role at a clinical education ward - an ethnographic study.

Science.gov (United States)

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silén, Charlotte

2015-01-01

Clinical practice is essential for health care students. The supervisor's role and how supervision should be organized are challenging issues for educators and clinicians. Clinical education wards have been established to meet these challenges and they are units with a pedagogical framework facilitating students' training in real clinical settings. Supervisors support students to link together theoretical and practical knowledge and skills. From students' perspectives, clinical education wards have shown potential to enhance students' learning. Thus there is a need for deeper understanding of supervisors' pedagogical role in this context. We explored supervisors' approaches to students' learning at a clinical education ward where students are encouraged to independently take care of patients. An ethnographic approach was used to study encounters between patients, students and supervisors. The setting was a clinical education ward for nursing students at a university hospital. Ten observations with ten patients, 11 students and five supervisors were included in the study. After each observation, individual follow-up interviews with all participants and a group interview with supervisors were conducted. Data were analysed using an ethnographic approach. Supervisors' pedagogical role has to do with balancing patient care and student learning. The students were given independence, which created pedagogical challenges for the supervisors. They handled these challenges by collaborating as a supervisory team and taking different acts of supervision such as allowing students their independence, being there for students and by applying patient-centredness. The supervisors' pedagogical role was perceived as to facilitate students' learning as a team. Supervisors were both patient- and student-centred by making a nursing care plan for the patients and a learning plan for the students. The plans were guided by clinical and pedagogical guidelines, individually adjusted and

Aspects of solitons in noncommutative field theories. The modified Ward model

International Nuclear Information System (INIS)

Petersen, S.

2006-01-01

In this thesis several aspects of solutions to the equations of motions to noncommutative field theories are investigated in detail. The main focus of the analysis is on the integrable chiral or modified unitary sigma model with U(n)-valued fields as introduced by Ward and its noncommutative extension where the above mentioned new solutions arise. Of particular interest in this context are to us the question of stability of static solitons and the applicability of the so-called adiabatic approach to as a means to approximate time-dependent solutions by geodesic motion in the moduli space of static solutions. After some introductory remarks we proceed to present the Ward model together with its noncommutative extension and give a unified exposition of its known static solutions. This model, as the prime example of an almost Lorentz-invariant field theory in 1+2 dimensions, has several virtues which make its analysis worthwhile. First of all it is integrable thus allowing for powerful, well developed, techniques to generate soliton solutions. At the same time these feature interaction among them. Furthermore, the commutative counterpart of the Ward model has been investigated in great detail such that many results are available for comparison. Next, the question of stability for the present static solutions is considered. This stability is governed by the quadratic form of the fluctuations, which, upon concentrating on the case of diagonal U(1) solutions, is explicitly computed. We show that the considered solutions are stable within a certain subsector of possible configurations, namely the grassmannian ones, and become unstable upon embedding them into the full unitary sigma model. Finally, we remark on some possible generalization of these results. This subject is followed, after a brief review of time-dependent Ward model solutions, by the application of the adiabatic approach, as proposed by Manton, to the static solutions. (orig.)

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital

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Mekonnen AB

2013-03-01

Full Text Available Background: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however.Objective: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. Methods: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist using a standardized method for categorizing drug related problems (DRPs. Results: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3% were clinical pharmacists initiated interventions and 16(10.7% interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%; needs additional drug therapy, 34(22.8% and noncompliance, 29(19.5%. The most frequent intervention type was change of dosage/instruction for use, 23(15.4%. Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9% and 25(26.6% had major and moderate clinical importance respectively. Conclusion: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This

DEVELOPMENT OF GEOSPATIAL MAP BASED PORTAL FOR DELIMITATION OF MCD WARDS

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A. Kumar Chandra Gupta

2017-09-01

Full Text Available The Geospatial Delhi Limited (GSDL, a Govt. of NCT of Delhi Company formed in order to provide the geospatial information of National Capital Territory of Delhi (NCTD to the Government of National Capital Territory of Delhi (GNCTD and its organs such as DDA, MCD, DJB, State Election Department, DMRC etc., for the benefit of all citizens of Government of National Capital Territory of Delhi (GNCTD. This paper describes the development of Geospatial Map based Portal for Delimitation of MCD Wards (GMPDW and election of 3 Municipal Corporations of NCT of Delhi. The portal has been developed as a map based spatial decision support system (SDSS for delimitation of MCD Wards and draw of peripheral wards boundaries to planning and management of MCD Election process of State Election Commission, and as an MCD election related information searching tools (Polling Station, MCD Wards and Assembly constituency etc., for the citizens of NCTD. The GMPDW is based on Client-Server architecture model. It has been developed using Arc GIS Server 10.0 with .NET (pronounced dot net technology. The GMPDW is scalable to enterprise SDSS with enterprise Geo Database & Virtual Private Network (VPN connectivity. Spatial data to GMPDW includes Enumeration Block (EB and Enumeration Blocks Group (EBG boundaries of Citizens of Delhi, Assembly Constituency, Parliamentary Constituency, Election District, Landmark locations of Polling Stations & basic amenities (Police Stations, Hospitals, Schools and Fire Stations etc.. GMPDW could help achieve not only the desired transparency and easiness in planning process but also facilitates through efficient & effective tools for management of MCD election. It enables a faster response to the changing ground realities in the development planning, owing to its in-built scientific approach and open-ended design.

Trace and Ward-Takahashi identity anomalies in an SU(3) current model with energy-momentum tensor

International Nuclear Information System (INIS)

Zacrep, D.B.; Young, B.

1975-01-01

We discuss the validity of the naive Ward-Takahashi identities and trace identities for arbitrary n-point functions (n-pf's) of scalar, pseudoscalar, vector, and axial-vector currents and the improved energy-momentum tensor, thus extending the previous investigations in a unified way. We show that the validity of the naive Ward-Takahashi identities of the energy-momentum tensor implies the satisfaction of those of the vector currents. This removes an ambiguity concerning the minimal sets of anomalous current Ward-Takahashi identities. We find that all the anomalous Ward-Takahashi identities for the broad structure of n-pf's are again restricted to the axial-vector current of n-pf's of abnormal parity in a well-defined pattern, and the trace identity anomalies occur only in normal-parity n-pf's. We give all these anomalies. Our results show that there are no new anomalies associated with the inclusion of the energy-momentum tensor in the n-pf's

Comparative Assessment of Patients’ Rights Observance in the Hospitalization Wards of Shahid Beheshti University of Medical Sciences’ Hospitals

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M. Sharifi

2017-06-01

Full Text Available Background: Patients are one of the most vulnerable social groups. Respecting patients’ rights will lead in advantages like “decrease in hospitalization time” and “increase in patients’ satisfaction”. This study is performed to assess the patients' rights observance in the hospitalization wards of educational hospitals of Shahid Beheshti University of Medical Sciences. Methods: In this descriptive-cross sectional study 137 medical student (intern were selected by convenience sampling method. We used a questionnaire with 12 questions. Reliability of questionnaire was confirmed by experts of the field and validity was confirmed by Cronbach’s Alpha coefficient (81%. The obtained data were analyzed by SPSS (v21 using descriptive statistics, analysis of variance and Tukey test. Findings: In this study the observance rate of patients’ rights was at a good level in 41.6% of cases, at an average level in 55.5% of cases and at a low level in 2.9% of cases. There was a significant difference between several hospitalization wards in the observance rate of patients’ rights. (p = 0.001. The observance rate of patients’ rights in infectious disease ward and gynecology ward was at a lower level in comparison with other wards. Conclusion: The observance rate of patients’ rights was at an average to good level in most of hospitalization ward. However this observance rate is at a low level in some wards. More studies about the causes of these differences can help us in planning about improvement of patients’ rights observance.

An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy

DEFF Research Database (Denmark)

Merlo, Juan; Wagner, Philippe; Ghith, Nermin

2016-01-01

BACKGROUND AND AIM: Many multilevel logistic regression analyses of "neighbourhood and health" focus on interpreting measures of associations (e.g., odds ratio, OR). In contrast, multilevel analysis of variance is rarely considered. We propose an original stepwise analytical approach that disting...

Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward.

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Roar Fosse

Full Text Available No prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide.From 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014.Compared to a matched control group (n = 120, after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor.Suicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk.

Gauge-invariant three-boson vertices and their Ward identities in the standard model

International Nuclear Information System (INIS)

Papavassiliou, J.; Philippides, K.

1995-01-01

In the context of the standard model we extend the S-matrix pinch technique for nonconserved currents to the case of three-boson vertices. We outline in detail how effective gauge-invariant three-boson vertices can be constructed, with all three incoming momenta off shell. Explicit closed expressions for the vertices γW - W + , ZW - W + , and χW - W + are reported. The three-boson vertices so constructed satisfy naive QED-like Ward identities which relate them to the gauge-invariant gauge boson self-energies previously constructed by the same method. The derivation of the aforementioned Ward identities relies on the sole requirement of complete gauge invariance of the S-matrix element considered; in particular, no knowledge of the explicit closed form of the three-boson vertices involved is necessary. The validity of one of these Ward identities is demonstrated explicitly, through a detailed diagrammatic one-loop analysis, in the context of three different gauges

Prediction of Partition Coefficients of Organic Compounds for SPME/PDMS

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Liao Hsuan-Yu

2016-01-01

Full Text Available The partition coefficients of 51 organic compounds between SPME/PDMS and gas were compiled from the literature sources in this study. The effect of physicochemical properties and descriptors on the partitioning process of partition coefficients was explicated by the correlation analysis. The PDMS-gas partition coefficients were well correlated to the molecular weight of organic compounds (r = 0.832, p < 0.05. An empirical model, consisting of the molecular weight and the polarizability, was developed to appropriately predict the partition coefficients of organic compounds. The empirical model for estimating the PDMS-gas partition coefficient will contribute to the practical applications of the SPME technique.

Ward Round - Late Presentation of Acute Compartment Syndrome in ...

African Journals Online (AJOL)

following the course of ibuprofen mentioned. Twelve days after admission he started to complain of increasing pain and tightness in his left thigh. Sensation and motor function. Ward Round - Late Presentation of Acute. Compartment Syndrome in the Thigh. University of Malawi, College of Medicine, Department of Surgery,.

A multilevel shape fit analysis of neutron transmission data

International Nuclear Information System (INIS)

Naguib, K.; Sallam, O.H.; Adib, M.

1989-01-01

A multilevel shape fit analysis of neutron transmission data is presented. A multilevel computer code SHAPE is used to analyse clean transmission data obtained from time-of-flight (TOF) measurements. The shape analysis deduces the parameters of the observed resonances in the energy region considered in the measurements. The shape code is based upon a least square fit of a multilevel Breit-Wigner formula and includes both instrumental resolution and Doppler broadenings. Operating the SHAPE code on a test example of a measured transmission data of 151 Eu, 153 Eu and natural Eu in the energy range 0.025-1 eV acquired a good result for the used technique of analysis. (author)

Pediatric resident perceptions of shift work in ward rotations.

Science.gov (United States)

Nomura, Osamu; Mishina, Hiroki; Jasti, Harish; Sakai, Hirokazu; Ishiguro, Akira

2017-10-01

Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education. © 2017 Japan Pediatric Society.

Variable length adjacent partitioning for PTS based PAPR reduction of OFDM signal

International Nuclear Information System (INIS)

Ibraheem, Zeyid T.; Rahman, Md. Mijanur; Yaakob, S. N.; Razalli, Mohammad Shahrazel; Kadhim, Rasim A.

2015-01-01

Peak-to-Average power ratio (PAPR) is a major drawback in OFDM communication. It leads the power amplifier into nonlinear region operation resulting into loss of data integrity. As such, there is a strong motivation to find techniques to reduce PAPR. Partial Transmit Sequence (PTS) is an attractive scheme for this purpose. Judicious partitioning the OFDM data frame into disjoint subsets is a pivotal component of any PTS scheme. Out of the existing partitioning techniques, adjacent partitioning is characterized by an attractive trade-off between cost and performance. With an aim of determining effects of length variability of adjacent partitions, we performed an investigation into the performances of a variable length adjacent partitioning (VL-AP) and fixed length adjacent partitioning in comparison with other partitioning schemes such as pseudorandom partitioning. Simulation results with different modulation and partitioning scenarios showed that fixed length adjacent partition had better performance compared to variable length adjacent partitioning. As expected, simulation results showed a slightly better performance of pseudorandom partitioning technique compared to fixed and variable adjacent partitioning schemes. However, as the pseudorandom technique incurs high computational complexities, adjacent partitioning schemes were still seen as favorable candidates for PAPR reduction

Variable length adjacent partitioning for PTS based PAPR reduction of OFDM signal

Energy Technology Data Exchange (ETDEWEB)

Ibraheem, Zeyid T.; Rahman, Md. Mijanur; Yaakob, S. N.; Razalli, Mohammad Shahrazel; Kadhim, Rasim A. [School of Computer and Communication Engineering, Universiti Malaysia Perlis, 02600 Arau, Perlis (Malaysia)

2015-05-15

Peak-to-Average power ratio (PAPR) is a major drawback in OFDM communication. It leads the power amplifier into nonlinear region operation resulting into loss of data integrity. As such, there is a strong motivation to find techniques to reduce PAPR. Partial Transmit Sequence (PTS) is an attractive scheme for this purpose. Judicious partitioning the OFDM data frame into disjoint subsets is a pivotal component of any PTS scheme. Out of the existing partitioning techniques, adjacent partitioning is characterized by an attractive trade-off between cost and performance. With an aim of determining effects of length variability of adjacent partitions, we performed an investigation into the performances of a variable length adjacent partitioning (VL-AP) and fixed length adjacent partitioning in comparison with other partitioning schemes such as pseudorandom partitioning. Simulation results with different modulation and partitioning scenarios showed that fixed length adjacent partition had better performance compared to variable length adjacent partitioning. As expected, simulation results showed a slightly better performance of pseudorandom partitioning technique compared to fixed and variable adjacent partitioning schemes. However, as the pseudorandom technique incurs high computational complexities, adjacent partitioning schemes were still seen as favorable candidates for PAPR reduction.

Phase Grouping Line Extraction Algorithm Using Overlapped Partition

Directory of Open Access Journals (Sweden)

WANG Jingxue

2015-07-01

Full Text Available Aiming at solving the problem of fracture at the discontinuities area and the challenges of line fitting in each partition, an innovative line extraction algorithm is proposed based on phase grouping using overlapped partition. The proposed algorithm adopted dual partition steps, which will generate overlapped eight partitions. Between the two steps, the middle axis in the first step coincides with the border lines in the other step. Firstly, the connected edge points that share the same phase gradients are merged into the line candidates, and fitted into line segments. Then to remedy the break lines at the border areas, the break segments in the second partition steps are refitted. The proposed algorithm is robust and does not need any parameter tuning. Experiments with various datasets have confirmed that the method is not only capable of handling the linear features, but also powerful enough in handling the curve features.

Hepatitis B antigen HB Ag examination by radioimmunological method in a hemodialysis ward

Energy Technology Data Exchange (ETDEWEB)

Opatrny, K; Karlicek, V; Topolcan, O; Farnik, J [Karlova Universita, Plzen (Czechoslovakia). Lekarska Fakulta; Kulich, V [Transfuzni oddeleni FN, Plzen (Czechoslovakia)

1975-11-07

The results are reported of regular examinations for the so-called Australian antigen of patients, medical personnel, and of equipment and working surfaces in the hemodialysis ward of the Plzen university hospital using the Ling and Overby method by the Ausria-125 and Ausria II kits by Abbott. It was found that the radioimmunological method was more sensitive than methods previously used and that it allowed for early ascertainment of contamination, thus reducing nosocomial and professional infections and reducing the occurrence of the disease in the ward.

Exploring the transition from\\ud staff nurse to\\ud ward sister/manager –\\ud An exploratory case study

OpenAIRE

Enterkin, Judith

2016-01-01

Background\\ud The ward sister/manager figure has traditionally been considered the ward based\\ud clinical leader. This role has evolved over time in response to professional and\\ud political demands; despite or because of this, reports of role ambiguity exist and\\ud the ward sister/manager position has become increasingly difficult to recruit to,\\ud with nurses arguably looking to roles perceived to have greater influence and\\ud status, but less onerous managerial responsibility. Understandin...

Analytical model for macromolecular partitioning during yeast cell division

International Nuclear Information System (INIS)

Kinkhabwala, Ali; Khmelinskii, Anton; Knop, Michael

2014-01-01

Asymmetric cell division, whereby a parent cell generates two sibling cells with unequal content and thereby distinct fates, is central to cell differentiation, organism development and ageing. Unequal partitioning of the macromolecular content of the parent cell — which includes proteins, DNA, RNA, large proteinaceous assemblies and organelles — can be achieved by both passive (e.g. diffusion, localized retention sites) and active (e.g. motor-driven transport) processes operating in the presence of external polarity cues, internal asymmetries, spontaneous symmetry breaking, or stochastic effects. However, the quantitative contribution of different processes to the partitioning of macromolecular content is difficult to evaluate. Here we developed an analytical model that allows rapid quantitative assessment of partitioning as a function of various parameters in the budding yeast Saccharomyces cerevisiae. This model exposes quantitative degeneracies among the physical parameters that govern macromolecular partitioning, and reveals regions of the solution space where diffusion is sufficient to drive asymmetric partitioning and regions where asymmetric partitioning can only be achieved through additional processes such as motor-driven transport. Application of the model to different macromolecular assemblies suggests that partitioning of protein aggregates and episomes, but not prions, is diffusion-limited in yeast, consistent with previous reports. In contrast to computationally intensive stochastic simulations of particular scenarios, our analytical model provides an efficient and comprehensive overview of partitioning as a function of global and macromolecule-specific parameters. Identification of quantitative degeneracies among these parameters highlights the importance of their careful measurement for a given macromolecular species in order to understand the dominant processes responsible for its observed partitioning

Design and Implementation of 13 Levels Multilevel Inverter for Photovoltaic System

Science.gov (United States)

Subramani, C.; Dhineshkumar, K.; Palanivel, P.

2018-04-01

This paper approaches the appearing and modernization of S-Type PV based 13- level multilevel inverter with less quantity of switch. The current S-Type Multi level inverter contains more number of switches and voltage sources. Multilevel level inverter is a be understandable among the most gainful power converters for high power application and present day applications with reduced switches. The fundamental good arrangement of the 13-level multilevel inverter is to get ventured voltage from a couple of levels of DC voltages.. The controller gives actual way day and age to switches through driver circuit using PWM methodology. The execution assessment of proposed multilevel inverter is checked using MATLAB/Simulink. This is the outstanding among other techniquem appeared differently in relation to all other existing system

Design Proposal for Pleasurable Light Atmosphere in Hospital Wards

DEFF Research Database (Denmark)

Stidsen, Lone; Kirkegaard, Poul Henning; Fisker, Anna Marie

2010-01-01

When constructing and designing Danish hospitals for the future, patients, staff and guests are in focus. It is found important to have a starting point in healing architecture and create an environment with knowledge of users sensory and functionally needs and looks at how hospital wards can sup...

Partition wall structure in spent fuel storage pool and construction method for the partition wall

International Nuclear Information System (INIS)

Izawa, Masaaki

1998-01-01

A partitioning wall for forming cask pits as radiation shielding regions by partitioning inside of a spent fuel storage pool is prepared by covering both surface of a concrete body by shielding metal plates. The metal plate comprises opposed plate units integrated by welding while sandwiching a metal frame as a reinforcing material for the concrete body, the lower end of the units is connected to a floor of a pool by fastening members, and concrete is set while using the metal plate of the units as a frame to form the concrete body. The shielding metal plate has a double walled structure formed by welding a lining plate disposed on the outer surface of the partition wall and a shield plate disposed to the inner side. Then the term for construction can be shortened, and the capacity for storing spent fuels can be increased. (N.H.)

Fast Multilevel Panel Method for Wind Turbine Rotor Flow Simulations

NARCIS (Netherlands)

van Garrel, Arne; Venner, Cornelis H.; Hoeijmakers, Hendrik Willem Marie

2017-01-01

A fast multilevel integral transform method has been developed that enables the rapid analysis of unsteady inviscid flows around wind turbines rotors. A low order panel method is used and the new multi-level multi-integration cluster (MLMIC) method reduces the computational complexity for

Stability of Boolean multilevel networks.

Science.gov (United States)

Cozzo, Emanuele; Arenas, Alex; Moreno, Yamir

2012-09-01

The study of the interplay between the structure and dynamics of complex multilevel systems is a pressing challenge nowadays. In this paper, we use a semiannealed approximation to study the stability properties of random Boolean networks in multiplex (multilayered) graphs. Our main finding is that the multilevel structure provides a mechanism for the stabilization of the dynamics of the whole system even when individual layers work on the chaotic regime, therefore identifying new ways of feedback between the structure and the dynamics of these systems. Our results point out the need for a conceptual transition from the physics of single-layered networks to the physics of multiplex networks. Finally, the fact that the coupling modifies the phase diagram and the critical conditions of the isolated layers suggests that interdependency can be used as a control mechanism.

Words in Maternity Wards: An Aproximation to Perinatal Psychology

Directory of Open Access Journals (Sweden)

Alicia Oiberman

2016-02-01

Full Text Available The acknowledgment that just born babies interact with human and physical contexts originated changes in behaviors of health teems working in maternity wards settings. Concepts such as initial interactions, attachment, dyads, maternal vulnerability, behavioral competences of the just born babies and their applications to perinatal psychology, marked a transformation in different professionals involved in birth’s approaches. From one side, it can be said that medicalization of the birth act in Western societies had allowed to minimize risk factors. But this progress had been carried out without taking into account emotional expressions. The introduction of psychological interventions in neonatal periods is a new field of knowledge. History shows that in different periods and cultures there were amulets, potions and other elements associated with magic that were used to swear baby or mother’s death risk during childbirth. All these practices were taken the place of words, in a hard emotional moment: parturition. It was necessary to walk a long and difficult road for Perinatal Psycholy to recuperate the ancient place of old good women and incorporate words in maternity wards, knowing that the main scenery is first occupied by the mother’s body and then by the baby. Our daily job in a maternity ward, working together with pediatricians and neonatologists, allowed us to verify that words come out when psychologists themselves “include their body” as well as do mothers, babies and the medical teem. Words contribute to facilitate emotional expressions related to motherhood and place the baby in the family history, making able his or her “psychological birth”. 

Eliciting Patients’ Health Concerns in Consulting Rooms and Wards in Vietnamese Public Hospitals

Directory of Open Access Journals (Sweden)

Huong Thi Linh Nguyen

2018-03-01

Full Text Available This article examines the doctor’s elicitation of the patient’s presenting health concern in two clinical settings in the Vietnamese public hospital system: the consulting room and the ward. The data were taken from 66 audio-recorded consultations. Our analysis shows that the elicitors used by the doctor in the consulting room often communicate a weak epistemic stance towards the patient’s health issue, while those used in the ward tend to signal a strong epistemic stance. In addition, this contrast between the elicitors employed in the consulting room and the ward is evident in our data regardless of whether the consultation is a first visit or a same follow-up (in which the doctor is the same one that treated the patient on their last visit, though the contrast is less clear for different follow-ups (in which the doctor has not treated the patient before. An additional finding is that the clinical setting has some bearing on the use of inappropriate elicitation formats (in which the doctor opens the visit with an elicitor which is more appropriate for another type of visit. The precise way in which each of the consulting room and the ward operates is, of course, a feature of the Vietnamese public hospital system itself. Hence, the overall contrast between the elicitors and elicitation formats used in these two settings illustrates how, on a more general level, the institutional context can have an impact on doctor-patient communication.

Patient safety ward round checklist via an electronic app: implications for harm prevention.

Science.gov (United States)

Keller, C; Arsenault, S; Lamothe, M; Bostan, S R; O'Donnell, R; Harbison, J; Doherty, C P

2017-11-06

Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application. Two research teams were formed; one auditing a medical team to establish a procedural baseline of "usual care" practice and an intervention team concurrently was enforcing the implementation of the checklist. The checklist was comprised of eight standard clinical practice items. The program was conducted over a 2-week period and 1 month later, a retrospective analysis of patient charts was conducted using a global trigger tool to determine variance between the experimental groups. Finally, feedback from the physician participants was considered. The results demonstrated a statistically significant difference on five variables of a total of 16. The auditing team observed low adherence to patient identification (0.0%), hand decontamination (5.5%), and presence of nurse on ward rounds (6.8%). Physician feedback was generally positive. The baseline audit demonstrated significant practice bias on daily ward rounds which tended to omit several key-proven patient safety practices such as prompting hand decontamination and obtaining up to date reports from nursing staff. Results of the intervention arm demonstrate the feasibility of using the Checklist App on daily ward rounds.

Spatial partitions systematize visual search and enhance target memory.

Science.gov (United States)

Solman, Grayden J F; Kingstone, Alan

2017-02-01

Humans are remarkably capable of finding desired objects in the world, despite the scale and complexity of naturalistic environments. Broadly, this ability is supported by an interplay between exploratory search and guidance from episodic memory for previously observed target locations. Here we examined how the environment itself may influence this interplay. In particular, we examined how partitions in the environment-like buildings, rooms, and furniture-can impact memory during repeated search. We report that the presence of partitions in a display, independent of item configuration, reliably improves episodic memory for item locations. Repeated search through partitioned displays was faster overall and was characterized by more rapid ballistic orienting in later repetitions. Explicit recall was also both faster and more accurate when displays were partitioned. Finally, we found that search paths were more regular and systematic when displays were partitioned. Given the ubiquity of partitions in real-world environments, these results provide important insights into the mechanisms of naturalistic search and its relation to memory.

FBILI method for multi-level line transfer

Science.gov (United States)

Kuzmanovska, O.; Atanacković, O.; Faurobert, M.

2017-07-01

Efficient non-LTE multilevel radiative transfer calculations are needed for a proper interpretation of astrophysical spectra. In particular, realistic simulations of time-dependent processes or multi-dimensional phenomena require that the iterative method used to solve such non-linear and non-local problem is as fast as possible. There are several multilevel codes based on efficient iterative schemes that provide a very high convergence rate, especially when combined with mathematical acceleration techniques. The Forth-and-Back Implicit Lambda Iteration (FBILI) developed by Atanacković-Vukmanović et al. [1] is a Gauss-Seidel-type iterative scheme that is characterized by a very high convergence rate without the need of complementing it with additional acceleration techniques. In this paper we make the implementation of the FBILI method to the multilevel atom line transfer in 1D more explicit. We also consider some of its variants and investigate their convergence properties by solving the benchmark problem of CaII line formation in the solar atmosphere. Finally, we compare our solutions with results obtained with the well known code MULTI.

Experiments and Recommendations for Partitioning Systems of Equations

Directory of Open Access Journals (Sweden)

Mafteiu-Scai Liviu Octavian

2014-06-01

Full Text Available Partitioning the systems of equations is a very important process when solving it on a parallel computer. This paper presents some criteria which leads to more efficient parallelization, that must be taken into consideration. New criteria added to preconditioning process by reducing average bandwidth are pro- posed in this paper. These new criteria lead to a combination between preconditioning and partitioning of systems equations, so no need two distinct algorithms/processes. In our proposed methods - where the preconditioning is done by reducing the average bandwidth- two directions were followed in terms of partitioning: for a given preconditioned system determining the best partitioning (or one as close and the second consist in achieving an adequate preconditioning, depending on a given/desired partitioning. A mixed method it is also proposed. Experimental results, conclusions and recommendations, obtained after parallel implementation of conjugate gradient on IBM BlueGene /P supercomputer- based on a synchronous model of parallelization- are also presented in this paper.

Multi-Level Wavelet Shannon Entropy-Based Method for Single-Sensor Fault Location

Directory of Open Access Journals (Sweden)

Qiaoning Yang

2015-10-01

Full Text Available In actual application, sensors are prone to failure because of harsh environments, battery drain, and sensor aging. Sensor fault location is an important step for follow-up sensor fault detection. In this paper, two new multi-level wavelet Shannon entropies (multi-level wavelet time Shannon entropy and multi-level wavelet time-energy Shannon entropy are defined. They take full advantage of sensor fault frequency distribution and energy distribution across multi-subband in wavelet domain. Based on the multi-level wavelet Shannon entropy, a method is proposed for single sensor fault location. The method firstly uses a criterion of maximum energy-to-Shannon entropy ratio to select the appropriate wavelet base for signal analysis. Then multi-level wavelet time Shannon entropy and multi-level wavelet time-energy Shannon entropy are used to locate the fault. The method is validated using practical chemical gas concentration data from a gas sensor array. Compared with wavelet time Shannon entropy and wavelet energy Shannon entropy, the experimental results demonstrate that the proposed method can achieve accurate location of a single sensor fault and has good anti-noise ability. The proposed method is feasible and effective for single-sensor fault location.

Partitional clustering algorithms

CERN Document Server

2015-01-01

This book summarizes the state-of-the-art in partitional clustering. Clustering, the unsupervised classification of patterns into groups, is one of the most important tasks in exploratory data analysis. Primary goals of clustering include gaining insight into, classifying, and compressing data. Clustering has a long and rich history that spans a variety of scientific disciplines including anthropology, biology, medicine, psychology, statistics, mathematics, engineering, and computer science. As a result, numerous clustering algorithms have been proposed since the early 1950s. Among these algorithms, partitional (nonhierarchical) ones have found many applications, especially in engineering and computer science. This book provides coverage of consensus clustering, constrained clustering, large scale and/or high dimensional clustering, cluster validity, cluster visualization, and applications of clustering. Examines clustering as it applies to large and/or high-dimensional data sets commonly encountered in reali...

Topological string partition functions as polynomials

International Nuclear Information System (INIS)

Yamaguchi, Satoshi; Yau Shingtung

2004-01-01

We investigate the structure of the higher genus topological string amplitudes on the quintic hypersurface. It is shown that the partition functions of the higher genus than one can be expressed as polynomials of five generators. We also compute the explicit polynomial forms of the partition functions for genus 2, 3, and 4. Moreover, some coefficients are written down for all genus. (author)

Partitioning of selected antioxidants in mayonnaise

DEFF Research Database (Denmark)

Jacobsen, Charlotte; Schwarz, K.; Stockmann, H.

1999-01-01

This study examined partitioning of alpha-, beta-, and gamma- tocopherol and six polar antioxidants (Trolox, ferulic acid, caffeic acid, propyl gallate, gallic acid, and catechin) in mayonnaise. Partitioning of antioxidants between different phases was determined after separation of mayonnaise...... acid and catechin) to 83% (Trolox). Accordingly, proportions of 6% (Trolox) to 80% (gallic acid and catechin) were found in the aqueous phase. Similar trends were observed after dialysis. After ultracentrifugation, large proportions of polar antioxidants were found in the "emulsion phase...... by either (a) centrifugation + ultracentrifugation or (b) centrifugation + dialysis. Antioxidants partitioned in accordance with their chemical structure and polarity: Tocopherols were concentrated in the oil phase (93-96%), while the proportion of polar antioxidants in the oil phase ranged from 0% (gallic...

Partitioning of resveratrol between pentane and DMSO

DEFF Research Database (Denmark)

Shen, Chen; Stein, Paul C.; Klösgen-Buchkremer, Beate Maria

2015-01-01

Partitioning of trans-3,5,4′-trihydroxy-stilbene (resveratrol) between n-pentane and DMSO was investigated as a contribution to understand the interaction between resveratrol and biomembranes. In order to determine the partition coefficient P* of resveratrol between pentane and DMSO, resveratrol ...

Quality assessment of emergency wards in Khorramabad public hospitals based on EFQM model

Directory of Open Access Journals (Sweden)

mohammad hasan Imani-Nasab

2012-12-01

Conclusion: Findings show that quality of studied wards is less than the model standards and other similar studies considerably. From view point of the researcher the existing gap with external studies is logical and in comparison with internal studies is irrational. The studied wards acquired the most score in process criterion and the least score in policy and strategy criterion. Also ,findings shows a negative relation between results of assessment based on EFQM model and current evaluation system of the ministry of health, so it is suggested that the current system should be revised fundamenally.

Fat polygonal partitions with applications to visualization and embeddings

Directory of Open Access Journals (Sweden)

Mark de Berg

2013-12-01

Full Text Available Let T be a rooted and weighted tree, where the weight of any node is equal to the sum of the weights of its children. The popular Treemap algorithm visualizes such a tree as a hierarchical partition of a square into rectangles, where the area of the rectangle corresponding to any node in T is equal to the weight of that node. The aspect ratio of the rectangles in such a rectangular partition necessarily depends on the weights and can become arbitrarily high.We introduce a new hierarchical partition scheme, called a polygonal partition, which uses convex polygons rather than just rectangles. We present two methods for constructing polygonal partitions, both having guarantees on the worst-case aspect ratio of the constructed polygons; in particular, both methods guarantee a bound on the aspect ratio that is independent of the weights of the nodes.We also consider rectangular partitions with slack, where the areas of the rectangles may differ slightly from the weights of the corresponding nodes. We show that this makes it possible to obtain partitions with constant aspect ratio. This result generalizes to hyper-rectangular partitions in ℝd. We use these partitions with slack for embedding ultrametrics into d-dimensional Euclidean space:  we give a polylog(Δ-approximation algorithm for embedding n-point ultrametrics into ℝd with minimum distortion, where Δ denotes the spread of the metric. The previously best-known approximation ratio for this problem was polynomial in n. This is the first algorithm for embedding a non-trivial family of weighted-graph metrics into a space of constant dimension that achieves polylogarithmic approximation ratio.

Multi-level decision making models, methods and applications

CERN Document Server

Zhang, Guangquan; Gao, Ya

2015-01-01

This monograph presents new developments in multi-level decision-making theory, technique and method in both modeling and solution issues. It especially presents how a decision support system can support managers in reaching a solution to a multi-level decision problem in practice. This monograph combines decision theories, methods, algorithms and applications effectively. It discusses in detail the models and solution algorithms of each issue of bi-level and tri-level decision-making, such as multi-leaders, multi-followers, multi-objectives, rule-set-based, and fuzzy parameters. Potential readers include organizational managers and practicing professionals, who can use the methods and software provided to solve their real decision problems; PhD students and researchers in the areas of bi-level and multi-level decision-making and decision support systems; students at an advanced undergraduate, master’s level in information systems, business administration, or the application of computer science.  

Mental Health of General Practitioners in Emergency Wards

Directory of Open Access Journals (Sweden)

Sepehrmanesh Z.1 PhD,

2015-01-01

Full Text Available Aims General practitioners have an essential role in patient care and are exposed to high levels of job stress. General practitioners’ mental health has effects on their functional abilities and medical managements.This study was carried out to evaluate the mental health of general practitioners in emergency wards in KashanUniversity of Medical Sciences, Iran. Materials & Methods In this cross-sectional study, all of General practitioners in emergency wards (n=87 were studied. The survey instruments includedtwo questionnaires: 1-demographic variables and 2- General Health Questionnaire (GHQ-28. Data were analyzed using SPSS 16 software and Chi square, Fisher exactand Mann-Whitney statistical tests. Findings The mean age of general practitioners was 36.11±5.67 years; 89.7% of them were married; 60.3% were male. 41% of the total general practitioners had mental health problems. The mean score of GHQ was 22.56±9.24. There were significant relationships between mental health and each age, employment situation, and number of children (p0.05. Conclusion The majority of employed general practitioners in emergency rooms do not have proper mental health statuses.

ROMANO-WARD SYNDROME ASSOCIATED WITH TU ELECTRICAL ALTERNANS

Directory of Open Access Journals (Sweden)

DJAWAN

1981-05-01

Full Text Available A case o f the electrical alternans of t he TU wave and peri odic nega t ive U wave associated with c l ini cal symptoms , e lectrocardi ographic a nd postmortem findi ng s o f Romano- Ward Syndrome has been pres ented. No e lec ~ r o l y te d ist urbance was found t o be r esponsible for t his exceptional l y rare situation . Changes i n A-V conduct i on and left bu n• d Ie branch block could be a t tributed to the d i f f use c or onary s clero sis and s ubs equent i schemia in the myocardial c onduction t.issues . The e lectrical alternans of t he U wave or TU complex of the e lectrocardiogram i s an exceeding ly r are s i t uation without any clearly known mechanism for i ts appea rance . A case of thi s phenome no~ i n as soc iation with RomanoWard Syndrome has been presented whe rein an abnorma l ity i n A-V conduction and left bund le branch block cou ld be encountered .

[The current aspects of hospital infections in maternity and neonatal wards].

Science.gov (United States)

Ribarova, N; Todorova, M; Khristov, Kh

1994-01-01

The epidemiologic, etiologic and clinical structure of HAI in the maternity and neonatal wards in the country for the 1982-1992 period has been specified. 934 women in child-birth and 2357 neonates acquire nosocomial infections at an average annually. A comparatively constant level in HAI epidemic process intensity is observed with inconsiderable diversions in the beginning and by the end of the studied period. Staphylococci like causative agents of HAI take up a leading place in both types of wards with especially marked incidence rate among the newborn children. The predominant clinical forms in the women in child-birth are the surgical wound infections, skin and genital infections and in the neonates--the staphylodermatites, upper respiratory airway infections, pulmonary and enteric infections.

Glueball candidate iota(1440), anomalous Ward identities, and two-photon decays

International Nuclear Information System (INIS)

Williams, P.G.

1984-01-01

Anomalous Ward identities are given for the U(1) problem, showing that some recent papers have neglected the large topological susceptibility coming from the pure Yang-Mills sector of QCD. A reanalysis of the Ward identities is given, including the pseudoscalar glueball candidate iota(1440) with the pseudoscalar nonet. It is shown that positivity of the topological susceptibility together with other constraints is sufficient to narrow down the permitted range of pseudoscalar axial couplings. In particular the iota(1440) couplings are consistent with those expected for a glueball with the decay iota→γγ probably immeasurably small. Contrary to a recent claim, the results are not sensitive to the branching ratio for iota→KK-barπ, which may be as large as 100%

High Pressure/Temperature Metal Silicate Partitioning of Tungsten

Science.gov (United States)

Shofner, G. A.; Danielson, L.; Righter, K.; Campbell, A. J.

2010-01-01

The behavior of chemical elements during metal/silicate segregation and their resulting distribution in Earth's mantle and core provide insight into core formation processes. Experimental determination of partition coefficients allows calculations of element distributions that can be compared to accepted values of element abundances in the silicate (mantle) and metallic (core) portions of the Earth. Tungsten (W) is a moderately siderophile element and thus preferentially partitions into metal versus silicate under many planetary conditions. The partitioning behavior has been shown to vary with temperature, silicate composition, oxygen fugacity, and pressure. Most of the previous work on W partitioning has been conducted at 1-bar conditions or at relatively low pressures, i.e. pressure. Predictions based on extrapolation of existing data and parameterizations suggest an increased pressured dependence on metal/ silicate partitioning of W at higher pressures 5. However, the dependence on pressure is not as well constrained as T, fO2, and silicate composition. This poses a problem because proposed equilibration pressures for core formation range from 27 to 50 GPa, falling well outside the experimental range, therefore requiring exptrapolation of a parametereized model. Higher pressure data are needed to improve our understanding of W partitioning at these more extreme conditions.

Implementation of an Electronic Checklist to Improve Patient Handover From Ward to Operating Room

DEFF Research Database (Denmark)

Münter, Kristine H; Møller, Thea P; Østergaard, Doris

2017-01-01

risk factors. The aim of this study was to describe the implementation process and completion rate of a new preoperative, ward-to-OR checklist. Our goal was a 90% fulfillment. METHOD: This study is a prospective, observational study in a Danish University Hospital including all patients undergoing......OBJECTIVE: Research has identified numerous safety risks in perioperative patient handover. In handover from ward to operating room (OR), patients are often transferred by a third person. This adds to the risk of loss of important information and of caregivers in the OR not identifying possible...... surgery in 2013. The checklist was a screen page with 27 checkboxes of information relevant for a safe handover. The checklist should be completed in the ward before handover to the OR and should be checked in the OR before receiving the patient. The Plan-Do-Study-Act (PDSA) cycle method was used...

Moxa-stick suffumigation for disinfecting air in hematology and hematopoietic stem cell transplantation wards with class 100 laminar flow.

Science.gov (United States)

He, Jing-song; Yang, Qing; Huang, Wei-jia; Hu, Xiao-rong

2014-04-01

To evaluate the effect of moxa-stick suffumigation in the hematology and hematopoietic stem cell transplantation (HSCT) wards with luminar flow. The plate exposure method was used to measure the effect of air-disinfection of moxa-stick suffumigation in hematology and HSCT wards. The yearly average qualified rates of air sampling in HSCT wards were evaluated from 2007 to 2010. To further investigate the disinfecting effect of moxa-stick suffumigation, the colony counts of common pathogens (including Staphylcoccus aureus and Pseudomonas aeruginosa) before and after moxa-stick suffumigation were compared. The mean air quality rates of the HSCT wards with class 100 laminar flow were all above 90.0% (91.2%-96.2%) from 2007 to 2010. Moxa-stick suffumigation effectively decreased the presence of bacteria in the hematology ward's air (Pplates exposed to air treated with moxa-stick suffumigation (77.1±52.9 cfu/m(2) vs 196.1±87.5 cfu/m(2), P<0.01; and 100.2±35.3 cfu/m(2) vs 371.5±35.3 cfu/m(2), P<0.01). Moxa-stick suffumigation proved to be a reliable and effective airdisinfection method for hematology and HSCT wards, and hence, it should be employed extensively.

Thermo-mechanical analysis for multi-level HLW repository concept

International Nuclear Information System (INIS)

Kwon, Sang Ki; Choi, Jong Won

2004-01-01

This work aims to investigate the influence of design parameters for the underground high-level nuclear waste repository with multi-level concept. B. Necessity o In order to construct an HLW repository in deep underground, it is required to select a site, which is far from major discontinuities. To dispose the whole spent fuels generated from the Korean nuclear power plants in a repository, the underground area of about 4km 2 is required. This would be a constraints for selecting an adequate repository site. It is recommended to dispose the two different spent fuels, PWR and CANDU, in different areas at the operation efficiency point of view. It is necessary to investigate the influence of parameters, which can affect the stability of multi-level repository. It is also needed to consider the influence of heat generated from the HLW and the high in situ stress in deep location. Therefore, thermo-mechanical coupling analysis should be carried out and the results should be compared with the results from single-level repository concept. Three-dimensional analysis is required to model the disposal tunnel and deposition hole. It is recommended to use the Korean geological condition and actually measured rock properties in Korea in order to achieve reliable modeling results. A FISH routine developed for effective modeling of Thermal-Mechanical coupling was implemented in the modeling using FLAC3D, which is a commercial three-dimensional FDM code. The thermal and mechanical properties of rock and rock mass achieved from Yusung drilling site, were used for the computer modeling. Different parameters such as level distance, waste type disposed on different levels, and time interval between the operation on different levels, were considered in the three-dimensional analysis. From the analysis, it was possible to derive adequate multi-level repository concept. Results and recommendations for application From the thermal-mechanical analysis for the multi-level repository

Labour ward midwives' perceptions of stress.

Science.gov (United States)

Mackin, P; Sinclair, M

1998-05-01

This exploratory study set out to examine labour ward midwives' perceptions of stress. It utilized a combination of two self-report questionnaires, one devised by McGrath et al. and the GHQ12. Additional qualitative data were collected by asking midwives to produce narratives about recent stressful events. A convenience sample of the 43 midwives formed the study population and a response rate of 77% was achieved. Quantitative data were analysed using descriptive statistics and qualitative narratives were explored for content analysis. Midwives in this study demonstrated their awareness of stress in their working and personal lives and many took active steps to redress the negative effects with exercise, hobbies and talking with colleagues. However, the study revealed that 78% of the midwives indicated that having insufficient time to perform their duties was very stressful, paralleled by their perceived inability to influence work-based decisions. The study revealed that both medical and midwifery colleagues frustrated their endeavours to change an unsatisfactory condition. The GHQ12 revealed 30% of the midwives had scores above the threshold level of 2 indicating psychiatric morbidity and this is of major concern. The narratives revealed that lack of communication between the professionals about decision making was a major source of stress and as a result of this study efforts to improve multidisciplinary communication through the development of journal clubs and planned social activities is under consideration by the unit. Overall, the findings from this study highlight stress as a potential, occupational health problem in the working lives of some labour ward midwives.

Identification and characteristics of imipenem-resistant Acinetobacter baumannii in surgical wards in a Chinese university hospital.

Science.gov (United States)

Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun

2015-03-01

The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type β-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region.

The notion of participatory democracy in relation to local ward committees: The distribution of power

Directory of Open Access Journals (Sweden)

Leepo J. Modise

2017-10-01

Full Text Available This article comprises four important parts: first, the two important components of democracy, namely participatory and non-participatory or representative democracy will be discussed with special reference to the distribution of powers. Second, it will address the roles and responsibilities of ward committees within the democratic society. Third, the ethical question of the basis of the committee members’ capacity to serve on the ward committees in relation to coercive leadership (tyranny of the majority will be investigated. Fourth, the theological standpoint on the distribution of powers or participatory democracy and the role of the church to improve participatory democracy will be discussed. The research question is the following: What can be done by the country to improve participatory democracy in South Africa, through engagement with ward committees?

Handbook of multilevel analysis

National Research Council Canada - National Science Library

Leeuw, Jan de; Meijer, Erik

2008-01-01

... appropriate and efficient model-based methods have become available to deal with this issue, that we have come to appreciate the power that more complex models provide for describing the world and providing new insights. This book sets out to present some of the most recent developments in what has come to be known as multilevel modelling. An...

Three-phase multilevel inverter configuration for open-winding high power application

DEFF Research Database (Denmark)

Sanjeevikumar, Padmanaban; Blaabjerg, Frede; Wheeler, Patrick William

2015-01-01

This paper work exploits a new dual open-winding three-phase multilevel inverter configuration suitable for high power medium-voltage applications. Modular structure comprised of standard three-phase voltage source inverter (VSI) along with one additional bi-directional semiconductor device (MOSFET...... for implementation purpose. Proposed dual-inverter configuration generates multilevel outputs with benefit includes reduced THD and dv/dt in comparison to other dual-inverter topologies. Complete model of the multilevel ac drive is developed with simple MSCFM modulation in Matlab/PLECs numerical software...

Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories.

Science.gov (United States)

Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine

2010-09-01

Scand J Caring Sci; 2010; 24; 581-591 
 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories   Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory.   To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories.   Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing.   The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff.   The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.

Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

Science.gov (United States)

Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

2016-01-01

There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

Variable-speed wind power system with improved energy capture via multilevel conversion

Science.gov (United States)

Erickson, Robert W.; Al-Naseem, Osama A.; Fingersh, Lee Jay

2005-05-31

A system and method for efficiently capturing electrical energy from a variable-speed generator are disclosed. The system includes a matrix converter using full-bridge, multilevel switch cells, in which semiconductor devices are clamped to a known constant DC voltage of a capacitor. The multilevel matrix converter is capable of generating multilevel voltage wave waveform of arbitrary magnitude and frequencies. The matrix converter can be controlled by using space vector modulation.

Ward identities and differential equations for supercharacters of N = 1 super-Kac-Moody algebras on supertorus

International Nuclear Information System (INIS)

Huang Chaoshang; Xu Kaiwen; Zhao Zhiyong.

1989-09-01

By using Bernard's method, the Ward identities for N = 1 super-Kac-Moody algebras on supertorus are completely given in the sense that any correlation function with currents inserted in it can be reduced from the correlation functions without insertion. The differential equations for the super-characters on supertorus are derived from the Ward identities. (author). 7 refs

Choosing the best partition of the output from a large-scale simulation

Energy Technology Data Exchange (ETDEWEB)

Challacombe, Chelsea Jordan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Casleton, Emily Michele [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-09-26

Data partitioning becomes necessary when a large-scale simulation produces more data than can be feasibly stored. The goal is to partition the data, typically so that every element belongs to one and only one partition, and store summary information about the partition, either a representative value plus an estimate of the error or a distribution. Once the partitions are determined and the summary information stored, the raw data is discarded. This process can be performed in-situ; meaning while the simulation is running. When creating the partitions there are many decisions that researchers must make. For instance, how to determine once an adequate number of partitions have been created, how are the partitions created with respect to dividing the data, or how many variables should be considered simultaneously. In addition, decisions must be made for how to summarize the information within each partition. Because of the combinatorial number of possible ways to partition and summarize the data, a method of comparing the different possibilities will help guide researchers into choosing a good partitioning and summarization scheme for their application.

Why partition nuclear waste

International Nuclear Information System (INIS)

Cohen, J.J.

1976-01-01

A cursory review of literature dealing with various separatory processes involved in the handling of high-level liquid nuclear waste discloses that, for the most part, discussion centers on separation procedures and methodology for handling the resulting fractions, particularly the actinide wastes. There appears to be relatively little discussion on the incentives or motivations for performing these separations in the first place. Discussion is often limited to the assumption that we must separate out ''long-term'' from our ''short-term'' management problems. This paper deals with that assumption and devotes primary attention to the question of ''why partition waste'' rather than the question of ''how to partition waste'' or ''what to do with the segregated waste.''

A Multilevel Secure Workflow Management System

National Research Council Canada - National Science Library

Kang, Myong H; Froscher, Judith N; Sheth, Amit P; Kochut, Krys J; Miller, John A

1999-01-01

The Department of Defense (DoD) needs multilevel secure (MLS) workflow management systems to enable globally distributed users and applications to cooperate across classification levels to achieve mission critical goals...

A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (1) Development of tool.

Science.gov (United States)

Lakshminarayana, Indumathy; Wall, David; Bindal, Taruna; Goodyear, Helen M

2015-05-01

Leading a ward round is an essential skill for hospital consultants and senior trainees but is rarely assessed during training. To investigate the key attributes for ward round leadership and to use these results to develop a multisource feedback (MSF) tool to assess the ward round leadership skills of senior specialist trainees. A panel of experts comprising four senior paediatric consultants and two nurse managers were interviewed from May to August 2009. From analysis of the interview transcripts, 10 key themes emerged. A structured questionnaire based on the key themes was designed and sent electronically to paediatric consultants, nurses and trainees at a large university hospital (June-October 2010). 81 consultants, nurses and trainees responded to the survey. The internal consistency of this tool was high (Cronbach's α 0.95). Factor analysis showed that five factors accounted for 72% of variance. The five key areas for ward round leadership were communication skills, preparation and organisation, teaching and enthusiasm, team working and punctuality; communication was the most important key theme. A MSF tool for ward round leadership skills was developed with these areas as five domains. We believe that this tool will add to the current assessment tools available by providing feedback about ward round leadership skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A Timing-Driven Partitioning System for Multiple FPGAs

Directory of Open Access Journals (Sweden)

Kalapi Roy

1996-01-01

Full Text Available Field-programmable systems with multiple FPGAs on a PCB or an MCM are being used by system designers when a single FPGA is not sufficient. We address the problem of partitioning a large technology mapped FPGA circuit onto multiple FPGA devices of a specific target technology. The physical characteristics of the multiple FPGA system (MFS pose additional constraints to the circuit partitioning algorithms: the capacity of each FPGA, the timing constraints, the number of I/Os per FPGA, and the pre-designed interconnection patterns of each FPGA and the package. Existing partitioning techniques which minimize just the cut sizes of partitions fail to satisfy the above challenges. We therefore present a timing driven N-way partitioning algorithm based on simulated annealing for technology-mapped FPGA circuits. The signal path delays are estimated during partitioning using a timing model specific to a multiple FPGA architecture. The model combines all possible delay factors in a system with multiple FPGA chips of a target technology. Furthermore, we have incorporated a new dynamic net-weighting scheme to minimize the number of pin-outs for each chip. Finally, we have developed a graph-based global router for pin assignment which can handle the pre-routed connections of our MFS structure. In order to reduce the time spent in the simulated annealing phase of the partitioner, clusters of circuit components are identified by a new linear-time bottom-up clustering algorithm. The annealing-based N-way partitioner executes four times faster using the clusters as opposed to a flat netlist with improved partitioning results. For several industrial circuits, our approach outperforms the recursive min-cut bi-partitioning algorithm by 35% in terms of nets cut. Our approach also outperforms an industrial FPGA partitioner by 73% on average in terms of unroutable nets. Using the performance optimization capabilities in our approach we have successfully partitioned the

Transforming the slum: The case of Mumbai's M-Ward | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

2016-12-13

Dec 13, 2016 ... Mumbai, India's largest and wealthiest city, is a study in contrasts: it is rich and ... of state corruption and collusion with private sector developers. ... the Slum through Creation of Property Market: A Case Study of M-Ward in ...

Combinatorics and complexity of partition functions

CERN Document Server

Barvinok, Alexander

2016-01-01

Partition functions arise in combinatorics and related problems of statistical physics as they encode in a succinct way the combinatorial structure of complicated systems. The main focus of the book is on efficient ways to compute (approximate) various partition functions, such as permanents, hafnians and their higher-dimensional versions, graph and hypergraph matching polynomials, the independence polynomial of a graph and partition functions enumerating 0-1 and integer points in polyhedra, which allows one to make algorithmic advances in otherwise intractable problems. The book unifies various, often quite recent, results scattered in the literature, concentrating on the three main approaches: scaling, interpolation and correlation decay. The prerequisites include moderate amounts of real and complex analysis and linear algebra, making the book accessible to advanced math and physics undergraduates. .

A novel partitioning method for block-structured adaptive meshes

Science.gov (United States)

Fu, Lin; Litvinov, Sergej; Hu, Xiangyu Y.; Adams, Nikolaus A.

2017-07-01

We propose a novel partitioning method for block-structured adaptive meshes utilizing the meshless Lagrangian particle concept. With the observation that an optimum partitioning has high analogy to the relaxation of a multi-phase fluid to steady state, physically motivated model equations are developed to characterize the background mesh topology and are solved by multi-phase smoothed-particle hydrodynamics. In contrast to well established partitioning approaches, all optimization objectives are implicitly incorporated and achieved during the particle relaxation to stationary state. Distinct partitioning sub-domains are represented by colored particles and separated by a sharp interface with a surface tension model. In order to obtain the particle relaxation, special viscous and skin friction models, coupled with a tailored time integration algorithm are proposed. Numerical experiments show that the present method has several important properties: generation of approximately equal-sized partitions without dependence on the mesh-element type, optimized interface communication between distinct partitioning sub-domains, continuous domain decomposition which is physically localized and implicitly incremental. Therefore it is particularly suitable for load-balancing of high-performance CFD simulations.

A novel partitioning method for block-structured adaptive meshes

Energy Technology Data Exchange (ETDEWEB)

Fu, Lin, E-mail: lin.fu@tum.de; Litvinov, Sergej, E-mail: sergej.litvinov@aer.mw.tum.de; Hu, Xiangyu Y., E-mail: xiangyu.hu@tum.de; Adams, Nikolaus A., E-mail: nikolaus.adams@tum.de

2017-07-15

We propose a novel partitioning method for block-structured adaptive meshes utilizing the meshless Lagrangian particle concept. With the observation that an optimum partitioning has high analogy to the relaxation of a multi-phase fluid to steady state, physically motivated model equations are developed to characterize the background mesh topology and are solved by multi-phase smoothed-particle hydrodynamics. In contrast to well established partitioning approaches, all optimization objectives are implicitly incorporated and achieved during the particle relaxation to stationary state. Distinct partitioning sub-domains are represented by colored particles and separated by a sharp interface with a surface tension model. In order to obtain the particle relaxation, special viscous and skin friction models, coupled with a tailored time integration algorithm are proposed. Numerical experiments show that the present method has several important properties: generation of approximately equal-sized partitions without dependence on the mesh-element type, optimized interface communication between distinct partitioning sub-domains, continuous domain decomposition which is physically localized and implicitly incremental. Therefore it is particularly suitable for load-balancing of high-performance CFD simulations.

'It teaches you what to expect in future . . . ': interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students.

Science.gov (United States)

Reeves, Scott; Freeth, Della; McCrorie, Peter; Perry, David

2002-04-01

This paper presents findings from a multimethod evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students. Unique in the UK, and following the pioneering work at Linköping, the training ward allowed senior pre-qualification students, under the supervision of practitioners, to plan and deliver interprofessional care for a group of orthopaedic and rheumatology patients. This responsibility enabled students to develop profession-specific skills and competencies in dealing with patients. It also allowed them to enhance their teamworking skills in an interprofessional environment. Student teams were supported by facilitators who ensured medical care was optimal, led reflective sessions and facilitated students' problem solving. Data were collected from all groups of participants involved in the ward: students, facilitators and patients. Methods included questionnaires, interviews and observations. Findings are presented from each participating group, with a particular emphasis placed on the perspective of medicine. The study found that students valued highly the experiential learning they received on the ward and felt the ward prepared them more effectively for future practice. However, many encountered difficulties adopting an autonomous learning style during their placement. Despite enjoying their work on the ward, facilitators were concerned that the demands of their role could result in 'burn-out'. Patients enjoyed their ward experience and scored higher on a range of satisfaction indicators than a comparative group of patients. Participants were generally positive about the training ward. All considered that it was a worthwhile experience and felt the ward should recommence in the near future.

Assessment of Measurement Tools of Observation Rate of Nursing Handover Standards in Clinical Wards of Hospital

Directory of Open Access Journals (Sweden)

Saadi Amini

2015-08-01

Full Text Available Background and objectives : In health centers, clinical information of patient is transferred among care staffs regularly. One of the common cases in information transferring is during the time of nurses’ handover in hospital which performing it correctly will help schedule patient care, providing safety and facilitating exact transferring of information. The aim of this study is investigating validity and reliability of assessment of observance rate of shift handover in clinical wards checklist. Material and Methods : In order to determine the reliability of checklist, two experts panel meetings were held with the presence of 10 experts in clinical field that in those meetings the reliability was investigated with discussion and consensus of participants. Checklist validity was investigated through pilot study in 4 wards of 4 hospitals and calculated by Kronbach- alpha method with 28 cases of shifts handover in morning, noon, and night shift. Results : In studying reliability, the primary checklist was divided into two checklists: patient handover, equipments and ward handover that included 27 and 72 items, respectively. The reliability of patient handover checklist was verified with 0.9155 Kronbach-alpha and that of equipments and ward handover was verified with 0.8779 Kronbach-alpha. Conclusion : Verifying checklists by mentioned scientific and statistical methods showed that these are very powerful instruments that can be used as one of the assessment tools of shift handover in clinical wards to be used towards promoting received services by customers of healthcare system.

The effect of multi-professional education on the recognition and outcome of patients at risk on general wards

DEFF Research Database (Denmark)

Fuhrmann, L.; Perner, A.; Klausen, T.W.

2009-01-01

The aim of this study was to evaluate the effect of multi-professional full-scale simulation-based education of staff on the mortality and staff awareness of patients at risk on general wards. DESIGN, SETTINGS AND PATIENTS: A prospective before-and-after study conducted on four general wards...... at Herlev Hospital, Denmark. In the pre-intervention period (June-July 2006) and post-intervention period (November-December 2007), all patients on the wards had vital signs measured in the evening by study personnel, who also asked nursing staff questions about patients with abnormal vital signs...

The influence of hydrogen bonding on partition coefficients

Science.gov (United States)

Borges, Nádia Melo; Kenny, Peter W.; Montanari, Carlos A.; Prokopczyk, Igor M.; Ribeiro, Jean F. R.; Rocha, Josmar R.; Sartori, Geraldo Rodrigues

2017-02-01

This Perspective explores how consideration of hydrogen bonding can be used to both predict and better understand partition coefficients. It is shown how polarity of both compounds and substructures can be estimated from measured alkane/water partition coefficients. When polarity is defined in this manner, hydrogen bond donors are typically less polar than hydrogen bond acceptors. Analysis of alkane/water partition coefficients in conjunction with molecular electrostatic potential calculations suggests that aromatic chloro substituents may be less lipophilic than is generally believed and that some of the effect of chloro-substitution stems from making the aromatic π-cloud less available to hydrogen bond donors. Relationships between polarity and calculated hydrogen bond basicity are derived for aromatic nitrogen and carbonyl oxygen. Aligned hydrogen bond acceptors appear to present special challenges for prediction of alkane/water partition coefficients and this may reflect `frustration' of solvation resulting from overlapping hydration spheres. It is also shown how calculated hydrogen bond basicity can be used to model the effect of aromatic aza-substitution on octanol/water partition coefficients.

Compactified webs and domain wall partition functions

Energy Technology Data Exchange (ETDEWEB)

Shabbir, Khurram [Government College University, Department of Mathematics, Lahore (Pakistan)

2017-04-15

In this paper we use the topological vertex formalism to calculate a generalization of the ''domain wall'' partition function of M-strings. This generalization allows calculation of partition function of certain compactified webs using a simple gluing algorithm similar to M-strings case. (orig.)

Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey.

Science.gov (United States)

Takai, Yukari; Yamamoto-Mitani, Noriko; Fukahori, Hiroki; Kobayashi, Sayuri; Chiba, Yumi

2013-09-01

This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Analysis of Harmonic Injection to the Modulation of Multi-Level ...

African Journals Online (AJOL)

This paper explores the analysis of third and ninth harmonic injection to the modulation of a multilevel diode clamped converter (DCC) at a varying modulation index. The spectral distributions of the various multi-level waveforms obtained under normal modulation index of 0.8 and over modulation index of 1.15 were ...

Structural analysis of the ParR/parC plasmid partition complex

DEFF Research Database (Denmark)

Møller-Jensen, Jakob; Ringgaard, Simon; Mercogliano, Christopher P

2007-01-01

Accurate DNA partition at cell division is vital to all living organisms. In bacteria, this process can involve partition loci, which are found on both chromosomes and plasmids. The initial step in Escherichia coli plasmid R1 partition involves the formation of a partition complex between the DNA...

Interfacial thermodynamics and electrochemistry of protein partitioning in two-phase systems

NARCIS (Netherlands)

Fraaije, J.G.E.M.

1987-01-01

The subject of this thesis is protein partition between an aqueous salt solution and a surface or an apolair liquid and the concomitant co-partition of small ions. The extent of co-partitioning determines the charge regulation in the protein partitioning process.

Chapters 2 and 3

Protected engagement time on older adult mental health wards: A thematic analysis of the views of patients, carers, and staff.

Science.gov (United States)

Dodd, Emily; Cheston, Richard; Procter, Charlie; Heneker, Sarah; Gray, Richard; Fox, Chris; Nolan, Fiona

2018-04-01

During protected engagement time (PET), ward routines are adjusted so that staff can spend time together with patients without interruption. The aim of PET is to increase staff and patient interaction on wards, and ultimately patient well-being. Although PET has been implemented on inpatient wards within the UK, including older adult wards, there is no systematic evidence as to how PET is carried out or how it is experienced by staff, patients, and families. Semistructured interviews were conducted with 28 participants (8 patients, 10 family members, and 10 ward staff) from three different wards with PET, and transcriptions were analysed using thematic analysis. Three themes were identified: (i) the patient is at the heart of care; (ii) PET depends on staff; and (iii) tensions in how PET operates. There was support in our sample for the principles of PET and its potential for a positive impact on patient well-being. However, the implementation of PET was identified as challenging, highlighting an existing tension between an individual's needs and the wider needs of patients on the ward as a whole. The impact of PET was generally described as being dependent on how PET was organized and the level of staff commitment to PET. Participants emphasized that if PET is to be successful, then it should be a fluid process that fits in with the local context. © 2017 Australian College of Mental Health Nurses Inc.

Partitioning of organochlorine pesticides from water to polyethylene passive samplers

International Nuclear Information System (INIS)

Hale, Sarah E.; Martin, Timothy J.; Goss, Kai-Uwe; Arp, Hans Peter H.; Werner, David

2010-01-01

The mass transfer rates and equilibrium partitioning behaviour of 14 diverse organochlorine pesticides (OCP) between water and polyethylene (PE) passive samplers, cut from custom made PE sheets and commercial polyethylene plastic bags, were quantified. Overall mass transfer coefficients, k O , estimated PE membrane diffusion coefficients, D PE , and PE-water partitioning coefficients, K PE-water, are reported. In addition, the partitioning of three polycyclic aromatic hydrocarbons (PAHs) from water to PE is quantified and compared with literature values. K PE-water values agreed mostly within a factor of two for both passive samplers and also with literature values for the reference PAHs. As PE is expected to exhibit similar sorption behaviour to long-chain alkanes, PE-water partitioning coefficients were compared to hexadecane-water partitioning coefficients estimated with the SPARC online calculator, COSMOtherm and a polyparameter linear free energy relationship based on the Abraham approach. The best correlation for all compounds tested was with COSMOtherm estimated hexadecane-water partitioning coefficients. - The partitioning of organochlorine pesticides between single phase polyethylene passive samplers and water is quantified.

Disruption of parent participation: nurses' strategies to manage parents on children's wards.

Science.gov (United States)

Coyne, Imelda

2008-12-01

To investigate parent participation in the hospitalized child's care from the perspectives of children, parents and nurses. Parent participation in the hospitalized child's care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents. Using grounded method, data were collected through in-depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England. The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents' participation and parents had to 'toe the line'. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non-compliance to the set of norms and rules was followed by reward or punishment. The nurses' dependence on parents' active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment. Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents' expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents' participation in care.

Time and Space Partitioning the EagleEye Reference Misson

Science.gov (United States)

Bos, Victor; Mendham, Peter; Kauppinen, Panu; Holsti, Niklas; Crespo, Alfons; Masmano, Miguel; de la Puente, Juan A.; Zamorano, Juan

2013-08-01

We discuss experiences gained by porting a Software Validation Facility (SVF) and a satellite Central Software (CSW) to a platform with support for Time and Space Partitioning (TSP). The SVF and CSW are part of the EagleEye Reference mission of the European Space Agency (ESA). As a reference mission, EagleEye is a perfect candidate to evaluate practical aspects of developing satellite CSW for and on TSP platforms. The specific TSP platform we used consists of a simulated LEON3 CPU controlled by the XtratuM separation micro-kernel. On top of this, we run five separate partitions. Each partition runs its own real-time operating system or Ada run-time kernel, which in turn are running the application software of the CSW. We describe issues related to partitioning; inter-partition communication; scheduling; I/O; and fault-detection, isolation, and recovery (FDIR).

Prediction of Partition Coefficients of Organic Compounds for SPME/PDMS

OpenAIRE

Liao Hsuan-Yu; Huang Miao-Ling; Lu Yu-Ting; Chao Keh-Ping

2016-01-01

The partition coefficients of 51 organic compounds between SPME/PDMS and gas were compiled from the literature sources in this study. The effect of physicochemical properties and descriptors on the partitioning process of partition coefficients was explicated by the correlation analysis. The PDMS-gas partition coefficients were well correlated to the molecular weight of organic compounds (r = 0.832, p < 0.05). An empirical model, consisting of the molecular weight and the polarizability, was ...

Analyzing chromatographic data using multilevel modeling.

Science.gov (United States)

Wiczling, Paweł

2018-06-01

It is relatively easy to collect chromatographic measurements for a large number of analytes, especially with gradient chromatographic methods coupled with mass spectrometry detection. Such data often have a hierarchical or clustered structure. For example, analytes with similar hydrophobicity and dissociation constant tend to be more alike in their retention than a randomly chosen set of analytes. Multilevel models recognize the existence of such data structures by assigning a model for each parameter, with its parameters also estimated from data. In this work, a multilevel model is proposed to describe retention time data obtained from a series of wide linear organic modifier gradients of different gradient duration and different mobile phase pH for a large set of acids and bases. The multilevel model consists of (1) the same deterministic equation describing the relationship between retention time and analyte-specific and instrument-specific parameters, (2) covariance relationships relating various physicochemical properties of the analyte to chromatographically specific parameters through quantitative structure-retention relationship based equations, and (3) stochastic components of intra-analyte and interanalyte variability. The model was implemented in Stan, which provides full Bayesian inference for continuous-variable models through Markov chain Monte Carlo methods. Graphical abstract Relationships between log k and MeOH content for acidic, basic, and neutral compounds with different log P. CI credible interval, PSA polar surface area.

Micro-spatial distribution of malaria cases and control strategies at ward level in Gwanda district, Matabeleland South, Zimbabwe.

Science.gov (United States)

Manyangadze, Tawanda; Chimbari, Moses J; Macherera, Margaret; Mukaratirwa, Samson

2017-11-21

Although there has been a decline in the number of malaria cases in Zimbabwe since 2010, the disease remains the biggest public health threat in the country. Gwanda district, located in Matabeleland South Province of Zimbabwe has progressed to the malaria pre-elimination phase. The aim of this study was to determine the spatial distribution of malaria incidence at ward level for improving the planning and implementation of malaria elimination in the district. The Poisson purely spatial model was used to detect malaria clusters and their properties, including relative risk and significance levels at ward level. The geographically weighted Poisson regression (GWPR) model was used to explore the potential role and significance of environmental variables [rainfall, minimum and maximum temperature, altitude, Enhanced Vegetation Index (EVI), Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI), rural/urban] and malaria control strategies [indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs)] on the spatial patterns of malaria incidence at ward level. Two significant clusters (p malaria cases were identified: (1) ward 24 south of Gwanda district and (2) ward 9 in the urban municipality, with relative risks of 5.583 and 4.316, respectively. The semiparametric-GWPR model with both local and global variables had higher performance based on AICc (70.882) compared to global regression (74.390) and GWPR which assumed that all variables varied locally (73.364). The semiparametric-GWPR captured the spatially non-stationary relationship between malaria cases and minimum temperature, NDVI, NDWI, and altitude at the ward level. The influence of LLINs, IRS and rural or urban did not vary and remained in the model as global terms. NDWI (positive coefficients) and NDVI (range from negative to positive coefficients) showed significant association with malaria cases in some of the wards. The IRS had a protection effect on

Application of Multilevel Models to Morphometric Data. Part 2. Correlations

Directory of Open Access Journals (Sweden)

O. Tsybrovskyy

2003-01-01

Full Text Available Multilevel organization of morphometric data (cells are “nested” within patients requires special methods for studying correlations between karyometric features. The most distinct feature of these methods is that separate correlation (covariance matrices are produced for every level in the hierarchy. In karyometric research, the cell‐level (i.e., within‐tumor correlations seem to be of major interest. Beside their biological importance, these correlation coefficients (CC are compulsory when dimensionality reduction is required. Using MLwiN, a dedicated program for multilevel modeling, we show how to use multivariate multilevel models (MMM to obtain and interpret CC in each of the levels. A comparison with two usual, “single‐level” statistics shows that MMM represent the only way to obtain correct cell‐level correlation coefficients. The summary statistics method (take average values across each patient produces patient‐level CC only, and the “pooling” method (merge all cells together and ignore patients as units of analysis yields incorrect CC at all. We conclude that multilevel modeling is an indispensable tool for studying correlations between morphometric variables.

Measurements of Radon Concentration in Several Wards of the University Clinical Center of Kosovo...

OpenAIRE

, Y. Halimi; , S. Kadiri; , G. Hodolli; , B. Xhafa; , A. Jonuzaj

2016-01-01

Understanding that what’s the level of environment pollution from radioactive pollutant in some wards of UCCK (University Clinical Center of Kosovo) in Prishtina are made measurements of α radiation which is the product of 222Rn and have been read doses of TLD to some staff workers in three wards of UCCK. All this is done to see the risk level of possible pollution. Concentration of radon 222Rn is measured with device CRM-510 portable instruments. During the measurements the apparatus has rec...

Evaluation of fungal air contamination in selected wards of two tertiary hospitals in Tehran, Iran

Directory of Open Access Journals (Sweden)

Zahra Kamali Sarwestani

2017-07-01

Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.

Phylogenetic systematics and biogeography of hummingbirds: Bayesian and maximum likelihood analyses of partitioned data and selection of an appropriate partitioning strategy.

Science.gov (United States)

McGuire, Jimmy A; Witt, Christopher C; Altshuler, Douglas L; Remsen, J V

2007-10-01

Hummingbirds are an important model system in avian biology, but to date the group has been the subject of remarkably few phylogenetic investigations. Here we present partitioned Bayesian and maximum likelihood phylogenetic analyses for 151 of approximately 330 species of hummingbirds and 12 outgroup taxa based on two protein-coding mitochondrial genes (ND2 and ND4), flanking tRNAs, and two nuclear introns (AK1 and BFib). We analyzed these data under several partitioning strategies ranging between unpartitioned and a maximum of nine partitions. In order to select a statistically justified partitioning strategy following partitioned Bayesian analysis, we considered four alternative criteria including Bayes factors, modified versions of the Akaike information criterion for small sample sizes (AIC(c)), Bayesian information criterion (BIC), and a decision-theoretic methodology (DT). Following partitioned maximum likelihood analyses, we selected a best-fitting strategy using hierarchical likelihood ratio tests (hLRTS), the conventional AICc, BIC, and DT, concluding that the most stringent criterion, the performance-based DT, was the most appropriate methodology for selecting amongst partitioning strategies. In the context of our well-resolved and well-supported phylogenetic estimate, we consider the historical biogeography of hummingbirds using ancestral state reconstructions of (1) primary geographic region of occurrence (i.e., South America, Central America, North America, Greater Antilles, Lesser Antilles), (2) Andean or non-Andean geographic distribution, and (3) minimum elevational occurrence. These analyses indicate that the basal hummingbird assemblages originated in the lowlands of South America, that most of the principle clades of hummingbirds (all but Mountain Gems and possibly Bees) originated on this continent, and that there have been many (at least 30) independent invasions of other primary landmasses, especially Central America.

Multi-level analysis in information systems research: the case of enterprise resource planning system usage in China

Science.gov (United States)

Sun, Yuan; Bhattacherjee, Anol

2011-11-01

Information technology (IT) usage within organisations is a multi-level phenomenon that is influenced by individual-level and organisational-level variables. Yet, current theories, such as the unified theory of acceptance and use of technology, describe IT usage as solely an individual-level phenomenon. This article postulates a model of organisational IT usage that integrates salient organisational-level variables such as user training, top management support and technical support within an individual-level model to postulate a multi-level model of IT usage. The multi-level model was then empirically validated using multi-level data collected from 128 end users and 26 managers in 26 firms in China regarding their use of enterprise resource planning systems and analysed using the multi-level structural equation modelling (MSEM) technique. We demonstrate the utility of MSEM analysis of multi-level data relative to the more common structural equation modelling analysis of single-level data and show how single-level data can be aggregated to approximate multi-level analysis when multi-level data collection is not possible. We hope that this article will motivate future scholars to employ multi-level data and multi-level analysis for understanding organisational phenomena that are truly multi-level in nature.

Construction of Scaling Partitions of Unity

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Ole Christensen

2017-11-01

Full Text Available Partitions of unity in ℝd formed by (matrix scales of a fixed function appear in many parts of harmonic analysis, e.g., wavelet analysis and the analysis of Triebel-Lizorkin spaces. We give a simple characterization of the functions and matrices yielding such a partition of unity. For expanding matrices, the characterization leads to easy ways of constructing appropriate functions with attractive properties like high regularity and small support. We also discuss a class of integral transforms that map functions having the partition of unity property to functions with the same property. The one-dimensional version of the transform allows a direct definition of a class of nonuniform splines with properties that are parallel to those of the classical B-splines. The results are illustrated with the construction of dual pairs of wavelet frames.

Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

DEFF Research Database (Denmark)

Vester-Andersen, M; Waldau, T; Wetterslev, J

2015-01-01

BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2...

Comparison of alcohol-dependent patients at a gastroenterological and a psychiatric ward according to the Lesch alcoholism typology: implications for treatment.

Science.gov (United States)

Vyssoki, Benjamin; Steindl-Munda, Petra; Ferenci, Peter; Walter, Henriette; Höfer, Peter; Blüml, Victor; Friedrich, Fabian; Kogoj, Dagmar; Lesch, Otto M

2010-01-01

To assess the clinical and biological status of alcohol-dependent patients admitted to a psychiatric or a gastroenterological ward, assessing and comparing dimensions important for prescribing treatment for withdrawal and relapse prevention. Eighty patients, alcohol-dependent according to international classification of diseases tenth revision and diagnostic and statistical manual, text revised, version IV, admitted to the Vienna General Hospital between January 2005 and  November 2006, were examined, of whom 44 were admitted to the psychiatric ward and 36 to the gastroenterological ward. Dimensions of alcohol dependence were assessed using a computerized structured interview, the Lesch alcoholism typology (LAT). Biological markers and the model for end-stage liver disease (MELD) score defined the severity of alcohol-related physical disturbances. As might be expected, gastroenterological patients had more advanced physical diseases than psychiatric patients, and affective disorders and suicidal tendencies were significantly commoner among the psychiatric patients. Thus, LAT Type II patients were overrepresented at the gastroenterological ward and LAT Type III patients at the psychiatric ward. The severity of somatic diseases and psychiatric disorders as well as the distribution of the four types according to Lesch differ between alcohol-dependent patients admitted to a psychiatric ward or a gastroenterological ward. Regarding the positive long-term outcome, different evidence-based medical treatment approaches for withdrawal and relapse prevention are needed for these patients.

Xerostomia and medication: a cross-sectional study in long-term geriatric wards.

Science.gov (United States)

Desoutter, A; Soudain-Pineau, M; Munsch, F; Mauprivez, C; Dufour, T; Coeuriot, J-L

2012-01-01

The purpose of this study was to determine the prevalence of xerostomia in old people living in long-term geriatric wards, and to measure the relationship between xerostomia and etiologic factors such as age and medication (total number of medications, xerogenic medications, anticholinergic medications and medications that induce hypersialorrhea). An observational retrospective, comparative, multicentre epidemiological study. Long-term geriatric wards, in Reims, France. 769 old people living in long-term geriatric wards. Prevalence of xerostomia assessed from age, total number of medications, xerogenic medications, anticholinergic medications and those that induce hypersialorrhea. Multivariable logistic regression was used to calculate Odds Ratios (OR) and their 95% Confidence Intervals (95% CI). Among 769 old people (average age 84.6±8.4 years old), 287 residents suffered from xerostomia (37.3%). Significant predictors of xerostomia were: resident's age OR=1.56, 95% CI (1.30-1.88), pxerostomia identified was medications that induce hypersialorrhea OR=0.81, 95% CI (0.67-0.98), p=0.03. The total number of medications and xerogenic medications did not play a significant role in xerostomia. Increasing Age and anticholinergic medications induce a dry mouth. Conversely, the total number of medications and xerogenic medications do not influence xerostomia. Medications that induce hypersialorrhea protect against the occurrence of dry mouth.

Probabilistic Decision Based Block Partitioning for Future Video Coding

KAUST Repository

Wang, Zhao

2017-11-29

In the latest Joint Video Exploration Team development, the quadtree plus binary tree (QTBT) block partitioning structure has been proposed for future video coding. Compared to the traditional quadtree structure of High Efficiency Video Coding (HEVC) standard, QTBT provides more flexible patterns for splitting the blocks, which results in dramatically increased combinations of block partitions and high computational complexity. In view of this, a confidence interval based early termination (CIET) scheme is proposed for QTBT to identify the unnecessary partition modes in the sense of rate-distortion (RD) optimization. In particular, a RD model is established to predict the RD cost of each partition pattern without the full encoding process. Subsequently, the mode decision problem is casted into a probabilistic framework to select the final partition based on the confidence interval decision strategy. Experimental results show that the proposed CIET algorithm can speed up QTBT block partitioning structure by reducing 54.7% encoding time with only 1.12% increase in terms of bit rate. Moreover, the proposed scheme performs consistently well for the high resolution sequences, of which the video coding efficiency is crucial in real applications.

Development of the four group partitioning process at JAERI

International Nuclear Information System (INIS)

Kubota, Masumitsu; Morita, Yasuji; Yamaguchi, Isoo; Yamagishi, Isao; Fujiwara, T.; Watanabe, Masayuki; Mizoguchi, Kenichi; Tatsugae, Ryozo

1999-01-01

At JAERI, development of a partitioning method started about 24 years ago. From 1973 to 1984, a partitioning process was developed for separating elements in HLLW into 3 groups; TRU, Sr-Cs and others. The partitioning process consisted of three steps; solvent extraction of U and Pu with TBP, solvent extraction of Am and Cm with DIDPA, and adsorption of Sr and Cs with inorganic ion exchangers. The process was demonstrated with real HLLW. Since 1985, a four group partitioning process has been developed, in which a step for separating the Tc-PGM group was developed in addition to the three group separation. Effective methods for separating TRU, especially Np, and Tc have been developed. In this paper, the flow sheet of the four group partitioning and the results of tests with simulated and real HLLW in NUCEF hot-cell are shown. (J.P.N.)

Designing of vague logic based multilevel feedback queue scheduler

Directory of Open Access Journals (Sweden)

Supriya Raheja

2016-03-01

Full Text Available Multilevel feedback queue scheduler suffers from major issues of scheduling such as starvation for long tasks, fixed number of queues, and static length of time quantum in each queue. These factors directly affect the performance of the scheduler. At many times impreciseness exists in attributes of tasks which make the performance even worse. In this paper, our intent is to improve the performance by providing a solution to these issues. We design a multilevel feedback queue scheduler using a vague set which we call as VMLFQ scheduler. VMLFQ scheduler intelligently handles the impreciseness and defines the optimum number of queues as well as the optimal size of time quantum for each queue. It also resolves the problem of starvation. This paper simulates and analyzes the performance of VMLFQ scheduler with the other multilevel feedback queue techniques using MatLab.

Chaos synchronization basing on symbolic dynamics with nongenerating partition.

Science.gov (United States)

Wang, Xingyuan; Wang, Mogei; Liu, Zhenzhen

2009-06-01

Using symbolic dynamics and information theory, we study the information transmission needed for synchronizing unidirectionally coupled oscillators. It is found that when sustaining chaos synchronization with nongenerating partition, the synchronization error will be larger than a critical value, although the required coupled channel capacity can be smaller than the case of using a generating partition. Then we show that no matter whether a generating or nongenerating partition is in use, a high-quality detector can guarantee the lead of the response oscillator, while the lag responding can make up the low precision of the detector. A practicable synchronization scheme basing on a nongenerating partition is also proposed in this paper.

The Partition of Multi-Resolution LOD Based on Qtm

Science.gov (United States)

Hou, M.-L.; Xing, H.-Q.; Zhao, X.-S.; Chen, J.

2011-08-01

The partition hierarch of Quaternary Triangular Mesh (QTM) determine the accuracy of spatial analysis and application based on QTM. In order to resolve the problem that the partition hierarch of QTM is limited by the level of the computer hardware, the new method that Multi- Resolution LOD (Level of Details) based on QTM will be discussed in this paper. This method can make the resolution of the cells varying with the viewpoint position by partitioning the cells of QTM, selecting the particular area according to the viewpoint; dealing with the cracks caused by different subdivisions, it satisfies the request of unlimited partition in part.

THE PARTITION OF MULTI-RESOLUTION LOD BASED ON QTM

Directory of Open Access Journals (Sweden)

M.-L. Hou

2012-08-01

Full Text Available The partition hierarch of Quaternary Triangular Mesh (QTM determine the accuracy of spatial analysis and application based on QTM. In order to resolve the problem that the partition hierarch of QTM is limited by the level of the computer hardware, the new method that Multi- Resolution LOD (Level of Details based on QTM will be discussed in this paper. This method can make the resolution of the cells varying with the viewpoint position by partitioning the cells of QTM, selecting the particular area according to the viewpoint; dealing with the cracks caused by different subdivisions, it satisfies the request of unlimited partition in part.

Optimized Thermal Management System of Modular Multilevel Converter for HVDC applications

DEFF Research Database (Denmark)

Hajizadeh, Amin

2017-01-01

The dynamical behavior of temperature is becoming a critical design consideration for the Modular Multilevel Converter (MMC). Investigation of an advanced control structure for Grid Connected-Modular Multilevel Converter (GC-MMC) is proposed in this paper. To achieve this goal, an non-linear mode...

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

Directory of Open Access Journals (Sweden)

Vladimir Zivanovic

Full Text Available In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S and medical (M wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia, in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1% than on the M (63.2% and 36.9% wards. The percentage of MDR A. baumannii was not different between S (93.7% and M (79.5% wards. An overall antibiotics consumption (defined daily doses/100 bed-days during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%. The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%, inappropriate dose interval (70.6% vs. 16.9% or duration of therapy (72.5% vs. 23.1%, a non-documented stop/review data (73.6% vs. 16.9% and divergence from guidelines (71.9% vs. 23.1%. Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards.

LHCb: Optimising query execution time in LHCb Bookkeeping System using partition pruning and partition wise joins

CERN Multimedia

Mathe, Z

2013-01-01

The LHCb experiment produces a huge amount of data which has associated metadata such as run number, data taking condition (detector status when the data was taken), simulation condition, etc. The data are stored in files, replicated on the Computing Grid around the world. The LHCb Bookkeeping System provides methods for retrieving datasets based on their metadata. The metadata is stored in a hybrid database model, which is a mixture of Relational and Hierarchical database models and is based on the Oracle Relational Database Management System (RDBMS). The database access has to be reliable and fast. In order to achieve a high timing performance, the tables are partitioned and the queries are executed in parallel. When we store large amounts of data the partition pruning is essential for database performance, because it reduces the amount of data retrieved from the disk and optimises the resource utilisation. This research presented here is focusing on the extended composite partitioning strategy such as rang...

The Sage handbook of multilevel modeling

CERN Document Server

Scott, Marc A; Marx, Brian D

2013-01-01

Leading contributors combine practical pieces with overviews of the state of the art in the field, making this handbook essential reading for any student or researcher looking to apply multilevel techniques in their own research

Optimal Multi-Level Lot Sizing for Requirements Planning Systems

OpenAIRE

Earle Steinberg; H. Albert Napier

1980-01-01

The wide spread use of advanced information systems such as Material Requirements Planning (MRP) has significantly altered the practice of dependent demand inventory management. Recent research has focused on development of multi-level lot sizing heuristics for such systems. In this paper, we develop an optimal procedure for the multi-period, multi-product, multi-level lot sizing problem by modeling the system as a constrained generalized network with fixed charge arcs and side constraints. T...

Open software tools for eddy covariance flux partitioning

Science.gov (United States)

Agro-ecosystem management and assessment will benefit greatly from the development of reliable techniques for partitioning evapotranspiration (ET) into evaporation (E) and transpiration (T). Among other activities, flux partitioning can aid in evaluating consumptive vs. non-consumptive agricultural...

Partitioning a macroscopic system into independent subsystems

Science.gov (United States)

Delle Site, Luigi; Ciccotti, Giovanni; Hartmann, Carsten

2017-08-01

We discuss the problem of partitioning a macroscopic system into a collection of independent subsystems. The partitioning of a system into replica-like subsystems is nowadays a subject of major interest in several fields of theoretical and applied physics. The thermodynamic approach currently favoured by practitioners is based on a phenomenological definition of an interface energy associated with the partition, due to a lack of easily computable expressions for a microscopic (i.e. particle-based) interface energy. In this article, we outline a general approach to derive sharp and computable bounds for the interface free energy in terms of microscopic statistical quantities. We discuss potential applications in nanothermodynamics and outline possible future directions.

Off-diagonal series expansion for quantum partition functions

Science.gov (United States)

Hen, Itay

2018-05-01

We derive an integral-free thermodynamic perturbation series expansion for quantum partition functions which enables an analytical term-by-term calculation of the series. The expansion is carried out around the partition function of the classical component of the Hamiltonian with the expansion parameter being the strength of the off-diagonal, or quantum, portion. To demonstrate the usefulness of the technique we analytically compute to third order the partition functions of the 1D Ising model with longitudinal and transverse fields, and the quantum 1D Heisenberg model.

Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study.

Science.gov (United States)

Nishioka, Shinta; Wakabayashi, Hidetaka; Yoshida, Tomomi; Mori, Natsumi; Watanabe, Riko; Nishioka, Emi

2016-01-01

A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight stroke may have some advantages for functional recovery in rehabilitation wards. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

The background scale Ward identity in quantum gravity

Energy Technology Data Exchange (ETDEWEB)

Percacci, Roberto [International School for Advanced Studies, Trieste (Italy); INFN, Sezione di Trieste, Trieste (Italy); Vacca, Gian Paolo [INFN, Sezione di Bologna, Bologna (Italy)

2017-01-15

We show that with suitable choices of parametrization, gauge fixing and cutoff, the anomalous variation of the effective action under global rescalings of the background metric is identical to the derivative with respect to the cutoff, i.e. to the beta functional, as defined by the exact RG equation. The Ward identity and the RG equation can be combined, resulting in a modified flow equation that is manifestly invariant under global background rescalings. (orig.)

Nurses' role transition from the clinical ward environment to the critical care environment.

Science.gov (United States)

Gohery, Patricia; Meaney, Teresa

2013-12-01

To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

Job satisfaction and intent to leave among psychiatric nurses: closed versus open wards.

Science.gov (United States)

Baum, Alexander; Kagan, Ilya

2015-08-01

The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. Copyright © 2015 Elsevier Inc. All rights reserved.

Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates

Directory of Open Access Journals (Sweden)

Ma Ling

2009-10-01

Full Text Available Abstract Background Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs, the impact of these potential sources of contamination on clinical infection needs to be clarified. Methods This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA, Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Results Our results revealed a 17.4% (49/282 contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. Conclusion With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.

Modeling water and hydrogen networks with partitioning regeneration units

Directory of Open Access Journals (Sweden)

W.M. Shehata

2015-03-01

Full Text Available Strict environment regulations in chemical and refinery industries lead to minimize resource consumption by designing utility networks within industrial process plants. The present study proposed a superstructure based optimization model for the synthesis of water and hydrogen networks with partitioning regenerators without mixing the regenerated sources. This method determines the number of partitioning regenerators needed for the regeneration of the sources. The number of the regenerators is based on the number of sources required to be treated for recovery. Each source is regenerated in an individual partitioning regenerator. Multiple regeneration systems can be employed to achieve minimum flowrate and costs. The formulation is linear in the regenerator balance equations. The optimized model is applied for two systems, partitioning regeneration systems of the fixed outlet impurity concentration and partitioning regeneration systems of the fixed impurity load removal ratio (RR for water and hydrogen networks. Several case studies from the literature are solved to illustrate the ease and applicability of the proposed method.

A layer model of ethanol partitioning into lipid membranes.

Science.gov (United States)

Nizza, David T; Gawrisch, Klaus

2009-06-01

The effect of membrane composition on ethanol partitioning into lipid bilayers was assessed by headspace gas chromatography. A series of model membranes with different compositions have been investigated. Membranes were exposed to a physiological ethanol concentration of 20 mmol/l. The concentration of membranes was 20 wt% which roughly corresponds to values found in tissue. Partitioning depended on the chemical nature of polar groups at the lipid/water interface. Compared to phosphatidylcholine, lipids with headgroups containing phosphatidylglycerol, phosphatidylserine, and sphingomyelin showed enhanced partitioning while headgroups containing phosphatidylethanolamine resulted in a lower partition coefficient. The molar partition coefficient was independent of a membrane's hydrophobic volume. This observation is in agreement with our previously published NMR results which showed that ethanol resides almost exclusively within the membrane/water interface. At an ethanol concentration of 20 mmol/l in water, ethanol concentrations at the lipid/water interface are in the range from 30-15 mmol/l, corresponding to one ethanol molecule per 100-200 lipids.

Dominant partition method. [based on a wave function formalism

Science.gov (United States)

Dixon, R. M.; Redish, E. F.

1979-01-01

By use of the L'Huillier, Redish, and Tandy (LRT) wave function formalism, a partially connected method, the dominant partition method (DPM) is developed for obtaining few body reductions of the many body problem in the LRT and Bencze, Redish, and Sloan (BRS) formalisms. The DPM maps the many body problem to a fewer body one by using the criterion that the truncated formalism must be such that consistency with the full Schroedinger equation is preserved. The DPM is based on a class of new forms for the irreducible cluster potential, which is introduced in the LRT formalism. Connectivity is maintained with respect to all partitions containing a given partition, which is referred to as the dominant partition. Degrees of freedom corresponding to the breakup of one or more of the clusters of the dominant partition are treated in a disconnected manner. This approach for simplifying the complicated BRS equations is appropriate for physical problems where a few body reaction mechanism prevails.

Sharing-Aware Horizontal Partitioning for Exploiting Correlations during Query Processing

DEFF Research Database (Denmark)

Tzoumas, Kostas; Deshpande, Amol; Jensen, Christian Søndergaard

2010-01-01

Optimization of join queries based on average selectivities is suboptimal in highly correlated databases. In such databases, relations are naturally divided into partitions, each partition having substantially different statistical characteristics. It is very compelling to discover such data...... partitions during query optimization and create multiple plans for a given query, one plan being optimal for a particular combination of data partitions. This scenario calls for the sharing of state among plans, so that common intermediate results are not recomputed. We study this problem in a setting...

Vertical partitioning of relational OLTP databases using integer programming

DEFF Research Database (Denmark)

Amossen, Rasmus Resen

2010-01-01

A way to optimize performance of relational row store databases is to reduce the row widths by vertically partition- ing tables into table fractions in order to minimize the number of irrelevant columns/attributes read by each transaction. This pa- per considers vertical partitioning algorithms...... for relational row- store OLTP databases with an H-store-like architecture, meaning that we would like to maximize the number of single-sited transactions. We present a model for the vertical partitioning problem that, given a schema together with a vertical partitioning and a workload, estimates the costs...... applied to the TPC-C benchmark and the heuristic is shown to obtain solutions with costs close to the ones found using the quadratic program....

Metric Structures on Fibered Manifolds Through Partitions of Unity

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Hulya Kadioglu

2016-05-01

Full Text Available The notion of partitions of unity is extremely useful as it allows one to extend local constructions on Euclidean patches to global ones. It is widely used in many fields in mathematics. Therefore, prolongation of this useful tool to another manifold may help constructing many geometric structures. In this paper, we construct a partition of unity on a fiber bundle by using a given partition of unity on the base manifold. On the other hand we show that the converse is also possible if it is a vector bundle. As an application, we define a Riemannian metric on the fiber bundle by using induced partition of unity on the fiber bundle.

Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

Science.gov (United States)

Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung

2017-12-01

To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI scorestroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

COORDINATION IN MULTILEVEL NETWORK-CENTRIC CONTROL SYSTEMS OF REGIONAL SECURITY: APPROACH AND FORMAL MODEL

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A. V. Masloboev

2015-01-01

Full Text Available The paper deals with development of methods and tools for mathematical and computer modeling of the multilevel network-centric control systems of regional security. This research is carried out under development strategy implementation of the Arctic zone of the Russian Federation and national safeguarding for the period before 2020 in the Murmansk region territory. Creation of unified interdepartmental multilevel computer-aided system is proposed intended for decision-making information support and socio-economic security monitoring of the Arctic regions of Russia. The distinctive features of the investigated system class are openness, self-organization, decentralization of management functions and decision-making, weak hierarchy in the decision-making circuit and goal generation capability inside itself. Research techniques include functional-target approach, mathematical apparatus of multilevel hierarchical system theory and principles of network-centric control of distributed systems with pro-active components and variable structure. The work considers network-centric management local decisions coordination problem-solving within the multilevel distributed systems intended for information support of regional security. The coordination problem-solving approach and problem formalization in the multilevel network-centric control systems of regional security have been proposed based on developed multilevel recurrent hierarchical model of regional socio-economic system complex security. The model provides coordination of regional security indexes, optimized by the different elements of multilevel control systems, subject to decentralized decision-making. The model specificity consists in application of functional-target technology and mathematical apparatus of multilevel hierarchical system theory for coordination procedures implementation of the network-centric management local decisions. The work-out and research results can find further

Vacuum Ward identities for higher genera

International Nuclear Information System (INIS)

Zamolodchikov, Al.B.

1988-01-01

The minimal models of two-dimensional conformal field theory are considered on the surfaces with nontrivial topology. Due to degeneration of the vacuum module in these models, the stress tensor components satisfy special equations can be written in the form of partial differential equations on the moduli space, satisfied by the partition functions of the theory. 22 refs.; 1 tab

Analog Filter Design Rules for Multilevel Polybinary Signaling Generation

DEFF Research Database (Denmark)

Vegas Olmos, Juan José; Cavallero, Francisco javier Vaquero; Tafur Monroy, Idelfonso

2014-01-01

Polybinary signaling has gained attention lately due to its generation simplicity and reduced spectral usage. This paper presents a study on the requirements for analog filters for the generation of multilevel polybinary signals with three to nine levels.......Polybinary signaling has gained attention lately due to its generation simplicity and reduced spectral usage. This paper presents a study on the requirements for analog filters for the generation of multilevel polybinary signals with three to nine levels....

Domain decomposition and multilevel integration for fermions

International Nuclear Information System (INIS)

Ce, Marco; Giusti, Leonardo; Schaefer, Stefan

2016-01-01

The numerical computation of many hadronic correlation functions is exceedingly difficult due to the exponentially decreasing signal-to-noise ratio with the distance between source and sink. Multilevel integration methods, using independent updates of separate regions in space-time, are known to be able to solve such problems but have so far been available only for pure gauge theory. We present first steps into the direction of making such integration schemes amenable to theories with fermions, by factorizing a given observable via an approximated domain decomposition of the quark propagator. This allows for multilevel integration of the (large) factorized contribution to the observable, while its (small) correction can be computed in the standard way.

[The relative's need of participation in the care plan in a general medicine ward].

Science.gov (United States)

Artioli, Giovanna; Finotto, Stefano; Paverelli, Luisa; Carpanoni, Marika; Casadei, Elena Turroni

2006-01-01

All the scientific literature agrees on the fact that the shelter in hospital is a delicate moment for the patient. Also for relatives the shelter in hospital of their dear one is not of easy management, often they are excluded, insecure, alone and with a frankly uncertain role. The purpose of this study is to explore the role and the needs perceived from the relatives of an in-patient in a general medicine unit and to explore which role and which needs of the relatives are perceived from the nurses of a same ward. The sample of the study consisted of 49 relatives of in-patients in the ward of Medicina III dell'Azienda Ospedaliera di Reggio Emilia and of 18 nurses of the same ward. It was found that information is the most important need expressed by the relatives and that for the nurses is hard to satisfy it. Moreover, the nurses haven't a clear idea of the relative's role and they are inclined to exclude them from the care project.

PAQ: Partition Analysis of Quasispecies.

Science.gov (United States)

Baccam, P; Thompson, R J; Fedrigo, O; Carpenter, S; Cornette, J L

2001-01-01

The complexities of genetic data may not be accurately described by any single analytical tool. Phylogenetic analysis is often used to study the genetic relationship among different sequences. Evolutionary models and assumptions are invoked to reconstruct trees that describe the phylogenetic relationship among sequences. Genetic databases are rapidly accumulating large amounts of sequences. Newly acquired sequences, which have not yet been characterized, may require preliminary genetic exploration in order to build models describing the evolutionary relationship among sequences. There are clustering techniques that rely less on models of evolution, and thus may provide nice exploratory tools for identifying genetic similarities. Some of the more commonly used clustering methods perform better when data can be grouped into mutually exclusive groups. Genetic data from viral quasispecies, which consist of closely related variants that differ by small changes, however, may best be partitioned by overlapping groups. We have developed an intuitive exploratory program, Partition Analysis of Quasispecies (PAQ), which utilizes a non-hierarchical technique to partition sequences that are genetically similar. PAQ was used to analyze a data set of human immunodeficiency virus type 1 (HIV-1) envelope sequences isolated from different regions of the brain and another data set consisting of the equine infectious anemia virus (EIAV) regulatory gene rev. Analysis of the HIV-1 data set by PAQ was consistent with phylogenetic analysis of the same data, and the EIAV rev variants were partitioned into two overlapping groups. PAQ provides an additional tool which can be used to glean information from genetic data and can be used in conjunction with other tools to study genetic similarities and genetic evolution of viral quasispecies.

Quantitative Risk Assessment of Patient Manual Handling in Wards of One of the Hospitals of Tehran using MAPO Method, Iran

Directory of Open Access Journals (Sweden)

Sajad Ataei

2017-05-01

Full Text Available Background and Objectives: Manual handling of disabled patients is one of the important and effective factors in acute low back pain among exposed nurses. The present study was conducted with the objective of quantitative risk assessment of patient manual handling among nurses in wards of one of the hospitals in Tehran using MAPO method. Methods: The present study was conducted as an analytical-cross-sectional study in 26 wards of one of the hospitals in Tehran city. Samples were selected by census method from nurses and paramedics of different wards of hospital. Data collection was performed using demographic information and MAPO checklist. Results: The highest score of MAPO were, respectively, related to wards of DI clinic (score, 14.7, men orthopedic (score, 6.3, and general operating room (score, 57. 53.8% of hospital wards were at the level 2 corrective action, which indicated that the risk of musculoskeletal disorder is 2.4 times higher than level 1 corrective action. Conclusion: Given that the proportion of disabled patient in cooperation and/or partial cooperation, lifting tools, auxiliary, wheelchair, and training have the most role among risk factors for above-mentioned wards, increasing the number of human resources and wheelchair, use of lifting and auxiliary tools and training reduce MAPO score and consequently the risk of musculoskeletal disorders.

Social Capital and Health: A Review of Prospective Multilevel Studies

Science.gov (United States)

Murayama, Hiroshi; Fujiwara, Yoshinori; Kawachi, Ichiro

2012-01-01

Background This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital. Methods We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome. Results We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia. Conclusions Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health. PMID:22447212

Actinide and fission product partitioning and transmutation

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-07-01

The fourth international information exchange meeting on actinide and fission product partitioning and transmutation, took place in Mito City in Japan, on 111-13 September 1996. The proceedings are presented in six sessions: the major programmes and international cooperation, the partitioning and transmutation programs, feasibility studies, particular separation processes, the accelerator driven transmutation, and the chemistry of the fuel cycle. (A.L.B.)

VLSI PARTITIONING ALGORITHM WITH ADAPTIVE CONTROL PARAMETER

Directory of Open Access Journals (Sweden)

P. N. Filippenko

2013-03-01

Full Text Available The article deals with the problem of very large-scale integration circuit partitioning. A graph is selected as a mathematical model describing integrated circuit. Modification of ant colony optimization algorithm is presented, which is used to solve graph partitioning problem. Ant colony optimization algorithm is an optimization method based on the principles of self-organization and other useful features of the ants’ behavior. The proposed search system is based on ant colony optimization algorithm with the improved method of the initial distribution and dynamic adjustment of the control search parameters. The experimental results and performance comparison show that the proposed method of very large-scale integration circuit partitioning provides the better search performance over other well known algorithms.

Governance and the Commons in a Multi-Level World

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Derek Armitage

2007-11-01

Full Text Available Multi-level governance may facilitate learning and adaptation in complex social-ecological circumstances. Such arrangements should connect community-based management with regional/national government-level management, link scientific management and traditional management systems, encourage the sharing of knowledge and information, and promote collaboration and dialogue around goals and outcomes. Governance innovations of this type can thus build capacity to adapt to change and manage for resilience. However, critical reflection on the emergence of adaptive, multi-level governance for the commons is warranted. Drawing on examples from the North and South, the purpose of this review is to connect three complementary bodies of scholarship with insights for commons governance in a multi-level world: common property theory, resilience thinking and political ecology. From the commons and resilience literature, normative principles of adaptive, multi-level governance are synthesized (e.g., participation, accountability, leadership, knowledge pluralism, learning and trust. Political ecological interpretations, however, help to reveal the challenge of actualizing these principles and the contextual forces that make entrenched, top-down management systems resilient to change. These forces include the role of power, scale and levels of organization, knowledge valuation, the positioning of social actors and social constructions of nature. Also addressed are the policy narratives that shape governance, and the dialectic relationship among ecological systems and social change. tekst

Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards.

Science.gov (United States)

Goulding, Lucy; Adamson, Joy; Watt, Ian; Wright, John

2015-10-01

Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues. To explore patients' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward. Qualitative study using semi-structured interviews. Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England. Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses' knowledge and the resources available, each of which may contribute to unsafe care. Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified. © 2013 John Wiley & Sons Ltd.

Utilizing distributional analytics and electronic records to assess timeliness of inpatient blood glucose monitoring in non-critical care wards

Directory of Open Access Journals (Sweden)

Ying Chen

2016-04-01

Full Text Available Abstract Background Regular and timely monitoring of blood glucose (BG levels in hospitalized patients with diabetes mellitus is crucial to optimizing inpatient glycaemic control. However, methods to quantify timeliness as a measurement of quality of care are lacking. We propose an analytical approach that utilizes BG measurements from electronic records to assess adherence to an inpatient BG monitoring protocol in hospital wards. Methods We applied our proposed analytical approach to electronic records obtained from 24 non-critical care wards in November and December 2013 from a tertiary care hospital in Singapore. We applied distributional analytics to evaluate daily adherence to BG monitoring timings. A one-sample Kolmogorov-Smirnov (1S-KS test was performed to test daily BG timings against non-adherence represented by the uniform distribution. This test was performed among wards with high power, determined through simulation. The 1S-KS test was coupled with visualization via the cumulative distribution function (cdf plot and a two-sample Kolmogorov-Smirnov (2S-KS test, enabling comparison of the BG timing distributions between two consecutive days. We also applied mixture modelling to identify the key features in daily BG timings. Results We found that 11 out of the 24 wards had high power. Among these wards, 1S-KS test with cdf plots indicated adherence to BG monitoring protocols. Integrating both 1S-KS and 2S-KS information within a moving window consisting of two consecutive days did not suggest frequent potential change from or towards non-adherence to protocol. From mixture modelling among wards with high power, we consistently identified four components with high concentration of BG measurements taken before mealtimes and around bedtime. This agnostic analysis provided additional evidence that the wards were adherent to BG monitoring protocols. Conclusions We demonstrated the utility of our proposed analytical approach as a monitoring

Ward identities and mass spectrum of N=1 Super Yang-Mills theory on the lattice

International Nuclear Information System (INIS)

Kirchner, R.

2000-11-01

We study the lattice regularization of N=1 Super Yang-Mills theory. Projecting operators for the low-lying spectrum are discussed. We also consider a ''baryonic'' state consisting of three gluinos, and develop a numerical strategy to determine its mass in a Monte Carlo simulation. We present numerical results on the low-lying spectrum of SU(2) N=1 Super Yang-Mills theory with light dynamical gluinos. The lattice regularization of N=1 Super Yang-Mills theory breaks supersymmetry at any finite lattice spacing. We derive the form of the corresponding SUSY Ward identity and carry out renormalization. The ratios of the renormalization coefficients Z T /Z S and M R /Z S are determined non-perturbatively in a numerical simulation. The form of the renormalized SUSY Ward identity is confirmed numerically. We discuss how the SUSY Ward identity can be used to define a supersymmetric continuum limit, and how its approach can be monitored in numerical simulations. (orig.)

Asynchronous monitoring of the quality of multilevel optical PAM signals

Science.gov (United States)

Siuzdak, J.

2017-08-01

In the paper, there is analyzed the signal quality assessment method based on delay tap asynchronous sampling, both for binary and multilevel PAM signals. The obtained multilevel phase diagrams are far more complicated than binary ones. The phase diagrams are affected by the signal distortions but it is difficult to relate reliably the phase diagram form to the distortion type and its influence on the signal quality.

Consistent Estimation of Partition Markov Models

Directory of Open Access Journals (Sweden)

Jesús E. García

2017-04-01

Full Text Available The Partition Markov Model characterizes the process by a partition L of the state space, where the elements in each part of L share the same transition probability to an arbitrary element in the alphabet. This model aims to answer the following questions: what is the minimal number of parameters needed to specify a Markov chain and how to estimate these parameters. In order to answer these questions, we build a consistent strategy for model selection which consist of: giving a size n realization of the process, finding a model within the Partition Markov class, with a minimal number of parts to represent the process law. From the strategy, we derive a measure that establishes a metric in the state space. In addition, we show that if the law of the process is Markovian, then, eventually, when n goes to infinity, L will be retrieved. We show an application to model internet navigation patterns.

DC-DC Type High-Frequency Link DC for Improved Power Quality of Cascaded Multilevel Inverter

Science.gov (United States)

Sadikin, Muhammad; Senjyu, Tomonobu; Yona, Atsushi

2013-06-01

Multilevel inverters are emerging as a new breed of power converter options for power system applications. Recent advances in power switching devices enabled the suitability of multilevel inverters for high voltage and high power applications because they are connecting several devices in series without the need of component matching. Usually, a transformerless battery energy storage system, based on a cascaded multilevel inverter, is used as a measure for voltage and frequency deviations. System can be reduced in size, weight, and cost of energy storage system. High-frequency link circuit topology is advantageous in realizing compact and light-weight power converters for uninterruptible power supply systems, new energy systems using photovoltaic-cells, fuel-cells and so on. This paper presents a DC-DC type high-frequency link DC (HFLDC) cascaded multilevel inverter. Each converter cell is implemented a control strategy for two H-bridge inverters that are controlled with the same multicarrier pulse width modulation (PWM) technique. The proposed cascaded multilevel inverter generates lower voltage total harmonic distortion (THD) in comparison with conventional cascaded multilevel inverter. Digital simulations are carried out using PSCAD/EMTDC to validate the performance of the proposed cascaded multilevel inverter.

Correlative degree and collective side ward flow of final state particles in high energy heavy ion collisions

International Nuclear Information System (INIS)

Zhang Weigang

1999-01-01

A concept of correlative degree is proposed. Using the method of particle-group correlation's function, the effects of the particles with different correlative degrees on collective side ward flow are studied for 1.2A GeV Ar + Bal 2 collisions at the Bevalac stream chamber. The studies indicate that correlative degree is an important parameter on describing collective side ward flow properties. The minority of correlative particles (or fragments) with larger correlative degrees can produce the effect arising from the collective side ward flow, but the effect arising from high-order collective flow correlations can not be dominated by these minority of particles (or fragments). It is results from the collective contribution of the majority of collective particles (or fragments) with various correlative degrees

Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards.

Science.gov (United States)

Davis, C R

2010-05-01

Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance. Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period. For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P porters (21% - 67%, P 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ. This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.

Quantification of the diversity among common bean accessions using Ward-MLM strategy Quantificação da diversidade entre acessos de feijoeiro-comum com uso da estratégia Ward-MLM

Directory of Open Access Journals (Sweden)

Pablo Diego Silva Cabral

2010-10-01

Full Text Available The present work aimed at evaluating the divergence among common bean accessions by their agronomic, morphological and molecular traits, based on the Ward-MLM procedure. A collection of 57 accessions from the gene bank of Universidade Federal do Espírito Santo was used in this study, from which: 31 were landraces belonging to the community Fortaleza, in the municipality of Muqui, ES, Brazil; 20 accessions were provided by Embrapa Trigo; and 6 were commercial cultivars. Five agronomic traits (plant cycle, number of seeds per pod, number of pods per plant, weight of 100 seeds, and grain yield, five morphological traits (growth habit, plant size, seed shape, seed color, and commercial group and 16 microsatellite primers were evaluated. High genetic variability was detected considering morphological, agronomic and molecular traits in the 57 common bean accessions studied. The Ward-MLM procedure showed that the ideal number of groups was five, according to the pseudo F and pseudo t² criteria. The accessions from Andean origin had heavier seeds than others and formed a cluster. The Ward-MLM statistical procedure is a useful technique to detect genetic divergence and to cluster genotypes by simultaneously using morphological, agronomic and molecular data.O objetivo deste trabalho foi avaliar a divergência de acessos de feijoeiro-comum por suas características agronômicas, morfológicas e moleculares, com base no procedimento Ward-MLM. Uma coleção de 57 acessos do banco de germoplasma da Universidade Federal do Espírito Santo foi utilizada neste estudo, dos quais: 31 acessos locais, pertencentes à comunidade Fortaleza, no Município de Muqui, ES; 20 acessos fornecidos pela Embrapa Trigo; e 6 cultivares comerciais. Foram avaliados cinco caracteres agronômicos (ciclo da planta, número de sementes por vagem, número de vagens por planta, peso de 100 grãos e produtividade de grãos, cinco caracteres morfológicos (hábito de crescimento, porte

Mathematical model comparing of the multi-level economics systems

Science.gov (United States)

Brykalov, S. M.; Kryanev, A. V.

2017-12-01

The mathematical model (scheme) of a multi-level comparison of the economic system, characterized by the system of indices, is worked out. In the mathematical model of the multi-level comparison of the economic systems, the indicators of peer review and forecasting of the economic system under consideration can be used. The model can take into account the uncertainty in the estimated values of the parameters or expert estimations. The model uses the multi-criteria approach based on the Pareto solutions.

Influence of Parental Encouragement towards Health Care of Their Wards

Science.gov (United States)

Sophia, R. Grace; Veliappan, A.

2015-01-01

The purpose of the present study is to explore how parents are encouraging towards health care of their wards. A "Survey Method" was used in the present study. A standardized "Agarwal Parental Encouragement Scale (APES)" was used to collect information from the students. The sample consists of thousand and ninety five higher…

The Aesthetics of "Ladeoko Festival‟ of Isona Ward in Ilesa, Nigeria ...

African Journals Online (AJOL)

The Aesthetics of "Ladeoko Festival‟ of Isona Ward in Ilesa, Nigeria. ... the capacity to produce pleasure in those who experience or appreciate them; they have the ... In another vein, if the objects have the capacity: to help bring about social or ...

Limit Shapes and Fluctuations of Bounded Random Partitions

DEFF Research Database (Denmark)

Beltoft, Dan

Random partitions of integers, bounded both in the number of summands and the size of each summand are considered, subject to the probability measure which assigns a probability proportional to some fixed positive number to the power of the number being partitioned. This corresponds to considering...

Integrating psychology and obstetrics for medical students: shared labour ward teaching.

Science.gov (United States)

Chalmers, B E; McIntyre, J A

1993-01-01

Two studies relating to the inclusion of psycho-social issues in the training of obstetricians are reported here. The first reports on the extent to which currently practising obstetricians have received training in these aspects. The second explored the value of an innovative teaching approach combining psychological and obstetric training for medical students in the labour ward. A postal survey with responses from 220 obstetricians and paediatricians revealed that little information on psychological aspects of obstetric practice had been included in their undergraduate or postgraduate training or obtained from voluntary continuing education programmes. Experience was the primary source of training in these subjects. The second study explored the impact of joint psychological and obstetric teaching ward rounds for medical students. Students attending these integrated sessions reported being better prepared for the psycho-social aspects of obstetrics and showed a greater awareness of cross-cultural differences in needs of women during birth.

Hospital organizational factors influence work-family conflict in registered nurses: Multilevel modeling of a nation-wide cross-sectional survey in Sweden.

Science.gov (United States)

Leineweber, C; Chungkham, H S; Westerlund, H; Tishelman, C; Lindqvist, R

2014-05-01

The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work-family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Multi-level governance in EU climate law

NARCIS (Netherlands)

Vedder, Hans; Woerdman, Edwin; Roggenkamp, Martha; Holwerda, Marijn

2015-01-01

This chapter analyses the multi-level governance in EU climate law; it connects the international arena, with EU and national decision-making and relates climate change considerations to competitiveness concerns.

Application of a NAPL partitioning interwell tracer test (PITT) to support DNAPL remediation at the Sandia National Laboratories/New Mexico chemical waste landfill

International Nuclear Information System (INIS)

Studer, J.E.; Mariner, P.; Jin, M.

1996-01-01

Chlorinated solvents as dense non-aqueous phase liquid (DNAPL) are present at a large number of hazardous waste sites across the U.S. and world. DNAPL is difficult to detect in the subsurface, much less characterize to any degree of accuracy. Without proper site characterization, remedial decisions are often difficult to make and technically effective, cost-efficient remediations are even more difficult to obtain. A new non-aqueous phase liquid (NAPL) characterization technology that is superior to conventional technologies has been developed and applied at full-scale. This technology, referred to as the Partitioning Interwell Tracer Test (PITT), has been adopted from oil-field practices and tailored to environmental application in the vadose and saturated zones. A PITT has been applied for the first time at full-scale to characterize DNAPL in the vadose zone. The PITT was applied in December 1995 beneath two side-by-side organic disposal pits at Sandia National Laboratories/New Mexico (SNL/NM) RCRA Interim Status Chemical Waste Landfill (CWL), located in Albuquerque, New Mexico. DNAPL, consisting of a mixture of chlorinated solvents, aromatic hydrocarbons, and PCE oils, is known to exist in at least one of the two buried pits. The vadose zone PITT was conducted by injecting a slug of non-partitioning and NAPL-partitioning tracers into and through a zone of interest under a controlled forced gradient. The forced gradient was created by a balanced extraction of soil gas at a location 55 feet from the injector. The extracted gas stream was sampled over time to define tracer break-through curves. Soil gas sampling ports from multilevel monitoring installations were sampled to define break-through curves at specific locations and depths. Analytical instrumentation such as gas chromatographs and a photoacoustical analyzers operated autonomously, were used for tracer detection

Partitioning of fissile and radio-toxic materials from spent nuclear fuel

International Nuclear Information System (INIS)

Bychkov, A.V.; Skiba, O.V.; Kormilitsyn, M.V.

2007-01-01

Full text of publication follows. The term ''partitioning'' means separation of one group of radwaste components from another. Such technological approaches are mainly applied to extraction of long-lived fission products (Tc, I) and minor actinides (Np, Am, Cm) from the waste arising from spent nuclear fuel reprocessing. Transmutation of the extracted minor actinides should be performed in a reactor or some accelerated systems. The combination of these technologies, partitioning and transmutation (P and T), will reduce the radiotoxicity of radwaste. In recent decades, partitioning has been directly linked to spent fuel reprocessing. Therefore, the basic investigations have been focused on the partitioning of liquid wastes arising from the PUREX process. These subjects have been the most developed ones, but the processes of fine aqueous separation generates an extra amount of liquid waste. This fact has an effect on the nuclear fuel cycle economy. Therefore, some other advanced compact methods have also been studied. These are dry methods involving molten chlorides and fluorides, the methods based on a supercritical movable phase, etc. The report provides a brief review of information on the basic partitioning process flow-sheets developed in France, Japan, Russia and other countries. Recent approaches to partitioning have been mostly directed towards radio-toxic hazard reduction and ecology. In the future, partitioning should be closely bound up with reprocessing and other spent nuclear fuel management processes. Reprocessing/partitioning should also be aimed at solving the problems of safety (non-proliferation) and economy in a closed fuel cycle. It is necessary to change a future ''technological philosophy'' of reprocessing and partitioning. The basic spent fuel components (U, Pu, Th) are to be extracted only for recycling in a closed nuclear fuel cycle. If these elements are regarded as a waste, additional expenses are required for transmutation. If we consider

Checking the transverse Ward-Takahashi relation at one-loop order in four dimensions

International Nuclear Information System (INIS)

Pennington, M R; Williams, R

2006-01-01

Some time ago Takahashi derived the so-called transverse relations relating Green's functions of different orders to complement the well-known Ward-Green-Takahashi identities of gauge theories by considering wedge rather than inner products. These transverse relations have the potential to determine the full fermion-boson vertex in terms of the renormalization functions of the fermion propagator. He and Yu have given an indicative proof at one-loop level in four dimensions. However, their construct involves the fourth-rank Levi-Civita tensor defined only unambiguously in four dimensions exactly where the loop integrals diverge. Consequently, here we explicitly check the proposed transverse Ward-Takahashi relation holds at one-loop order in d-dimensions, with d = 4 + ε

'It's a matter of patient safety': understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study.

Science.gov (United States)

Jangland, Eva; Nyberg, Berit; Yngman-Uhlin, Pia

2017-06-01

Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. To explore situations and processes that support or hinder good safe patient care on the surgical ward. This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation. Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward. There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward. © 2016 Nordic College of Caring Science.

The effects of introducing a clinical pharmacist on orthopaedic wards in Denmark

DEFF Research Database (Denmark)

Buck, Thomas Croft; Brandstrup, Lene; Brandslund, Ivan

2007-01-01

OBJECTIVE: To assess the effects and cost effects of introducing clinical pharmacists on hospital wards. METHODS: Comparative prospective study on four orthopaedic surgical wards in two hospitals. The primary effect variables were 10 target areas widely considered to be indicators of good...... prescription practice. Prescriptions not following good practice in these intervention areas were defined as "sub-optimal prescriptions," and then discussed between a physician and a clinical pharmacist. The primary parameter was the difference in the number of days with a sub-optimal prescription (Mann......-Whitney test). RESULTS: On an average 20% of all the patients had a sub-optimal prescription. Of these, 70% were changed by the physician after intervention by the clinical pharmacist. There was a statistically significant difference in the duration of days in treatment with a sub-optimal prescription. Where...

Clostridium Difficile Infection in the Nephrology Ward

Directory of Open Access Journals (Sweden)

Sylwia Dudzicz

2017-11-01

Full Text Available Clostridium difficile is currently the most frequently identified pathogen causing antibiotic-associated diarrhea and the main cause of nosocomial diarrhea. In recent years, increases incidence of infection, severe infection, recurrent infection and mortality from Clostridium difficile infection (CDI have been observed. This may be a consequence of excessive antibiotic use and spread of the hypervirulent epidemic BI/NAP1/027 strain of Clostridium difficile. The main risk factors for CDI are: antibiotic therapy, previous hospitalizations and number of comorbid conditions. Prevention of CDI mainly is focused in two directions: reducing the exposure of patients to the disease pathogen by intensifying hygiene measures, and reducing the impact of risk factors. A meta-analyses of clinical studies (observational, cohort and case control showed significantly higher risk of CDI and CDI recurrence in patients with chronic kidney disease and increased mortality risk in chronic kidney disease patients with CDI comparing those without CDI. Increased risk of CDI in patients with chronic kidney disease can be caused by: frequent antibiotic therapy associated with numerous infections resulting in intestinal microflora dysfunction, frequent hospitalizations, older age of the patients and an impaired immune system. Among preventative measures against CDI, the use of probiotics were also studied. In patients hospitalized in nephrology ward highly significant reduction of the CDI incidence was observed after the introduction of Lactobacillus plantarum 299v as CDI prophylaxis. Therefore, the use of Lactobacillus plantarum 299v seems to be a promising method of CDI prevention in chronic kidney disease patients hospitalized in nephrology ward.

CoR's White Paper on Multilevel Governance - Advantages and Disadvantages

OpenAIRE

Gal, Diana; Brie, Mircea

2011-01-01

By the multilevel governance concept we can see the European Union as a political system with interconnected institutions that exist at multiple levels with unique policy features. The White Paper on Multilevel Governance reflects the determination to "Build Europe in partnership" and sets two main strategic objectives: encouraging participation in the European process and reinforcing the efficiency of Community action. The fact that public interest in European elections is decreasing, whils...

[Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward].

Science.gov (United States)

Lee, Ya-Fen; Yang, Yu-O; Tu, Chia-Ling

2013-06-01

The impact of general gender stereotypes on nursing is severe and influential, especially with regard to male nursing students working in obstetrics and gynecology wards. This study examined the experience of male nursing students in obstetrics and gynecology wards. We used a phenomenological qualitative research approach and a sample of 10 male nursing students currently studying at a nursing college in central Taiwan. All participants had obstetrics and gynecology ward experience. Individual interviews were transcribed into the procedural record. Colaizzi content analysis analyzed and categorized research data. Based on participants practical experiences in the obstetrics and gynecology ward, the main stages of participants professional development through their internship experience included: (1) Unbalanced self-role recognition; (2) being defined by the gender framework (gender stereotypes); (3) the difference between male doctor and male nurse; (4) learning appropriate communication techniques; (5) mutual and empathetic understanding of the female psychology during childbirth; (6) gaining sources for positive feedback; (7) releasing the shackles of gender and gaining full insight into and comprehension of nursing functions; and (8) given the opportunity to learn. Through ongoing examination and learning, participant internships in the obstetrics and gynecology wards were significant and essential learning experiences that validated their necessity. Nursing schools and internship institutions alike must realize the importance of gender-equality education to the nursing profession. Medical institutions are encouraged to offer equal learning opportunities to male and female nursing students and provide targeted assistance to males to help them master clinical nursing care practices in the obstetrics and gynecology department.

Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

Science.gov (United States)

Arora, Sonal; Hull, Louise; Fitzpatrick, Maureen; Sevdalis, Nick; Birnbach, David J

2015-05-01

To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward. Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment. A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills. Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P pre = 73.7% vs post = 94.8%, P pre = 21.1% vs post = 84.2% P pre = 42.1% vs post = 100%, P pre = 36.8% vs post = 89.8%, P pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001). The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

Multilevel models in international business research

NARCIS (Netherlands)

Peterson, M.F.; Arregle, J-L.; Martin, Xavier

2012-01-01

Multiple-level (or mixed linear) modeling (MLM) can simultaneously test hypotheses at several levels of analysis (usually two or three), or control for confounding effects at one level while testing hypotheses at others. Advances in multi-level modeling allow increased precision in quantitative

Multilevel Modeling and Policy Development: Guidelines and Applications to Medical Travel

Science.gov (United States)

Garcia-Garzon, Eduardo; Zhukovsky, Peter; Haller, Elisa; Plakolm, Sara; Fink, David; Petrova, Dafina; Mahalingam, Vaishali; Menezes, Igor G.; Ruggeri, Kai

2016-01-01

Medical travel has expanded rapidly in recent years, resulting in new markets and increased access to medical care. Whereas several studies investigated the motives of individuals seeking healthcare abroad, the conventional analytical approach is limited by substantial caveats. Classical techniques as found in the literature cannot provide sufficient insight due to the nested nature of data generated. The application of adequate analytical techniques, specifically multilevel modeling, is scarce to non-existent in the context of medical travel. This study introduces the guidelines for application of multilevel techniques in public health research by presenting an application of multilevel modeling in analyzing the decision-making patterns of potential medical travelers. Benefits and potential limitations are discussed. PMID:27252672

Multilevel Modeling and Policy Development: Guidelines and Applications to Medical Travel.

Science.gov (United States)

Garcia-Garzon, Eduardo; Zhukovsky, Peter; Haller, Elisa; Plakolm, Sara; Fink, David; Petrova, Dafina; Mahalingam, Vaishali; Menezes, Igor G; Ruggeri, Kai

2016-01-01

Medical travel has expanded rapidly in recent years, resulting in new markets and increased access to medical care. Whereas several studies investigated the motives of individuals seeking healthcare abroad, the conventional analytical approach is limited by substantial caveats. Classical techniques as found in the literature cannot provide sufficient insight due to the nested nature of data generated. The application of adequate analytical techniques, specifically multilevel modeling, is scarce to non-existent in the context of medical travel. This study introduces the guidelines for application of multilevel techniques in public health research by presenting an application of multilevel modeling in analyzing the decision-making patterns of potential medical travelers. Benefits and potential limitations are discussed.

Mesh Partitioning Algorithm Based on Parallel Finite Element Analysis and Its Actualization

Directory of Open Access Journals (Sweden)

Lei Zhang

2013-01-01

Full Text Available In parallel computing based on finite element analysis, domain decomposition is a key technique for its preprocessing. Generally, a domain decomposition of a mesh can be realized through partitioning of a graph which is converted from a finite element mesh. This paper discusses the method for graph partitioning and the way to actualize mesh partitioning. Relevant softwares are introduced, and the data structure and key functions of Metis and ParMetis are introduced. The writing, compiling, and testing of the mesh partitioning interface program based on these key functions are performed. The results indicate some objective law and characteristics to guide the users who use the graph partitioning algorithm and software to write PFEM program, and ideal partitioning effects can be achieved by actualizing mesh partitioning through the program. The interface program can also be used directly by the engineering researchers as a module of the PFEM software. So that it can reduce the application of the threshold of graph partitioning algorithm, improve the calculation efficiency, and promote the application of graph theory and parallel computing.

Pulse design for multilevel systems by utilizing Lie transforms

Science.gov (United States)

Kang, Yi-Hao; Chen, Ye-Hong; Shi, Zhi-Cheng; Huang, Bi-Hua; Song, Jie; Xia, Yan

2018-03-01

We put forward a scheme to design pulses to manipulate multilevel systems with Lie transforms. A formula to reverse construct a control Hamiltonian is given and is applied in pulse design in the three- and four-level systems as examples. To demonstrate the validity of the scheme, we perform numerical simulations, which show the population transfers for cascaded three-level and N -type four-level Rydberg atoms can be completed successfully with high fidelities. Therefore, the scheme may benefit quantum information tasks based on multilevel systems.

Harmonic elimination technique for a single-phase multilevel converter with unequal DC link voltage levels

DEFF Research Database (Denmark)

Ghasemi, N.; Zare, F.; Boora, A.A.

2012-01-01

Multilevel converters, because of the benefits they attract in generating high quality output voltage, are used in several applications. Various modulation and control techniques are introduced by several researchers to control the output voltage of the multilevel converters like space vector...... modulation and harmonic elimination (HE) methods. Multilevel converters may have a DC link with equal or unequal DC voltages. In this study a new HE technique based on the HE method is proposed for multilevel converters with unequal DC link voltage. The DC link voltage levels are considered as additional...

Multilevel (mental) health promotion as social innovation in peripheral areas of Denmark

DEFF Research Database (Denmark)

Delica, Kristian Nagel

, bureaucratic level over the front line welfare professionals’ practices to the young mother’s experiences. The paper aligns a multilevel approach to theories of social innovation. This forms a fundament for discussing ‘horizontal’ and ‘vertical’ multilevel health promotion and analysing the interwoven...

Partitioning of Nanoparticles into Organic Phases and Model Cells

Energy Technology Data Exchange (ETDEWEB)

Posner, J.D.; Westerhoff, P.; Hou, W-C.

2011-08-25

There is a recognized need to understand and predict the fate, transport and bioavailability of engineered nanoparticles (ENPs) in aquatic and soil ecosystems. Recent research focuses on either collection of empirical data (e.g., removal of a specific NP through water or soil matrices under variable experimental conditions) or precise NP characterization (e.g. size, degree of aggregation, morphology, zeta potential, purity, surface chemistry, and stability). However, it is almost impossible to transition from these precise measurements to models suitable to assess the NP behavior in the environment with complex and heterogeneous matrices. For decades, the USEPA has developed and applies basic partitioning parameters (e.g., octanol-water partition coefficients) and models (e.g., EPI Suite, ECOSAR) to predict the environmental fate, bioavailability, and toxicity of organic pollutants (e.g., pesticides, hydrocarbons, etc.). In this project we have investigated the hypothesis that NP partition coefficients between water and organic phases (octanol or lipid bilayer) is highly dependent on their physiochemical properties, aggregation, and presence of natural constituents in aquatic environments (salts, natural organic matter), which may impact their partitioning into biological matrices (bioaccumulation) and human exposure (bioavailability) as well as the eventual usage in modeling the fate and bioavailability of ENPs. In this report, we use the terminology "partitioning" to operationally define the fraction of ENPs distributed among different phases. The mechanisms leading to this partitioning probably involve both chemical force interactions (hydrophobic association, hydrogen bonding, ligand exchange, etc.) and physical forces that bring the ENPs in close contact with the phase interfaces (diffusion, electrostatic interactions, mixing turbulence, etc.). Our work focuses on partitioning, but also provides insight into the relative behavior of ENPs as either "more like

Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

Science.gov (United States)

Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

2013-02-01

Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology

On the Multilevel Nature of Meta-Analysis: A Tutorial, Comparison of Software Programs, and Discussion of Analytic Choices.

Science.gov (United States)